Pemicu 1

“Buah Pernikahan”
Stephen Wijayanto
405110198
Kelompok 17 Blok Reproduksi
FK UNTAR
 Learning Objectives:
1. Menjelaskan anatomi, histologi, dan faal organ
reproduksi wanita.
2. Menjelaskan perubahan anatomi, histo, dan faal organ
reproduksi wanita saat hamil.
3. Perubahan hormonal pada kehamilan
4. Menjelaskan Ante Natal Care (ANC).
5. Menjelaskan gizi pada ibu hamil.
6. Menjelaskan kelainan pada Trimester I.
7. Menjelaskan pemeriksaan pra-kehamilan dan kehamilan.
8. Menjelaskan kontrasepsi (hormonal dan non-hormonal).
LO1.
ANATOMI
ORGAN REPRODUKSI WANITA
Pintu Atas Panggul
Pintu Bawah Panggul
Damage to pelvic floor muscle
Female internal genital organs
 Vagina
•  musculomembranous tube (7-9 cm); extends from the cervix
of the uterus to the vestibule
• Functions
– Serves as a canal for menstrual fluid
– Forms the inferior part of the pelvic (birth) canal
– Receives the penis and ejaculate during sexual intercourse
– Communicates superiorly with the cervical canal & inferiorly with the
vestibule
• Relations
– Anterior  fundus of the urinary bladder and urethra
– Lateral  levator ani, visceral pelvic fascia, and ureters
– Posterior  the anal canal, rectum, and rectouterine pouch
• 4 muscles compress
the vagina; act as
sphincters
–  pubovaginalis,
external urethral
sphincter,
urethrovaginal
sphincter, and
bulbospongiosus
• Arterial supply
– Superior  uterine arteries
– Middle & inferior  vaginal and internal pudendal arteries
• Venous drainage
– vaginal venous plexuses
 Uterus
•  thick-walled, pear-shaped, hollow muscular
organ; usually anteverted
(7,5 cm x 5 cm x 2 cm); 90g
• Parts  body, fundus, isthmus, cervix
• The wall of uterus’ body:
– Perimetrium  serous layer consists peritoneum + thin
layer of connective tissue
– Myometrium  smooth muscle coat + blood vessel >>
– Endometrium  inner mucous coat
• Ligaments of uterus
– ligament of the ovary
– ligament of the uterus
– broad ligament of the uterus
– suspensory ligament of the ovary

• Ligaments of servix (mobile)

– Transverse cervical (cardinal) ligaments  cervix & lateral parts of fornix to wall
of pelvis
– Uterosacral ligaments  posterior side of cervix to middle sacrum (palpable
during examination)
• Relations
– Anterior  vesicouterine pouch and superior
surface of the bladder
– Posterior  rectouterine pouch containing loops of
small intestine and the anterior surface of rectum
– Lateral  peritoneal broad ligament flanking the
uterine body; ureters run anteriorly slightly
superior to the lateral part of the vaginal fornix and
inferior to the uterine arteries
• Arterial supply
– uterine arteries
– collateral supply from the ovarian arteries
• Venous drainage
– uterine venous plexus  internal iliac veins
• Innervation of vagina & uterus
-. Sympathetic 
lumbar splanchnic
nerves +
intermesenteric-
hypogastric-pelvic

-. Parasympathetic 
pelvic splanchnic nerves
(S2-S4) to inferior
hypogastric-
uterovaginal plexus
 Uterine tubes
•  conduct the oocyte (ovum); 10 cm; lie in mesosalpinx
• Parts
– Infundibulum
• funnel-shaped distal end of the tube that opens into the peritoneal
cavity; fimbriae
– Ampulla
• widest and longest part of the tube; medial end of the infundibulum
– Isthmus
• thick-walled part of the tube, which enters the uterine horn
– Uterine part
• short intramural segment of the tube that passes through the wall of
the uterus
 Ovaries
• almond-shaped and -sized female gonads in
which the ova develop
• endocrine glands that produce reproductive
hormones

