Drs.

Hendri
Busman,M.Biomed

 Syarat

Kapan

Bagaimana

Dimana

Ada sperma & sel telur yang matang

Sekitar ovulasi
Pertemuan dan persenyawaan ovum &
sperma
Di ampula

Gametogenesi
s

A. Two-cell stage
B. Three-cell
stage
C. Four-cell stage
D. Five-cell stage
E. Six-cell stage
F. Eight-cell stage

5 hari setelah

Pembentukan Ruang Amnion & Kuning

Telur

Zigo
t

Pembelaha
n

Morula (32
sel)
exocoelom

Blastokis
t
trofoblast
bintik benih

Nidas
i

Nodus embryonale :
ruang amnion
ruang kuning telur

Ectoderm

kulit, rambut, kuku, gigi, saraf

Entoderm
usus, hati, saluran nafas, kandung kencing
Mesoderm
otot, tulang, jaringan ikat, jantung &
pembuluh darah

Drawing of section implanted blastocysts. A. 10 days. B. 12

days after fertilization. The stage of development is
characterized by the intercommunication of the lacunae filled
with maternal blood. Note in B that large cavities have
appeared in the extraembryonic endodermal cells have begun
to form on the inside of the primary yolk sac. (From Moore,
1988)

Bintik
Benih
Ectoderm
mesoder
m
entoderm

Discus
embryonale
(D.e)
Janin

D.e menonjol ke Ruang Amnion

Hubungan D.e dengan
Trofoblast
Tangkai
penghubung

Decidua :
Str. Compactum
Str. Spongiosum
Str. Basale
Decidua :
basalis
capsularis
vera

Perubahan
Endometriu
m

Chorion
Frondosum

Trofoblast

Khorion

PERKEMBANGA
N
TROFOBLAST

1. Lapisan Langhans
(cytotrophoblast)
mesoderm
2. Lapisan luar
(syncytium/syncytio
trophoblast)
decidua
Vili
chorion laeve
chorion frondosum

Chorion
Frondosum
(chorionic
villi)

Chorion frondosum
pembuluh darah ibu
decidua (Haftzote)
Membran plasenta : Amnion
Khorion
16 minggu : sel Langhans hilang
terbentuk
lapisan Nitabuchl

These twin boys are at 9 weeks gestational

age in development. Each twin has an
amnionic cavity.
The amnions will eventually fuse to form a
diamnionic dividing membrane.

Berbentuk cakram
15-20 cm, tebal 2-3 cm
+ 500 gram
2 bagian (bagian ibu dan bagian
anak)
16 - 20 kotiledon
2 arteri umbilikales
1 vena umbilikalis

Skematik aliran darah dalam plasenta

manusia

The umbilical cord inserts into the fetal

surface of the placenta.
Note the vessels radiating out from the
cord over the fetal surface in this normal
term placenta.

The maternal surface of a normal term

placenta is seen here.
Note that the cotyledons that form the
placenta are reddish brown and
indistinct.

I. Pertukaran Zat
1. Pasif : filtrasi
difusi
diapedese
2. Aktif : enzim

pinositosis

III. Sebagai barier

mekanis
kimiawi

II. Kelenjar Endokrin

1. Steroid Hormon
(Estrogen dan Progesteron)
2. Protein Hormon
(HCG, HPL, HCT, HCCT)
3. Releasing Hormon
(TSHRF, FSHRH, CHR)
4. Enzim : HSAPase
Oksitosinose
Pregnancy spesific

1. Pertumbuhan janin
2. Amnioskopi /
amniosentesis
3. Estrogen / pregnandiol
urin
4. Oksitosinase serum
5. HPL
6. OCT
7. USG
8. Profil biofisik

Antara pusat janin - permukaan fetal

plasenta
30-100 cm; 1-1,5 cm

diliputi amnion

2 arteri umbilicales
1 vena umbilicalis

Whartons jelly
insersi
sentral / parasentral / lateral /
marginalis

Here is a normal three vessel umbilical cord. Note

that there are two arteries toward the right and a
single vein at the left.
Most of the cord consists of a loose mesenchyme
with intercellular ground substance (Wharton's
jelly).

