Post on 27-Sep-2015
FEMININE REPRODUCTION SYSTEMOleh :
Dr. Ibnu Pranoto, Sp.An, Sp.OG(K)
FeminineReproductive System
Anatomy of Female Reproductive SystemFemale reproductive organsOvariesUterine tubesUterusVaginaExternal genital organsMammary glands
Female Pelvis
Uterus, Vagina, Uterine Tubes, Ovaries and Supporting Ligaments
Ovarian functionOogenesisMaturation of oocyte.Expulsion of the mature oocyte (ovulation).Secretion of the female sex hormone (estrogen and progestogen), as well as the peptide hormone inhibin.
FOLLICLE DEVELOPMENT CHANGES IN OVARY
AGE FOLLICLES20 WEEKS GESTATIONAT BIRTH6.O00.000 7.000.0001.000.000 - 2.000.000PUBERTY300.000 400.000READY TO DEVELOP400 - 50037 YEARS 10.000
Ovary Histology
Maturation of Follicle and Oocyte
Folliculogenesis
Maturation and Fertilization of Oocyte
Ovulation and Follicle FateOvulationFollicle swells and ruptures, secondary oocyte is released from ovarySecond meiotic division completed when secondary oocyte unites with sperm cell to form zygoteFate of the follicleGraafian follicle become corpus luteumIf fertilization occurs, corpus luteum persistsIf no fertilization, becomes corpus albicans
Follicular Selection
Primordial Follicles
Recruitment
Preantral Follicles
Selected dominant follicle
Anthral follicle Maturation ( 2 weeks growth)
Preovulatory (Graafian) follicle
Follicles not selected undergo atresiaContinuous but asynchronous growthof folliclesFSH is responsible for:Recruitment of the pool of the precursor folliclesInitiating selection and maturation of the dominant follicle
Follicle and Oocyte DevelopmentOogenesis is the production of a secondary oocyte in ovariesOogonia are cells from which oocytes developPrimary oocytes are surround by granulosa cells and called a primordial folliclePrimordial follicle becomes a primary follicle when oocyte enlarges and cells changePrimary follicle becomes secondary follicle and enlarges to form mature or graafian follicleUsually only one is ovulated, others degeneratePrimary oocyte completes first meiotic division to produce secondary oocyte and a polar bodySecondary oocyte begins second meiotic division, which stops in metaphase II
Uterine Tubes and UterusUterine or fallopian tubes or oviductsOpen directly into peritoneal cavity to receive oocyte from ovaryTransport oocyte or zygote from ovary to uterusUterusParts: Body, isthmus, cervixComposed of 3 layersPerimetrium: Serous membrane Myometrium: Smooth muscleEndometrium: Mucous membrane
Vagina and PerineumVaginaFemale organ of copulationAllows menstrual flow and childbirthHymen covers the vaginal opening or orificePerineumDivided into two trianglesUrogenital: Contains the external genitaliaAnal triangleClinical perineum Region between vagina and anusEpisiotomy: Incision to prevent tearing during childbirth
Female External GenitaliaVulva or pudendum or external female genitaliaVestibule: SpaceLabia minora: Form borders on sidesClitoris: Erectile structureCorpora cavernosaCorpora spongiosaLabia majoraUnite to form mons pubis
Female Perineum
Mammary GlandsOrgans of milk production located within mammae or breastsConsist of glandular lobes and adipose tissueCoopers ligaments support the breasts
