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10/03/2011

BAHAN KULIAH 4
BIPER S2 UPI

SIKLUS MENSTRUASI

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(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

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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 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

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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

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Complications - delayed
Bleeding
retained products

Infection
Continued pregnancy
ectopic
intrauterine

SIKLUS MENSTRUASI

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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

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

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MATERNAL RISKS WITH


TWINS
Increased minor complaints of
pregnancy
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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