kuliah pk2 teskehamilanjuli2010

7/29/2019 Kuliah PK2 TESKehamilanJULI2010

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V.Oviducts

1. ~ 12 cm long

2. fimbriae


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Setelah mengikuti kuliah faham 1/2

Faham hormon2: FSH, LH, E2,Testosteron

human Chorionic Gonadotropin

(hCG)pregnancy hormonjugaTumor

marker

Prinsip TKSampel: urin atau darahCara pemeriksaan TK

Ketelitian/accuracyTKWaktu periksa TKArti TK negatif

Arti TK positifTK positif palsuTK negatif palsu


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Hypothalamic-pituitary-ovarian axis

Pituitary HypothalamusGnRH (+)

Estradiol

Progesterone

LH FSH Inhibins

Ovary


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Reproductive aging 1-2 million follicles at birth, only

approximately 1,000 bymenopause

Most follicular loss due to

atresia, not ovulation

Atresia accelerates at around age37

Age-related uterine changes alsocontribute to decreased fertility


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Ovarian functionin perimenopause

Ovaries begin decreasing in sizeEstradiol still dominant estrogenNumber of follicles decreases

substantiallyProduction of inhibin decreasesRemaining follicles respond poorly

to elevated FSH and LHErratic ovulation results in

menstrual cycle irregularity


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Decline in fertility

Fertility wanes starting at about

age 37, before perimenopausesigns occur

By age 45, risk of spontaneousmiscarriage increases to 50%

Fertility-enhancing techniquesavailable

Natural pregnancy still possibleuntil menopause is reached


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FEMALE REPRODUCTIVE SYSTEM

PRIMARY FUNCTIONS OF THE

FEMALE REPRODUCTIVESYSTEM ARE:-

[1] PRODUCTION OF FEMALE

HORMONES.[2] FORMATION OF THE OVUM.

[3] DEVELOPMENT OF THE

OFFSPRINGS.


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FEMALE REPRODUCTIVE

SYSTEMTHE ORGANS AND THEIR FUNCTIONS:-OVARIES:- PRODUCE HORMONES &

OVA.UTERINE TUBES:- TRANSPORT THE

OVA.

UTERUS:- OFFSPRINGDEVELOPMENT.

CERVIX:- PROTECTION OF UTERUS.

VAGINA:- BIRTH CANAL & THEFEMALE ORGAN OF COPULATION.

EXTERNAL GENITALIA:- CLITORIS,

LABIA MAJORA AND LABIA MINORA.


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Female Reproductive Hormons 1/2

Follicle-Stimulating Hormone(FSH) , serumGnRH frm hypothalamus ctrl

secretion gonadotropin FSH, LH frmanteriorpituitary evaluation menstrual irregularitiesPostmenopausal: 30-120 IU/L

Luteinizing Hormone(LH), serum

Menstrual cycle: midcycle surgeLH & FSH follicular lutealphase.Basal FSH & LHOvulation , Best indicator is 50% over mean basal plasma LH


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The female reproductive CycleWhat happens to the hormones


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The Menstrual Cycle


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Hormones of Plasenta

The placenta forms large quantities

ofhuman chorionic

gonadotropin, estrogen,

progesterone and human

chorionic somatomammotropin,which are all essential to a normal

pregnancy


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HCG is a glycoprotein with a molecularweight of 39,000. It is secreted by the

syncytial trophoblast cells and can be

measured in the blood 8 to 9 days after

ovulation. The rate of secretion rises

rapidly to reach maximum bout 10 to12 weeks after ovulation and decreases

to much lower value by 16 to 20 weeks

after ovulation.

It continues at this level for the

remainder of pregnancy.Diagnosis of the early pregnancy


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Home Pregnancy Test Kits

Measure Urinary humanChorionic gonadotropin

(hCG) levels.Can detect urinary hCG as

low as 25IUMaximum Sensitivity: 1 to4 days post MMP

Reason for use

Detects pregnancy at very

early stageEarlier prenatal care


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1st hCG specific

antibodies

2nd hCG-specific

antibodies

Sample windowAntibody against

Antibody to hCG



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Patient Consultation

1) 1st AM voiding; > conc. of HCG2) Run test immediately, or store sample in

refrig.

use within 24 hrs;

allow to come to room temp.

Follow timing and sequence of steps. If negative, repeat in 7 days.

See MD regardless of result

If negative - may require amenorrhea

workup

If positive - will need prenatal carefollow-up.


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Interpretation

Negative ResultHCG is not present at detectable

concentrations

Positive ResultPregnancy

False Positives

Drugs: Antiparkinsonian,anticonvulsants, phenothiazines.

Medical Conditions: Tumors,pregnancy > 10 wk, Recent completedpregnancy or miscarriage.

False Negatives

Testing too early, Urine not at roomtemp.


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Accuracy

97% sensitivityIn 100 pregnant women

97 will be positive

3 false-negative. 95% specificity

In 100 non-pregnant women

95 will be negative5 false-positives.

Accuracy similar to laboratory tests.

User and technique dependent.


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HCG: - Can be detected in pregnancy one day after

implantation, 8 days after ovulation and 9days after LH surge .

Concentration rises exponentially until 9 to

10 weeks of gestation with a doubling timeof 1.3 to 2 days.

Reaches its peak of around 105 IU/ml after

60 to 90 days of gestation. It decreases from this peak level to a

plateau value of 10,000 to 20,000 IU/ml,

which is maintained for the remainder ofthe pregnancy.

HCG level comes to nonpregnant level ofless then 5mU/ml, 21 to 24 days after

delivery.


