5.implantasi & plasentasi

7/21/2019 5.Implantasi & Plasentasi

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At time of ovulation, the cervical mucous is inthe most favourable condition for sperm

penetration and capacitation as:

1. It becomes more copious, less viscous andits macromolecules arrange in parallel chainsproviding channels for sperms passage.

2. Its contents from glucose and chloride areincreased.

The Sperm:


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The sperms ascent through the uterinecavity and Fallopian tubes to reach the

site of fertilization in the ampulla by:1. Its own motility, and by

2. Uterine and tubal peristalsis which isaggravated by the prostaglandins in the

seminal plasma.


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The sperms reach the tube within

30-40 minutes

But they are capable of fertilization

after 2-6 hours.

This period is needed for spermcapacitation.


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Is the process after which the spermbecomes able to penetrate the zona

pellucida,that surrounding the ovumand fertilize it.

The cervical and tubal secretions aremainly responsible for this capacitation.

Capacitation

of sperms


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Capacitation is believed to be due to :1.Increase in the DNA concentration in

the nucleus,

2.Increase permeability of the coat of

sperm head to allow more release of

hyaluronidase.


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The ovum:

The ovum leaves the ovary afterrupture of the Graafian follicle,

carrying23 chromosomes

and surrounded by thezona pellucida and corona radiata.


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OVULATION

Usually 1 egg is allowed to pass into fallopiantube (from about 20)

At the moment of conception the mothersegg cell is fertilized by the fathers sperm.

Though many sperm may surround the eggcell only one will penetrate the egg cells outer

wall.


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The ovum is picked up by thefimbrial end of the Fallopian

tubes and moved towards theampulla by the :

1. Ciliary movement of the cells and2. Rhythmic peristalsis of the tube.

The ovum:


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Fertilization:

Millions of sperms ejaculated in thevagina, but only hundreds of

thousands reach the outer portion ofthe tubes.

Only few succeed to penetrate the

zona pellucida, and only onespermatozoon enters the ovumtransversing the perivitelline space.


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After penetration of the ovum by asperm, the zona pellucida resists

penetration by another sperms due toalteration of its electrical potential.

The pronucleus of both ovum andsperm unite together to form the zygote

(46 chromosomes).


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FERTILIZATION

Begins with 46 pair of chromosomes, splits off to 23then combine for a unique new 46 pair.


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Acrosomal Reaction and Sperm Penetration

Figure 28.2a


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Figure 28.3

Events Immediately Following Sperm Penetration


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Zygote undergoes rapid mitotic cell division, but thesedo not increase the size of the zygote called cleavagedivisions

Cleavage produces a solid sphere of cells, stillsurrounded by zona pellucida now called a morula.

At 4.5 to 5 days, cells have developed into a hollowball of cellsblastocyst.

The cells become arranged into an :1. Inner cell mass (embryoblast) which will form all thetissues of the embryo

2.Outer layer called trophoblastwhich invade the uterinewall.

It is at this stage that it enters the uterus.


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6 days

1-3 days

7 days


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Blastocyst Development


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Blastocyst has an outer layer of cells called thetrophoblast, an inner cell mass, and a fluid

filled cavity called the blastocele.

The trophoblast and part of the inner cellmass will form the membranes of the fetal

portion of the placenta, the rest of the inner

mass forms the embryo.


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Blastocyst

Trophoblast - outer cells contains majority ofcells

This layer will become structures which enable life including

the yolk sac produces blood cells until the embryo can do it on

its own the allantois forms the embilical cord and blood vessels in the

placenta

the amnion develops into the amniotic sac holding amniotic fluidwhich protects the embryo

Inner Cells Become the Embryo itself

The chorion becomes the lining of the placenta and inner


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Blastocyst

Inner cells

At about 7- 8 days the inner cell mass has dividedinto two distict layers

Ectoderm which becomes external coverings toinclude skin, hair sense organs and nervous system

Endoderm - develops into digestive system, respiratorysystem and the glands

Mesoderm At about the 16th day develops into

muscles, connective tissues and circulatory andexcretory systems.


