11/15/2010 Normal Pregnancy -...

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Perkembangan Morfologi dan Perkembangan Morfologi dan Fungsional janinFungsional janin

Prof R Haryono Roeshadi SpOG KLetta Sari Lintang SpOG

Normal PregnancyNormal Pregnancy

•• PregnancyPregnancy

The course that the embryo and the The course that the embryo and the fetus grow in the maternal bodyfetus grow in the maternal body

•• Stages of pregnancyStages of pregnancy

1.1. Early pregnancy: ≤12 weeksEarly pregnancy: ≤12 weeks

2.2. Mid pregnancy: ≥13 weeks,≤27 weeks Mid pregnancy: ≥13 weeks,≤27 weeks

3.3. Late pregnancy:≥28 weeksLate pregnancy:≥28 weeks

4.4. Term pregnancy:≥37 weeks,<42 weeks Term pregnancy:≥37 weeks,<42 weeks

FertilizationFertilization

•• SPERM + EGG(OOCYTE) = ZYGOTESPERM + EGG(OOCYTE) = ZYGOTE•• The fertilization process takes about The fertilization process takes about

24 hours.24 hours.•• Sperm life = 48 hoursSperm life = 48 hours

–– It takes about ten hours to navigate the It takes about ten hours to navigate the female productive track, moving up the female productive track, moving up the vaginal canal, through the cervix, and vaginal canal, through the cervix, and into the fallopian tube where fertilization into the fallopian tube where fertilization begins. begins.

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Formation of EmbryoFormation of Embryo

•• FertilizationFertilization1.1. Place: oviduct (ampulla)Place: oviduct (ampulla)2.2. ProcessProcess

capacitation → acrosome reaction → capacitation → acrosome reaction → penetrate the zona pellucida → penetrate the zona pellucida → second meiosis →zygotesecond meiosis →zygote

FERTILISASIFERTILISASI

PERKEMBANGAN SEL TELUR SAMPAI BLASTOKISTAPERKEMBANGAN SEL TELUR SAMPAI BLASTOKISTA

•• 300 million sperm enter the the 300 million sperm enter the the vagina... only 1%, 3 million, enter the vagina... only 1%, 3 million, enter the uterusuterus

•• The next step is the penetration of the The next step is the penetration of the zona pellucida, a tough membrane zona pellucida, a tough membrane surrounding the oocyte. surrounding the oocyte.

•• Penetration of the zona pellucida Penetration of the zona pellucida takes about twenty minutestakes about twenty minutes

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•• Within Within 11 hours11 hours following following fertilization, the oocyte has fertilization, the oocyte has extruded a polar body with its extruded a polar body with its excess chromosomes. The excess chromosomes. The fusion of the oocyte and sperm fusion of the oocyte and sperm nuclei marks the creation of the nuclei marks the creation of the zygote and the end of zygote and the end of fertilizationfertilization ..


•• ImplantationImplantation1.1. requirementrequirement1)1) Disappear of zona Disappear of zona pellucidapellucida

2)2) Formation of Formation of syncytiotrophoblastsyncytiotrophoblast3)3) Synchronized development of Synchronized development of

blastocyst and endometriumblastocyst and endometrium4)4) Adequate progesterone Adequate progesterone

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•• Placental Circulation System Begins to Placental Circulation System Begins to formform

•• 0.1 0.1 -- 0.2 mm0.2 mm•• 7 7 -- 12 days post12 days post--ovulationovulation•• Trophoblast cells engulf and destroy Trophoblast cells engulf and destroy

cells of the uterine lining creating cells of the uterine lining creating blood pools, both stimulating new blood pools, both stimulating new capillaries to grow and foretelling the capillaries to grow and foretelling the growth of the growth of the placentaplacenta..


2.2. ProcessProcess1)1) morula (day 3) → enter uterine morula (day 3) → enter uterine

cavity (day 4) → early cavity (day 4) → early blastocyst → late blastocyst blastocyst → late blastocyst (day 6(day 6--7) → implantation7) → implantation

2)2) locationlocation →→→→→→→→ adherenceadherence →→→→→→→→penetrationpenetration

Development of embryo and fetusDevelopment of embryo and fetus

•• DefinitionDefinition1.1. embryo: embryo: ≤ ≤ ≤ ≤ ≤ ≤ ≤ ≤ 8 weeks8 weeks2.2. Fetus: Fetus: ≥≥≥≥≥≥≥≥ 9 weeks, human 9 weeks, human

shape shape

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•• Physiology of fetusPhysiology of fetus1.1. CirculationCirculation1)1) fetus ←→placenta ←→ materfetus ←→placenta ←→ mater2)2) 1 umbilical vein (full of oxygen), 1 umbilical vein (full of oxygen),