This is a true knot of the umbilical cord.

Such knots are more likely with abnormally
long umbilical cords that are seen with
increased fetal movement.
Such a knot could constrict the blood
vessels and lead to fetal demise.

Seen here is a "velamentous" insertion of the umbilical

cord in which the major umbilical vessels break up in the
fetal membranes before reaching the placental disk.
Such a condition is of no major consequence in utero,
but could lead to a greater chance for cord trauma with
bleeding during delivery.
Dividing membranes are see at the left in this twin

The amniotic cavity has been opened here to

reveal the normal fetal surface of the placenta at
the upper right.
The umbilical cord inserts centrally into the
placental disk.
The abnormal finding here is a "nuchal cord" in
which one or more loops of umbilical cord are

The relationship of the

placenta to the amniotic
cavity and fetus is shown
here in the case of a term
infant whose mother died
in an accident.
The placental disk is at the
left, with the maternal
surface that would be
attached to the uterus at
the decidual plate.
The baby is seen inside the
amniotic cavity.
The amniotic fluid in this
cavity allows for fetal
movement and protects the
baby.

The fetus at the left is macerated from prolonged

demise in utero.
The cause of the demise in this case is the
marked twisting, or torsion, of the umbilical cord.
A macerated placenta is present at the right.

Berisi cairan amnion

Banyaknya ~ umur kehamilan
alkalis
lanugo
vernix caseosa

Oligohidramnion < 500

cc
Polihidramnion > 2000
cc

1.
2.
3.
4.

Pergerakan anak
Barier fisik
Pertahanan suhu
Membuka serviks
(persalinan)
Asalnya : kencing janin
transudat dari ibu
sekret epitel amnion
campuran

Lama hamil = 280 hari

266 hari dari
ovulasi
Taksiran Persalinan = NAEGELE
(siklus 28 hari)
Haid terakhir :

Hari +7
Bulan -3
Tahun +1

Abortus

: < 500 gr
< 22 minggu

Partus Imaturus

: 500 - 1000 gr
22 - 28 minggu
Partus Prematurus
: 1000 2500 gr
28 - 37 minggu
Partus Maturus : > 2500 gr
37 - 42 minggu
Partus Serotinus : > 42 minggu

1
2
3
4
5
6
7
8
9
10

bulan =
bulan =
bulan =
bulan =
bulan =
bulan =
bulan =
bulan =
bulan =
bulan =

1 cm
4 cm
9 cm
16 cm
25 cm
30 cm
35 cm
40 cm
45 cm
50 cm

=
=
=
=
=
=
=
=
=

1
14,2
108
316
630
1045
1680
2478
3400

gr
gr
gr
gr
gr
gr
gr
gr
gr

7th day
150u (0.15mm)

Implantation is beginning.
Trophoblast cells
proliferate and begin to
invade the uterine
epithelium. Invasion is
effected through digestion
of the uterine cells by
secretions of the
trophoblast cells. Upon
contact with the
endometrium the
cytotrophoblast forms the
syncytiotrophoblast and
HCG (human chorionic
gonadotropin) production
begins.

8th day

Syncytiotrophoblast
cells further invade the
Endometrium by
secreting hydrolytic
enzymes.

10th day
Implantation continues.
The synctiotrophoblast
nearly completely
surrounds the
cytotrophoblast cells of
the blastocyst. The
primary yolk sac is
(probably) formed as the
hypoblast cells move
around the blastocyst
cavity.

2nd week

Gastrulation begins when

the primitive pit forms,
though it can not be seen
in this picture. Gastrulation
is the process by which the
third germ layer, the
intraembryonic mesoderm,
is formed. It involves
ingression and migration of
cells from the epiblast
through the primitive pit
and primitive streak. This
results in a trilaminar
embryo with the three
basic germ layers;
ectoderm, mesoderm, and
endoderm.

