Sirkulasi uteroplasenta

Sirkulasi darah plasenta

Maternal-placental (uteroplacental) blood circulation
Maternal blood flow decidual spiral artery intervillous space
Terjadi pertukaran oksigen dan nutrisi

Fetal-placental (fetoplacental) blood circulation

Memungkinkan arteri umbilikalis membawa darah yang tidak
teroksigenasi dari fetus ke ibu
Normal Uteroplacental Circulation
Placenta
Function: gas exchange, nutrition, waste elimination
Composed by projection of fetal tissue (vili) that lie in maternal
vascular space (intervillous space)
Placental exchange:
Diffusion
Osmotic and hydrostatic pressure
Facilitated diffusion
Active transport
Vesicular transport
Breaks
Perubahan selama kehamilan
Uterine Blood Flow (UBF) meningkat dari 50-100 cc/mnt sebelum
kehamilan sampai 700-900 cc/mnt saat aterm

3 Fase
1. Hormon estrogen dan progesteron
2. Remodeling struktur pembuluh darah uteroplasenta
3. Vasodilatasi progresif arteri uterina
Distribusi aliran darah
Perubahan distribusi aliran darah
regional di daerah pelvis
steal phenomenon

Aliran darah ke pelvis cenderung

di distribusikan ke uterus
Uterine Blood Flow

UBF = UAP UVP

UVR
Perubahan vaskular selama kehamilan
1. Vaskular remodeling
Peningkatan diameter dan panjang pembuluh darah arteri
Palmer et al diameter a. uterina berukuran 2x lipat saat 21
minggu kehamilan, sedangkan diameter a. iliaka komunis dan
externa tidak ada perubahan
Peningkatan diameter dan distensibilitas serta penurunan
kandungan elastin v. uterina
Penurunan resistensi pembuluh darah
2. Hormon Steroid
Estrogen: vasodilatasi uteri, peningkatan UBF
Progesteron
Respiratory Gas Exchange
Fetal oxygen consumption: 7 mL/min/kgBW
Transfer oxygen dependent on the ratio of maternal uterine blood
flow to fetal umbilical blood flow
Fetal hemoglobin oxygen dissociation curve shifted to the left
Fetal hemoglobin has higher affinity to normal hemoglobin
CO2 exchange depends on concentration gradients and uterine blood
flow
Maternal hypocapnea can cause fetal hypoxia and acidosis
Placental Transfer of Anesthetic Agents
Transfer of drug across placenta reflected by ratio of fetal umbilical
vein to maternal venous concentration (UV/MV), uptake by fetal
tissue correlated to ratio of umbilical artery to umbilical vein
concentration
All inhalational agent and most intravenous anesthetics freely cross
the placenta
Anestesi Neuroaxial
Nyeri dan stress selama
proses kelahiran
menurunkan UBF dan
peningkatan katekolamin
Fetal bradikardia kadang
terjadi pada CSE
penurunan UBF
 Pemberian loading cairan intravena sebelum tindakan anesthesia
neuroaxial tidak menyebabkan perubahan resitensi vascular

Agonis alfa adrenergic seperti fenilefrin merupakan vasopressor lini

pertama dalam mengatasi hipotensi. Efedrin menurunkan pH dan
kadar base excess a. umbilical
Effect of Anesthetic Agents on Uteroplacental
Blood Flow
Propofol: no effect
Etomidate: minimal change
Ketamine: no change if using 0.5 0.7 mg/kgBW
Volatile anesthetics: minor effect on concentrations < 1 MAC
Spinal and epidural anesthesia typically do not decrease uterine blood
flow except when arterial hypotension occurs