PERUBAHAN ANATOMI &

FISIOLOGI IBU HAMIL

dr. ADNAN ABADI , SpOG , KFER

 IT Obstetri : Obstetri Fisiologi

1.Perubahan morfologi janin dan fisiologi

janin.
2.Perubahan anatomik dan Fisiologi ibu
hamil.
 PERUBAHAN ANATOMI & FISIOLOGI
IBU HAMIL

Perubahan pada traktus genitalia

 Uterus
 Serviks
 Ovarium
 Tuba Fallofii
 Vagina
 Perineum
 PERUBAHAN ANATOMI & FISIOLOGI
IBU HAMIL

Perubahan pada kulit

Perubahan pada Payudara
Perubahan Metabolisme
Perubahan Hematologi
Perubahan Pada sistem Kardiovaskuler
 PERUBAHAN ANATOMI & FISIOLOGI
IBU HAMIL

Perubahan pada sistem Respirasi

Perubahan pada SistemTraktus
Gastrointestinal
Perubahan Sistem Endokrin
Perubahan Hematologi
Perubahan pada Sistem Muskuloskletal
 MATERNAL ADAPTATION TO
PREGNANCY

 Uterus
 Duringpregnancy, uterine enlargement
involves stretching and marked hypertrophy of
muscle cells
 MATERNAL ADAPTATION TO
PREGNANCY

 Cervix
 softening and cyanosis of the cervix
 vascularity and edema of the entire
cervix
 hypertrophy and hyperplasia of the
cervical glands.
 MATERNAL ADAPTATION TO
PREGNANCY

Ovarium
 Ovulation ceases during pregnancy and the
maturation of new follicles is suspended
 only a single corpus luteum of pregnancy can
be found
 functions maximally during the first 6-7 wks of
pregnancy (4-5 wks postovulation)
 MATERNAL ADAPTATIONS

 Fallopian tubes
 The musculature of the fallopian tubes  little
hypertrophy
 The epithelium of the tubal mucosa  flattened
 Decidual cells may develop in the stroma of the
endosalpinx, but a continuous decidual
membrane is not formed.
 MATERNAL ADAPTATIONS

 Vagina & perineum

 increased vascularity and hyperemia develop in
the skin and muscles of the perineum and vulva
 softening of the normally abundant connective
tissue of these structures
 Increased vascularity prominently affects the
vagina
 MATERNAL ADAPTATIONS

 Vagina & perineum

 The copious secretion and the characteristic
violet color of the vagina during pregnancy
(Chadwick sign)
 hypertrophy of the smooth-muscle cells
 The papillae of the vaginal mucosa
hypertrophy, creating a fine, hobnailed
appearance
 SKIN CHANGES

 In the later months of pregnancy, reddish,

slightly depressed streaks  develop in the
skin of the abdomen,the breasts and thighs
 the reddish striae of the present pregnancy,
glistening, silvery lines that represent the
cicatrices of previous striae
 SKIN CHANGES

 the midline of the abdominal skin becomes

markedly pigmented, assuming a brownish-
black color to form the linea nigra
 irregular brownish patches of varying size
appear on the face and neck, giving rise to
chloasma or melasma gravidarum (mask of
pregnancy)
 accentuation of pigment of the areolae and
genital skin
 BREAST CHANGES

 1st month  breast tenderness and

tingling
 2nd month  the breasts increase in size
 the nipples  larger, more deeply
pigmented, and more erectile
 BREAST CHANGES

 Then a thick, yellowish fluid, colostrum,

can often be expressed from the nipples by
gentle massage
 the areolae  broader and more deeply
pigmented
 Scattered through the areolae  glands of
Montgomery, (hypertrophic sebaceous
glands)
 METABOLIC CHANGES
 Water metabolism

 Atterm, the water content of the fetus,

placenta, and amnionic fluid amounts to
about 3.5 L.
 METABOLIC CHANGES

 Water metabolism
 Increasedwater retention is a normal
physiological alteration of pregnancy.

 Thisis mediated by a fall in plasma osmolality

of approximately 10 mOsm/kg induced by a
resetting of osmotic thresholds for thirst and
vasopressin secretion
 METABOLIC CHANGES
 Water metabolism
 Another 3.0 L accumulates as a result of
increases in the maternal blood volume
and in the size of the uterus and the
breasts.
 Thus, the minimum amount of extra water
that the average women retains during
normal pregnancy is about 6.5 L.
 PROTEIN METABOLISM

 At term, the fetus + placenta 4 kg &

contain approximately 500 g of protein, or
about half of the total pregnancy increase .

 The remaining 500 g is added to the

uterus as contractile protein, to the breasts
primarily in the glands, and to the maternal
blood as hemoglobin and plasma proteins.
 PROTEIN METABOLISM

 Amino acids used for energy are not

available for synthesis of maternal protein.

 With increasing intake of fat and

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

 Normal pregnancy is characterized by mild

fasting hypoglycemia, postprandial
hyperglycemia, and hyperinsulinemia
 pregnancy-induced state of peripheral
resistance to insulin
1. Increased insulin response to glucose.
2. Reduced peripheral uptake of glucose.
3. Suppressed glucagon response.
 FAT METABOLISM

 The concentrations of lipids, lipoproteins,

and apolipoproteins in plasma increase.

 Low-density lipoprotein cholesterol (LDL-

C) levels peak week 36 ∞ the hepatic
effects of estradiol and progesterone
 FAT METABOLISM

 High-density lipoprotein cholesterol (HDL-

C) peaks at week 25, decreases until week
32, and remains constant for the remainder
of pregnancy.

 High-density lipoprotein-2 and -3

cholesterol levels peak at approximately 28
weeks and remain unchanged throughout
the remainder of pregnancy
 HAEMATOLOGICAL CHANGES

 the blood volumes at or very near term

averaged about 40 to 45 percent above
their nonpregnant levels

 hemoglobin concentration and the

hematocrit decrease slightly during normal
pregnancy
 HAEMATOLOGICAL CHANGES

 The total iron content of normal adult

women ranges from 2.0 to 2.5 g
 The leukocyte ranges 5000 - 12,000/Ul
 fibrinogen concentration increases about
50 percent to average about 450 mg/dL
late in pregnancy, with a range from 300 to
600
 CARDIOVASCULAR SYSTEM
CHANGES

 The most important changes in cardiac

function  the first 8 weeks of pregnancy
 Cardiac output is increased  the 5th
week of pregnancy
 Between weeks 10 - 20, plasma volume
↑,preload ↑
RESPIRATORY SYSTEM CHANGES

 The diaphragm rises + 4 cm during

pregnancy .
 The subcostal angle widens ∞ transverse
diameter of the thoracic cage ↑ +2 cm
 The thoracic circumference increases + 6
cm
 RESPIRATORY SYSTEM CHANGES

 The amount of oxygen needs ↑

 The respiratory rate is little changed during
pregnancy
 the tidal volume, minute ventilatory
volume, and minute oxygen uptake
increase appreciably as pregnancy
advances
 GI TRACT CHANGES

 Gastric emptying and intestinal transit

times are delayed in pregnancy because
of hormonal or mechanical factors.
 Pyrosis (heartburn) is common during
pregnancy and is most likely caused by
reflux of acidic secretions into the lower
esophagus
 BAHAN / BUKU ACUAN
1. Buku Kebidanan YBP Sarwono Prawiroharjo
2. William Obstetric
3. Kebidanan Fisiologi dr. Supono
4. Kebidanan Fisiologi FK UNPAD
5. Bunga Rampai Kebidanan Rustam Mochtar
6. Dll.