4th week

A very significant week for the

embryo. It has changed from a
flat trilaminar disc into a tubular
embryo and has now acquired a
three-dimensional form. The
embryo and amnion have grown
vigorously, but the yolk sac has
not. The lateral edges fold under
and become the ventral surface
of the embryo. Neurulation is
almost completed and the
anterior (rostal) and posterior
(caudal) neuropores are closing.
Sometimes are still forming. Two
pairs of branchial (pharyngeal)
arches have formed (beginning
about day 22).
Upper limb buds appear around
day 25. The primordia of the eye
and ear are present. The heart
bulge is present.

5th week

The size of the embryo is now

(approximately) 3.5 - 4.0 mm.
Cranial and caudal
neuropores have recently
closed, and the buccal
(oropharyngeal) membrane is
opening. Upper (anterior) and
lower (posterior) limb buds
are present. Lower limb bud
appears around day 28.
Somite formation is ending at
their final number of 38-44
pairs. The last half of the
embryonic period (from 4 to 8
weeks) is the time when most
of the organs are formed
(organogenesis) and
teratogens have their most
damaging effects on the

7th
week
30mmC
RL

The size of the embryo is

now (approximately)
30mmCRL (Crown-Rump
Length). The embryo
trunk is elongating and
the cervical region is
straightening, raising the
head. Genital ridges are
ambisexual gonads.

8th
week
35mmC
RL

The size of the embryo is now

(approximately) 35-40mmCRL
(Crown-Rump Length). This marks
the end of the Embryonic Period
and the beginning of the Fetal
Period. The first eight weeks is a
time of embryogenesis, when
major organ development begins.
The beginnings of all essential
structures are now present. The
eyelids meet and close in this
week. The head is large, most
erect, and more rounded. External
genitalia still not distinguishable
as male or female. If male
hormones are present, the
ambisexual gonad will now begin
to differentiate into a testis. The
intestines are in the proximal part
of the umbilical cord. The ears are
still very lowset. Teratogens have

15th
week
130mmC
RL

The head is now erect

and the eyes face
anteriorly. The ears are
still lowset, but very close
to their definitive
position. The lower limbs
are now well developed.
Early toenail
development.

20th week
185mmCR
L

Head and body hair (lanugo)

are visible. External ears
stand out from the head. At
this point the mother has felt
movements of the fetus.

30th week
275mmCR
L

The fetus has now been

viable since 20-22 weeks,
i.e., survival is possible in
the outside world without
extraordinary measures.
Fingernails, toenails, and
eyelashes are present. The
fetus may now have a good
head of hair. The body is
filling out. Testes are
descending. The eyelids
have parted and the eyes
are open.

11 12 16

20

24

28

32
36
38
KEHAMILAN ATERM

Kehamila
n
Enam
Fetus
:+2
Minggu
cm

Kehamilan
Duabelas
Minggu

Fetus : + 7
cm

Kehamilan
Duapuluh
Minggu

Fetus : + 18-27 cm
Berat : + 300 grm

Kehamilan
Duapuluh
Delapan
Minggu

Fetus : + 25 - 38 cm
Berat : + 1000 grm

Kehamilan
Aterm
> 37 minggu
Berat : + 3000
grm

1. Faktor Ibu : tinggi badan

gizi
tempat tinggal
kehamilan ganda
kelainan uterus
2. Faktor Anak : jenis kelamin
kelainan genetis
infeksi intrauterin
kelainan congenital
3. Faktor Plasenta : insufisiensi plasenta

Berat plasenta/Berat Bayi

menurun sampai dengan 36
mg
28 mg = 0.25
38 mg = 0.15

Bagian terpenting dalam persalinan terdiri

dari :
a. Bagian muka : tulang hidung
tulang pipi
rahang atas
rahang bawah
b. Bagian tengkorak : tulang dahi
tulang ubun-ubun
tulang pelipis
tulang belakang kepala

Kepala Janin pada saat

aterm yang
memperlihatkan
bermacam-macam
ubun-ubun, sutura,
dan diameter
biparietal

