V.

Oviducts
1. ~ 12 cm long 2. fimbriae

Setelah mengikuti kuliah faham 1/2

Faham

hormon2: FSH, LH, E2, Testosteron human Chorionic Gonadotropin (hCG) pregnancy hormon juga Tumor marker Prinsip TK Sampel: urin atau darah Cara pemeriksaan TK Ketelitian/accuracy TK Waktu periksa TK Arti TK negatif Arti TK positif TK positif palsu TK negatif palsu

Setelah mengikuti kuliah faham 2/2

Hypothalamic-pituitary-ovarian

axis Perubahan hormon pada waktu subur (ovulasi) Kehamilan ektopik Mola Menopos: FSH,LH,E2 Cardiovascular Lipid Changes Osteoporosis

Hypothalamic-pituitary-ovarian axis
GnRH (+)

Pituitary

Hypothalamus

LH FSH

Inhibins

Ovary

Estradiol Progesterone

Reproductive aging
1-2

million follicles at birth, only approximately 1,000 by menopause follicular loss due to atresia, not ovulation accelerates at around age 37

Most

Atresia

Age-related

uterine changes also contribute to decreased fertility

Ovarian function in perimenopause

Ovaries

begin decreasing in size Estradiol still dominant estrogen Number of follicles decreases substantially Production of inhibin decreases Remaining follicles respond poorly to elevated FSH and LH Erratic ovulation results in menstrual cycle irregularity
7

Decline in fertility
Fertility

wanes starting at about age 37, before perimenopause signs occur age 45, risk of spontaneous miscarriage increases to 50% techniques
available

By

Fertility-enhancing Natural

pregnancy still possible until menopause is reached

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HORMONAL REGULATION SYSTEM

HYPOTHALAMUS:-

GONADOTROPIN RELEASING HORMONE [GnRH]. PITUITARY:-LUTEINIZING HORMONE [LH] FOLLICLE STIMULATING HORMONE [FSH]

FEMALE REPRODUCTIVE SYSTEM

PRIMARY

FUNCTIONS OF THE FEMALE REPRODUCTIVE SYSTEM ARE:[1] PRODUCTION OF FEMALE HORMONES. [2] FORMATION OF THE OVUM. [3] DEVELOPMENT OF THE OFFSPRINGS.

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FEMALE REPRODUCTIVE SYSTEM

THE ORGANS AND THEIR FUNCTIONS: OVARIES:- PRODUCE HORMONES & OVA. UTERINE TUBES:- TRANSPORT THE OVA. UTERUS:- OFFSPRING DEVELOPMENT. CERVIX:- PROTECTION OF UTERUS. VAGINA:- BIRTH CANAL & THE FEMALE ORGAN OF COPULATION. EXTERNAL GENITALIA:- CLITORIS, LABIA MAJORA AND LABIA MINORA.
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Female Reproductive Hormons 1/2

Follicle-Stimulating

Hormone

(FSH) , serum GnRH frm hypothalamus ctrl secretion gonadotropin FSH, LH frm anterior pituitaryevaluationmenstrual irregularities Postmenopausal: 30-120 IU/L Luteinizing Hormone (LH), serum Menstrual cycle: midcycle surge LH & FSH follicular luteal phase. Basal FSH & LH Ovulation , Best indicator is 50% over mean basal plasma LH

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The female reproductive Cycle What happens to the hormones

13

The Menstrual Cycle

14

Hormones of Plasenta

The placenta forms large quantities of human chorionic gonadotropin, estrogen, progesterone and human chorionic somatomammotropin, which are all essential to a normal pregnancy

15

HCG is a glycoprotein with a molecular weight of 39,000. It is secreted by the syncytial trophoblast cells and can be measured in the blood 8 to 9 days after ovulation. The rate of secretion rises rapidly to reach maximum bout 10 to 12 weeks after ovulation and decreases to much lower value by 16 to 20 weeks after ovulation. It continues at this level for the remainder of pregnancy.

