Download - 1. Anatomi Alat Reproduksi & Panggul_WDD
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Anatomi alat reproduksi &panggul
Shofwal WidadBagian Obstetri & Ginekologi FK UGM/RS Dr.SardjitoYogyakarta
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Widad – Obgyn UGM
Organ genitalia eksterna
• Mons pubisMons pubis• Labia mayoraLabia mayora• Labia minoraLabia minora• ClitorisClitoris• VestibulumVestibulum• VaginaVagina• PerineumPerineum
nullipara
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Widad – Obgyn UGM
Organ genitalia eksterna
Struktur di bawah kulit
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Widad – Obgyn UGM
Organ genitalia interna
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Widad – Obgyn UGM
Organ genitalia interna
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Widad – Obgyn UGM
Tuba
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Widad – Obgyn UGM
Tuba
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Widad – Obgyn UGM
Uterus
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Widad – Obgyn UGM
Dinding Uterus
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Widad – Obgyn UGM
Vagina
• Terdiri dari 3 lapisan– Adventitia – jaringan ikat fibrosa– Muscularis – otot polos– Mucosa – ditandai dg lipatan-lipatan transversa
• Tersusun dari lamina propria dan epitel skuamosa stratifikatum
• Hymen – diafragma inkomplit
• Fornix – lipatan di vagina bagian atas
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Widad – Obgyn UGM
Vagina
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Widad – Obgyn UGM
Vagina
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Widad – Obgyn UGM
Anatomi vagina
Te Linde’s Operative Gynecology, Eight Edition
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Widad – Obgyn UGM
Anatomi vagina
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Widad – Obgyn UGM
Vaskularisasi vagina
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Widad – Obgyn UGM
Innervasi vagina
• ¼ vagina bagian bawah dinnervasi oleh serabut syaraf perifer sehingga menjadi sangat sensitif terhadap sentuhan dan suhu
• Vagina bagian atas dinnervasi oleh serabut syaraf otonom sehingga menjadi tidak terlalu sensitif terhadap sentuhan dan suhu
• ¼ vagina bagian bawah dinnervasi oleh serabut syaraf perifer sehingga menjadi sangat sensitif terhadap sentuhan dan suhu
• Vagina bagian atas dinnervasi oleh serabut syaraf otonom sehingga menjadi tidak terlalu sensitif terhadap sentuhan dan suhu
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Widad – Obgyn UGM
Innervasi vagina
The Ciba Collection of Medical Illustrations, Volume 2, Reproductive System
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Widad – Obgyn UGM
Histologi dinding vagina
Epithel squamosaEpithel squamosa
Lamina propria
Longitudinal smooth muscle layer
Circular smooth muscle layer
Fibrous layer
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Widad – Obgyn UGM
Histologi vagina
• Vagina ditutupi oleh lapisan epitel skuamosa stratifikatum yang memiliki kemampuan untuk absorpsi obat
• Jaringan kolagen dan elastin pada lamina propria menyebabkan dinding vagina elastis
• Vaskularisasi banyak absorbsi obat cepat
• Vagina ditutupi oleh lapisan epitel skuamosa stratifikatum yang memiliki kemampuan untuk absorpsi obat
• Jaringan kolagen dan elastin pada lamina propria menyebabkan dinding vagina elastis
• Vaskularisasi banyak absorbsi obat cepat
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Widad – Obgyn UGM
Sel-sel epitel vagina yang mengalami regenerasi terus-menerus
Sel-sel epitel vagina yang mengalami regenerasi terus-menerus
Fisiologi vagina
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Widad – Obgyn UGM
Fisiologi vagina• Aktivitas bakteri lactobacilus vagina
– Lactobacilli bersaing dengan mikroba eksogen dalam mendapatkan nutrisi
– Lactobacilli mempertahankan maintain pH vagina tetap rendah (3,8 - 4,2)
– Lactobacilli menghasilkan asam yang bersifat antimicroba dan bakteriosida
• Imunologi
– Sel-sel Langerhans
– Terutama menghasilkan antibodi IgA yang disekresikan di vagina
• Aktivitas bakteri lactobacilus vagina– Lactobacilli bersaing dengan mikroba eksogen dalam
mendapatkan nutrisi– Lactobacilli mempertahankan maintain pH vagina tetap
rendah (3,8 - 4,2)– Lactobacilli menghasilkan asam yang bersifat antimicroba
dan bakteriosida
• Imunologi
– Sel-sel Langerhans
– Terutama menghasilkan antibodi IgA yang disekresikan di vagina
Valore et al Am J Obstet Gynecol 2002;187:562-8
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Widad – Obgyn UGM
Hymen
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Widad – Obgyn UGM
Vaskularisasi
• A/v ovarica dan a/v uterina saling beranastomosis
• A/v uterina menyilangi ureter pd perbatasan serviks
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Widad – Obgyn UGM
Vaskularisasi
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Widad – Obgyn UGM
Pelvis
• Kurvatura sumbu panggul• Konjugata obstetrica
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Widad – Obgyn UGM
Diameter antero-posterior
PAP• Konjugata vera• Konjugata obstetrica
penting• Konjugata diagonalis
dpt diukur secara klinis
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Widad – Obgyn UGM
Pintu atas & pintu bawah panggul
PAP: • diameter transversa
(13,5 cm) • Konjugata obstetrica
normal >10 cmPTP:
• diameter interspinosum (10 cm)
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Widad – Obgyn UGM
Pintu bawah panggul
• Diameter anteroposterior (11,5 cm)
• Diameter transversa (11 cm)
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Widad – Obgyn UGM
Klasifikiasi bentuk panggul menurut Caldwell-Moloy
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Widad – Obgyn UGM
4 bentuk panggul
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Widad – Obgyn UGM
Pelvis (panggul)
• Panggul normal: panggul yg dapat dilalui oleh kepala janin aterm dg BB 2500-4000 gram
• Bentuk panggul (PAP) Caldwell-Moloy– Ginekoid : oval, T>AP, arcus >90o
– Antropoid : AP>T, arcus <90o
– Android : jantung, AP=T, spina menonjol, arcus <90o
– Platipeloid : AP<T, arcus >90o
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Widad – Obgyn UGM
Kepala janin
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Widad – Obgyn UGM
Pemeriksaan utk menentukan konjugata diagonalis
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Widad – Obgyn UGM
Hubungan konjugata obstetrica & konjugata diagonalis
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Widad – Obgyn UGM
Engaged
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Widad – Obgyn UGM
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Widad – Obgyn UGM
The Uterine Cycle• Series of cyclic phases of the endometrium
• Phases coordinate with the ovarian cycle
• Endometrial phases directed by FSH and LH
• Phases of uterine cycle– Menstrual phase – days 1-5
• Stratum functionalis is shed
– Proliferative phase – days 6-14 – Secretory phase – days 15-28
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Widad – Obgyn UGM
Cycle Overview
hypothalamus
anterior pituitary
FSH LH
FSH LH LH
estrogens
estrogens
FOLLICULAR PHASE LUTEAL PHASE
menstruation
ovulation
GnRH
FSH LH
estrogens
progesterone
• GnRH secretion affects LH and FSH secretion by pituitary
• LH and FSH affect follicle maturation
• Estrogen and progesterone from ovary affect uterus
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Widad – Obgyn UGM
The Menstrual Cycle
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Widad – Obgyn UGM
Stages of early embryonic development
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Widad – Obgyn UGM
Early & late implantation
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Widad – Obgyn UGM
Growth & development of embryo & supporting structures
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Widad – Obgyn UGM
The Placenta