• Ligaments
– suspensory ligament of the ovary
– ligament of the ovary
• Arterial supply
– ovarian arteries
• Venous drainage
– Ovaries: pampiniform plexus of veins  ovarian vein
– Uterine tubes: tubal veins  ovarian veins and uterine (uterovaginal)
venous plexus
Female external genitalia
• Arterial supply (vulva)
– internal pudendal artery supplies most of the skin,
external genitalia, and perineal muscles. The labial
arteries are branches of the internal pudendal
artery, as are those of the clitoris
• Venous & lymphatic drainage (vulva)
– labial veins are tributaries of the internal pudendal
veins
– superficial inguinal lymph nodes
• Innervation (vulva)
– Anterior  lumbar plexus: the anterior labial nerves, derived
from the ilioinguinal nerve, and the genital branch of the
genitofemoral nerve
– Posterior  derivatives of the sacral plexus: the perineal
branch of the posterior cutaneous nerve of the thigh laterally
and the pudendal nerve centrally
– posterior labial nerves  labia
– deep and muscular branches of the perineal nerve supply
the orifice of the vagina and superficial perineal muscles
– dorsal nerve of the clitoris supplies deep perineal muscles
and sensation to the clitoris
– The bulb of the vestibule and erectile bodies of the clitoris
receive parasympathetic fibers via cavernous nerves from the
uterovaginal nerve plexus
LO1.
HISTOLOGI
ORGAN REPRODUKSI WANITA
 Ovaries
• almond-shaped bodies (3 cm long, 1.5 cm
wide, and 1 cm thick)
• Ovarian follicles
• Primordial ovarian
follicles
– single layer of the
flattened follicular cells
– found in the superficial
areas of the cortex
• Primary
follicles
– simple
cuboidal
epithelium
– zona
pellucida
develops
• Secondary/antral follicles
– increasing oocyte size and
numbers of granulosa cells
– secrete follicular fluid (or
liquor folliculi)
• hyaluronate,
• growth factors,
• plasminogen,
• fibrinogen,
• the anticoagulant heparan
sulfate proteoglycans
• steroids (progesterone,
androstenedione, and
estrogens)
• Wall of the antral follicles
• Mature/graafian follicle
– diameter of 20-30 mm
– large enough to protrude
from the surface of the
ovary
– antrum increases greatly in
size by accumulating
follicular fluid
– oocyte adheres to the wall
of the follicle through the
cumulus oophorus of
granulosa cells
• Follicular atresia
• Corpus luteum
• Corpus albicans
• Uterine tubes
– folded mucosa
– thick muscularis with
somewhat interwoven
circular (or spiral) and
longitudinal layers of
smooth muscle
– thin serosa covered by
visceral peritoneum with
mesothelium
• Uterus
– Perimetrium  an outer
connective tissue layer;
adventitial in some areas,
but largely a serosa
covered by mesothelium
– Myometrium  thick
tunic of highly vascular
smooth muscle
– Endometrium  mucosa;
lined by simple columnar
epithelium
• Uterine cervix
– Endocervix  mucus-
secreting simple
columnar epithelium on
a thick lamina propria
– Exocervix  stratified
squamous epithelium
• Vagina
– mucosa, muscular,
adventitia layer
– stratified squamous
• small amount of
keratohyaline, but do
undergo keratinization to
form keratin plates as in
the epidermis
• Mammary glands
– resembling highly
modified apocrine sweat
glands persists on each
side of the chest
– 15–25 lobes of the
compound
tubuloalveolar type
• Adult ; non pregnant • Pregnancy
• Lactation
LO1.
FAAL
ORGAN REPRODUKSI WANITA
Oogenesis
Perkembangan folikel
Peranan estrogen
 Siklus ovarium -
Siklus menstruasi
Events in menstrual cycle
Kontrol umpan balik FSH & sekresi LH tonik
selama fase folikel
Kontrol lonjakan LH pada saat ovulasi
Mekanisme umpan balik saat fase luteal
LO2.
PERUBAHAN ANATOMI DAN FAAL
ORGAN REPRODUKSI WANITA SAAT HAMIL
Perubahan Anatomi
 Labia majora
• Uterine weight >  rich venous plexus in
labia engorged turtous vein / small
grapelike clusters  asymptomatic
 Vagina & perineum
• > vascularity  violet color characteristic
(Chadwick sign)
• Mucosal thickness >, loosening of the
connective tissue, hypertrophy of smooth
muscle cells
• Hypertrophy of papillae of vaginal epithelium
• Secret  thick, white discharge
 Uterine
• Hypertrophy of muscle fibers
• > weight (70g  1100g)
• > volume (5L)
• Fundus  dome shape
• Round ligaments  insert at
the junction of the middle
and upper thirds of the organ
• fallopian tubes elongate
• Myometrium  marked
hypertrophy
 Cervix
• Enlargement of the
cervix
– Band of columnar
epithelium may ring the
external os.  vaginal
acidity / reparative
healing  squamous
metaplasia  block
endocervical cleft 
mucous accumulation 
nabothian cysts
• Vascularity > + edema
within cervix stroma 
blue tint (Chadwick
sign) & softening
characteristic (Hegar
sign)
 Skin changes in pregnancy
• fetoplacental hormone production / alteration of
clearance  plasma availability of estrogens,
progesterone, and a variety of androgens >>
• concentrations of some adrenal steroids, including
cortisol, aldosterone, and deoxycorticosterone
• melanocyte-stimulating hormone (MSH) (8 weeks
gestation)