2 umbilical artery (lack of 2 umbilical artery (lack of oxygen)oxygen)

3)3) Mixed blood (vein and artery)Mixed blood (vein and artery)

Fetal CirculationFetal Circulation

• Fetal circulation iscomplex and differentfrom adult blood flowswith three major shunts:

• Ductus venosusForman ovaleDuctus arterosus

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2.2. HematologyHematology1)1) ErythropoiesisErythropoiesisFrom yolk sac: 3 weeksFrom yolk sac: 3 weeksFrom liver: 10 weeksFrom liver: 10 weeksFrom bone marrow and spleen: From bone marrow and spleen:

term (90%)term (90%)EPO production: 32EPO production: 32 ndnd weekweek


2)2) Fetal hemoglobinFetal hemoglobinFetal hemoglobin: early pregnancyFetal hemoglobin: early pregnancyAdult hemoglobin: 32Adult hemoglobin: 32 ndnd weekweekTerm: fetal type Hb 25%Term: fetal type Hb 25%3)3) White cellsWhite cellsLeukocytes: 8 weekLeukocytes: 8 weekLymphocytes (antibody production): 12 Lymphocytes (antibody production): 12

week, thymus and spleenweek, thymus and spleen

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3.3. Gastrointestinal tractGastrointestinal tract1)1) drink amniotic fluid: 4drink amniotic fluid: 4 thth monthmonth2)2) no proteolytic activityno proteolytic activity3)3) enzymatic deficiencies in liver: enzymatic deficiencies in liver: bilirubin is not easy to be clear.bilirubin is not easy to be clear.


4.4. KidneyKidneyIts function begins at 11Its function begins at 11--1414 thth weekweek

5)5) EndocrinologyEndocrinology1)1) Fetal thyroid: the first endocrine Fetal thyroid: the first endocrine

gland (6gland (6 thth week), synthesize week), synthesize thyroxine at 12thyroxine at 12 thth weekweek

2)2) Fetal adrenal cortex: widen (20Fetal adrenal cortex: widen (20 thth

week), a fetal zone. synthesize week), a fetal zone. synthesize steroid hormones (E3, liver placenta steroid hormones (E3, liver placenta mater)mater)

PlacentaPlacenta

•• StructureStructure1.1. Primary villusPrimary villus

syncytiotrophoblast syncytiotrophoblast cytotrophoblastcytotrophoblast

2.2. Secondary villusSecondary villus3.3. third class vilusthird class vilusfetal capillary enter the stromafetal capillary enter the stroma

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PlacentaPlacenta

•• FunctionFunction1.1. metabolismmetabolism1)1) Exchange of OExchange of O 22 and COand CO 22

2)2) Exchange of nutritive factors and Exchange of nutritive factors and wastewaste

2.2. DefensiveDefensiveLimited. IgG, virus, drug Limited. IgG, virus, drug

PlacentaPlacenta

3.3. EndocrineEndocrine1)1) HCGHCG2)2) HPLHPL3)3) EE4)4) PP5)5) OxytocinaseOxytocinase6)6) Cytokines and Growth FactorsCytokines and Growth Factors4.4. Immunity toleranceImmunity tolerance

Fetal membranesFetal membranes

•• StructureStructurechorion and amnionchorion and amnion

•• AmnionAmnionA doubleA double--layered translucent layered translucent membranemembraneBecome distended with fluidBecome distended with fluid

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Umbilical CordUmbilical Cord

•• StructureStructureamnion, yolk sac, one vein, two amnion, yolk sac, one vein, two artery and Wharton jellyartery and Wharton jelly

•• LengthLength3030--70cm70cm

Amniotic fliudAmniotic fliud

•• SourceSource1.1. exudation of fetal membranes exudation of fetal membranes

(early pregnancy)(early pregnancy)2.2. Fetal urineFetal urine3.3. Fetal lungFetal lung4.4. Exudation of amnion and fetal Exudation of amnion and fetal

skinskin

Amniotic fliudAmniotic fliud

•• AbsordAbsord1.1. Fetal membraneFetal membrane2.2. Umbilical cordUmbilical cord3.3. Fetal skinFetal skin4.4. Fetal drinkingFetal drinking•• FeatureFeature10001000--1500ml at 361500ml at 36 thth --3838thth week (peak), week (peak),

transparent transparent →→→→→→→→ slightly turbidslightly turbid

Amniotic FliudAmniotic Fliud

•• FunctionFunction1.1. Protect fetalProtect fetal

move freely, warmmove freely, warm2.2. Protect materProtect mater

prevent infectionprevent infection

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Physiologic changes in pregnant womanPhysiologic changes in pregnant woman

