praktikum anatomi 2.1 sesi 2
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Praktikum Anatomi 2.1 (Sesi 2)
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2 mth( w 9 – 12)
3 mth(w 13 – 16)
4 mth(w 17 – 20)
5 mth(w 21 – 24)
6 mth(w 25 – 28)
7 mth(w 29 – 32)
8 mth(w 33 – 36)
9 mth(w 37 – aterm)
Body(head-neck : body proportion)
1 : 1 Fetus lengthens rapidly
Lean body (1 : 3)
Body filling out
Body usually plump
Prominent chest; Breasts protrude
Weight(grams)
2.7 10 - 45 60 - 200 250 - 450
500 - 820
900 - 1300
1400 - 2100
2200 – 2900
(aterm : 3200)
CRL (cm) 2.8 - 3 5 - 8 9 - 14 15 - 19 20 - 23 24 - 27 28 - 30 31 – 34
(aterm : 35 – 36)
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2 mth( w 9 – 12)
3 mth(w 13 – 16)
4 mth(w 17 – 20)
5 mth(w 21 – 24)
6 mth(w 25 – 28)
7 mth(w 29 – 32)
8 mth(w 33 – 36)
9 mth(w 37 – aterm)
Fetal face
Face is distinctly human in appearance
Face becomes more human looking, head erect
Skull has the largest circumference of the body
Upper limbs
Limbs long, bent at elbows (upper limbs) and knees (lower limbs)
Reach relative length in comparison w/ the body (lower limbs are a little shorter), primary ossification centers develop
Flexed limbs, firm grasps
Lower limbs
Nails Formation of nail beds, early fingernails development
Early toenails development
Fingernails present
Toenails present
Fingernails reach fingertips
Fingernails extend beyond fingertips
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2 mth( w 9 – 12)
3 mth(w 13 – 16)
4 mth(w 17 – 20)
5 mth(w 21 – 24)
6 mth(w 25 – 28)
7 mth(w 29 – 32)
8 mth(w 33 – 36)
9 mth(w 37 – aterm)
Eyes Eyelids close
Eyes (initially direct laterally) move to ventral aspect of the face
Eyelids partially open;Eyelashes present
Eyelids widely open;Eyes are sensitive to light
Ears Ears are low set
Ears come to lie close to the definitive porsition
Basic ear structures;External ears stand out from head
Some sounds can be heard
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2 mth( w 9 – 12)
3 mth(w 13 – 16)
4 mth(w 17 – 20)
5 mth(w 21 – 24)
6 mth(w 25 – 28)
7 mth(w 29 – 32)
8 mth(w 33 – 36)
9 mth(w 37 – aterm)
Body hair, Lanugo
Head and body hair, lanugo are visible
Lanugo covers entire body
Good hair of head often present
Lanugo vanishes from face
Lanugo is almost absent
Body skin
Skin wrinkled, translucent, pink to red in color
Skin wrinkled, reddish in color
Skin slightly wrinkled
Smooth skin
Vernix caseosa
Vernix caseosa covers skin
Vernix caseosa covers body in thick layer
Vernix caseosa only on back, scalp, creases
No vernix caseosa
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2 mth( w 9 – 12)
3 mth(w 13 – 16)
4 mth(w 17 – 20)
5 mth(w 21 – 24)
6 mth(w 25 – 28)
7 mth(w 29 – 32)
8 mth(w 33 – 36)
9 mth(w 37 – aterm)
Genitourinaty changes
Formation of kidneys (metanephros),Formation of gonads, genitalia ducts,Sex distiguishable externally
Degeneration of embryonic kidneys (mesonephros)
Descent of testis;Prominent clitoris, labia majora small, widely separated
Labia majora larger, nearly covers clitoris
Testes are in scrotum / palpable in inguinal canals
Physiologic changes of fetus
Swallowing
Respiratory movement,Quickening
Sucking movement,Some sounds can be heard
Eyes are sensitive to light
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Assessment of Fetal Status• Perinatology cabang ilmu yang mempelajari tentang periode fetus
sampai newborn (26 week – 4 week post birth)• Ultrasonografi
- Primary for evaluation fetal status - Mendeteksi kelainan pada very early stage• Transabdominal amniocentesis
- Dilakukan pada 15-18 week gestation- Mendeteksi gangguan genetik; kromosom
• Alfa-fetoprotein assay- Disintesis : liver, yolk sac, gut- Deteksi : CNS abnormality, trisomy, defek abdominal wall
• Chorionic villous sampling (CVS)- Dilakukan pada 10-12 week gestation- Teknik : transabdominal, transcervical- Fungsi : deteksi abnormalitas kromosom, X-linked dis.
