TUGAS T1 A

Helena Parisianne Irianto

Shofi Faiza

Embriogenesis

Up to the fifth and sixth week of fetal life, the genital system remains indifferent. Two pairs of
genital ducts are present at this time: the mesonephric (Wolffian duct) and paramesonephric
(Mullerian duct). In females, the absence of anti-Mullerian hormone (AMH) and SRY gene
conditions the regression of Wolff ducts and further differentiation of Mullerian ducts. The
upper third of the vagina, the cervix, both fallopian tubes, and the uterus derive from the
paramesonephric ducts.[3] During the seventh week, paired paramesonephric ducts arise from
focal invaginations of the coelomic epithelium that is found on the upper pole of each
mesonephros, shortly after this the Mullerian ducts grow caudally and laterally to the urogenital
ridges.[4]
In the eighth week, a vertical fusion of paramesonephric ducts occurs. The fused cranial end
gives origin to the left and right parts of what will ultimately become the uterus. This structure
contains mesoderm that will form the endometrium and myometrium. The unfused cranial ends
of the Mullerian ducts will develop into the fallopian tubes, the fimbrial portion of the
fallopian tubes derives from the tip of this structure that remains open and acquires a funnel
shape. The caudal end of the fused ducts will form the upper third of the vagina.[5] At this
stage, a midline septum is present along these structures, and within the uterine cavity, this
septum usually reabsorbs completely around 20 weeks, but it can persist and produce a septate
uterus.[3] Regarding uterine ligaments, both the round ligament and the ovarian ligament
develop from the gubernaculum, and undifferentiated mesenchymal tissue is attached to the
ovary in the female fetus. The round ligament must attach to both the ovary and uterus for the
ovary to be in place.[6] By the end of the first trimester development of the uterus and the other
structures derived from the Mullerian ducts is complete.[3]
For the first 10 weeks, the human fetus has the potential to become either female or male. The
final phenotype depends on genetic information that influences differentiation in the embryonic
structures. A female fetus will classically develop if there is the presence of a XX genotype.
For a male fetus to develop there must be the presence of a Y chromosome that codes for SRY
protein that enables testicular, epididymis, ductus deferens, ejaculatory duct, and seminal
vesicles differentiation and secretion of anti-Mullerian hormone (AMH) from the Sertoli cells
which will inhibit the further differentiation of paramesonephric ducts and condition their
regression. In cases where this characteristic does not occur, an immature female fetus, or an
intersex fetus will develop
Anatomi serviks dan uterus

Ukuran serviks

Size
Age
children under 16 25.2 mm
between 16 and 18 years old 30.5 mm
between 19 and 30 years old 33.7 mm
between 31 and 35 years old 34.1 mm
between 36 and 40 years old 39.7 mm
between 41 and 45 years old 37.6 mm
between 46 and 50 years old 36.8 mm

Ukuran uterus
Sumber :
Langer, Jill E., et al. "Imaging of the female pelvis through the life cycle." Radiographics 32.6 (2012):
1575-1597.

Seven Cardinal movement

1. Engagement
In an occiput presentation, passage of the biparietal diameter through the pelvic inlet defines
engagement. The fetal head may engage during the last few weeks of pregnancy or not until
after labor commences The fetal head is freely movable above the pelvic inlet at labor onset
and is often referred to as “floating.” In most cases, the vertex enters the pelvis with the
sagittal suture lying in the transverse pelvic diameter. Left occiput transverse (LOT)

2. Descent
In nulliparas, engagement may take place before labor onset, and further descent may not
follow until second-stage labor. In multiparas, descent usually begins with engagement.

3. Flexion
As soon as the descending head meets resistance, whether from the cervix, pelvic walls, or
pelvic floor, it normally flexes. The result of complete flexion is to present the smallest
diameter of the fetal head (from occipitofrontal to the suboccipitobregmatic diameter) for
optimal passage through the pelvis.

4. Internal rotation
Usually the occiput rotates anteriorly toward the symphysis pubis. LO positions transition to
left occiput anterior (LOA) position.

5. Extension
With progressive distention of the perineum and vaginal opening, an increasingly large
portion of the occiput gradually appears. The head is born as the occiput, anterior fontanel,
brow, nose, mouth, and chin pass successively over the perineal body.

6. External rotation
The delivered head next undergoes restitution. If the occiput was originally directed toward
the maternal left, it rotates toward the mother’s left ischial tuberosity. If it was originally
directed toward the right, the occiput rotates to the right. With restitution, the head reaches
a transverse position. The fetal body aligns its bisacromial diameter, which is the distance
across the shoulders, with the anteroposterior diameter of the pelvic outlet.

7. Expulsion
after external rotation, the anterior shoulder appears under the symphysis pubis, and the
perineum soon becomes distended by the posterior shoulder.

Sumber : Obstetri Williams ed 26