PEMICU 1 BLOK REPRODUKSI

Thedi Darma Wijaya 405090120 Kelompok 5

LO 1 : Anatomi

LO 1: Faal & ggg haid

ABNORMAL MENSTRUATION
Amenorrhea and oligomenorrhea (lack of bleeding or too little bleeding) Dysmenorrhea (painful menstruation) Menorrhagia (excessive bleeding) Oligomenorrhea: menstrual periods at intervals of more than 35 days. Menometrorrhagia: uterine bleeding usually excessive and prolonged occurring at frequent and irregular intervals. Polymenorrhea: frequent but regular episodes of uterine bleeding occurring at intervals of 21 days or less. Metrorrhagia: uterine bleeding occurring at irregular intervals. Hypomenorrhea: uterine bleeding that is regular but decreased in amount. Intermenstrual bleeding: uterine bleeding, usually not excessive, occurring at any time during the menstrual cycle other than during normal menstruation.

Amenorrhea

Definition
primary (ie, never menstruated)
= the absence of menstruation by age 16 years in the presence of normal pubertal development or by age 14 years in the absence of normal pubertal development. Evaluating for breast and uterine development in patients

secondary (ie, menarche, but no periods for 3 consecutive months).

more common than primary amenorrhea. The most common etiology is dysfunction of the hypothalamic-pituitary-ovarian (HPO) axis.

 Amenore yang normal hanya terjadi sebelum masa pubertas, selama kehamilan, selama menyusui dan setelah menopause

Etiologi
Penyebab amenore primer: Kelainan bawaan pada sistem kelamin (misalnya tidak memiliki rahim atau vagina, adanya sekat pada vagina, serviks yang sempit, lubang pada selaput yang menutupi vagina terlalu sempit/himen imperforata) Penurunan berat badan yang drastis Kelainan bawaan pada sistem kelamin Kelainan kromosom (misalnya sindroma Turner atau sindroma Swyer) dimana sel hanya mengandung 1 kromosom X) Obesitas yang ekstrim Hipoglikemia Disgenesis gonad
Hipogonadisme hipogonadotropik Sindroma feminisasi testis Hermafrodit sejati Kekurangan gizi Penyakit Cushing Fibrosis kistik Penyakit jantung bawaan (sianotik) Kraniofaringioma, tumor ovarium, tumor adrenal Hipotiroidisme Sindroma adrenogenital Sindroma Prader-Willi Penyakit ovarium polikista Hiperplasia adrenal kongenital

Etiologi

Penyebab amenore sekunder: Kehamilan Kecemasan akan kehamilan Penurunan berat badan yang drastis Olah raga yang berlebihan Lemak tubuh kurang dari 1517%extreme Mengkonsumsi hormon tambahan Obesitas Stres emosional Kelainan endokrin (misalnya sindroma Cushing yang menghasilkan sejumlah besar hormon kortisol oleh kelenjar adrenal)

Menopause Obat-obatan (misalnya busulfan, klorambusil, siklofosfamid, pil KB, fenotiazid) Prosedur dilatasi dan kuretase Kelainan pada rahim, seperti mola hidatidosa (tumor plasenta) dan sindrom Asherman (pembentukan jaringan parut pada lapisan rahim akibat infeksi atau pembedahan).

Dx
History
Detailed history of pubertal development Family history of menarche, pubertal development History of weight loss, stress, exercise (athletic activity) Detailed dietary history History of contraception, medications History suggestive of CNS disease (eg, headaches, visual changes) History of chronic illnesses (eg, Crohn disease)

Dx
Physical
Height, weight, and growth charts Breast development, pubic hair Syndromic appearance (eg, short stature, webbed neck) Visual fields, thorough neurologic examination, optic fundi Evidence of hyperandrogenism (eg, acne, hirsutism, clitoromegaly) Evidence of thyroid disease Evidence of chronic illnesses Evidence of pregnancy

Dx
Laboratory Studies
Obtain a karyotype if the patient is syndromic or has evidence of ovarian failure. Obtain serum FSH levels. Differentiating central from peripheral causes is important. High levels of FSH indicate ovarian failure or gonadal dysgenesis; low levels indicate hypothalamic or pituitary causes. Obtain a bone age in primary amenorrhea. Obtain a serum prolactin level. Obtain thyroid function tests. Obtain urine beta-human chorionic gonadotropin levels. This is mandatory for secondary amenorrhea. For secondary amenorrhea
consider testing serum LH, serum testosterone, dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, and serum cortisol.

Dx
Imaging Studies
Consider MRI of the head if CNS symptoms or hyperprolactinemia are present. Consider pelvic ultrasonography if absent uterus or structural anomalies are suspected.

Treatment
Treatment depends on etiology. Direct therapy to the underlying cause. If the patient has a completely normal physical examination with secondary amenorrhea, consider administering medroxyprogesterone 10 mg daily for 5-10 days to see if withdrawal bleeding occurs. If this occurs, adequate levels of endogenous estrogen and normal anatomy are indicated.

Dysmenorrhea

Definition
primary or secondary, although primary dysmenorrhea is more prevalent. Secondary dysmenorrhea is rare, and pain is associated with pelvic pathology

Etiology
Caused by : prostaglandins and leukotrienes during ovulatory cycles.
Endometrial prostaglandin levels during the luteal and menstrual phases of the cycle uterine contractions.

