5. perubahan ibu hamil

PERUBAHAN ANATOMI & PERUBAHAN ANATOMI & FISIOLOGI IBU HAMILFISIOLOGI IBU HAMIL

dr. ADNAN ABADI , SpOG , KFERdr. ADNAN ABADI , SpOG , KFER

IT Obstetri IT Obstetri : Obstetri Fisiologi: Obstetri Fisiologi

1.1.Perubahan morfologi janin dan fisiologi Perubahan morfologi janin dan fisiologi janin.janin.

2.2.Perubahan anatomik dan Fisiologi ibu Perubahan anatomik dan Fisiologi ibu hamil.hamil.

PERUBAHAN ANATOMI & FISIOLOGI PERUBAHAN ANATOMI & FISIOLOGI IBU HAMILIBU HAMIL

Perubahan pada traktus genitalia Perubahan pada traktus genitalia UterusUterus ServiksServiks OvariumOvarium Tuba FallofiiTuba Fallofii VaginaVagina Perineum Perineum


Perubahan pada kulitPerubahan pada kulitPerubahan pada PayudaraPerubahan pada PayudaraPerubahan MetabolismePerubahan MetabolismePerubahan Hematologi Perubahan Hematologi Perubahan Pada sistem KardiovaskulerPerubahan Pada sistem Kardiovaskuler


Perubahan pada sistem RespirasiPerubahan pada sistem RespirasiPerubahan pada SistemTraktus Perubahan pada SistemTraktus GastrointestinalGastrointestinalPerubahan Sistem EndokrinPerubahan Sistem EndokrinPerubahan Hematologi Perubahan Hematologi Perubahan pada Sistem MuskuloskletalPerubahan pada Sistem Muskuloskletal

MATERNAL ADAPTATION TO MATERNAL ADAPTATION TO PREGNANCYPREGNANCY

Uterus Uterus During pregnancy, uterine enlargement During pregnancy, uterine enlargement

involves stretching and marked hypertrophy of involves stretching and marked hypertrophy of muscle cellsmuscle cells


Cervix Cervix softening and cyanosis of the cervixsoftening and cyanosis of the cervixvascularity and edema of the entire vascularity and edema of the entire

cervixcervixhypertrophy and hyperplasia of the hypertrophy and hyperplasia of the

cervical glands. cervical glands.


OvariumOvarium Ovulation ceases during pregnancy and the Ovulation ceases during pregnancy and the

maturation of new follicles is suspended maturation of new follicles is suspended only a single corpus luteum of pregnancy can only a single corpus luteum of pregnancy can

be found be found functions maximally during the first 6-7 wks of functions maximally during the first 6-7 wks of

pregnancy (4-5 wks pregnancy (4-5 wks postovulation)postovulation)

MATERNAL ADAPTATIONSMATERNAL ADAPTATIONS

Fallopian tubesFallopian tubes The musculature of the fallopian tubes The musculature of the fallopian tubes little little

hypertrophy hypertrophy The epithelium of the tubal mucosa The epithelium of the tubal mucosa flattened flattened Decidual cells may develop in the stroma of the Decidual cells may develop in the stroma of the

endosalpinx, but a continuous decidual endosalpinx, but a continuous decidual membrane is not formed.membrane is not formed.


Vagina & perineumVagina & perineum increased vascularity and hyperemia develop in increased vascularity and hyperemia develop in

the skin and muscles of the perineum and vulvathe skin and muscles of the perineum and vulva softening of the normally abundant connective softening of the normally abundant connective

tissue of these structurestissue of these structures Increased vascularity prominently affects the Increased vascularity prominently affects the

vaginavagina


Vagina & perineumVagina & perineum The copious secretion and the characteristic The copious secretion and the characteristic

violet color of the vagina during pregnancy violet color of the vagina during pregnancy (Chadwick sign) (Chadwick sign)

hypertrophy of the smooth-muscle cells hypertrophy of the smooth-muscle cells The papillae of the vaginal mucosa The papillae of the vaginal mucosa

hypertrophy, creating a fine, hobnailed hypertrophy, creating a fine, hobnailed appearanceappearance

SKIN CHANGESSKIN CHANGES

In the later months of pregnancy, reddish, In the later months of pregnancy, reddish, slightly depressed streaks slightly depressed streaks develop in the develop in the skin of the abdomen,the breasts and thighsskin of the abdomen,the breasts and thighs

the reddish striae of the present pregnancy, the reddish striae of the present pregnancy, glistening, silvery lines that represent the glistening, silvery lines that represent the cicatrices of previous striae cicatrices of previous striae