Puberty and Menstrual CyclePubertyBegins with menarche or first episode of menstrual bleedingBegins when GnRH levels increase
Menstrual CycleAbout 28 days longPhasesMensesProliferative phaseSecretory phaseMensesAmenorrhea: Absence of a menstrual cycleMenopause: Cessation of menstrual cycles
Menstrual Cycle
Hormone Regulation during Menstrual Cycle
Female Sexual Behaviorand Sex ActFemale sexual behaviorDepends on hormonesAndrogens and steroidsDepends on psychological factorsFemale sex actParasympathetic stimulationBlood engorgement in clitoris and around vaginal openingErect nipplesMucouslike fluid extruded into vagina and through wallOrgasm not necessary for fertilization to occur
ANATOMI DASAR PANGGULKumpulan jaringan yang menutupi rongga panggul.Terdiri atas :otot,ligamentum, organ visera, fascia yang menahan tekanan intraabdomen-menjaga kontinensia dan faeses-koitus,persalinan,pengeluaran produk ekskresi
TIGA LAPISAN PENUNJANG1. Fascia endopelvis2. M. levator ani3. membran perineum& dd.pelvis/sfingter ani ekterna
M.LEVATOR ANIM.pubokoksigeus/puboviseralM.ileokoksigeus
DIAFRAGMA UROGENITALM.burbokavernosusM.perineus transversalis dalam dan luar.Fungsi: mencegah prolapsus tidak lebih parah (bila fascia endopelvis melemah)
PERINEAL BODYMasa jaringan fibrosa yang tebal, tanpa batas yang jelas diantara vagina dan anus.M.sfingter ani eksternusRobekan pd ruptur perinei totalis
STRES INKONTINENSIA Definisi:keluarnya urin yg tidak dapat dikontrol/dikendalikan secara objektif dapat diperlihatkan dan merupakan masalah sosial atau higienis.Tekanan intravesika>intrauretraFaktor penyokong kontinensia urin:uretra, vu,UVJ, sfingter uretra interna dan eksterna.Paritas,menopause, usia, operasi panggul dan obesitas.Aktifitas tubuh:batuk, bersin,meloncat,naik tangga dll.
MACAM INKONTINENSIA URIN
STRES INKONTINENSIAOVERAKTIVE BLADDER/urgeMIXED INCONTINENCEOVERFLOW INCONTINENCEKELAINAN ANATOMISINKONTINENS. FUNGSIONALINKONTINENSIA TRANSIEN
INKONTINENSIA TRANSIEN(DIAPPERS)DeliriumInfectionAtrophic vaginitisPharmacologicPsychologicalEndocrineRestricted mobilityStool impaction
DIAGNOSISSTRES INKONTINENSIATerdapat sindroma saluran kemih bawah dan rasa maluKarena operasi perbaikan vagina
PEMERIKSAAN TAMBAHANInkontinensia urine & aktifitas seksualUrine sisaTes provokasi :batuk.Pemeriksaan : spekulum,Q test, urodinamik dan tekanan uretra.
PENATALAKSANAANPemberian estrogenPemakaian pesariumOperasi
ANATOMI ALAT GENITALPerubahan anatomi o.k. kehamilan,partus, umur, menopause.Anatomi :kadaver, teranetesi berbeda dng waktu berdiri.
TUJUAN BEDAH REKONTRUKSIUntuk mengembalikan organ abnormal kekeadaan biasa.
ANATOMI PROLAPSUS UTERIDIFINISI TURUNNYA ALAT GENITAL KARENA HILANGNYA PENUNJANG ANATOMI DIAFRAGMA PELVIS/VAGINA
KAUSAUSIA LANJUTDEFISIENSI ESTROGENTRAUMA PERSALINANGENETIKTEKANAN INTRAABDOMINAL
RIWAYATPeningkatan insidensiPeningkatan usia wanita/umur panjangAktivitas seksualRekontruksi vagina, fungsi kandung kemih dan rektum
PROLAPS GENITAL 1. SISTOKEL2. REKTOKEL3. ENTEROKEL4.PROLAPSUS UTERI5. PROLAPSUS VAGINA
Vesikokel/Kistokel
Rektokel
Prolapsus Uteri Total (Procidensia)
Procidensia
KLASIFIKASI PROLAPSUSTINGKAT I : didalam vaginaTINGKAT II : di introitus vagina TINGKAT III : di luar introitus PROSIDENSIA
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