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PERKEMBANGAN JANIN

RICARDI W. ALIBASJAH
BAGIAN
OBSTETRI GINEKOLOGI
FAKULTAS KEDOKTERAN
UNSWAGATI

7th day
150u (0.15mm)

Implantation is
beginning. Trophoblast
cells proliferate and
begin to invade the
uterine epithelium.
Invasion is effected
through digestion of the
uterine cells by
secretions of the
trophoblast cells. Upon
contact with the
endometrium the
cytotrophoblast forms
the syncytiotrophoblast
and HCG (human
chorionic gonadotropin)

8th day

Syncytiotrophoblast cells
further invade the
Endometrium by secreting
hydrolytic enzymes.

10th day
Implantation continues. The
synctiotrophoblast nearly
completely surrounds the
cytotrophoblast cells of the
blastocyst. The primary yolk
sac is (probably) formed as the
hypoblast cells move around
the blastocyst cavity.

2nd
week

Gastrulation begins when the


primitive pit forms, though it can
not be seen in this picture.
Gastrulation is the process by
which the third germ layer, the
intraembryonic mesoderm, is
formed. It involves ingression and
migration of cells from the
epiblast through the primitive pit
and primitive streak. This results
in a trilaminar embryo with the
three basic germ layers;
ectoderm, mesoderm, and
endoderm.

4th week

A very significant week for the


embryo. It has changed from a
flat trilaminar disc into a
tubular embryo and has now
acquired a three-dimensional
form. The embryo and amnion
have grown vigorously, but
the yolk sac has not. The
lateral edges fold under and
become the ventral surface of
the embryo. Neurulation is
almost completed and the
anterior (rostal) and posterior
(caudal) neuropores are
closing. Sometimes are still
forming. Two pairs of
branchial (pharyngeal) arches
have formed (beginning about
day 22).
Upper limb buds appear
around day 25. The primordia

5th
week

The size of the embryo is


now (approximately) 3.5 4.0 mm. Cranial and caudal
neuropores have recently
closed, and the buccal
(oropharyngeal) membrane
is opening. Upper (anterior)
and lower (posterior) limb
buds are present. Lower
limb bud appears around
day 28. Somite formation is
ending at their final
number of 38-44 pairs. The
last half of the embryonic
period (from 4 to 8 weeks)
is the time when most of
the organs are formed
(organogenesis) and
teratogens have their most

7th
week
30mmC
RL

The size of the embryo is now


(approximately) 30mmCRL
(Crown-Rump Length). The
embryo trunk is elongating
and the cervical region is
straightening, raising the
head. Genital ridges are
ambisexual gonads.

8th
week
35mmC
RL

The size of the embryo is now


(approximately) 35-40mmCRL
(Crown-Rump Length). This
marks the end of the Embryonic
Period and the beginning of the
Fetal Period. The first eight
weeks is a time of
embryogenesis, when major
organ development begins. The
beginnings of all essential
structures are now present. The
eyelids meet and close in this
week. The head is large, most
erect, and more rounded.
External genitalia still not
distinguishable as male or
female. If male hormones are
present, the ambisexual gonad
will now begin to differentiate
into a testis. The intestines are
in the proximal part of the

15th
week
130mm
CRL

The head is now erect and the


eyes face anteriorly. The ears
are still lowset, but very close
to their definitive position. The
lower limbs are now well
developed. Early toenail
development.

20th
week
185mmC
RL
Head and body hair (lanugo) are
visible. External ears stand out from
the head. At this point the mother
has felt movements of the fetus.

30th
week
275mmC
RL

The fetus has now been viable


since 20-22 weeks, i.e., survival is
possible in the outside world
without extraordinary measures.
Fingernails, toenails, and
eyelashes are present. The fetus
may now have a good head of
hair. The body is filling out. Testes
are descending. The eyelids have
parted and the eyes are open.

Average duration of pregnancy =


280 days from first day of last
menstrual period (LMP)
266 days from ovulation
NAEGELEs RULE
Estimation the Expected Date of
Delivery
(EDD) from first day of LMP
Day + 7
Month -3

Abortus

: < 500 gr.