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Blastocyst

Inner cells

At about 7- 8 days the inner cell mass has dividedinto two distict layers

Ectoderm which becomes external coverings toinclude skin, hair sense organs and nervous system

Endoderm - develops into digestive system, respiratorysystem and the glands

Mesoderm At about the 16th day develops into

muscles, connective tissues and circulatory andexcretory systems.


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Development of endometrium and embryo

Under influence of progesterone,

endometrium thickens and increases

vascularity for implantation

Maternal part of placenta develops from

decidua basalis


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About 10 to 14th day after conception,

blastocyst differentiate into primary germ

layers

All tissues, organs develop from three germ

cell layers


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Implantation

(nidation) :


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Implantation

Occurs 7 days after fertilization

Implants near fundus

Chorionic villae implant into endometriumwhich becomes decidua

Placental formation begins

Outer layer of chorionic villae becomemembranes- chorion and amnion


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IMPLANTATION

suatu proses bagaimana embryo terhubung erat dengan jaringan

maternal uterus.

6-7 hari setelah konsepsi (fertilisasi)

3 fase yaitu aposisi, adhesi dan penetrasi

Aposisi adhesi awal blastokist pada dinding uterus. Mikrovili pada permukaan apikal sinsitiotrofoblas saling

berhubungan dengan mikroprotusi dari permukaan apikal

epithelium uterus (pinopodes).

pada dinding posterior uterus.

Adhesi peningkatan interaksi fisik antara blastokist denganepithelium uteri.

Penetrasi/invasi penetrasi syncytiotrophoblast melalui epitel

uterus infiltrasi mononuclear cytotrophoblast pada keseluruhan

endometrium, myometrium dan pembuluh darah uterus.


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Implantation of the Blastocyst

Figure 28.5a


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Implantation of the Blastocyst

Figure 28.5b


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Th

d id


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The decidua:

It is the thickened vascularendometrium of the pregnant uterus.

The glands become enlarged, tortuousand filled with secretion.

The stromal cells become large withsmall nuclei and clear cytoplasm,

these are called decidual cells.

h

d d


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The decidua, like secretoryendometrium, consists of three

layers:1. The superficial compact layer,

2. The intermediate spongy layer,

3 The thin basal layer

The decidua


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The separation of placentaoccurs through the spongy

layer

While the endometrium

regenerates again from the

basal layer.

The decidua

Th

d id


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The trophoblast of the blastocyst invadesthe decidua to be implanted in:

-The posterior surface of the upper

uterine segment in about 2/3 of cases,-The anterior surface of the upper

uterine segment in about 1/3 of cases.

The decidua

Th

d id


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After implantation the decidua

becomes differentiated into:

1. Decidua basalis; under the site of

implantation.

2. Decidua capsularis; covering the

ovum.3. Decidua parietalis or vera; lining the

rest of the uterine cavity.

The decidua


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h

d id


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The decidua


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As the conceptus enlarges and

fills the uterine cavity the

decidua capsularis fuses withthe decidua parietalis.

This occurs nearly at the end of12 weeks.

The decidua


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The decidua has the following functions:

1.It is the site of implantation.

2.It resists more invasion of the trophoblast.

3.It nourishes the early implanted ovum by

its glycogen and lipid contents.4.It shares in the formation of the placenta.

The decidua


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IMPLANTATION

First weeks of human development:

Blastocyst embedded in endometrium.

Chorion


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Chorion:

After implantation, the trophoblast differentiatesinto 2 layers:

a. An outer one calledsyncytium (syncytiotrophoblast)which is multinucleated cells without cellboundaries,

b. An inner one called Langhanslayer(Cytotrophoblast) which is cuboidal cells with simplecytoplasm.

A third layer of mesoderm appears inner to thecytotrophoblast.

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The trophoblast and the lining

mesoderm together form the

chorion. Mesodermal tissue ( connecting stalk)

connects the inner cell mass to thechorion and will form the umbilical

cord later on.