•  skin changes
• Pigmentation
–  skin darkening from
melanin deposition into
epidermal and dermal
macrophages (90%)
– areolae, perineum,
umbilicus, axillae, inner
thighs
• Striae gravidarum
– linear lesions that
frequently appear during
pregnancy
– reddish purple
– abdomen and breasts
• Nevi
– e/  enlarged
melanocytes and
increased melanin
deposition during
pregnancy
– no evidence for
malignant
transformation
• Hair
– Pregnancy  estrogen >
 anagen (hair-growth
phase) >
– Post partum  dissipate
 telogen effluvium (1-4
mo post partum)
• Nail changes
– soft and brittle
– Darker skinned individuals  brown pigment
stripe extends the length of the nail
(melanonychia)
• Vascular changes
– minute, red elevations on the skin (face, neck,
upper chest, and arms; radicles branching out
from a central lesion)  angioma (vascular
spider)/nevus/telangiectasis
– Palmar erythema

– e/  hyperestrogenemia
 Breasts
• breast tenderness and paresthesias (early
pregnancy)
• > size, delicate veins, larger nipple; deeply
pigmented, more erected (2 mo)
• Gentle massage  thick yellowish fluid
(colostrum)
• Number elevations of glands of Montgomery
(hypertrophic sebaceous glands)
Perubahan Fisiologi
 Metabolic changes
• maternal basal metabolic rate  > 10-20%
– Response to the increased demands of the rapidly
growing fetus & placenta

• Weight gain
• > uterus & contents
• > breast
• > blood volume
• > extravascular & extracellular fluid
• Water metabolism
water retention
• fetus, placenta, and amnionic
fluid  3.5 L
• > maternal blood volume  3
L
• Minimum amount of extra
water  6.5 L

• The reason unclear 

contributes more significantly
to infant birthweight
• Protein metabolism
• products of conception, the uterus, and maternal blood are
relatively rich in protein; fetus & placenta  4 kg (500 g of
protein)
• Another 500 g  uterus as contractile protein; breasts primarily
in the glands; maternal blood as hemoglobin and plasma proteins

• Amino acid concentrations are higher in the fetal than in the

maternal compartment (placenta regulation)

• There are more efficient use of dietary protein

• Carbohydrate metabolism
mild fasting hypoglycemia,
postprandial hyperglycemia,
and hyperinsulinemia

