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PERUBAHAN LINGKUNGAN
INTRA EKSTRA UTERUS
TERHADAP FISIOLOGI
SISTEM TUBUH
Department of Physiology, Faculty of Medicine
University of Sumatera Utara, Medan
Indonesia

PROSES KELAHIRAN
(Perubahan Link. Intrauterine Link. Ekstrauterine)
at term
KONTRAKSI uterus
(Frekuensi-Durasi-Intensitas)
Sirkulasi (PO2/PCO2) terganggu
Asphyxia (PO2 & PCO2 )
Heart Rate :
140x/mnt 160-180x/mnt
bila O2 100-120x/mnt
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Perubahan SIRKULASI segera setelah Lahir
Rangs. Dingin pd Kulit + Asphyxia
Bayi lahir (normal)
Bayi Menangis
PO2 70-80 mmHg
Saturasi Hb-O2 : 80-90%
at birth
potong Umbilical cord (tali pusat)
Tahanan peripher
TD. Aorta >> TD. Art.Pulmonal
Sirkulasi Plasenta (-)
Asphyxia (CO2 & O2 )
Menangis Tarik Napas
Paru mengembang
Tahanan paru
TD.Aorta TD. pulmonal
Rangs. Dingin
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Bbrp. Jam postpartum
Aliran Atrium Kiri & Aliran Atrium Kanan
Aliran darah Aorta Arteri Pulmonalis
Konstriksi Duktus Arteriosus
(Penutupan Fungsional)
1 - 4 Bulan
Fibrosis Occluded
Sirkulasi Dewasa
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TD. Aorta >> TD. Art.Pulmonal
Aliran darah paru
Aliran Atrium Kiri & Aliran Atrium Kanan
Tek. Atrium Kiri >>Tek. Atrium Kanan
Foramen Ovale Tertutup
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Circulation in Fetus and Newborn
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PERUBAHAN SIRKULASI
PLASENTA
JARINGAN TUBUH
VENT Ki ATR Ki
PARU
VENT Ka ATR Ka
FETUS PERINATAL (0-1 Bln) BAYI (1-4 Bln) Dewasa
FO : Foramen Ovale
FO
DA
DA : Ductus Arteriosus
JARINGAN TUBUH
VENT Ki ATR Ki
PARU
VENT Ka ATR Ka
DA
PLASENTA
FO
PLASENTA
PARU
JARINGAN TUBUH
FO
VENT Ki ATR Ki
VENT Ka ATR Ka
PARU
JARINGAN TUBUH
DA DA
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MENARIK NAFAS PERTAMA (The First Breath)
Perubahan Respirasi Placenta Respirasi paru
Bayi Lahir
Rangsang sensorik : Kulit & Otot
Asidosis Ringan
Pusat Pernapasan
Kontraksi otot-otot Pernapasan
Vol. Intra Thoraks & Tek. Intra Thoraks
Udara Masuk ke Paru
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REGULASI SUHU TUBUH
Bayi
Iklim intrauterine (tropis) Iklim Ekstrauterine
STRESS
Regulasi Suhu
BELUM STABIL
Suhu Tubuh
TDK STABIL
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Regulasi Suhu Blm. Stabil
Thermogenesis (Heat Gain) Thermolysis (Heat Loss)
Tak dpt menggigil (respon
dingin) Sistem syaraf blm.
Sempurna.
Respon dingin :
Metabolisme brown fat
Trigliserida
Free fatty acid
Luas permukaan bayi >>
Dewasa
Kulit & Jar. Subcutan tipis
High Conductance
Panas hilang >>
Cairan Tubuh
BB (5-10%) 2-3 Hr
pertama
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FUNGSI LIVER
Bayi baru lahir
Sumber Energi
GLIKOGEN
LIVER, OTOT, JANTUNG,
dll
Beberapa jam
postpartum GLIKOGEN
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REGULASI GLUKOSA
Segera setelah lahir KGD 30-40mg/100mL
Bbrp. jam
Glikogen
KGD <20mg/100mL
GLUKONEOGENESIS
Gangguan/gagal
Ggn. Syaraf & Koma
Apnoe + Cyanosis
Pemberian
Glukosa
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METABOLISME PROTEIN & LEMAK
Fetus
Melawati Barrier Placenta
- Immunoglobulin
Tak Melawati Barrier Placenta
- Plasma Protein
- Lemak
Sintesa di Hati :
Albumin & Lemak
Aktivasi Met. As.Nukleat &
sintesa Protein
Segera
Setelah Lahir
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BILIRUBIN & FUNGSI DETOXIFIKASI
Fungsi Ekskresi Bilirubin (Hati) &
Detoxifikasi Obat-obatan
Physiological
Joundice (3-7 Hari)
Blm. Sempurna
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TRACT. GASTROINTESTINALIS
Rute PLACENTA Rute INTESTINAL
Gastric Emptying Time : 3-4 jam
Enzym Lambung & HCl, pH : <3
(pencernaan Susu)
Enzym Intestinal, dan Empedu
CUKUP
Amilase Pankreas <<<
MOTILITAS
SEKRES
I
ABSORPSI
Zat Nutrisi BAIK
Kecuali LEMAK
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PENGATURAN ENDOKRIN
PERTUMBUHAN