Chorion:

Chorion

:


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Spaces (lacunae) appear in thesyncytium, increase in size and fusetogether to form the

" chorio-decidual space"or" intervillus space".

Erosion of the decidual blood vessels bythe trophoblast allows blood to circulate inthis space.

Chorion:

Chorion

:


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The outer syncytium and inner Langhans cells

form buds surrounding the developing ovumcalledprimary villi.

When the mesoderm invades the center of theprimary villi they are called secondary villi.

When blood vessels (branches from the

umbilical vessels) develop inside the

mesodermal core, they are called tertiary

villi.

Chorion:

Primary villous Secondary villous


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Primary villous Secondary villous


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Transverse section of tertiary villous

Cytotrophoblast Invasion of Decidual Vessels


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Chorion

:


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At first, the chorionic villi surround thedeveloping ovum.

After the 12th week, the villi opposite thedecidua capsularis atrophy leaving the

chorion laeve which forms the outer

layer of the foetal membrane and isattached to the margin of the placenta.

Chorion:

The villi opposite the decidua basalis


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The villi opposite the decidua basalis

grow and branch to form the chorion

frondosum and together with thedecidua basalis will form the placenta.

Some of these villi attach to thedecidua basalis ( the basal plate)

called the "anchoring villi", other hangfreely in the intervillus spaces called

"absorbing villi"


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Trophoblast development


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Amnion:


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Amnion:

After implantation,2 cavities appear

in the inner cell mass;the amniotic cavity and yolk

sac and in between these 2cavities the mesoderm

develops


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PL ENT TION


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PLACENTA


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PLACENTA

the highly specialised organ of pregnancy along with the fetal membranes and amniotic

fluid support the normal growth anddevelopment of the fetus

Changes in placental development andfunction dramatic effects on the fetus andits ability to cope with the intrauterineenvironment.

Implantation and the formation of the placenta

is a highly coordinated process involvinginteraction between maternal and embryoniccells.


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Placentation

Formation of the placenta from:

Embryonic trophoblastic tissues

Maternal endometrial tissues


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Placentation

The chorion develops fingerlike villi, which:

Become vascularized

Extend to the embryo as umbilical arteries and

veins

Lie immersed in maternal blood

Decidua basalis part of the endometrium

that lies between the chorionic villi and thestratum basalis


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Placentation

Decidua capsularis part of the endometrium surrounding the uterinecavity face of the implanted embryo

The placenta is fully formed and functional by the end of the third month

Embryonic placental barriers include:

The chorionic villi

The endothelium of embryonic capillaries

The placenta also secretes other hormones human placental lactogen,

human chorionic thyrotropin, and relaxin

The placenta


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The placenta

The chorion develops into the fetal part of the

placenta. The chorionic villi connect the fetal circulation

to the placenta

Composed of both fetal and maternal tissues


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PLACENTA

MOM

Baby

Schematic drawing of placenta: how it supplies oxygen and nutrition to embryo and removes waste

products. Deoxygenated blood leaves fetus through the umbilical arteries and enters placenta,

where it is oxygenated. Oxygenated blood leaves placenta through the umbilical vein, which enters

Baby

mom


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Cytotrophoblast Invasion of Decidual Vessels


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Placentation

Figure 28.7a-c

Placentation


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Placentation

Figure 28.7d

Placentation


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Placentation

Figure 28.7f


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Placenta


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KOTILEDON PLASENTA

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SAAT PLASENTA MATANG VILUS MUDAMEMBENTUK PERCABANGAN YG EKSTENSIF

SETIAP VILUS UTAMA ( TRUNCAL VILI,MAINSTEM VILI ) DAN RAMUS-RAMUS NYA

MEMBENTUK KOTILEDON ( LOBUSPLASENTA)

SETIAP KOTILEDON DIVASKULARISASI OLEHCABANG TRUNCAL ARTERI KORIONIK

SETIAP KOTILEDON TERDAPAT SEBUAHVENA


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Sebagian besar villi berakhir dengan bebas dalamrongga intervillous tanpa mencapai desidua.

