PERAN PROGESTERONE PERAN PROGESTERONE PADA AWAL KEHAMILANPADA AWAL KEHAMILAN

DANDANABORTUSABORTUS

SAMSULHADISEKSI FERTILITAS & ENDOKRINOLOGI REPRODUKSI

LAB. SMF OBSTETRI & GINEKOLOGIFAK. KEDOKTERAN UNIV. AIRLANGGA

SURABAYA

DFL

ABORTUS

A.S.B*P00030

HAMIL< 7 MG

HAMIL>7 – 12 MGPASCA LUTEOPLAC. SHIFT

ABORTUS

40%

LUTE- ECTOMY

RU- 486( ANTI- PROGESTERONE)

* ASB = ABORTUS SPONTAN BERULANG* ASB = ABORTUS SPONTAN BERULANGGIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P251- 2691996. P251- 269

TERUTAMA OLEH

A.KORPUS LUTEUM- HAID- HAMIL

B. PLASENTA

FSH1.Proliferasi sel granulosa

2.Aromatisasi andr estrogn

3. + estrogen me reseptr FSH di sel granulosa

LH Prog

FSH & LH

1. OMI

2. Prostaglandin

3. Progestrn : a. enz Proteolitik = Plasminogen Plasmin

b. FSH

OVARIUMOVARIUM

KORPUS LUTEUM - P - SIKLUS HAIDKORPUS LUTEUM - P - SIKLUS HAID

FASE FOLIKULER - SEMPURNAFASE FOLIKULER - SEMPURNA

FSH & EFSH & E2 2 ADEKWATADEKWAT

R/ FSH & LH CUKUPR/ FSH & LH CUKUP

FASE – LUTEAL/ KORPUS LUTEUMFASE – LUTEAL/ KORPUS LUTEUM

TUMBUH & BERFUNGSI BAIKTUMBUH & BERFUNGSI BAIK

•UMUR : 2 MINGGUUMUR : 2 MINGGU•PROD. P CUKUPPROD. P CUKUP

•FREQ. LH FREQ. LH

•E & PGFE & PGF22αα (LOKAL)(LOKAL)

MENGAPA UMURMENGAPA UMURKORPUS LUTEUMKORPUS LUTEUM

HAID HANYA 2HAID HANYA 2MINGGU ?MINGGU ?

??

KORPUS LUTEUM – HAMIL BERUMURKORPUS LUTEUM – HAMIL BERUMURLEBIH PANJANG ?LEBIH PANJANG ?

ADA SIGNAL UTERO EMBRYONICADA SIGNAL UTERO EMBRYONIC( hCG )( hCG )

2 4 6 8 10 12 14 16 18 20 4 6 8 10 12 142 4 6 8 10 12 14 16 18 20 4 6 8 10 12 14

DAYSDAYS WEEKSWEEKS

IMPLANTATIONIMPLANTATIONOV.OV.SPEROFF (1999). CLINICAL GYNECOLOGIC ENDOCRINOLOGY & INFERTILITYSPEROFF (1999). CLINICAL GYNECOLOGIC ENDOCRINOLOGY & INFERTILITYLIPPINCOTT WILLIAMS & WILKINS BALTIMORE 1999. P 201 - 246LIPPINCOTT WILLIAMS & WILKINS BALTIMORE 1999. P 201 - 246

LHLH

FSHFSH

hCGhCG

PROGESTERONPROGESTERON

•STEROIDOGENESIS E&P TERJADI KARENASTEROIDOGENESIS E&P TERJADI KARENA RANGSANGAN LH/ hCGRANGSANGAN LH/ hCG•KEPEKAAN TERTINGGI PADA MID LUTEALKEPEKAAN TERTINGGI PADA MID LUTEAL KMD MENURUNKMD MENURUN

• K. LUTEUM HAIDK. LUTEUM HAID BERUMUR 2 MINGGU (?) BERUMUR 2 MINGGU (?)

