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ANATOMI DAN FISIOLOGI

KANDUNGAN
D R. A D I T I YO J A N U A J I E , S P O G , M K E S

LABIA

BARTHOLIN GLANDS

ANATOMY: BONY PELVIS/GIRDLE

ANATOMY: FEMALE PELVIS

The True Conjugate = 11 cm


The Obstet. Conjugate = 10.5cm
The Diagonal Conjugate = 12 cm

Interspinous diam. = 10.5 cm.


Anato. Ant. Post diam= 11
cm.
Obstet. Ant. Post diam= 13
cm.

ANATOMY
Vagina
Uterus
Cervix

Fallopian tubes/ovaries
External genitalia

UTERUS, FALLOPIAN TUBES,


OVARIES
Hollow, thick-walled
Situated between
bladder and rectum
Lined with endometrium
Ligaments suspend the
uterus

THE FOLLOWING ARE INCISED

The Fourchette.
ischiocavernosus
The vaginal mucosa
and submucosa.
Bulbocavernosus
The interdigitating
fibers of the suerficial
and deep transverse
perinii & the
pubococcygeus muscle
group.
Pubococcygeus
The inferior fascia of
the urogenital
Iliococcygeus
diaphragm.
In mediolateral
Coccygeus
episiotomy, the medial
portions of the Superficial transverse perinii
bulbocavernosus is
also incised

THE STATIONS OF THE BONY PELVIS

-5

Station -5

Station 0

Station +5

+5

The station 1 cm. Below the inlet is station -4.


The station below the spine are numbered from +1 to +5 : The perineum

fifth above the pelvic brim

THE FETAL HEAD HAS FIVE


FIFTHS
0 : Head Not Palpable
1 : Sinciput felt Occiput Not
Felt
2 : Sinciput felt Occiput Just
Felt
3 : Sinciput easily felt
Occiput Felt
4 : Sinciput High Occiput
easily Felt
5 : Complete above pelvic
brim

-5

+5

II. STRUCTURES RELATED TO PREGNANCY


1. Placenta

Anatomy:
Size- 6-10 across and 1 thick. Weight-1 lb. to 1
lbs.
Structure- Divided into sections or segments
called Cotyledons.
Two sides:
1) Fetal side- shiny and smooth in appearance,
the amniotic sac is attached to it (Schultz).
2) Maternal side- dark red and rough in
appearance (Duncan).

Maternal side of placenta

Fetal Side of placenta

PLACENTA

mom

Baby

MOM

Baby
Schematic drawing of placenta: how it supplies oxygen and nutrition to embryo and removes waste
products. Deoxygenated blood leaves fetus through the umbilical arteries and enters placenta,
where it is oxygenated. Oxygenated blood leaves placenta through the umbilical vein, which enters

PHYSIOLOGY:
Functions of Placenta
1) Endocrine Gland: produces
several hormones necessary for
normal pregnancy
HCG (human chorionic gonadotropin)
Estrogen
Progesterone
Human Placental Lactogen

2) Site of nutrient and O2


exchange and fetal waste
excretion
Occurs in the Intervillous space
About 150ml of the mothers blood is briefly
outside of her circulatory system while it
bathes the Chorionic Villi.
These are treelike structures that are derived
from fetal tissue.
The blood is exchanged 3 to 4 times per
minute in this space.
*Maternal and Fetal blood do not mix

Intervillous space and


Chorionic Villi

3) Blocks certain harmful substances- most


Bacteria and some Viruses are too large to pass
through the placenta
4) Maternal antibodies- many
immunoglobulins are passed to the fetus giving
passive immunity to diseases such as measles
5) Metabolic functions- substances are
synthesized in the placenta (glycogen,
cholesterol, fatty acids)

2. UMBILICAL
CORD
The lifeline between mother and fetus
20-22 long, 1 thick.
Contains 3 vessels: 2 arteries and 1 vein,
which are protected by Whartons Jelly.
If abnormal # of vessels present- often
associated with fetal anomalies (heart and
kidneys).
The arteries carry dirty blood away from
fetus. The vein carries clean blood to fetus.
Central insertion into the placenta is normal

3. FETAL MEMBRANES

Called the Bag of Waters


Consists of two layers
1) Amnion- inner membrane, next to fetus
2) Chorion- outer membrane, next to mother
Function: to house the fetus for the duration of
pregnancy, protects from outside world,
prevents vertical transmission of infection.

