PERAN PROGESTERON.ppt
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Transcript of PERAN PROGESTERON.ppt
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