Diagnosis of the early pregnancy

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Home Pregnancy Test Kits

Measure

Urinary human Chorionic gonadotropin (hCG) levels. Can detect urinary hCG as low as 25IU Maximum Sensitivity: 1 to 4 days post MMP Reason for use Detects pregnancy at very early stage Earlier prenatal care

17

Home Pregnancy Test Kits

18

Home Pregnancy Test Kits

Sample window

1st hCG specific antibodies

2nd hCG-specific antibodies Antibody against Antibody to hCG

19

Patient Consultation

1st AM voiding; > conc. of HCG 2) Run test immediately, or store sample in refrig. use within 24 hrs; allow to come to room temp. Follow timing and sequence of steps. If negative, repeat in 7 days. See MD regardless of result If negative - may require amenorrhea workup If positive - will need prenatal care follow-up.
1)
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Interpretation
Negative Result HCG is not present at detectable concentrations Positive Result Pregnancy False Positives Drugs: Antiparkinsonian, anticonvulsants, phenothiazines. Medical Conditions: Tumors, pregnancy > 10 wk, Recent completed pregnancy or miscarriage. False Negatives Testing too early, Urine not at room temp.

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Accuracy

97% sensitivity In 100 pregnant women 97 will be positive 3 false-negative. 95% specificity In 100 non-pregnant women 95 will be negative 5 false-positives. Accuracy similar to laboratory tests. User and technique dependent.

22

HCG: Can be detected in pregnancy one day after implantation, 8 days after ovulation and 9 days after LH surge . Concentration rises exponentially until 9 to 10 weeks of gestation with a doubling time of 1.3 to 2 days. Reaches its peak of around 105 IU/ml after 60 to 90 days of gestation. It decreases from this peak level to a plateau value of 10,000 to 20,000 IU/ml, which is maintained for the remainder of the pregnancy. HCG level comes to nonpregnant level of less then 5mU/ml, 21 to 24 days after delivery.

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HCG: The

HCG doubling time can differentiate between viable intrauterine pregnancy from ectopic pregnancy. A 66% rise in the HCG level over 48 hours represents the lower limit of normal value of viable intrauterine pregnancy but in 15% of cases of viable intrauterine pregnancy, rise of HCG may be less than 66% in 48 hours in 15% cases of ectopic pregnancy rise of HCGmay be more then 66% in 48 hours It is also produced by some ovarian epithelial tumours
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HCG: - in Hydatidform Mole

Hydatidform

mole is very much suggestive if:urine in dilution of 1 in 200 to 1 in 500 is positive for HCG beyond 100 days of gestation. If HCG in urine in 24 hours is around 0.3 to 3 million IU during similar period of amenorrhoea. Molar pregnancy patients are more prone to develop Choriocrcinoma: If excreting HCG > 100,000 IU/ in urine in 24 hours If serum level of HCG is > 40,000 mIU/ml.

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Predicting Ovulation
Pattern

of Menstrual Cycle with Calendar Cervical Mucous BBT (Basal Body Temperature) LH Surge

26

Detecting Ovulation
Measures Urinary LH

Best indicator is 50% over mean basal plasma LH in urine follows. Ovulation usually within 12-24 hours. (Basal body temp change follows ovulation)

27

How the Test Works

LH

increases sharply prior to Ovulation LH Surge Causes ovarian follicle rupture and release of mature egg within in 1 to 2 days. Occurs 8 to 12 hrs later in urine ~6 consecutive days of testing will detect LH Surge in about 66% of ovulating women ~10 consecutive days of testing increase probability to 95%. Intensity of color on test strip is proportional to LH in Urine
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Ovulation Prediction Kits

29

 is

the permanent cessation of menstruation resulting from loss of ovarian follicular activity. It can only be determined after 12 months' spontaneous amenorrhoea. Mean age is 51 years. menopause: E2 FSH LH ,

30

The stages of menopause

There are three stages of menopause that take place

over about a decade

Peri-menopause Menopause Post-menopause
31

 is

the period of time in which the ovaries are beginning to fail, where endocrine, biological, and clinical changes are seen. It ends with the final menstrual period. Length of the transition is approximately 4 years

32

is the time period over which the ovaries are failing (when symptoms begin) up until the cessation of menstruation, and ends 12 months after the final menstrual period.