• After glucose ingestion 

prolonged hyperglycemia
and hyperinsulinemia
(pregnancy-induced state of
peripheral insulin
resistance)  sustained
postprandial supply of
glucose to the fetus
• Fat metabolism
• lipids, lipoproteins, and apolipoproteins >
• e/  progesterone acts to reset a lipostat in the hypothalamus
• Fat is deposited mostly in central rather than peripheral sites
• Triacylglycero & cholesterol levels in very-low-density lipoprotein (VLDL), low-
density lipoproteins (LDLs), and high-density lipoproteins (HDLs) > (T III)

• LDL-C (267 ± 30 mg/dL);

• HDL-C (136 ± 33 mg/dL);
• triglyceride (245 ± 73 mg/dL)

• Leptin >  regulation of body fat and energy expenditure

• Ghreline >  fetal growth and cell proliferation; regulates growth hormone
secretion
• Electrolyte & mineral metabolism
• 1000 mEq of sodium + 300 mEq of potassium  retained
• Enhanced tubular activity  GFR >, but excretion unchanged
• Total serum calcium levels <, because albumin <, ionized
calcium  unchanged
•  fetal skeleton  doubling of maternal intestinal calcium
absorption + dietary
• Serum magnesium levels <
• Serum phosphate levels are within the nonpregnant range
• increased requirement for iron
 Hematologic changes
• Blood volume
• > 40-45% after 32-34 weeks

• Purposes
• metabolic demands of the
enlarged uterus +
hypertrophied vascular
• provide an abundance of
nutrients and elements 
growing placenta and fetus
• protect the mother and in turn
the fetus
• safeguard the mother against
the adverse effects of blood
loss associated with parturition
• Hemoglobin concentration & hematocrit
• Hb  +/- 12.5 g/dL; < 11.0 g/dL (5% 
concerned)

• Iron requirements
1000 mg of iron required 
300 mg are actively
transferred to the fetus and
placenta, 200 mg are lost

 requires another 500 mg

because 1 mL of erythrocytes
contains 1.1 mg of iron
• Immunological function
– suppression of a variety of humoral and cell-mediated immunological functions to
accommodate the "foreign" semiallogeneic fetal graft
• suppression of Th1 & Tc1 cells  Il-2, IFN-gamma, TNF-B <

• Leukocytes
– chemotaxis and adherence functions <  T II
– leukocyte count  5000 to 12,000/microL

• Inflammatory markers
– Many tests performed to diagnose inflammation cannot be used reliably during
pregnancy
• leukocyte alkaline phosphatase  >
• C-reactive protein  >
• erythrocyte sedimentation rate (ESR)  >
• Coagulation & Fibrinolysis
 maintain hemostasis
– more enhanced in multifetal gestation
• Platelets
• decreased slightly during pregnancy 
213,000/microL
•  effects of hemodilution

•  increased platelet consumption  greater

proportion of younger, and therefore, larger platelets

• thromboxane A2 >  platelet aggregation

 Cardiovascular system
• Hemodynamic changes
• systemic vascular resistance < +
heart rate >  cardiac output >
(5 weeks)

• Ventricular performance
influenced by both the
decrease in systemic vascular
resistance and changes in
pulsatile arterial flow
• Heart
• Elevating of diapraghm 
displaced to the left and
upward; rotated somewhat
on its long axis

• benign pericardial effusion

• Altered cardiac sound

(systolic murmur  90%)
• Cardiac output
• Late pregnancy  large
pregnant uterus compress
venous return from the
lower body / compress
aorta  cardiac filling < 
cardiac output < (supine
position)

• Standing position 
normal
• Central hemodynamic changes
• Circulation & blood pressure
• Renin, angiotensin II, plasma volume
– RAA axis >
– Progesteron >  refractoriness to angiotensin II >

• Cardiac natriuretic peptide

– ANP & BNP  normal range; > when severe preeclampsia

• Prostaglandin
– > prostaglandin  control of vascular tone, blood pressure, and sodium balance;
natriuretic