SKIN CHANGESSKIN CHANGES

the midline of the abdominal skin becomes the midline of the abdominal skin becomes markedly pigmented, assuming a brownish-markedly pigmented, assuming a brownish-black color to form the linea nigra black color to form the linea nigra

irregular brownish patches of varying size irregular brownish patches of varying size appear on the face and neck, giving rise to appear on the face and neck, giving rise to chloasma or melasma gravidarum (mask of chloasma or melasma gravidarum (mask of pregnancy) pregnancy)

accentuation of pigment of the areolae and accentuation of pigment of the areolae and genital skingenital skin

BREAST CHANGESBREAST CHANGES

11stst month month breast tenderness and breast tenderness and tinglingtingling

22ndnd month month the breasts increase in size the breasts increase in size the nipples the nipples larger, more deeply larger, more deeply

pigmented, and more erectilepigmented, and more erectile

BREAST CHANGESBREAST CHANGES

Then Then a thick, yellowish fluid, colostrum, a thick, yellowish fluid, colostrum, can often be expressed from the nipples can often be expressed from the nipples by gentle massageby gentle massage

the areolae the areolae broader and more deeply broader and more deeply pigmentedpigmented

Scattered through the areolae Scattered through the areolae glands of glands of Montgomery, (hypertrophic sebaceous Montgomery, (hypertrophic sebaceous glands)glands)

METABOLIC CHANGESMETABOLIC CHANGESWater metabolismWater metabolism

At term, the water content of the fetus, At term, the water content of the fetus, placenta, and amnionic fluid amounts to placenta, and amnionic fluid amounts to about 3.5 L. about 3.5 L.

METABOLIC CHANGESMETABOLIC CHANGES

Water metabolismWater metabolism Increased water retention is a normal Increased water retention is a normal

physiological alteration of pregnancy. physiological alteration of pregnancy.

This is mediated by a fall in plasma osmolality This is mediated by a fall in plasma osmolality of approximately 10 mOsm/kg induced by a of approximately 10 mOsm/kg induced by a resetting of osmotic thresholds for thirst and resetting of osmotic thresholds for thirst and vasopressin secretionvasopressin secretion

METABOLIC CHANGESMETABOLIC CHANGES

Water metabolismWater metabolismAnother 3.0 L accumulates as a result of Another 3.0 L accumulates as a result of

increases in the maternal blood volume increases in the maternal blood volume and in the size of the uterus and the and in the size of the uterus and the breasts. breasts.

Thus, the minimum amount of extra water Thus, the minimum amount of extra water that the average women retains during that the average women retains during normal pregnancy is about 6.5 L.normal pregnancy is about 6.5 L.

PROTEIN METABOLISMPROTEIN METABOLISM

At term, the fetus + placenta 4 kg & At term, the fetus + placenta 4 kg & contain approximately 500 g of protein, or contain approximately 500 g of protein, or about half of the total pregnancy increase .about half of the total pregnancy increase .

The remaining 500 g is added to the The remaining 500 g is added to the uterus as contractile protein, to the breasts uterus as contractile protein, to the breasts primarily in the glands, and to the maternal primarily in the glands, and to the maternal blood as hemoglobin and plasma proteins.blood as hemoglobin and plasma proteins.

PROTEIN METABOLISMPROTEIN METABOLISM

Amino acids used for energy are not Amino acids used for energy are not available for synthesis of maternal protein.available for synthesis of maternal protein.

With increasing intake of fat and With increasing intake of fat and

carbohydrates as energy sources, less carbohydrates as energy sources, less dietary protein is required to maintain dietary protein is required to maintain positive nitrogen balance.positive nitrogen balance.

CARBOHYDRATE METABOLISMCARBOHYDRATE METABOLISM

Normal pregnancy is characterized by mild Normal pregnancy is characterized by mild fasting hypoglycemia, postprandial fasting hypoglycemia, postprandial hyperglycemia, and hyperinsulinemiahyperglycemia, and hyperinsulinemia

pregnancy-induced state of peripheral pregnancy-induced state of peripheral resistance to insulinresistance to insulin

1. Increased insulin response to glucose. 1. Increased insulin response to glucose.

2. Reduced peripheral uptake of glucose. 2. Reduced peripheral uptake of glucose.

3. Suppressed glucagon response. 3. Suppressed glucagon response.

FAT METABOLISMFAT METABOLISM

The concentrations of lipids, lipoproteins, The concentrations of lipids, lipoproteins, and apolipoproteins in plasma increase.and apolipoproteins in plasma increase.