•• Genital organsGenital organs1.1. UterusUterus1)1) capacity: 5mlcapacity: 5ml--5000ml.weight: 50g5000ml.weight: 50g--

1000g1000g2)2) Hypertrophy of muscle cellsHypertrophy of muscle cells3)3) EndometriumEndometrium →→→→→→→→decidua: basal decidua: basal

decidua, capsular decidua, true decidua, capsular decidua, true deciduadecidua

4)4) Contraction: Braxton HicksContraction: Braxton Hicks5)5) Isthmus uteri: 1cmIsthmus uteri: 1cm →→→→→→→→ 77--10cm10cm


6)6) Cervix: coloredCervix: colored7)7) Ovary: placenta replaces ovary (10Ovary: placenta replaces ovary (10 thth

week)week)8)8) Vagina: dilated and soft, pHVagina: dilated and soft, pH ↓↓↓↓↓↓↓↓(anti(anti--

bacteri bacteria)bacteri bacteria)9)9) Ligaments: relaxedLigaments: relaxed


•• Cardiovascular systemCardiovascular system1.1. Heart:Heart:

move upward, hypertrophy of move upward, hypertrophy of cardiac musclecardiac muscle

2.2. Cardiac Output Cardiac Output increase by 30%, reach to peak at increase by 30%, reach to peak at 3232ndnd ––3434thth weekweek

3.3. Blood pressureBlood pressureearly or mid pregnancy Bpearly or mid pregnancy Bp ↓.↓.↓.↓.↓.↓.↓.↓.late late pregnancy Bp ↑ .Supine hypotensive pregnancy Bp ↑ .Supine hypotensive syndromesyndrome

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•• HematologyHematology1.1. Blood volumeBlood volume1)1) Increase by 30%Increase by 30%--45% at 3245% at 32ndnd ––3434thth

(peak)(peak)2)2) Relatively dilutedRelatively diluted2.2. CompositionComposition1)1) Red cellsRed cells

Hb:130Hb:130→→→→→→→→110g/L, HCT:38%110g/L, HCT:38%→→→→→→→→ 31%.31%.2)2) White cells: slightly increaseWhite cells: slightly increase3)3) Coagulating power of blood: Coagulating power of blood: ↑↑↑↑↑↑↑↑

4)4) Albumin: Albumin: ↓,↓,↓,↓,↓,↓,↓,↓,35 g/L35 g/L


•• The Respiratory systemThe Respiratory system1.1. R rate: slightly R rate: slightly ↑↑↑↑↑↑↑↑

2.2. vital capacity: no changevital capacity: no change3.3. Tidal volume: Tidal volume: ↑↑↑↑↑↑↑↑ 40%40%4.4. Functional residual capacity:Functional residual capacity: ↓↓↓↓↓↓↓↓

5.5. OO22 consumption: consumption: ↑↑↑↑↑↑↑↑ 20%20%


•• The urinary systemThe urinary system1.1. KidneyKidney1)1) Renal plasma flow (RFP):Renal plasma flow (RFP): ↑↑↑↑↑↑↑↑35%35%2)2) Glomerular filtration rate (GFR):Glomerular filtration rate (GFR): ↑↑↑↑↑↑↑↑

50%50%2.2. UreterUreter

Dilated (PDilated (P ↑↑↑↑↑↑↑↑))3.3. BladderBladder

Frequent micturationFrequent micturation


•• Gastrointestinal systemGastrointestinal system1)1) Gastric emptying time is Gastric emptying time is

prolongedprolonged →→→→→→→→ nausea. nausea. 2)2) The motility of large bowel is The motility of large bowel is

diminished diminished →→→→→→→→ constipationconstipation3)3) Liver function: unchanged Liver function: unchanged

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•• EndocrineEndocrine1.1. Pituitary (hypertrophy)Pituitary (hypertrophy)1)1) LH/FSH: LH/FSH: ↓↓↓↓↓↓↓↓2)2) PRL:PRL:↑↑↑↑↑↑↑↑3)3) TSH and ACTH:TSH and ACTH: ↑↑↑↑↑↑↑↑2.2. ThyroidThyroid1)1) enlarged (TSH and HCGenlarged (TSH and HCG ↑↑↑↑↑↑↑↑))2)2) thyroxinethyroxine ↑↑↑↑↑↑↑↑ and TBGand TBG ↑↑↑↑↑↑↑↑ →→→→→→→→ free Tfree T 33 TT44

unchangedunchanged

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