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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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Home Pregnancy Test Kits
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1st hCG specific
antibodies
2nd hCG-specific
antibodies
Sample windowAntibody against
Antibody to hCG
Home Pregnancy Test Kits
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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