4. AMNIOTIC
FLUID

Amniotic fluid is made up mainly from fetal


urine, fluid from maternal blood, castoff cells,
vernix, and fetal waste products.
exudation of fetal membranes (early
pregnancy)
Its function is to cushion fetus and protect
from injury, to keep infant at stable 98.6
temperature, to allow room for fetal movement
and growth.
Normal volume- 500 to 1000 ml at term.

NORMAL PREGNANCY

1.
2.
3.
4.

Pregnancy
The course that the embryo and the
fetus grow in the maternal body
Stages of pregnancy
Early pregnancy: 12 weeks
Mid pregnancy: 13 weeks,27 weeks
Late pregnancy:28 weeks
Term pregnancy:37 weeks,<42 weeks

FORMATION OF EMBRYO
Fertilization
1. Place: oviduct (ampulla)
2. Process
capacitation acrosome
reaction penetrate the zona
pellucida second meiosis zygote

FORMATION OF EMBRYO

1.

Implantation
requirement

1) Disappear of zona pellucida

2) Formation of syncytiotrophoblast
3) Synchronized development of blastocyst
and endometrium
4) Adequate progesterone

FORMATION OF EMBRYO
2. Process
1) morula (day 3) enter uterine cavity (day 4)
early blastocyst late blastocyst (day 6-7)
implantation
2) location adherence penetration

DEVELOPMENT OF EMBRYO AND FETUS

1.
2.

Definition
embryo: 8 weeks
Fetus: 9 weeks, human shape

DEVELOPMENT OF EMBRYO AND FETUS


Gastrointestinal tract
1) drink amniotic fluid: 4th month
2) no proteolytic activity
3) enzymatic deficiencies in liver:
bilirubin is not easy to be clear.

DEVELOPMENT OF EMBRYO AND FETUS


Kidney
Its function begins at 11-14th week
5) Endocrinology
6) Fetal thyroid: the first endocrine gland
(6th week), synthesize thyroxine at 12th
week
7) Fetal adrenal cortex: widen (20th week), a
fetal zone. synthesize steroid hormones
(E3, liver placenta mater)

PHYSIOLOGIC CHANGES IN PREGNANT


WOMAN

1.
1)
2)
3)

Genital organs
Uterus
capacity: 5ml-5000ml.weight: 50g-1000g
Hypertrophy of muscle cells
Endometriumdecidua: basal decidua,
capsular decidua, true decidua
4) Contraction: Braxton Hicks
5) Isthmus uteri: 1cm 7-10cm

PHYSIOLOGIC CHANGES IN PREGNANT


WOMAN
6) Cervix: colored
7) Ovary: placenta replaces ovary (10th
week)
8) Vagina: dilated and soft, pH(antibacteri bacteria)
9) Ligaments: relaxed

PHYSIOLOGIC CHANGES IN PREGNANT


WOMAN
Cardiovascular system
1. Heart:
move upward, hypertrophy of cardiac
muscle
2. Cardiac Output
increase by 30%, reach to peak at 32nd
34th week
3. Blood pressure
early or mid pregnancy Bp.late pregnancy
Bp .Supine hypotensive syndrome

PHYSIOLOGIC CHANGES IN PREGNANT


WOMAN

1.
1)
2)
2.
1)

Hematology
Blood volume
Increase by 30%-45% at 32nd 34th (peak)
Relatively diluted
Composition
Red cells
Hb:130110g/L, HCT:38% 31%.
2) White cells: slightly increase
3) Coagulating power of blood:
4) Albumin: ,35 g/L

PHYSIOLOGIC CHANGES IN PREGNANT


WOMAN

1.
2.
3.
4.
5.

