FISIOLOGI JANIN

LIHAT ILMU KEBIDANAN ED KEEMPAT

PT BINA PUSTAKA SARWONO PRAWIROHARDJO,
JAKARTA 2010

AHMAD HIDAYAT DR SPOG

TUJUAN INSTRUKSIONAL
2

UMUM
MENJELASKAN PERKEMBANGAN ORGAN
JANIN DAN FUNGSINYA

KHUSUS
MENJELASKAN PERKEMBANGAN ORGAN
JANIN SESUAI DENGAN USIA GESTASI
MENJELASKAN SIRKULASI DARAH JANIN

Pre-Natal BABY Development

Embryo:
3

The beginning developmental processes

are :
1) cleavage
2) growth
3) differentiation

Prenatal Baby Development

4

Development of the baby during the

period before birth.
Develops in three stages
Zygote
Embryo
Fetus

Conception
Once a month and ovum
is released
Ovum- A female egg

The Egg moves through

the Fallopian Tube to the
uterus
Uterus-Where the baby
develops during pregnancy

If not fertilized it
disintegrates and is
flushed away with
menstruation
5

But . . .
6

If it is fertilized in the Fallopian Tube by a

spermConception occurs
This Union is what
we call a zygote!

The ZygoteMonth 1
7

Fertilized egg reaches the uterus and attaches

itself to the uterus.
Cell multiplication begins
Internal organs and circulatory system begins to
form.
Cell Division takes place and at the end of two
weeks the zygote is the size of a pin-head
Heart begins to beat
Small bumps show the beginnings of arms and
legs

Parts of the Zygote

8

4 Weeks

The EmbryoMonth 2
10

At 5 weeks the embryo is inch long

All major organ systems develop
The placenta and Umbilical Cord develop
Placenta- The tissue that connects the sac
around the unborn baby to the mothers uterus
Umbilical Cord- Tube that connects the baby
to the placenta
Brings the baby nourishment and oxygen
from the mothers blood
Takes away waster products
Amniotic Fluid surrounds the baby
Face, and limbs take shape

Two Months
11

12

6 Weeks

7 Weeks

8 Weeks

13

7 weeks

8 weeks

The FetusMonth 3
14

The fetus is about 1 inch long

Nostrils, mouth, lips, teeth buds, and eyelids form
Fingers and toes are almost complete
Eyelids are fused shut
Arms, legs, fingers, and toes have developed
All internal organs are presentbut arent ready
to function
The genital organs can be recognized as male or
female

3 Months
15

16

12 Weeks
11 Weeks

The FetusMonth 4
17

Fetus is 3 inches long and weights 5 oz.

Your baby is covered with a layer of thick,
downy hair called lanugo.
His heartbeat can be heard clearly.
This may be when you feel your baby's first
kick.
The baby can such thumb, swallow and hiccup

18

4 months

19

18 Weeks

15 Weeks
16 Weeks

The FetusMonth 5
20

The Fetus is about 6 inches long and weighs 4-5

oz.
A protective coating called vernix begins to form
on baby's skin.
Hair eyelashes and eyebrows appear
Organs keep maturing
Fetus is very active
The eyes can open and blink

Smallest baby in the world born

At just 22 weeks
21

Her little feet

She was 10 OUNCES when born and 9.5

inches. That's just longer than the length
of your hand. She weighed less than a
can of soda!

The FetusMonth 6
22

The fetus is 8-10 inches long and weighs

4-5 oz.
Your baby's lungs are filled with amniotic
fluid, and he has started breathing
motions.
If you talk or sing, he can hear you.
Fat is starting to deposit under the skin

23

6 Months

The FetusMonth 7
24

Fetus is 10-12 inches long and weighs

about 1-2 pounds.
Fetus is active and then rests.
The baby now uses the four senses of
vision, hearing, taste and touch

Seven Months
25

The FetusMonth 8
26

The fetus is 14-16 inches long and weighs

2-3 pounds
Layers of fat are piling on.
Fetus has probably turned head-down in
preparation for birth.
Fetus may react to noises with a jerking
action

Eight Month
27

The FetusMonth 9
28

Fetus is about 17-18 inches long and weighs

5-6 pounds
Skin is smooth because of the fat
Babys movement slows down due to lack of
room
Lightening occurs when the baby drops in
the pelvis
Disease fighting antibodies are taken from the
mothers blood

29

FETAL
PHYSIOLOGICAL
DEVELOPMENT

DARAH JANIN
31

EMBRIO:

YOLK SAC BERFUNGSI PEMBENTUKAN DAN PEREDARAN DARAH 10

MG.
LIMPA, GINJAL, HATI DAN SS. TULANG

FETUS > 16 MG : SS. TULANG

YOLK SAC: MEGALOBLAST

HATI
: MEGALOBLAST, MEGALOSIT, MAKROSIT
SS. TULANG: NORMOSIT

AWAL KEHAMILAN: ERITROSIT MASIH BERINTI

Hb JANIN: HbF DAN HbA, HbF DAYA IKAT O2 TINGGI
KEHAMILAN 8 10 MG. VASA DARAH MULAI TERBENTUK

DG. FETAL EKG DAN USG JANTUNG MULAI NAMPAK BERDENYUT

(PULSASI) LEBIH JELAS PADA USIA 12 MG

VOL. DARAH IBU MENINGKAT (16 32 MG) UNTUK SIRKULASI

PLASENTA, UTERUS, MAMAE, HEMODINAMIK
BEBERAPA HARI SESUDAH LAHIR DARAH JANIN MENJADI
SEPERTI ORANG DEWASA (ERITROSIT JANIN UMURNYA PENDEK)
HEMOLISIS HIPERBILIRUBINEMIA / IKTERUS FISIOLOGIK, HAL
INI TERJADI OK. HEPAR BELUM MAMPU SEKRESI / EKSKRESI
TERUTAMA PADA BAYI PREMATUR

PEREDARAN DARAH JANIN

32

PADA JANIN MASIH ADA:

FORAMEN OVALE
DUKTUS ARTERIOSUS BOTALLI
VENA UMBILIKALIS
ARTERIA UMBILIKALIS
DUKTUS VENOSUS ARANTII

SETELAH LAHIR:
REFLEKS BERNAFAS, PARU2 BERKEMBANG DARAH
TERHISAP KE PARU2, SEHINGGA:
DUKTUS BOTALLI TAK BERFUNGSI MENUTUP
TEKANAN ATRIUM KIRI MENINGKAT FORAMEN OVALE
MENUTUP

TALI PUSAT DIIKAT / DIPOTONG

VENA UMBILIKALIS OBLITERASI
ARTERIA UMBILIKALIS OBLITERASI
DUKTUS VENOSUS OBLITERASI

CARDIOVASCULAR SYSTEM
33

Fetal Circulation
Nutrients for growth and development are
delivered from the umbilical vein in the
umbilical cord placenta fetal heart

Fetal Circulation
34

Oxygenated blood from mother

(via umbilical vein)
Liver
Portal sinus Ductus venosus

Inferior vena cava (mixes with

deoxygenated blood)

35

Right atrium
(through Foramen ovale)

Left atrium

Left ventricle
(through Aorta)

Heart and Brain

36

Deoxygenated blood
from lower half of
fetal body

Inferior vena cava

Deoxygenated blood
flowing through
Superior vena cava

Right atrium

Right ventricle

37

Right ventricle

Pulmonary artery
(through Ductus arteriosus)
Descending aorta

Hypogastric arteries

Umbilical arteries

Placenta

Fetal
Circulatio
n

38

Source: http://images.google.com.ph

Cardiovascular system
( fetal circulation)
39

Cardiovascular system
( fetal circulation)
40

Foramen ovale
41

http://www.wellesley.edu/Biology/Courses/111/DuctArt.gif

Differences in Fetal and Adult Circulation

42

1st difference:
Presence of shunts which allow oxygenated
blood to bypass the right ventricle and
pulmonary circulation, flow directly to the left
ventricle, and for the aorta to supply the
heart and brain
3 shunts:
- Ductus venosus
- Foramen ovale
- Ductus arteriosus

Differences in Fetal and Adult Circulation

43

2nd difference:
Ventricles of the fetal heart work in
parallel compared to the adult heart which
works in sequence.

Differences in Fetal and Adult Circulation

44

Fetal cardiac output per unit weight is 3

times higher than that of an adult at rest.
This compensated for low O2 content of
fetal blood.
Is accomplished by heart rate and
peripheral resistance

Changes After Birth

45

Clamped cord + fetal lung expansion =

constricting and collapsing of umbilical
vessels, ductus arteriosus, foramen ovale,
ductus venosus
Fetal circulation changes to that of an
adult

Changes After Birth: Closing of Shunts

Shunt
Ductus
arteriosus

Functional
closure

Anatomical
closure

Remnant

10 96 hrs after 2 3 wks after Ligamentum

birth
birth
arteriosum

Formamen Within several

ovale
mins after birth

One year after Fossa ovalis

birth

Ductus
venosus

3 7 days
after birth

Within several
mins after birth

Ligamentum
venosum

Umbilical arteries Umbilical ligaments

Umbilical vein Ligamentum teres46

Fetal Blood
47

Hematopoiesis
First seen in the yolk sac during
embryonic period (mesoblastic period)
Liver takes over up to bear term (hepatic
period)
Bone marrow: starts hematopoietic
function at around 4 months fetal age;
major site of blood formation in adults
(myeloid period)