Sutura : sagitalis
coronaria
lambdoidea
frontalis
Ubun-ubun besar :
Pertemuan 4 sutura : sagitalis
coronaria
frontalis
Ubun-ubun kecil :
Pertemuan 3 sutura : sagitalis
lambdoidea

A. Muka Belakang
1. D. Suboccipito-bregmatica : 9,5
cm
foramen magnum - UUB
2. D. Suboccipto frontalis : 11 cm
foramen magnum - pangkal hidung
3. D. Fronto-occipitalis : 12 cm
pangkal hidung - belakang kepala
4. D. Mento-occipitalis : 13,5 cm
dagu - belakang kepala
5. D. Submento - bregmatica : 9,5
cm

1. Diameter
suboksipotobregmatikus
2. Diameter suboksipitofrontalis
3. Diameter oksipitofrontalis
4. Diameter oksipitomentalis
5. Diameter
submentobregmatikus

Diameter Kepala
Janin pada cukup
bulan

B. Ukuran melintang
1. D. Biparietalis ( 9 cm )
2. D. Bitemporalis ( 8 cm )

C. Ukuran lingkaran
1. C. Suboccipito - bregmatica : 32
cm
( lingkaran kecil )
2. C. Fronto - occipitalis : 34 cm
( lingkaran besar )

Diameter
biparietalis dan
Diameter
bitemporalis

Kepala dengan
beberapa
sirkumferensia

2 arteri
1 vena
darah campuran
isi vena cava inferior lebih bersih dari
aorta
Setelah lahir :
Ductus Botali menutup lig. Arteriosum
Foramen ovale menutup
Duct. Venosus aranti lig teres hepatis
Aa umbilicales lig vesico umbilicale
laterale

Sirkulas
i Darah
Janin

Cardiovascula
r
system of
fetus

HB janin Hb dewasa
Dibuat terutama di hepar
Transport O2 lebih mudah
Menjadi Hb biasa 4 bulan
O2 darah janin lebih
rendah

Peredaran darah lebih

cepat
Kadar Hb lebih tinggi
eritrosit lebih banyak

1. UTERUS
Uterus membesar
hiperplasi, hipertrofi otot
pertumbuhan aktif (estrogen)
pertumbuhan pasif : segmen bawah
rahim
lingkaran retraksi
Tanda Piskacek
Kontraksi Braxton Hicks
Perubahan serviks

Pembentukan segmen bawah rahim dari isthmus

uteri.
Pada dystocia lingkaran retraksi sangat tinggi

Minggu
6

12

16

20

24

Minggu
28

32

36

40

Pembentukan rahim dan perubahan

sikap tubuh ibu selama kehamilan

2. VAGINA
Elastisitas bertambah
Tanda Chadwick
Keasaman bertambah

3. OVARIUM
Corpus luteum
graviditatum

4. DINDING PERUT
Striae gravidarum
lividae
albicans
O.K. hiperfungsi gl.
suprarenalis
5. KULIT
hiperpigmentasi : linea nigra
chloasma
6. PAYUDARA
Membesar, nyeri
( hipertrofi alveoli )
Colostrum
Hiperpigmentasi

7. Berat Badan
Triwulan 1
Triwulan 2
Triwulan 3

Janin
Plasenta
Air ketuban
Rahim
Lemak
Protein
Air

: 1 kg
: 5 kg
: 5,5 kg
: 3 kg
: 0,5 kg
: 1 kg
: 1 kg
: 0,5 kg
: 2 kg
: 1,5 kg

Kebutuhan Fe, Ca
dan P bertambah

8. DARAH
Volume darah bertambah
Eritrosit bertambah
Hydremi
Batas fisiologis : Hb
: 11 gr%
Eri
: 3,8
juta/mm3
Leuco : 12000/mm3

9. Lain-lain
beban jantung bertambah
kerja paru-paru bertambah
sekresi HCl & gerakan lambung
berkurang
kerja ginjal bertambah
ureter melebar
polakisuri
perubahan mental