• Endotelin
– Vascular sensitivity to endothelin-1 is not altered during normal pregnancy

• Nitric oxide
– important implications for modifying vascular resistance during pregnancy
 Respiratory tract
• Pulmonary function

Elevated diaphragm
• Acid-base equilibrium
– Tidal volume >  PCO2 <  dyspnea
– Progesterone  lowers the threshold and increases
the sensitivity of the chemoreflex response to CO2
– Compensation  plasma bicarbonate levels
decrease from 26 to approximately 22 mmol/L
– PCO2 <  carbon dioxide (waste) transfer from the
fetus to the mother while also facilitating oxygen
release to the fetus
 Urinary system
• Kidney
 Urinary frequency
• Loss of nutrients
– increased amounts of various nutrients lost in the
urine (Amino acids and water-soluble vitamins
lost>)

• Urinalysis
– Glucosuria, proteinuria, hematuria
• Ureters
– uterus rises completely out of the pelvis  rests upon
the ureters  displacing and compressing them at the
pelvic brim  ureteral dilatation (effects of
progesteron)

• Bladder
– increased uterine size  hyperplasia of the bladder's
muscle + elevates the bladder trigone and causes
thickening of its posterior
 Gastrointestinal tract
• stomach and intestines are displaced by the
enlarging uterus
– Gastric emptying time  unchanged
– Pyrosis (heartburn)
• altered position of the stomach  esophageal sphincter tone <
– The gums may become hyperemic and softened  focal,
highly vascular swelling of the gums (epulis of pregnancy)
• Mild trauma  bleeding
– Hemorrhoids
• Liver
– no distinct morphological changes
– alkaline phosphatase activity almost > 2x; AST, ALT, GGT,
bilirubin <
– Leucine aminopeptidase (proteolytic liver enzyme)  >
in liver disease; > in pregnant woman

• Gallblader
– contractility of the gallbladder <  stasis  cholesterol
gallstones (multiparous woman)
 Endocrine system
• Pituitary gland
– enlarges by approximately 135 percent  compress the optic
chiasma  reduce visual fields

– Growth hormone
• > slowly from approximately 3.5 ng/mL at 10 weeks to plateau after
28 weeks at approximately 14 ng/mL
• 17 weeks  placenta produces GH (peak: 14 to 15 weeks ) 
influence on fetal growth & preeclampsia
– Prolactin
• > markedly  10x
• decrease after delivery even in women who are breast feeding
• Thyroid gland
• thyroid gland enlarge
• thyroid hormones > 40-100%
• Parathyroid glands
– PTH & calcium
• < during the first trimester and then increase progressively
throughout the remainder of pregnancy
• Estrogens  block the action of parathyroid hormone on bone
resorption  another mechanism to increase parathyroid
hormone during pregnancy  physiological hyperparathyroidism
( supply fetus)
– Calcitonin & calcium
• > calcitonin levels
– Vit D & calcium
• > increased during normal pregnancy
• Adrenal glands
– Cortisol
• serum concentration >
• metabolic clearance
rate of cortisol <

• Progesterone > 
cortisol > to maintain
homeostasis (normal
increase plasma volume
during late pregnancy)
– Aldosterone
• > (15 weeks); T III  1 mg/day
•  affords protection against the natriuretic effect of progesterone and
atrial natriuretic peptide
– Deoxycorticosterone
• > progressively during pregnancy (1500 pg/mL by term / 15x)
– Dehydroepiandrosterone Sulfate
• < during normal pregnancy
• e/  increased metabolic clearance through extensive maternal hepatic
16-hydroxylation and placental conversion to estrogen
– Androstenedione and Testosterone
• > during pregnancy
• Converted to estradiol in placenta
 Musculoskeletal system
• Progressive lordosis
• sacroiliac, sacrococcygeal, and pubic joints mobility >
–  alteration of maternal posture and in turn may cause discomfort in the
lower back
• The bones and ligaments of the pelvis undergo remarkable adaptation
during pregnancy
 Eyes
• < intraocular pressure
• < corneal sensitivity; > corneal thickness
(edema)
• Brownish-red opacities on the posterior
surface of the cornea (Krukenberg spindles)
 CNS & sleep
• problems with attention, concentration, and
memory
• blood flow in the middle and posterior cerebral
arteries <<  from 147 and 56 mL/min