Fetal Blood
48

Hematopoiesis
Erythrocytes progress from nulceated to
non-nucleated
Blood vol. and Hgb concentration
increase progressively
Midpregnancy: Hgb 15 gms/dl
Term: 18 gms/dl

Fetal Blood
49

Hematopoiesis
Fetal erythrocytes: 2/3 that of adults (due to
large volume and more easily deformable)
During states of fetal anemia: fetal liver
synthesizes erythropoietin and excretes it
into the amniotic fluid. (for erythropoiesis in
utero)

Fetal Blood
50

Fetal Blood Volume

Average volume of 80 ml/kg body wt. right
after cord clamping in normal term infants
Placenta contains 45 ml/kg body weight
Fetoplacental blood volume at term is
approx. 125 ml/kg of fetus

Fetal Blood
Fetal Hemoglobin
Type

Description

Hemoglobin F Fetal Hgb or alkalineresistant Hgb

Chains
2 alpha chains,
2 gamma chains

Hemoglobin A Adult Hgb. Formed starting 2 alpha chains,

at 32-34 wks gestation and 2 beta chains
results from methylation of
gamma globin chains
Hemoglobin
A2

Present in mature fetus in

small amounts that
increase after birth

2 alpha chains,
2 delta
chains
51

Oxygen dissociation curve of fetal and

maternal blood

52

Source: http://www.colorado.edu/intphys/Class/IPHY3430-200/image/1812.jpg

Fetal Blood
53

Fetal Coagulation Factors

Contains lowers levels of coagulation factors II, VI,
IX, X, XI, XII, XIII and fibrinogen (vit. K dependent
factors)
Routine prophylaxis of vit. K injections to prevent
hemorrhagic disease of the newborn
Platelet count is normal
Thrombin time prolonged
Factor XIII (fibrin stabilizing factor) & plasminogen
lower than adult
Low level of factor VIII hemophilia in male infants

Fetal Blood
54

Fetal Plasma Proteins and Blood Viscosity

Mean total plasma protein, Plasma
albumin concentration, and Blood
viscosity: similar in maternal & fetal blood
Increased viscosity in fetal blood: due to
higher Hct. Is offset by lower levels of
fibrinogen and IgM, and by more
deformable erythrocytes

Fetal Blood
55

Immunocompetence of Fetus
IgG from mother begins at around 16 wks and is
most pronounce during last 4 wks or pregnancy
Newborns produce IgG and adult values are reached
at 3 years old
IgM produced by fetus in response to congenital
infections (Rubella, CMV, Toxoplasmosis)
Adult levels of IgM attained by 9 mos old

Fetal Blood
56

B lymphocytes appear in liver by 9 wks

gestation, and seen in the blood and spleen
by 12 wks gestation
T lymphocytes produced by thymus at 14
wks
Monocytes of newborns able to process and
present antigen when tested w/ maternal
antigen-specific T-cells

Fetal Blood
57

Ontogeny of the Immune Response

Newborn responds poorly to immunization
(due to deficient response of newborn B cells
or lack of T cells)
Only IgA from colostrum may protect against
enteric infections
IgM predominantly produced in response to
antigenic stimulation. Identification may help
diagnose intrauterine infections

Circulatory Changes following birth

58

Cord clamped: Collapse in

umbilical vein & arteries, ductus
venosus & hypogastric arteries.
Reduction in blood flow to the right
atrium results in lower pressure in
the right atrium.
Ductus Venosus closes functionally
within minutes after birth.
Ultimately becomes a ligament

http://mywebpages.comcast.net/wnor/thoraxlesson4

PERNAFASAN
59

JANIN IN UTERO SUDAH ADA GERAKAN PERNAFASAN

LIQ. AMNII TIDAK MASUK KEDALAM ALVEOLUS
BILA SATURASI O2 TINGGI (>50%) APNOE
SATURASI O2 RENDAH, PUSAT PERNAFASAN
SENSITIF THD. RANGSANGAN O2
PD. GANGGUAN SIRKULASI UTEROPLASENTER (PE/E,
KONTRAKSI JELEK) GANGGUAN ASAM BASA
PUSAT PERNAFASAN LUMPUH JANIN MATI
JANIN MATUR KADAR LESITIN ALVEOLUS TINGGI
LENTUR UNTUK MENGEMBANG DAN MENGEMPIS
PADA KELAHIRAN TERJADI TEKANAN PADA DADA
JANIN CAIRAN DI PARU2 DIKELUARKAN TIMBUL
REFLEKS BERNAFAS PENTING MEMBERSIHKAN
LENDIR DI SALURAN PERNAFASAN

60

KELENJAR ENDOKRIN:

HIPOFISE MULAI BERFUNGSI PADA USIA 10 MG.

