10/03/2011

BAHAN KULIAH 4
BIPER S2 UPI

SIKLUS MENSTRUASI

10/03/2011

(3) OVARIAN CYCLE

Inhibited by combination
(1) CONTROL BY HYPOTHALAMUS
of estrogen and
progesterone
Stimulated by high
levels of estrogen

Hypothalamus
Releasing
hormone
Anterior pituitary
FSH

Growing
follicle

Mature
follicle

Ovulation

Post-ovulatory phase

Pre-ovulatory phase

LH

Progesterone
and estrogen

Estrogen

(2) PITUITARY HORMONES

IN BLOOD

LH peak triggers
ovulation and
corpus luteum
formation

LH

(4) OVARIAN HORMONES

IN BLOOD

Estrogen
Progesterone

FSH
FSH

Corpus Degenerating
luteum
corpus
luteum

Progesterone
and estrogen

Estrogen

LH

(5) MENSTRUAL CYCLE

Endometrium

Menstruation

Days

ABORSI

10/03/2011

10/03/2011

10/03/2011

Medical Abortion
Mifepristone (RU486)
analogue of progestin norethindrone
strong affinity for the progesterone receptor,
acting as an antagonist
a single oral dose given to women 5 weeks or
less produces abortion in 85% of cases

Medical Abortion - politics

RU486 - Mifepristone
developed in 1980s
approved for use by French government 1988
one day later manufacturer withdrew it from the market
succumbing to international boycott
French government ordered redistribution

Prohibited in US during Reagan and Bush

Ban lifted by Clinton, clinical trials, preliminary FDA
approval 9/96
Final approval stalled secondary to inability to
manufacture and distribute until 9/2000

10/03/2011

Medical Abortion - politics

RU486 - Mifepristone
developed in 1980s
approved for use by French government 1988
one day later manufacturer withdrew it from the market
succumbing to international boycott
French government ordered redistribution

Prohibited in US during Reagan and Bush

Ban lifted by Clinton, clinical trials, preliminary FDA
approval 9/96
Final approval stalled secondary to inability to
manufacture and distribute until 9/2000

Surgical vs. Medical: pro vs. con

Provider perspective:
Less skill needed to
provide
Methotrexate also
treats ectopic
pregnancy

Increased anxiety re:

off site management
More unscheduled
care: calls, ER visits
Need to guard against
unnecessary
intervention
Limited to 49 days
LMP

10/03/2011

Complications - rates
Varies as a function of the gestational age
they are performed
Major complications:
0.25% < 7 weeks
1% < 12 weeks
2% over 12 weeks

Complications - immediate

Complications of local anesthetic

Cervical shock
Cervical lacerations
Uterine perforation
Hemorrhage
Post abortal syndrome

10/03/2011

Complications - delayed
Bleeding
retained products

Infection
Continued pregnancy
ectopic
intrauterine

SIKLUS MENSTRUASI

10/03/2011

TWIN PREGNANCY
Multiple pregnancy rates vary world
wide
Instance of monozygotic twin is
relatively constant
Dizygotic twinning rates vary by age,
parity, ethnic group and assisted
reproduction

10/03/2011

Monozgotic Twins
TIMING OF CLEAVAGE
1-3 days
Dichorionic
4-8 days
Monochorionic/diamniotic
8-10 days
Monchorionic/ Monoamniotic
13-16 days
Conjoined

10

10/03/2011

MATERNAL RISKS WITH

TWINS
Increased minor complaints of
pregnancy
Increased risk of miscarriage
Increased anaemia, pre-term delivery
Hypertension
Antepartum Haemorrhage

11

10/03/2011

MATERNAL RISKS WITH

TWINS (contd.)

Hydramnios
Need for hospitalisation
Single fetal death in twins
Operative Delivery
Caesarean Section
Postpartum Haemorrhage

12

10/03/2011

13

10/03/2011

14

10/03/2011

15