• difficulty going to sleep, frequent awakenings,

fewer hours of night sleep, and reduced sleep
efficiency (12weeks – 2 mo post partum) 
decreased significantly in pregnant women
LO3.
Perubahan Hormonal pada Kehamilan
LO4.
ANTENATAL CARE (ANC)
 Antenatal Care
• ANC  upaya preventif program pelayanan kesehatan obstetrik utk
optimalisasi luaran maternal dan neonatal melalui serangkaian
kegiatan pemantauan rutin selama kehamilan.
• 6 alasan penting ANC:
1. Mebangun rasa saling percaya antara klien dan petugas kesehatan.
2. Mengupayakan terwujudnya kondisi terbaik bagi ibu dan bayi yg
dikandungnya.
3. Memperoleh informasi dasar tentang kesehatan ibu dan kehamilannya.
4. Mengidentifikasi dan menata laksana kehamilan risiko tinggi.
5. Memberikan pendidikan kesehatan yg diperlukan dlm menjaga kualitas
kehamilan dan merawat bayi.
6. Menghindarkan gangguan kesehatan selama kehamilan yg akan
membahayakan keselamatan ibu hamil dan bayi yg dikandungnya.
 Jadwal Pemeriksaan ante natal
• Lengkap  K1, K2, K3, K4
– Min 1x hingga usia kehamilan 28 minggu
– 1x kunjungan selama kehamilan 28-36 minggu
– 2x kunjungan pd waktu usia kehamilan > 36
minggu
 Pemeriksaan Rutin ANC
• Identifikasi & riwayat kesehatan
– Data umum pribadi
– Keluhan saat ini
– Riwayat haid (usia kehamilan dan taksiran persalinan)
– Riwayat kehamilan & persalinan
– Riyawat kehamilan saat ini
– Riwayat penyakit dalam keluarga
– Riwayat penyakit ibu
– Riwayat penyakit yg memerlukan tindakan pembedahan
– Riwayat mengikuti KB
– Riwayat imunisasi
– Riwayat menyusui
• Pemeriksaan
– Keadaan umum (tanda vital, pem jantung paru, pem
payudara, kelainan otot dan rangka serta neurologik)
– Pemeriksaan abdomen
• Inspeksi
– bentuk dan ukuran abdomen, parut bekas operasi, tanda” kehamilan, gerakan
janin, varises, hernia, edema
• Palpasi
– tinggi fundus, punggung bayi, presentasi sejauh mana bagian terbawah bayi
masuk PAP
• Auskultasi
– 10minggu dgn Doppler, 20minggu dgn fetoskop Pinard
• Inspekulo vagina  identifikasi vaginitis pd Trimester I/II
• Pemeriksaan laboratorium
– Analisis urin rutin
– Analisis tinja rutin
– Hb
– Golongan darah
– Hitung jenis sel darah
– Gula darah
– Antigen hepatitis B virus
– Antibodi Rubella
– HIV
• USG  rutin pada kehamilan 18-22 minggu utk identifikasi
kelainan janin
• Beberapa gejala dan tanda bahaya selama kehamilan
– Perdarahan
– Preeklampsia
– Nyeri hebat di daerah abdominopelvikum
• Gejala dan tanda lain yg harus diwaspadai
– Muntah berlebihan yg berlangsung selama kehamilan
– Disuria
– Menggigil atau demam
– Ketuban pecah dini
– Uterus lbh besar atau lbh kecil dr usia kehamilan sesungguhnya
• Edukasi Kesehatan bagi Ibu Hamil
– Pendidikan dan konseling kesehatan tntg
kesehatan reproduksi, terutama tntg kehamilan
dan upaya utk menjaga agar kehamilan tetap
sehat dan berkualitas.
– Memberi informasi kesehatan esensial bagi ibu
hamil dan keluarganya  rencana persalinan dan
cara merawat bayi.
LO5.
GIZI PADA IBU HAMIL
 Callories
• additional 80,000 kcal  most are accumulated in
the last 20 weeks
–  caloric increase of 100 to 300 kcal per day is
recommended
• Protein
– added the demands for growth and remodeling of the
fetus, placenta, uterus, and breasts, as well as
increased maternal blood volume
– second half of pregnancy  1000 g of protein are
deposited; amounting to 5 to 6 g/day
• ornithine, glycine, taurine, and proline <
• glutamic acid and alanine >