<

22weeks
Partus Imaturus

: 500 - 1000gr
22 - 28 week
Partus Prematurus
: 1000 2500gr
(Preterm labor)
28 - 37 week
Partus Maturus : > 2500 gr
(Term labor)
37 - 42 week
Partus Serotinus : > 42 week
(Prolonged/Postdate Pregnancy)

1 month
2 month
3 month
gr
4 month
gr
5 month
gr
6 month
gr
7 month

=
=
=

1 cm
4 cm
9 cm

= 1gr
= 14,2

= 16 cm

= 108

= 25 cm

= 316

= 30 cm

= 630

= 35 cm

= 1045

11 12 16

20

PREGNANCY

24

28

32

36
TERM

38

1. Mothers factor: Height


Nutrition
Altitude
Multiplepregnancy
Uterus anomaly
2. Fetals factor : Sex
Genetic
Infection
Congenitalanomalies
3. Placentals Insufficiency

Plasental weight/Birth weight


decrease until 36 mg
28 mg = 0.25
38 mg = 0.15

A most important part during labor


a. The Face : Nasal bone
Zygomaticum bone
Maxilla bone
Mandibula bone
b. The Skull : Frontal bone
Parietal bone
Temporal bone
Occipital bone
Wings of the Sphenoid

Fetal head at term


Showing various
fontanels, sutures and
Diameter

Sutures : sagital
coronal
lambdoid
frontal
Anterior (Greater) Fontanel:
Lozenges shape/ Junction of :
sagital suture
coronal
frontal

Lesser/Posterior Fontanel (small


triangular): Intersection of sagital
suture

lambdoid suture

1. The occipto-frontal : 11,5 cm


Root of the nose - prominent portion of the
occ.bone
2. The biparietal : 9,5 cm
The greatest diameter transverse of the head ;
between 2 parietal bone
3. The bitemporal: 8 cm
The greatest distance between the two temporal
sutures
4. The occipitomental :12,5 cm
From the chin to the most prominent portion of
the
occiput
5. The suboccipito-bregmatic : 9,5 cm

1.
2.
3.
4.
5.

Diameters of the
fetal head at term

The
The
The
The
The

subocciput-bregmatic
suboccipito-frontal
occipito-frontal
occipito-mental
submento-bregmatic

Biparietalis
diameter
Bitemporal
diameter

Fetal Head
Circumference

2 Umbilical arteries
1 Umbilical vein
Umbilical vein carries oxygenated
blood
The difference from adult:
Ductus Arteriosus Botali
Foramen ovale
Duct. Venosus aranti
Aa umbilicales

Fetal
Circulati
on

Cardiovascul
ar
system of
fetus

FETAL BLOOD

Fetal Hb Adult Hb
Hematopoiesis: Yolk sac - Liver - Bone
marrow
Hb A & Hb F
Fetal Hb bind more oxygen

Hb Concentration higher than


adult
Lifespan erythrocyte 2/3 normal
adult

1. UTERUS
Hypertrophy and Dilatation
Arrangement of the Muscle Cells
Change in Size, Shape and Position
Change in Contractility
Change in the Cervix

Sequence of development of the


segment and ring in the pregnant
uterus

week
6
24

12

16

20

week
40

28

32

36

Change of the Uterus


and Mother Position

Six
week
s
Fetus : + 2
Pregnant
cm

Pregnancy
12 weeks
Fetus : + 7
cm

Pregnancy
20 weeks
Fetus : + 18-27
cm
Weight : + 300
grm

Pregnancy
28 week
Fetus : + 25 - 38
cm
Weight : + 1000
grm

> 37 weeks
Weight : + 3000 gm

2. VAGINA and OUTLET


Increased vascularity - Chadwicks
sign
Increase in thickness of the
mucosa & smooth muscle
Vaginal secretion

3. OVARIUM
Corpus luteum graviditatum

4. Abdominal wall and skin


Striae gravidarum
livid
albicans due to hyperfunction gl.
suprarenal
5. Skin hyperpigmentation : linea nigra
chloasma
6. Breast
Hypertrophy
Colostrum
Hyperpigmentation

7. Weight Gain
1st Trimester : 1 kg
2nd Trimester : 5 kg
3rd Trimester : 5,5 kg
Fetus
: 3 kg
Plancenta
: 0,5kg
Amnionic fluid : 1 kg

Uterus
Fat
Protein
Water

:
:
:
:

1 kg
0,5 kg
2 kg
1,5 kg

Increase mineral
requirement
(Fe,Ca,Mg)

8. HEMATOLOGIC CHANGES
Blood volume increase ~ 45%
Increase Plasma & Erythrocyte (~33%)
Hydraemia
O2 affinity decrease
Hematocrit decrease
Normal value :
Hb
: 11 gr%
Ery
: 3,8 million /mm3
Leuco
: 12000/mm3

9.

Others
Cardiovascular system
Respiratory tract
Urinary system

Gastrointestinal tract
Liver & Gallbladder
Endocrine glands
Musculo-skeletal system
Psychological
disturbances