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8/19/2019 Anatomi Fisiologi Sirkulasi Fetus Bayi Dan Dewasa 2013
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ANATOMI FISIOLOGISIRKULASIFETUS, BAYI & DEWASA
Rahmatina B. Herman
Baian Fi!i"#"iFa$%#ta! Ke"$teran Uni'er!ita!Ana#a!
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Feta# (ir)%#ati"n
Di*er! +r"m the "!tnata# -a+terirth/ )ir)%#ati"n, e)a%!e
L%n!, $ine0!, an
a!tr"inte!tina# tra)t aren"n+%n)ti"na#
O1 an n%trient! are eri'e +r"mmaterna# #""
(O1 an 2a!te! are e#iminate int"
materna# #""
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3#a)enta
i! the 4+eta# #%n5H"2e'er )e##%#ar #a0er! )"'erin the'i##i are thi)$er an #e!! ermea#e
than the a#'e"#ar memrane! in the#%n! an e6)hane i! m%)h #e!!e7)ient
i! a#!" the r"%te 0 2hi)h a##n%triti'e materia#! enter the +et%!
an 2a!te! are i!)hare t" the
materna# #""
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Arranement "+ Feta# (ir)%#ati"n
88 9 "+ +eta# (O3 "e! thr"%h #a)enta
B#"" in %mi#i)a# 'ein : ;< 9 !at%rate2ith O1 -in arteria# )ir)%#ati"n "+ a%#t= :
>; 9 /D%)t%! 'en"!%! i'ert! !"me "+ the #""ire)t#0 t" In+eri"r ?ena (a'a -I?(/anremainer! mi6e! 2ith "rta# #""
@ I?( #"" i! : 9 !at%rate 2ith O1
@ 3"rta# an !0!temi) 'en"%! #"" i!"n#0 : 1 9 !at%rate 2ith O1
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C.Arranement "+ Feta#(ir)%#ati"n
M"!t "+ the #"" enterin heart thr"%hI?( i! i'erte ire)t#0 t" #e+t atri%m 'ia+"ramen "'a#e #e+t 'entri)#e
M"!t "+ #"" +r"m S?( enter! riht'entri)#e an i! e6e##e int" %#m"nar0arter0
Re!i!tan)e "+ )"##a!e #%n! i! 'er0 hih
3re!!%re in %#m"nar0 arter0 a"rta
M"!t "+ the #"" +r"m %#m"nar0 arter0a!!e! int" a"rta 'ia %)t%! arteri"!%!
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C.Arranement "+ Feta#(ir)%#ati"n
In thi! +a!hi"n=
Re#ati'e#0 %n!at%rate #"" +r"m riht'entri)#e i! i'erte int" tr%n$ an #"2er
"0The hea "+ +et%! re)ei'e! the etter@"60enate #"" +r"m the #e+t 'entri)#e
Fr"m a"rta, !"me "+ #"" i! %me int"
the %mi#i)a# arterie! an a)$ t" #a)entaO1 !at%rati"n "+ the #"" in #"2er a"rtaan %mi#i)a# arterie! i! : < 9 !at%rate2ith O1
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Feta# Re!irati"n
Ti!!%e! "+ +eta# an ne2"rn mamma#!ha'e a remar$@a#e %t ""r#0%ner!t"" re!i!tan)e t" h0"6ia
O1 !at%rati"n "+ materna# #"" in#a)enta i! !" #"2 that the +et%! miht!%*er h0"6i) amae i+ +eta# re )e##!i n"t ha'e a reater O1 a7nit0 than
a%#tFeta# re )e##! )"ntain +eta# H -H F/ 2hi#e a%#t re )e##! )"ntain a%#t H-H A/
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C..Feta# Re!irati"n
The +eta# "60hem"#"in i!!")iati"n)%r'e i! !hi+te t" the #e+t at e%a#re!!%re "+ O1, +eta# #"" )arrie!
!ini)ant#0 m"re O1 than "e!materna#
In ear#0 +eta# #i+e, the hih )aria)#0)"en #e'e#! that re'ai# ma0 r"te)tthe heart +r"m a)%te eri"! "+ h0"6ia
The #0)"en #e'e#! e)rea!e in the #ate+eta# #i+e an rea)h a%#t #e'e#! 0 term
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Umi#i)a# ?e!!e#!
Umi#i)a# 'e!!e#! ha'e thi)$ m%!)%#ar 2a##!2ith a m%!)%#ar !hin)ter
Hem"rrhae "+ the ne2"rn i! re'ente 0)"n!tri)ti"n "+ the %mi#i)a# 'e!!e#!, e)a%!e
the0 are 'er0 rea)ti'e t" tra%ma,!0math"mimeti) amine!, ra0$inin,ani"ten!in, an )hane! in 3O1
(#"!%re "+ the %mi#i)a# 'e!!e#! in)rea!e! the
t"ta# erihera# re!i!tan)e an the #""re!!%re
When #"" "2 )ea!e! thr"%h the %mi#i)a#'e!!e#!, the %)t%! 'en"!%! )#"!e! -the e'entthat )#"!e! "+ %)t%! 'en"!%! i! !ti## %n$n"2n/
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(hane! inFeta# (ir)%#ati"n & Re!irati"n at Birth
At irth, #a)enta# )ir)%#ati"n i! )%t"* an erihera# re!i!tan)e!%en#0 ri!e!