– Sources  meat, milk, eggs, cheese, poultry, and fish

• Vitamins
• Minerals

Folic acid  400 microg daily (prevent neural tube defect); 100 microg per day
(childbearing age)
LO6.
KELAINAN PADA TRIMESTER 1
 Hiperemesis Gravidarum
• Hiperemesis gravidarum  muntah yg terjadi
pada awal kehamilan sampai umur kehamilan
20 minggu.
• Dpt mempengaruhi keadaan umum,
mengganggu pekerjaan sehari – hari, BB turun,
dehidrasi, terdapat aseton dalam urin, bahkan
seperti gejala penyakit apendisitis, pielititis, dll.
• Kebanyakan simptom akan teratasi hingga akhir
semester pertama.
Klasifikasi Hiperemesis Gravidarum
• Tingkat I
– Muntah yang terus menerus
– Intoleransi thdp makanan dan minuman
– BB turun
– Nyeri epigastrium
– Muntah pertama keluar makanan, lendir dan sedikit cairan empedu, dan yg
terakhir keluar darah
– Nadi meningkat sampai 100x/menit
– Tekanan darah sistolik menurun
– Mata cekung
– Lidah kering
– Turgor kulit berkurang
– Urin sedikit tetapi masih normal
• Tingkat II
– Segala yg dimakan dan diminum dimuntahkan
– Haus hebat
– Subfebril
– Nadi cepat 100 – 140x/menit
– Tekanan darah sistolik <80 mmHg
– Apatis
– Kulit pucat
– Lidah kotor
– Kadang ikterus, aseton, bilirubin dalam urin
– BB cepat menurun
• Tingkat III
– Gangguan kesadaran (delirium – koma)
– Muntah berkurang atau berhenti
– Dapat terjadi ikterus
– Sianosis
– Nistagmus
– Gangguan jantung
– Bilirubin
– Proteinuria dalam urin
 Diagnosis
• Amenore yg disertai muntah hebat, pekerjaan sehari – hari terganggu
• Fungsi vital: nadi me↑ 100x/menit, tekanan darah me↓ pd keadaan
berat, subfebril, dan gangguan kesadaran (apatis – koma)
• Fisik: dehidrasi, kulit pucat, ikterus, sianosis, BB↓, pd vaginal toucher
uterus besar sesuai besarnya kehamilan, konsistensi lunak, pd
pemeriksaan inspekulo serviks berwarna biru (livide)
• Pemeriksaan USG: utk mengetahui kondisi kesehatan kehamilan,
kemungkinan adanya kehamilan kembar, ataupun kehamilan
molahidatidosa
• Lab: kenaikan relatif Hb dan hematokrit, shift to the left, benda keton,
proteinuria
• Keluhan hiperemis berat dan berulang  konsultasi psikologik
 Gejala Klinik
• Mulai terjadi pd trimester I
• Nausea
• Muntah
• Bb ↓
• Ptialism (hipersalivasi)
• Tanda – tanda dehidrasi  hipotensi postural,
takikardi
• Lab: hiponatremi, hipokalemia, pe↑ hematokrit
• Hipertiroid dan LFT yg abnormal
 Risiko
• Maternal
– Akibat def tiamin B1  diplopia, palsi nervus ke6,
nistagmus, ataksia, kejang.
– Jika tdk segera ditangani  psikosis Korsakoff (amnesia,
menurunnya kemampuan utk beraktifitas), ataupun
kematian