33

is the time after the menopause, that is, after the permanent cessation of menstruation. It can only be determined after 12 months of spontaneous amenorrhoea.

In practice this definition is difficult to apply, especially in women who have started hormone replacement therapy (HRT) in the perimenopause. It

has been estimated that by the age of 54 years, 80% of women are postmenopausal
[McKinlay et al, 1992; DTB, 1996].

34

occurs after bilateral oophorectomy with

or without hysterectomy.
Premature menopause may also be radiation- or chemotherapy-induced, or occur after hysterectomy with ovarian conservation.

35

Osteoporosis

Bone demineralization is a natural consequence of aging. Diminishing bone density occurs in both men and women. However, the onset of bone demineralization occurs 15 to 20 years earlier in women than in men by virtue of acceleration after ovarian function ceases. Bone demineralization not only occurs with natural menopause but also has been reported in association with decreased estrogen production in certain groups of young women. Tes laboratorium deteksi osteoporosis.

36

Cardiovascular Lipid Changes

With

approaching ovarian failure, changes occur in the cardiovascular lipid profile. Total cholesterol increases, high-density lipoprotein (HDL) cholesterol decreases and low-density lipoprotein (LDL) cholesterol increases. Tes Lipid Profile

37

Kepustakaan

Buku wajib McPhersonRA.,PincusMR.,Editors.HenrysClinicalDiagnosisandManagement by Laboratory Methods 21st edition, ISBN-13:978-1-4260-0287-1Saunders Elsevier 2007 Kepustakaan lain yang dianjurkan: Gaw A, Clinical Biochemistry, ISBN 0-443-04481-3 Churchill Living Stone New York 1995, 92-93 Churchill Living Stone New York ISBN 0-443-04481-3 Abraham P. editor, Physiology, ISBN-13: 978-1-905704-64-4, Amber Books London 2007 66-73 Federman DD., The Biology pf Human Sex Differences. N Engl J Med 2006; 354:1507-14 Interpretive Handbook. Mayo Medical Laboratories. Minnesota 2005

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Mata Kuliah Ilmu Patologi Klink Blok . Topik: Tes kehamilan, Menopos Pengampu: dr. Sanarko Lukman Halim SpPk Waktu: 1 X 100 Sasaran Belajar: setelah mengikuti kuliah ini diharapakan mahasiswa mampu: a) Memahami siklus reproduksi wanita b) Memahami tes kehamilan c) Memahami menopos RINGKASAN Pemeriksaan laboratorium sistem reproduksi wanita untuk deteksi fase menstruasi, ovulasi dan menopos. SELF ASSESSMENTJelaskan cara evaluasi menopos pada wanita usia sekitar 44 tahun dengan haid tidak teratur Buku wajib: Webster RA., in Henrys Clinical Diagnosis and Management by Laboratory Methods, 21st edition, ISBN-13:978-1-4260-0287-1, ISBN-13:978-1-4260-0287-1, ,Saunders Elsevier 2007: Kepustakaan lain yang dianjurkan: 1. Abraham P. editor, Physiology, ISBN-13: 978-1-905704-64-4, Amber Books London 2007 2. Gaw A, Clinical Biochemistry, ISBN 0-443-04481-3 Churchill Living Stone New York 1995, 3 Federman DD., The Biology pf Human Sex Differences. N Engl J Med 2006; 354:1507-14 4 Interpretive Handbook. Mayo Medical Laboratories. Minnesota 2005

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