KORTIKOTROPIN, SOMATOTROPIN, TIROID STIMULATING
HORMON DAN HORMON STIMULASI SEKS

URAT SYARAF:

BERFUNGSI MULAI USIA 10 MG.

TIMBUL GERAKAN SPONTAN
RANGSANGAN GERAKAN JANIN
PADA TRIWULAN 3 HUBUNGAN OTOT SYARAF SUDAH BAIK,
SHG. ANAK YG. LAHIR PADA USIA 32 MG. SUDAH BISA HIDUP

IMMUNOLOGI:

HAMIL 8 MG. DIDAPAT LIMFOSIT PADA TEMPAT CALON THIMUS

MAKIN TUA TAMBAH BANYAK LIMFE, TRTM. PD. LIEN
IgG, IgA, IgM MULAI DIBENTUK
IgG TRTM. DARI IBU SEBAGAI KEKEBALAN PASIF

NERVOUS SYSTEM and SENSORY

ORGANS
61

Sufficient development of synaptic

functions are signified by flexion of fetal
neck & trunk
If fetus is removed from the uterus during
the 10th wk, spontaneous movements may
be observed although movements in utero
arent felt by the mother until 18-20 wks

NERVOUS SYSTEM and SENSORY ORGANS

Gestational age

Fetal development

10 wks

Squinting, opening of mouth, incomplete

finger closure, plantar flexion of toes,
swallowing and respiration

12 wks

Taste buds evident histologically

16 wks

Complete finger closure

24 26 wks Ability to suck, hears some sounds

28 wks

Eyes sensitive to light, responsive to

variations in taste of ingested62substances

63

TRAKTUS DIGESTIVUS:
KEHAMILAN 4 BLN. TERBENTUK
TERJADI MENELAN AIR KETUBAN
TERDAPAT LANUGO, VERNIKS KASEOSA DI
MEKONIUM
MEKONIUM HIJAU OK. PERUSAKAN BILIRUBIN
BILA HIPOKSIA PERISTALTIK MENINGKAT
KELUAR MEKONIUM DI CAIRAN AMNION
AMNION BERWARNA HIJAU SBG. TANDA
ASFIKSIA INTRAUTERI

DIGESTIVE SYSTEM
64

11 wks gestation peristalsis in small

intestine, transporting glucose actively
16 wks gestation able to swallow
amniotic fluid, absorb much water from it,
and propel unabsorbed matter to lowe
colon
Hydrochloric acid & other digestive
enzymes present in very small amounts

DIGESTIVE SYSTEM
65

Term fetuses can swallow 450 ml amniotic fluid in 24

hours
This regulates amniotic fluid volume:
- inhibition of swallowing (esophageal atresia) =
Polyhydramnios
Amniotic fluid contributes little to caloric requirements
of fetus, but contributes essential nutrients: 0.8 gms
of soluble protein is ingested daily by the fetus from
amniotic fluids. Half is alubumin.
65

DIGESTIVE SYSTEM
66

Meconium passed after birth

Dark greenish black color of meconium caused by
bile pigments (esp. biliverdin)
Meconium passage during labor due to hypoxia
(stimulates smooth muscle of colon to contract)
Small bowel obstruction may lead to vomiting in
utero
Fetuses with congenital chloride diarrhea may
have diarrhea in utero. Vomiting and diarrhea in
utero may lead to polyhydramnios and preterm
delivery

DIGESTIVE SYSTEM
67

Liver and Pancreas

Fetal liver enzymes reduced in amount compared
to adult
Fetal liver has limited capacity to convert free
bilirubin to conjugated bilirubin
Fetus produces more bilirubin due to shorter life
span of fetal erythrocytes. Small fraction is
conjugated and excreted and oxidized to biliverdin
Much bilirubin is transferred to the placenta and to
the maternal liver for conjugation and excretion

DIGESTIVE SYSTEM
68

Fetal pancreas responds to

hyperglycemia by insulin
Insulin containing granules identified in
fetal pancreas at 9-10 wks. Insulin in fetal
plasma detectable at 12 wks.
Insulin levels: in newborns of diabetic
mothers and LGAs (large for gestational
age); in infants who are SGA (small for
gestational age)

69

TRAKTUS URINARIUS:
SISTEM EKSKRESI UTAMA JANIN ADALAH
PLASENTA
GINJAL MULAI BERFUNGSI PADA USIA
KEHAMILAN 3 BULAN
VESIKA URINARIA BERISI URINE
DIKELUARKAN KE CAIRAN AMNION
INTRAUTERI GINJAL SEDIKIT BERFUNGSI,
SHG. TIDAK BANYAK MENDAPAT DARAH
EKSTRA UTERI SETELAH TALI PUSAT
DIPOTONG/DIIKAT BANYAK ALIRAN DARAH
KE GINJAL GINJAL BERFUNGSI PENUH