Perkembangan Morfologi dan Fungsional janinProf R Haryono Roeshadi SpOG KLetta Sari Lintang SpOG

Normal PregnancyPregnancy The course that the embryo and the fetus grow in the maternal bodyStages of pregnancyEarly pregnancy: 12 weeksMid pregnancy: 13 weeks,27 weeks Late pregnancy:28 weeksTerm pregnancy:37 weeks,

Fertilization

SPERM + EGG(OOCYTE) = ZYGOTEThe fertilization process takes about 24 hours.Sperm life = 48 hoursIt takes about ten hours to navigate the female productive track, moving up the vaginal canal, through the cervix, and into the fallopian tube where fertilization begins.

Formation of Embryo FertilizationPlace: oviduct (ampulla)Process capacitation acrosome reaction penetrate the zona pellucida second meiosis zygote

FERTILISASI

PERKEMBANGAN SEL TELUR SAMPAI BLASTOKISTA

300 million sperm enter the the vagina... only 1%, 3 million, enter the uterusThe next step is the penetration of the zona pellucida, a tough membrane surrounding the oocyte. Penetration of the zona pellucida takes about twenty minutes

Within 11 hours following fertilization, the oocyte has extruded a polar body with its excess chromosomes. The fusion of the oocyte and sperm nuclei marks the creation of the zygote and the end of fertilization.

Formation of EmbryoImplantationrequirementDisappear of zona pellucidaFormation of syncytiotrophoblastSynchronized development of blastocyst and endometriumAdequate progesterone

Placental Circulation System Begins to form0.1 - 0.2 mm7 - 12 days post-ovulationTrophoblast cells engulf and destroy cells of the uterine lining creating blood pools, both stimulating new capillaries to grow and foretelling the growth of the placenta.

Formation of EmbryoProcessmorula (day 3) enter uterine cavity (day 4) early blastocyst late blastocyst (day 6-7) implantationlocation adherence penetration

Development of embryo and fetusDefinitionembryo: 8 weeksFetus: 9 weeks, human shape

Development of embryo and fetusPhysiology of fetusCirculationfetus placenta mater1 umbilical vein (full of oxygen), 2 umbilical artery (lack of oxygen)Mixed blood (vein and artery)

Fetal CirculationFetal circulation is complex and different from adult blood flows with three major shunts:Ductus venosus Forman ovale Ductus arterosus

Development of embryo and fetus

Development of embryo and fetusHematologyErythropoiesisFrom yolk sac: 3 weeksFrom liver: 10 weeksFrom bone marrow and spleen: term (90%)EPO production: 32nd week

Development of embryo and fetusFetal hemoglobinFetal hemoglobin: early pregnancyAdult hemoglobin: 32nd weekTerm: fetal type Hb 25%White cellsLeukocytes: 8 weekLymphocytes (antibody production): 12 week, thymus and spleen

Development of embryo and fetusGastrointestinal tractdrink amniotic fluid: 4th monthno proteolytic activityenzymatic deficiencies in liver: bilirubin is not easy to be clear.

Development of embryo and fetusKidney Its function begins at 11-14th weekEndocrinologyFetal thyroid: the first endocrine gland (6th week), synthesize thyroxine at 12th weekFetal adrenal cortex: widen (20th week), a fetal zone. synthesize steroid hormones (E3, liver placenta mater)

PlacentaStructurePrimary villus syncytiotrophoblast cytotrophoblastSecondary villusthird class vilusfetal capillary enter the stroma

PlacentaFunctionmetabolismExchange of O2 and CO2Exchange of nutritive factors and wasteDefensiveLimited. IgG, virus, drug

PlacentaEndocrineHCGHPLEPOxytocinaseCytokines and Growth FactorsImmunity tolerance

Fetal membranesStructure chorion and amnionAmnion A double-layered translucent membrane Become distended with fluid

Umbilical CordStructure amnion, yolk sac, one vein, two artery and Wharton jellyLength 30-70cm

Amniotic fliudSourceexudation of fetal membranes (early pregnancy)Fetal urineFetal lungExudation of amnion and fetal skin

Amniotic fliudAbsordFetal membraneUmbilical cordFetal skinFetal drinkingFeature1000-1500ml at 36th-38th week (peak), transparent slightly turbid

Amniotic FliudFunctionProtect fetal move freely, warmProtect mater prevent infection

Physiologic changes in pregnant womanGenital organsUteruscapacity: 5ml-5000ml.weight: 50g-1000gHypertrophy of muscle cellsEndometriumdecidua: basal decidua, capsular decidua, true deciduaContraction: Braxton HicksIsthmus uteri: 1cm 7-10cm

Physiologic changes in pregnant womanCervix: coloredOvary: placenta replaces ovary (10th week)Vagina: dilated and soft, pH(anti-bacteri bacteria)Ligaments: relaxed

Physiologic changes in pregnant womanCardiovascular systemHeart: move upward, hypertrophy of cardiac muscleCardiac Output increase by 30%, reach to peak at 32nd 34th weekBlood pressure early or mid pregnancy Bp.late pregnancy Bp .Supine hypotensive syndrome

Physiologic changes in pregnant womanHematologyBlood volumeIncrease by 30%-45% at 32nd 34th (peak)Relatively dilutedCompositionRed cells Hb:130110g/L, HCT:38% 31%.White cells: slightly increaseCoagulating power of blood: Albumin: ,35 g/L

Physiologic changes in pregnant womanThe Respiratory systemR rate: slightly vital capacity: no changeTidal volume: 40%Functional residual capacity: O2 consumption: 20%

Physiologic changes in pregnant womanThe urinary systemKidneyRenal plasma flow (RFP):35%Glomerular filtration rate (GFR): 50%Ureter Dilated (P)Bladder Frequent micturation

Physiologic changes in pregnant womanGastrointestinal systemGastric emptying time is prolonged nausea. The motility of large bowel is diminished constipationLiver function: unchanged

Physiologic changes in pregnant womanEndocrinePituitary (hypertrophy)LH/FSH: PRL:TSH and ACTH:Thyroidenlarged (TSH and HCG)thyroxine and TBG free T3 T4 unchanged