3re!!%re in a"rta ri!e! %nti# in%#m"nar0 arter0
Be)a%!e "+ #a)enta# )ir)%#ati"n ha!
een )%t "*, the in+ant e)"me!in)rea!in#0 a!h06ia# an )""#in "+the "0 a)ti'ate! re!irat"r0)enter
Fina##0, in+ant a!! !e'era# time!an the #%n! e6an 'a!)%#arre!i!tan)e e)rea!e t" : J<
Mar$e#0 neati'e intra#e%ra#
re!!%re -@< t" @8< mmH/ %rin
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C..(hane! inFeta# (ir)%#ati"n & Re!irati"n at Birth
The !%)$in a)ti"n "+ the r!t reath #%!)"n!tri)ti"n %mi#i)a# 'ein !%eee!
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C..(hane! inFeta# (ir)%#ati"n & Re!irati"n at Birth
The #e+t atri%m re!!%re i! rai!e I?( anriht atri%m 0=
.The e)rea!e in %#m"nar0 re!i!tan)e #are "2 "+ #"" thr"%h the #%n! t" the
#e+t atri%m1.The re%)ti"n "+ "2 t" the riht atri%m "))#%!i"n "+ the %mi#i)a# 'ein
.The in)rea!e re!i!tan)e t" #e+t 'entri)#e
"%t%t "))#%!i"n "+ the %mi#i)a# arterie!
Ar%t#0 )#"!e! the 'a#'e "'er the +"ramen"'a#e
The !eta# #eaet! +%!e "'er !e'era# a0!
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C..(hane! inFeta# (ir)%#ati"n & Re!irati"n at Birth
The e)rea!e in %#m"nar0 'a!)%#arre!i!tan)e
the re!!%re in the %#m"nar0 arter0 +a## t": P -t" : 8 mmH/
The !#iht in)rea!e in a"rti) re!!%re re'er!e! the #"" "2 thr"%h the %)t%!arteri"!%! -DA/
The #are %)t%! arteri"!%! ein t" )"n!tri)t
Mani+e!te a! a m%rm%r in the ne2"rn,e)a%!e "+ t%r%#ent "2
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C..(hane! inFeta# (ir)%#ati"n & Re!irati"n at Birth
D%)t%! arteri"!%! )"n!tri)t! 2ithin a +e2 h"%r!a+ter irth, r"%)in +%n)ti"na# )#"!%re, anermanent anat"mi) )#"!%re +"##"2! in the ne6t 1Q@Q; h"%r! %e t" e6ten!i'e intima# thi)$enin
Me)hani!m r"%)in the initia# )"n!tri)ti"n i! n"t
)"m#ete#0 %ner!t"", %t the in)rea!e in arteria#O1 ten!i"n #a0! an im"rtant r"#e a! +"##"2!=. The hih O1 ten!i"n "+ the arteria# #"" that a!!e!thr"%h the DA1. The %#m"nar0 'enti#ati"n 2ith O1 that )#"!e! the
DA.?enti#ati"n 2ith air #"2 in O1 "en! thi! !h%nt 'e!!e#
Whether O1 a)t! ire)t#0 "n the DA, "r thr"%h there#ea!e "+ a 'a!")"n!tri)t"r !%!tan)e i! n"t $n"2n
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C..(hane! inFeta# (ir)%#ati"n & Re!irati"n at Birth
Re#ati'e#0 hih )"n)entrati"n! "+'a!"i#at"r! -e!e)ia##0
r"!ta#anin/ are re!ent in the DA
S0nthe!i! "+ the r"!ta#anin i!
+a)i#itate 0 )0)#""60ena!e at irth
In man0 remat%re in+ant! the %)t%!
+ai#! t" )#"!e !"ntane"%!#0, %t
)#"!%re )an e r"%)e 0 in+%!i"n
"+ r%! that inhiit )0)#""60ena!e
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The Wa##! "+ (ari"'a!)%#ar S0!tem
At irth=@ The 2a##! "+ the t2" 'entri)#e! are
ar"6imate#0 "+ the !ame thi)$ne!!, 2ith a
"!!i#0 !#iht re"neran)e "+ the R?
@ The m%!)#e #a0er "+ the 3A i! thi)$, 2hi)h i!art#0 re!"n!i#e +"r the hih %#m"nar0
'a!)%#ar re!i!tan)e "+ the +et%!
A+ter irth=
@ The thi)$ne!! "+ the R? an 3A 2a##!imini!he!
@ The L? 2a##! e)"me thi)$er
The!e )hane! are r"re!!i'e "'er a eri"
"+ 2ee$! a+ter irth
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han$ Y"
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