Foetus Growth dipengaruhi :
Maternal Nourishment
Estrogen & Progesteron


Fetus Growth Tdk.dipengaruhi :
Growth Hormon Foetus
Thyroxine Foetus

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Thyroid Gland
IBU
(HYPOTHYROIDISM)
Lahir Bayi
(HYPOTHYROIDISM)
PERKEMBANGAN
AKTIF segera Stlh Lahir
(respon thd dingin)
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Adrenal Korteks
Kortikosteroid (+)
Respon kelenjar (+)
Pada urine
Keadaan stress
Adrenal
Medula
Saat Lahir
Mempertahankan
Sirkulasi Darah Otak
PO2
ASPHYXIA
Epinephrin/NE
VASOKONSTRIKSI
Respon Metabolik
Thd DINGIN
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SISTEM SYARAF
Sist. Syaraf Pusat

Pertumbuhan :
- me pd Trimester II & III (maks)
-Berat : berat Otak Dewasa

Sifat Refleks

Flexion Reflex,menangis wkt.
Lapar, memutar Kepala, dll.
Buka mata (respon Cahaya &
Suara)
Tidur barbagai posisi

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PERAN HORMON DALAM
PROSES TUMBUH DAN
KEMBANG
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Multiple hormones, including growth hormone (GH),
insulin-like growth factors (IGF-I and -II), insulin, thyroid
hormones, glucocorticoids, androgens, and estrogens
contribute to the growth process in humans.
Among these, GH and IGF-I have been implicated as the
major determinants of growth in normal postuterine life.
However, deficiencies (or excesses) of each of the other
hormones can seriously affect the normal growth of the
musculoskeletal system as well as the growth and
maturation of other tissues.

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Pancreas: Insulin
actions: hypoglycemic (lowers blood
glucose)
increases transport of glucose into muscle and fat
cells (NOTE: does not increase uptake by brain,
liver, or kidney)
inhibits breakdown of glycogen and formation of
glucose from amino acids or fatty acids (inhibits
glycogenolysis and gluconeogenesis)
promotes formation of glycogen (liver, skeletal
muscles), protein synthesis (muscle), and fat
synthesis and storage (adipose)
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5. Pancreas: Insulin (Control)
stimulated by:
increased blood glucose
increased blood amino acid
and fatty acid levels
parasympathetic impulses
hyperglycemic hormones
(GH, glucagon, epinephrine,
thyroxine, glucocorticoids)
indirectly result in insulin
secretion by increasing blood
glucose levels
inhibited by:
low blood glucose and by
somatostatin
sympathetic impulses
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