• K. LUTEUM HAMILK. LUTEUM HAMIL BERTAHAN: BERTAHAN:

KARENA hCG MENINGKAT DG U. K KARENA hCG MENINGKAT DG U. K

STOUFER (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,STOUFER (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P251- 2691996. P251- 269

GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P251- 2691996. P251- 269

SAMPAI KAPAN SAMPAI KAPAN KORPUS LUTEUMKORPUS LUTEUM

HAMIL BERTAHANHAMIL BERTAHAN

KORPUS LUTEUMKORPUS LUTEUMHAMILHAMIL

PLASENTAPLASENTA7 – 12 MG7 – 12 MG

KONTRIBUSI P KORPUS LUTEUM HAMILKONTRIBUSI P KORPUS LUTEUM HAMIL

UMUR KEHAMILANUMUR KEHAMILAN( MINGGU)( MINGGU)

P KORPUSP KORPUSLUTEUMLUTEUM

(%)(%)

66

1010

1515

7575

50501515

LUTEO – PLACENTAL SHIFTLUTEO – PLACENTAL SHIFT

GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P251- 2691996. P251- 269

A.A.DEFISIENSI PDEFISIENSI P

B.B.KELAINAN FASE FOLIKULERKELAINAN FASE FOLIKULER

( S.O.P.K – LH -KWAL. OOSIT )( S.O.P.K – LH -KWAL. OOSIT )

•KADAR hCG SERIALKADAR hCG SERIAL•TVSTVS

HARGA P “N” & DEFISIENSIHARGA P “N” & DEFISIENSITUMPANG TINDIHTUMPANG TINDIH

DX. DEFISIENSI P & HAMIL MUDADX. DEFISIENSI P & HAMIL MUDA

SULITSULIT

BERSAMABERSAMA

GIBSON ( 1996 )GIBSON ( 1996 )

DEFISIENSI P TERJADI SAAT DEFISIENSI P TERJADI SAAT

I.I. SEGERA SSD IMPLANTASI ( DFL )SEGERA SSD IMPLANTASI ( DFL )

II.II. U.K < 7 – 8 MINGGU U.K < 7 – 8 MINGGU ( TERGANTUNG PD K. LUTEUM)( TERGANTUNG PD K. LUTEUM)

III.III. PASCA LUTEO – PLACENTAL SHIFTPASCA LUTEO – PLACENTAL SHIFT

GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P251- 2691996. P251- 269

GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P251- 2691996. P251- 269

MODEL IMODEL I DEFEK DASE LUTEALDEFEK DASE LUTEAL( DFL )( DFL )

•DPT KARENA GGAN PD F. FOLIKULERDPT KARENA GGAN PD F. FOLIKULER (FOL. TIDAK SEMPURNA)(FOL. TIDAK SEMPURNA)•KLINIS : - FASE SEKRESI KLINIS : - FASE SEKRESI ≥ 2 HARI≥ 2 HARI

( SIKLUS PENDEK ? )( SIKLUS PENDEK ? ) - ABORTUS- ABORTUS

•DX : - BBTDX : - BBT- BIOPSI ENDOMETRIUM- BIOPSI ENDOMETRIUM- KADAR P - KADAR P

•TX: - SUPPORT FASE LUTEALTX: - SUPPORT FASE LUTEAL ( TX SAAT FASE LUTEAL )( TX SAAT FASE LUTEAL )

- MEMPERBAIKI FASE FOLIKULER- MEMPERBAIKI FASE FOLIKULER

DARI BBRP SIKLUS HAIDDARI BBRP SIKLUS HAIDNON FERTIL SEBELUM TERJADINYANON FERTIL SEBELUM TERJADINYA

KEHAMILANKEHAMILAN

SIEBEL (1997) INFERTILITY A COMPREHENSIVE TEXT. ED IISIEBEL (1997) INFERTILITY A COMPREHENSIVE TEXT. ED IIEDED. . APPLETON & LANGE CONNECTICUT ( 1997). P 3 - 27APPLETON & LANGE CONNECTICUT ( 1997). P 3 - 27