The Respiratory system


R rate: slightly
vital capacity: no change
Tidal volume: 40%
Functional residual capacity:
O2 consumption: 20%

PHYSIOLOGIC CHANGES IN PREGNANT


WOMAN

1.
1)
2)
2.

The urinary system


Kidney
Renal plasma flow (RFP):35%
Glomerular filtration rate (GFR): 50%
Ureter
Dilated (P)
3. Bladder
Frequent micturation

PHYSIOLOGIC CHANGES IN PREGNANT


WOMAN

Gastrointestinal system
1) Gastric emptying time is prolonged nausea.
2) The motility of large bowel is diminished
constipation
3) Liver function: unchanged

STAGES OF DEVELOPMENT

1 MONTH
First Trimester
At the end of four weeks:
Baby is 1/4 inch in length
Heart, digestive system,
backbone and spinal cord
begin to form
Placenta (sometimes called
"afterbirth") begins to
develop
The single fertilized egg is
now 10,000 times larger
than size at conception

FIRST MONTH

MONTH 2
First Trimester
At the end of 8 weeks:
Baby is 1-1/8 inches long
Heart is functioning
Eyes, nose, lips, tongue,
ears and teeth are forming
Penis begins to appear in
boys
Baby is moving, although
the mother can not yet feel
movement

TWO MONTHS

MONTH 3
First Trimester
At the end of 12 weeks:
Baby is 2 1/2 to 3 inches long
Weight is about 1/2 to 1 ounce
Baby develops recognizable form.
Nails start to develop and
earlobes are formed
Arms, hands, fingers, legs, feet
and toes are fully formed
Eyes are almost fully developed
Baby has developed most of
his/her organs and tissues
Baby's heart rate can be heard at
10 weeks with a special
instrument called a Doppler

MONTH 4
Second Trimester
At the end of 4 months:
Baby is 6 1/2 to 7 inches long
Weight is about 6 to 7 ounces
Baby is developing reflexes, such
as sucking and swallowing and
may begin sucking his/her thumb
Tooth buds are developing
Sweat glands are forming on
palms and soles
Fingers and toes are well defined
Sex is identifiable
Skin is bright pink, transparent
and covered with soft, downy hair
Although recognizably human in
appearance, the baby would not
be able to survive outside the
mother's body

4 MONTHS

MONTH 5
Second Trimester
At the end of 5 months:
Baby is 8 to 10 inches long
Weight is about 1 pound
Hair begins to grow on baby's
head
Soft woolly hair called lanugo
will cover its body. Some may
remain until a week after
birth, when it is shed.
Mother begins to feel fetal
movement
Internal organs are maturing
Eyebrows, eyelids and
eyelashes appear

MONTH 6
Second Trimester
At the end of 6 months:
Baby is 11 to 14 inches
long
Weight is about 1 3/4 to 2
pounds
Eyelids begin to part and
eyes open sometimes for
short periods of time
Skin is covered with
protective coating called
vernix
Baby is able to hiccup

6 MONTHS

MONTH 7

Third Trimester
At the end of 7 months:
Baby is 14 to 16 inches long
Weight is about 2 1/2 to 3 1/2
pounds
Taste buds have developed
Fat layers are forming
Organs are maturing
Skin is still wrinkled and red
If born at this time, baby will
be considered a premature
baby and require special care

7 Months

MONTH 8
Third Trimester
At the end of 8 months:
Baby is 16 1/2 to 18 inches long
Weight is about 4 to 6 pounds
Overall growth is rapid this month
Tremendous brain growth occurs
at this time
Most body organs are now
developed with the exception of
the lungs
Movements or "kicks" are strong
enough to be visible from the
outside
Kidneys are mature
Skin is less wrinkled
Fingernails now extend beyond
fingertips

8 months

MONTH 9
Third Trimester
At the end of 9 months:
Baby is 19 to 20 inches
long
Weight is about 7 to 7 1/2
pounds
The lungs are mature
Baby is now fully
developed and can survive
outside the mother's body
Skin is pink and smooth
Baby settles down lower in
the abdomen in
preparation for birth and
may seem less active

SELESAI
H AT U R N U H U N