Low-density lipoprotein cholesterol (LDL-Low-density lipoprotein cholesterol (LDL-C) levels peak week 36 ∞ the hepatic C) levels peak week 36 ∞ the hepatic effects of estradiol and progesterone effects of estradiol and progesterone

FAT METABOLISMFAT METABOLISM

High-density lipoprotein cholesterol (HDL-High-density lipoprotein cholesterol (HDL-C) peaks at week 25, decreases until C) peaks at week 25, decreases until week 32, and remains constant for the week 32, and remains constant for the remainder of pregnancy. remainder of pregnancy.

High-density lipoprotein-2 and -3 High-density lipoprotein-2 and -3 cholesterol levels peak at approximately cholesterol levels peak at approximately 28 weeks and remain unchanged 28 weeks and remain unchanged throughout the remainder of pregnancythroughout the remainder of pregnancy

HAEMATOLOGICAL CHANGESHAEMATOLOGICAL CHANGES

the blood volumes at or very near term the blood volumes at or very near term averaged about 40 to 45 percent above averaged about 40 to 45 percent above their nonpregnant levelstheir nonpregnant levels

hemoglobin concentration and the hemoglobin concentration and the hematocrit decrease slightly during normal hematocrit decrease slightly during normal pregnancypregnancy

HAEMATOLOGICAL CHANGESHAEMATOLOGICAL CHANGES

The total iron content of normal adult The total iron content of normal adult women ranges from 2.0 to 2.5 g women ranges from 2.0 to 2.5 g

The leukocyte ranges 5000 - 12,000/UlThe leukocyte ranges 5000 - 12,000/Ul fibrinogen concentration increases about fibrinogen concentration increases about

50 percent to average about 450 mg/dL 50 percent to average about 450 mg/dL late in pregnancy, with a range from 300 to late in pregnancy, with a range from 300 to 600600

CARDIOVASCULAR SYSTEM CARDIOVASCULAR SYSTEM CHANGESCHANGES

The most important changes in cardiac The most important changes in cardiac function function the first 8 weeks of pregnancy the first 8 weeks of pregnancy

Cardiac output is increased Cardiac output is increased the 5 the 5thth week of pregnancyweek of pregnancy

Between weeks 10 - 20, plasma volume Between weeks 10 - 20, plasma volume ↑↑,preload ,preload ↑↑

RESPIRATORY SYSTEM CHANGESRESPIRATORY SYSTEM CHANGES

The diaphragm rises The diaphragm rises ++ 4 cm during 4 cm during pregnancy .pregnancy .

The subcostal angle widens ∞ transverse The subcostal angle widens ∞ transverse diameter of the thoracic cage diameter of the thoracic cage ↑↑ ++2 cm2 cm

The thoracic circumference increases The thoracic circumference increases ++ 6 6 cmcm

RESPIRATORY SYSTEM CHANGESRESPIRATORY SYSTEM CHANGES

The amount of oxygen needs The amount of oxygen needs ↑↑The respiratory rate is little changed during The respiratory rate is little changed during

pregnancypregnancy the tidal volume, minute ventilatory the tidal volume, minute ventilatory

volume, and minute oxygen uptake volume, and minute oxygen uptake increase appreciably as pregnancy increase appreciably as pregnancy advancesadvances

GI TRACT CHANGESGI TRACT CHANGES

Gastric emptying and intestinal transit Gastric emptying and intestinal transit times are delayed in pregnancy because times are delayed in pregnancy because of hormonal or mechanical factors.of hormonal or mechanical factors.

Pyrosis (heartburn) is common during Pyrosis (heartburn) is common during pregnancy and is most likely caused by pregnancy and is most likely caused by reflux of acidic secretions into the lower reflux of acidic secretions into the lower esophagusesophagus

BAHAN / BUKU ACUANBAHAN / BUKU ACUAN

1. Buku Kebidanan YBP Sarwono Prawiroharjo2. William Obstetric3. Kebidanan Fisiologi dr. Supono4. Kebidanan Fisiologi FK UNPAD5. Bunga Rampai Kebidanan Rustam Mochtar6. Dll.

5. perubahan ibu hamil

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