• Fetal
– Pe↓ BB yg kronis  gangguan pertumbuhan janin
dalam rahim (IUGR)
 Tatalaksana
• Hiperemesis berat  dirawat di RS
• Stop makanan per oral 24 -48 jam
• Infus glukosa 10% atau 5% : RL = 2:1, 40 tetes per menit
• Obat
– Vit B1, B2, dan B6  @50-100 mg/hari/infus
– Vit B12 200 μg/hari/infus, Vit C 200 mg/hari/infus
– Fenobarbital 30mg IM 2-3x/hari atau Klorpromazin 25-50 mg/hari IM
atau kalau diperlukan Diazepam 5 mg 2-3x/hari IM
– Antiemetik: Prometazin 2-3x 25mg per hari per oral atau Proklorperazin
3x 3mg per hari per oral atau mediamer B6 3x1 per hari per oral
– Antasida: Asidrin 3x1tab per hari per oral atau Milanta 3x1tab per hari
per oral atau Magnam 3x1 per hari per oral
• Diet sebaiknya meminta advice ahli gizi
• Rehidrasi dan suplemen vitamin
– Normal salin (NaCl 0,9%)
– Suplemen potasium IV  sbg tambahan
– Suplemen tiamin 50mg oral atau 100mg dilarutkan ke dalam 100cc NaCl
– Urine output hrs dimonitor
– Pemeriksaan dipstik  cek ketonuria
• Antiemesis (tidak teratogenik)
– Dopamin antagonis (metokloperamid, domperidon)
– Fenotiazin (klorpromazin, proklorperazin)
– Antikolinergik (disiklomin)
– Antihistamin H1 reseptor antagonis (prometazin, siklizin)
– Tidak memberikan respons  kombinasi kortikosteroid dengan reseptor
antagonis 5-Hidrokstriptamin (5-HT3) (ondansetron, sisaprid)
LO7.
PEMERIKSAAN PRA-KEHAMILAN
DAN KEHAMILAN
Pemeriksaan pra kehamilan
LO8
Kotrasepsi(Hormonal dan Non Hormonal)
ETIKA DAN HUKUM PADA
PEMERIKSAAN OBSTETRI
 Prinsip – Prinsip Etika
• Otonomi
– Menghormati kebebasan pasien  mengakui hak individu
–  dasar moral kuat bagi informed consent, tetapi tidak bersifat
absolut atas permintaan pasien  pertimbangan moral lain
• Beneficence & nonmalefience
– Beneficence  dokter bertindak dengan cara menguntungkan
pasien
– Nonmalefience  tidak merugikan atau menyebabkan luka
• Justice
– Memperlakukan orang2 dalam situasi yg sama dengan
penekanan kebutuhan, bukannya kekayaan & kedudukan sosial
PEMBERIAN OBAT PADA IBU HAMIL
Kategori penggunaan obat2an selama kehamilan
(United Stae Food & Drug Administration)
• Kategori A
 tdk menunjukan peningkatan risiko abnormalitas terhadap janin
• Kategori B
 pada hewan tdk menunjukan bukti bahwa obat berbahaya pd janin, tapi belum
ada penelitian yg memadai dgn menggunakan pembanding pada ibu hamil
• Kategori C
 pada hewan telah menunjukan efek yg tdk dikehendaki pd janin, belum ada
penelitian memadai dgn menggunakan pembanding pd ibu hamil
• Kategori D
 penelitian menunjukan risiko bagi janin pd pembanding ibu hamil;
pertimbangan manfaat pemberian obat dibanding risiko yg dpt ditimbulkan
• Kategori X
 bukti positif terjadinya abnormalitas pada janin
Daftar obat yg terbukti teratogenik