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• Spectrophotometric assayfungsi: mendeteksi adanya erythroblastosis fetalis
• Sex chromatin patternsada tidaknya sex chromatin dlm nukleus. Fungsi: deteksi sex-linked hereditery disease, trisomy gonosom
• Cell cultures• Precutaneous Umbilcal cord Blood Sampling
(cordocentesis). Fungsi: deteksi infeksi, FGR, anemia. Dilakukan pd week 18 gestasi
• Fetoscopy (endoscope)fiber-optic endoscope secara transcervical atau transabdominal
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Placenta
• Plasenta adalah organ fetomaternal yang memiliki dua komponen :
- Fetal part berasal dari chorionic sac
- maternal part berasal dari gravid endometrium
• Gravid endometrium disebut sebagai desidua (lapisan fungsional yang terpisah dari lapisan uterus lainnya pada saat partus/proses persalinan)
• Desidua memiliki tiga bagian :
- Desidua basalis(terletak profundal dari conceptus)
- Desidua capsularis (Menyelubungi conceptus)
- Desidua parietalis(bagian desidua sisanya)
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• Chorionic villi/vili choriales terbagi menjadi dua jenis :- Smooth chorion berhubungan dengan desidua
capsularis(villi di bagian ini menjadi halus/smooth karena penekanan yg menyebabkan penurunan suplai darah kemudian terjadi degenerasi)
- Villous chorion Villi yang berhubungan dengan desidua basalis yang akan berkembang dgn cepat
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Terminologi yang harus diketahui :- Smooth Chorion, Villous Chorion(Chorion Frondosum)- Decidua basalis, Decidua Parietalis, Decidua Capsularis- Intervillous Space, Septum placenta, Placental
Membran(Hingga week 20 terdiri dari 4 lapis : Syncitiotrophoblast, Cytotrophoblast, Villous Connectiove tissue, Fetal capillary endothelium)
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Amniocentesis• Deteksi : Genetic disorder ( ex : Down syndrome)• Dilakukan pada 15 – 18 week gestation ( karena sebelum
week 15 cairan amnion masih sedikit)• Yang di tembus : abdomen Chorion Amnion• Diambil 15-20 ml
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• Indikasi :1. Umur ibu 38 tahun atau lebih2. Pada kelahiran sebelumnya , bayi trisomi3. Terdeteksi adanya kelainan kromosom parental (ayah or/and
ibu)4. Ibu adalah carrier x-linked resesif disorder ( ex : hemofilia)5. Ada riwayat neural tube defect di keluarga
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Intra Uterine Growth Retardation• Bisa menyebabkan Low birth weight ( < 500 g)• Faktor-faktor penyebab IUGR :- Placental insufficiency- multiple gestations (e.g., triplets) - infectious diseases (CMV) - cardiovascular anomalies - inadequate maternal nutrition - maternal and fetal hormon- Teratogens (drugs, chemicals, alcohol and viruses) - genetic factors
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Karakteristik• lack of subcutaneous fat • skin is wrinkled• white fat nya hilang
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- Placenta Accreta : placenta menginvasi endometrium hingga melekat ke miometrium
- Placenta Increta : placenta menginvasi penuh miometrium - Placenta Percreta : penetrasi miometrium hingga mencapai perimetrium
Penyebab perdarahan Postpartum, Terjadi retensi plasenta, kemungkinan besar membutuhkan hysterectomy.
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Expected Date of Delivery• Normalnya : 266 hari / 38 minggu setelah fertilisasi• Naegele’s rule : H+7 : B-3 : T+1• Klinis : Post Maturity syndrome- Prolonged pregnancy selama 3 minggu atau lebih dari HPL- Karakteristik : - kering, kulit seperti kertas - biasanya overweight - tidak ada lanugo, - Tidak ada atau sedikit vernix caseosa, - long nails - Meningkatnya alertness.