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By :

Hafiz Syaifullah Siregar


090100126

Uterus is functional syntitium and consist of


smooth muscle single unit-type
This type had self-excitable and gradation on
contraction

Hormonal
Progesterone -> relaxation
Estrogen -> moderate contraction
Oxytocin -> powerful contraction

Non-hormonal
Prostaglandin -> menstrual cramps

Tension of the smooth muscle


Biochemical
Calsium

99% of calsium is stored at form of crystal on


bone and teeth
0,9% in soft tissue and only 0,1% in
extracellular
Half of calsium on extracellular binds to
protein plasma, and another half can diffuse
to plasma-intersitium freely (active form)

Parathyroid hormon
Vitamin D
calsitonin

Na+
cell

enter

Membran
depolarization

Ca2+ + calmodulin
binding to MLCK
(myosin light
chain kinase)

Inhibition of MLCP
(myosin light chain
phosphatase)

Voltage gated
L-type Ca2+
channel open

Ca2+ intercell
binding to
calmodulin

Phosphorila
tion of MLC

Influx Ca2+ to
intracellular

Stimulate Ca2+ from


sarcoplasma in the cell

Myosin on thick
filament binding to
actin,
need ATP to
contraction

When atony is due to drugs that have


impaired calcium entry into the cell
(magnesium sulfate, nifedipine) calcium
gluconate should be considered as an
adjuvant therapy.
Give one ampule ( 1 gr) intravenous can
effectively improve uterine tone and resolve
bleeding due to atony