Tiap villi stem utama dengan percabangannyamembentuk suatu fetal cotyledon

bagian plasenta antara dua septa terletak daridesidua hingga hampir ke lempeng chorionic sebagai maternal cotyledon

Setiap trophoblast yang menginvasi bertemudengan desidua, akan berkembang suatu zonadengan degenerasi fibroid (lapisan Nitabuch)


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PLASENTA PADA KEHAMILAN ATERM

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berat plasenta rata-rata 508 (500-600 gr)

diameter 185mm (15-25 cm),

tebal 23 mm (3 cm), dan volume 497 ml

terjadi perubahan pada stroma yg

melibatkan sel hofbauer


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PLASENTA PADA KEHAMILAN ATERM

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proliferasi trofoblas seluler pada ujung vilusakan menghasilkan kolom-kolom sel trofoblastik

kolom-kolom sel ini tidak diinvasi oleh mesenkim

janin sehingga ruang antar villus ( sisi yg menghadap

ibu ) terdiri dari sitotrofoblas yg berasal dari

kolom-kolom sel , sinsitium perifer

Pl t l Si d W i ht


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Placetal Size and Weight

Total number of cotyledons remains the same

throughout gestation Individual cotyledones continue to grow

Placental weights vary considerably

SIRKULASI DARAH PADA PLASENTA


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YANG MATANG

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secara fungsional plasenta menggambarkan keterkaitanyg erat antara jaringan kapiler janin dan darah ibu

permukaan maternal plasenta dibagi menjadi lobus-lobus ireguler

terdapat dua pola percabangan arteri korion yaitu polamenyebar (diperse) dan pola magistral

pola disperse berjalan dari tempat insersi tali pusat keberbagai kotiledon



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YANG MATANG

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pola magistral arteri berjalan ke tepi plasenta tanpamengalami banyak penyusutan diameter, mendarahikotiledon sewaktu percabangan membelok kebawahuntuk menembus lempeng korion

homeostasis janin bergantung sirkulasi ibu-plasenta

yang efisien penelitian ramsay dan rekan dengan radiokontras

menunjukan bahwa pintu masuk arteri serta pintu keluarvena tersebar secara acak diseluruh dasar plasenta

FISIOLOGI SIRKULASI PLASENTA


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FISIOLOGI SIRKULASI PLASENTA

darah ibu masuk melalui lempeng basal danterdorong keatas kelempeng korion oleh puncakarteri ibu sebelum terjadi dispersi kelateral

setelah membasahi permukaan mikrvillus

eksterna, darah ibu mengalir kembali melaluilubanglubang vena dilempeng basal dan masukkevena-vena uterus

darah ibu melintasi plasenta secara acak tanpamelalui saluran-saluran yg sudah ada, didorongoleh tekanan arteri ibu


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panjang,ketebalan, dan permukaan plasentameningkat sewaktu kontraksi

disebabkan peregangan ruang antar vilus oleh darahkonsekuensi aliran balik vena lebih besar dari padagangguan aliran masuk arteri

faktor utama yg mengendalikan aliran darah diruangantarvilus :

tekanan darah arteri

tekanan intrauterus

pola kontraksi uterusfaktor yg bekerja secara spesifik pada dinding

arteriol

F ti f Pl t


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Exchange of metabolic & gaseous productsbetween maternal and fetal bloodstreams

Exchange of Gases

- diffusion, facilitated diffusion, active

transport, pinocytosis Exchanges o f nu tr ients and Electro lytes

Transm ission o f Maternal Ant ibodies

- IgG and passive immunity against diphteria,smallpox, measles and not againstchickenpox and whooping cough

Function of Placenta

F ti f Pl t


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Hormone production- hCG

- Progesterone

- Estrogen- hPL (somatomammotropine)

