KULIAH 4_Siklus Menstruasi

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    (1) CONTROL BY HYPOTHALAMUS Inhibited by combinationof estrogen andprogesteroneStimulated by highlevels of estrogen

    Hypothalamus

    Releasinghormone

    Anterior pituitary

    FSH LH

    (2) PITUITARY HORMONESIN BLOOD LH peak triggers

    ovulation andcorpus luteumformation

    LH

    FSH

    FSH LH

    (3) OVARIAN CYCLE

    Growingfollicle

    Maturefollicle

    OvulationCorpusluteum

    Degeneratingcorpusluteum

    Pre-ovulatory phase Post-ovulatory phase

    Estrogen Progesteroneand estrogen

    (4) OVARIAN HORMONESIN BLOOD

    EstrogenProgesterone

    Estrogen Progesteroneand estrogen

    (5) MENSTRUAL CYCLE

    Endometrium

    Menstruation Days

    ABORSI

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    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 1980’s – approved for use by French government 1988

    • one day later manufacturer withdrew it from the marketsuccumbing 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

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    Medical Abortion - politics

    • RU486 - Mifepristone – developed in 1980’s – approved for use by French government 1988

    • one day later manufacturer withdrew it from the marketsuccumbing to international boycott

    • French government ordered redistribution – Prohibited in US during Reagan and Bush –

    Ban lifted by Clinton, clinical trials, preliminary FDAapproval 9/96 – Final approval stalled secondary to inability to

    manufacture and distribute until 9/2000

    Surgical vs. Medical: pro vs. conProvider perspective:

    • Less skill needed toprovide

    • Methotrexate alsotreats ectopicpregnancy

    • Increased anxiety re:off site management

    • More unscheduledcare: calls, ER visits

    • Need to guard againstunnecessaryintervention

    • Limited to 49 daysLMP

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    Complications - rates

    • Varies as a function of the gestational agethey 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

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    MATERNAL RISKS WITHTWINS

    • Increased minor complaints ofpregnancy

    Increased risk of miscarriage• Increased anaemia, pre-term delivery• Hypertension• Antepartum Haemorrhage

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    MATERNAL RISKS WITH

    TWINS (contd.)• Hydramnios• Need for hospitalisation• Single fetal death in twins• Operative Delivery• Caesarean Section• Postpartum Haemorrhage

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