Secondary dysmenorrhea
bicornuate uterus Endometriosis pelvic inflammatory disease uterine fibroids.

Symptoms
crampy lower abdominal and pelvic pain that radiates to the thighs and back with or without associated pelvic pathology.

Dx
History & Physical
Evaluation should include a detailed menstrual history and the relationship of the pain to the menstrual cycle. Ask about a family history of endometriosis. Ascertain the degree of incapacitation. If pain is mild and physical examination is normal, a pelvic examination is not indicated. If pain is severe and interferes with daily living, a pelvic examination is warranted. If a patient is sexually active, a pelvic examination is mandatory. Be suspicious of secondary dysmenorrhea if onset of dysmenorrhea occurs at menarche.

Dx
Imaging Studies
Ultrasonography and MRI may be helpful if secondary cause of dysmenorrhea is suspected.

Treatment
Provide symptomatic relief with nonsteroidal anti-inflammatory drugs (eg, naproxen, ibuprofen) at the first sign of cramps. If nonsteroidal anti-inflammatory therapy fails, consider oral contraceptive pills for 3-6 months. If this fails as well, look for secondary causes of dysmenorrhea. Short-term use of selective estrogen receptor modulators (SERMs), such as tamoxifen, in selected refractory cases has produced good results.

Menorrhagia

Definition
Menstrual bleeding that lasts more than 8-10 days with blood loss of over 80 mL is considered excessive.

Etiology
Anovulatory dysfunctional uterine bleeding (DUB) Immature HPO axis, adolescent DUB Hyperandrogenic chronic anovulation (eg, polycystic ovarian syndrome, adrenal hyperplasia) Pregnancy-related complications Sexually transmitted diseases Chronic illnesses Blood dyscrasia Trauma Drugs Endocrine disorders Neoplasms

Dx
History
Date of menarche Menstrual calendar (invaluable) Sexual activity Use of hormones, such as oral contraceptive pills or depo-medroxyprogesterone acetate, and use of other medications such as warfarin, aspirin Chronic illnesses Bleeding disorders, including family and personal history CNS symptoms

Dx
Physical
Growth percentiles Palpation of thyroid Breast examination for galactorrhea Evidence of bleeding elsewhere Pelvic examination, if sexually active

Dx
Laboratory
Test for gonorrhea and chlamydia if patient is sexually active. Obtain a urine pregnancy test. Obtain a CBC count with reticulocyte count. Obtain coagulation studies. Obtain a blood type and cross-match in very severe cases. Also consider testing for thyroid-stimulating hormone (TSH) level, FSH level, serum prolactin, and serum androgens if clinical evidence of hyperandrogenism is present.

 Imaging Studies
Consider pelvic ultrasonography if a mass or structural anomaly is suspected.

Treatment
Treatment of the underlying cause is necessary. For patients with mild DUB,
provide reassurance and observation. Instruct the patient to keep a menstrual calendar. Consider iron supplementation and antiprostaglandin medications during bleeding episodes.

For patients with moderate DUB

prescribe combination oral contraceptive pills beginning with 4 monophasic 35-microgram pills a day and tapering down. Oral contraceptive pills are usually continued for 6 months. Medroxyprogesterone alone may also be used. Also administer oral iron and folic acid supplements.

If DUB is severe
consider an undiagnosed underlying disorder, such as von Willebrand disease or factor VII deficiency. consider hospitalization and coagulation studies. Administer intravenous Premarin every 4 hours until the bleeding stops, up to 4 doses. Simultaneously administer a monophasic 35-microgram oral contraceptive pill every 6 hours for 24-48 hours and then twice daily to complete a 28-day course. If Premarin does not stop the bleeding after 4 doses, consider pelvic pathology. Examination under anesthesia and dilatation and curettage may be necessary.

LO 2 : Perubahan Anatomi & Fisiologi

Perubahan anatomi
Uterus
Bentuk sprt telur Ukuran 30x25x20 cm Berat 30g 1000g Isthmus lunak tanda Hegar Isthmus menjadi bagian dari corpus uteri

Vulva & vagina

Warna livide tanda Chadwik

Serviks Uteri melunak tanda Goodbell Ovarium corpus luteum gravidiatis Mammae
Estrogen proliferasi duktus Progesteron proliferasi alveolus Glandula Montgomery tampak jelas Putting & areola hiperpigmentasi

Kulit chloasma gravidarum

Linea alba linea grisea

Perubahan faal
Sistem sirkulasi
vol darah 25 % CO 30 % Hidremia, hemodilusi Lekosit & trombosit

Sistem respirasi
Sesak, kebutuhan O2 20%

Sistem GIT
Nausea, emesis Motilitas obstipasi Salivasi

Sistem urinarius
GF 69%, poliuria

BMR 15-20 % BB 6,5-16,5 kg

LO 3 : Dx Kehamilan

Berdasar tanda & gejala

Amenore Nausea & emesis Mengidam Pingsan Mammae membesar Kulit kloasma Anoreksia Poliuria Obstipasi varises

Tanda2 pd kehamilan
Tanda Hegar Tanda chadwick Tanda piscaseck Tanda Braxton hicks Suhu basal 37,2-37,8 C HcG +

Dx pasti
Bila:
Teraba Ada gerakan2 janin Terdengar DJJ Dapat dirasakan gerakan janin dan balotemen Dengan USG terlihat fetoskopi

DD
Pseudiesis Kistoma ovari Mioma uteri VU dgn retensi menopause

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