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HCG: - The HCG doubling time can

differentiate between viableintrauterine pregnancy from ectopicpregnancy.

A 66% rise in the HCG level over 48hours represents the lower limit ofnormal value of viable intrauterine

pregnancy butin 15% of cases of viable

intrauterine pregnancy, rise of HCGmay be less than 66% in 48 hours

in 15% cases of ectopic pregnancyrise of HCGmay be more then 66%in 48 hours

It is also produced by some ovarianepithelial tumours


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HCG: - in Hydatidform Mole

Hydatidform mole is very muchsuggestive if:-

urine in dilution of 1 in 200 to 1 in

500 is positive for HCG beyond 100daysof gestation.

If HCG in urine in 24 hours isaround 0.3 to 3 million IU duringsimilar period of amenorrhoea.

Molar pregnancy patients are moreprone to develop Choriocrcinoma: -

If excreting HCG > 100,000 IU/ inurine in 24 hours

If serum level of HCG is > 40,000mIU/ml.


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Predicting Ovulation

Pattern of Menstrual Cycle withCalendar

Cervical MucousBBT (Basal Body Temperature)

LH Surge


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Detecting Ovulation

Measures Urinary LH

Best indicator is 50% over mean basal

plasma LH in urine follows.Ovulation usually

within 12-24 hours. (Basal body temp

change follows

ovulation)


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How the Test Works

LH increases sharply prior to

OvulationLH Surge

Causes ovarian follicle ruptureand release of mature eggwithin in 1 to 2 days.

Occurs 8 to 12 hrs later in urine~6 consecutive days of testingwill detect LH Surge in about

66% of ovulating women~10 consecutive days of testingincrease probability to 95%.

Intensity of color on test strip isproportional to LH in Urine


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Ovulation Prediction Kits


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is the permanent cessation of

menstruation resulting from lossof ovarian follicular activity.

It can only be determined after 12

months' spontaneousamenorrhoea.

Mean age is 51 years.

menopause: E2 FSH LH ,


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The stages of menopause

Peri-menopause

Menopause

Post-menopause

There are three stages of

menopause that take placeover about a decade


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is the period oftime in which the

ovaries are beginning to fail,where endocrine, biological, andclinical changes are seen. It

ends with the final menstrualperiod.

Length of the transition is

approximately 4 years


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is the time period over which theovaries are failing (whensymptoms begin) up until the

cessation of menstruation, andends 12 months after the

final menstrual period.


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occurs after bilateral oophorectomy withor without hysterectomy.

Premature menopause may also beradiation- or chemotherapy-induced, oroccur after hysterectomy with ovarianconservation.

O i


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Osteoporosis

Bone demineralization is a naturalconsequence of aging. Diminishing bonedensity occurs in both men and women.

However, the onset of bone demineralizationoccurs 15 to 20 years earlier in women than inmen by virtue of acceleration after ovarianfunction ceases. Bone demineralization not

only occurs with natural menopause butalso has been reported in association withdecreased estrogen production in certain

groups of young women.Tes laboratorium deteksi osteoporosis.


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Cardiovascular Lipid Changes

With approaching ovarian failure,changes occur in the cardiovascular

lipid profile. Total cholesterolincreases, high-density lipoprotein(HDL) cholesterol decreases and

low-density lipoprotein (LDL)cholesterol increases.Tes Lipid Profile


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Kepustakaan

Buku wajib

McPherson RA., Pincus MR., Editors. Henrys Clinical Diagnosis and Management by LaboratoryMethods 21st edition, ISBN-13:978-1-4260-0287-1Saunders Elsevier 2007

Kepustakaan lain yang dianjurkan: Gaw A, Clinical Biochemistry, ISBN 0-443-04481-3 Churchill Living Stone New

York 1995, 92-93

Churchill Living Stone New YorkISBN 0-443-04481-3

Abraham P. editor, Physiology, ISBN-13: 978-1-905704-64-4, Amber BooksLondon 2007 66-73

Federman DD., The Biology pf Human Sex Differences. N Engl J Med 2006;354:1507-14

Interpretive Handbook. Mayo Medical Laboratories. Minnesota 2005

Mata Kuliah Ilmu Patologi Klink Blok .


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Mata KuliahIlmu Patologi Klink Blok .Topik: Tes kehamilan, MenoposPengampu: dr. Sanarko Lukman Halim SpPkWaktu: 1 X 100

Sasaran Belajar: setelah mengikuti kuliah ini diharapakanmahasiswa mampu:

a)Memahami siklus reproduksi wanitab) Memahami tes kehamilanc) Memahami menopos

RINGKASAN Pemeriksaan laboratorium sistem reproduksi wanita untuk deteksi

fase menstruasi, ovulasi dan menopos.SELF ASSESSMENTJelaskan cara evaluasi menopos pada wanitausia sekitar 44 tahun dengan haid tidak teratur

Buku wajib:

Webster RA., in Henrys Clinical Diagnosis and Management by LaboratoryMethods,

21st edition, ISBN-13:978-1-4260-0287-1, ISBN-13:978-1-4260-0287-1,,Saunders Elsevier 2007:

Kepustakaan lain yang dianjurkan:

1. Abraham P. editor, Physiology, ISBN-13: 978-1-905704-64-4, AmberBooks London 20072. Gaw A, Clinical Biochemistry, ISBN 0-443-04481-3 Churchill Living Stone

New York 1995,3 Federman DD., The Biology pf Human Sex Differences. N Engl J Med2006; 354:1507-14

4 Interpretive Handbook. Mayo Medical Laboratories. Minnesota 2005

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