DDFFLL

HAHAIDID

OOVV

6-76-7HARIHARI

IMPIMP

TXTX- PP- hCGhCG

77HARIHARI

HAHAIDID

--

MONITORINGMONITORING

- hCG- hCG- TVS- TVS

H + H + TX TERUS TX TERUS

H - H - TX STOP TX STOP

FSHFSHCCCC

FF

MODEL IIMODEL II DEF. P PD. UK. < 7 – 8 MINGGUDEF. P PD. UK. < 7 – 8 MINGGU

DXDX

•RIWAYAT RIWAYAT ASBASB PD UK < 7 – 8 MINGGU PD UK < 7 – 8 MINGGU

•KADAR P < 7 KADAR P < 7 ηηg/ mlg/ ml

MODEL IIIMODEL III DEF. P - PASCA LUTEO – DEF. P - PASCA LUTEO – PLACENTAL SHIFTPLACENTAL SHIFT

PROGESTERON TETAP BERPERANPROGESTERON TETAP BERPERANPD UK. LEBIH LANJUTPD UK. LEBIH LANJUT

•GANGGUAN PADA KORPUS LUTEUM &GANGGUAN PADA KORPUS LUTEUM & PLASENTA ( ABETALIPOPROTEINEMIA)PLASENTA ( ABETALIPOPROTEINEMIA)

• HAMIL + R.U 486HAMIL + R.U 486 ABORTUSABORTUS

DEF. PDEF. P TX. PTX. P MONITORINGMONITORING

OBTAIN hCG, PROGESTERONE LEVELOBTAIN hCG, PROGESTERONE LEVELRRXX PROGESTERONE SUPPOSITORIES, 50 MG TID PROGESTERONE SUPPOSITORIES, 50 MG TID

OBTAIN OBTAIN REPEAT REPEAT

hCGhCG

hCG ABNORM.hCG ABNORM.PROGEST. LOWPROGEST. LOW

INTRINSICALLY ABN.INTRINSICALLY ABN.PREGNANCY:PREGNANCY:DISCONTINUE TX.DISCONTINUE TX.

hCG NORMALhCG NORMALPROGEST. LOWPROGEST. LOW

PROGEST. DEF.PROGEST. DEF.POTENTIALLY NORM.POTENTIALLY NORM.PREGNANCY: CONTIN.PREGNANCY: CONTIN.TX., CONFRIM NORMALCYTX., CONFRIM NORMALCYWITH REPEAT hCG, USGWITH REPEAT hCG, USG

hCG NORMALhCG NORMALPROGEST. NORMAL:PROGEST. NORMAL:

PROGEST. NORMALPROGEST. NORMALIN POTENTIALLYIN POTENTIALLYNORMAL PREGANCY,NORMAL PREGANCY,DISCONTINUE TXDISCONTINUE TX

GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,GIBSON (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P251- 2691996. P251- 269

TX P PADA KEHAMILANTX P PADA KEHAMILAN

AWAS: MACAM PAWAS: MACAM P

BAHAYA : LUTEOLYTICBAHAYA : LUTEOLYTIC

A.A. - DESIDUALISASI ENDOMET. ( F. LUTEAL)- DESIDUALISASI ENDOMET. ( F. LUTEAL)

- RANGSANG KELENJAR TUBA & ENDOMET. - RANGSANG KELENJAR TUBA & ENDOMET. SEKRESI SEKRESI

NUTRISI UNTUK ZYGOTENUTRISI UNTUK ZYGOTE

B.B. - HAMBAT PENOLAKAN IMMUNOLOGIK THD BUAH- HAMBAT PENOLAKAN IMMUNOLOGIK THD BUAH

KEHAMILAN ( HAMBAT RESPON T – LYMPHOCYTE)KEHAMILAN ( HAMBAT RESPON T – LYMPHOCYTE)

C. UTERUS “ TENANG” & CX “ UNRIPE”C. UTERUS “ TENANG” & CX “ UNRIPE”

D. ALVEOLI BUAH DADA TUMBUHD. ALVEOLI BUAH DADA TUMBUH

E. 5 E. 5 αα- PREGNANE-3, 20 DIONE ( METABOLITE P )- PREGNANE-3, 20 DIONE ( METABOLITE P )

EFEK ANGIOTENSIN II EFEK ANGIOTENSIN II

F. 21- HIDROXYLASI DARI P MEMBANTU GINJALF. 21- HIDROXYLASI DARI P MEMBANTU GINJAL D.O.C SAAT ATERMD.O.C SAAT ATERM

WILSON LIARD, JR (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,WILSON LIARD, JR (1996) IN. ADASHI ELI Y. REPRODUCTIVE ENDOCRINOLOGY,SURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIASURGERY AND TECHNOLOGY. LIPPINCOTT - RAVEN. PHILADELPHIA1996. P. 451 – 475 1996. P. 451 – 475