- Human Corticotropine hormone

- Human Thyrotropine hormone Synthesis : Cholesterol and fatty acid




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Hormonal Changes During Pregnancy


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Hormonal Changes During Pregnancy

Figure 28.6


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AMNION


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AMNION

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merupakan membran janin paling dalam danberdampingan dengan cairan amnion

permukaan dalam terdiri dari selapis sel kuboid

epitel terdiri dari kolagen intertisial tipe i,iii, dan v

lapisan luar terdiri dari sel mesenkim mirip fibroblas lapisan paling luar zona spongiosa relatif aseluler

amnion manusia pertama kali diidentifikasi sekitarhari ke-7 atau hari ke-8 perkembangan mudigah


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sel-sel epitel amnion berasal dari ektoderm janinpada diskus embrionik

pada awal kehamilan sel-sel epitel reflkasi dengankecepatan yg lebih besar dibanding sel mesenkimdan pada awal kehamilan aterm

sel epitel melapisi seluruh sisi dalam membranamnion

sel epitel aktif secara metabolis sesuai fungsinyauntuk sintesis inhibitor jar.metaloproteinase-1

sel-sel mesenkim berperan untuk sintesis kolagenintertisial dan berbagai sitokin termasuk il-6,il-8,monocyte chemoatractan protein-1 (mcp-1)


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kemampuan daya regang pada amnion terletak padalapisan kompak yg terdiri dari kolagen interstitium tipei,iii,v, dan vi yg saling berikatan secara silang

benirschke dan kauffman 2000 membran cukup elastisdan mampu mengembang 2 x ukuran normal

kolagen iii memiliki konstribusi unik terhadap integritasjaringan

kolagen tipe i dan iii diproduksi oleh sel-sel mesenkim


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sel epitel menghasilkan protein membran basal ,prokolagen iv, fibronektin dan laminin

suatu temuan baru metalotionin , suatuprotein yg mempunyai afinitas yg tinggi

terhapad cu 2+ hipotesis kejadian resiko ketuban pecah dini

lebih tinggi pada wanita-wanita perokok

FUNGSI AMNION


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FUNGSI AMNION

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menampung cairan amnion transpor air dan zat terlarut untuk mempertahankan

homeostasis cairan amnion

menghasilkan senyawa bioaktif seperti peptida vasoactif,faktor pertumbuhan, dan sitokin

mensintesis vasokontriksor endothelin-1 serta vasorelaksanparathyroid hormone-related protein, sel epitel dapat jugamenhasilkan peptida natriuretik otak (bnp), cortico realisinghormone (crh)

diduga amnion plasenta terlibat proses modulasi tonus dan

aliran darah di pembuluh korion


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TALI PUSAT DAN STRUKTUR TERKAIT


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secara embriologis terbentuk pada bulan ketiga yaituberasal dari korda umbilikasis

tali pusat aterm memiliki dua arteri umbilikalis dan

satu vena umbilikalis

berjalan dipermukaan fetal plasenta

diameter rata-rata 0,8-2,0 cm, dan panjang rata-rata

55 cm



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darah mengalir dari vena umbilikalis melalui dua rute duktusvenosus vena cava inferior, dan saluran kecil kesirkulasijanin dan kemudian ke vena cava inferior melalui venahepatika

pembuluh-pembuluh mempunyai bentuk spiral dan

terpeluntir, bisa searah jarum jam (dekstral) atau berlawananarah jarum jam ( sinistral ), tipe sinistral terdapat dalam 90%kasus

diperkirakan dengan bentuk spiral ini memungkinkan untukterhindar dari kusut akibat terpeluntir pada suatu organberongga sperti tali pusat.


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PLACENTA


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PLACENTA

MOM

Baby

Schematic drawing of placenta: how it supplies oxygen and nutrition to embryo and removes waste

products. Deoxygenated blood leaves fetus through the umbilical arteries and enters placenta,

where it is oxygenated. Oxygenated blood leaves placenta through the umbilical vein, which enters

Baby

mom


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Thank you


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5.implantasi & plasentasi

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