INTRODUCTION
The medical curriculum has become increasingly vertically integrated, with a much greater use of clinical examples and cases to help in the understanding of the relevance of the underlying basic science, and conversely use of basic science concepts to help in the understanding of the phatophysiology and treatment of disease. The reproductive system and disorder block has been written to take account of this trend, and to integrate core aspects of basic science, pathophysiology and treatment into a single, easy to use revision aid.
In accordance the lectures that have been full integrated for studens in 6 Th
semester, period of 2015, one of there is The Reproductive System and Disorders Block. There are many topics will be discuss as below:
Anatomy of male &female, histology of male and female, physiology of male and female, antenatal care and normal labor, abnormal labor, obstetric emergency, puerperium and disorders, benign and malignant diseases of the breast, common gynecologic and disorders, male and female sexual dysfunction, male and female infertility, male and female family planning, drugs therapy in pregnant and genital disorders.
Beside those topics, also describes the learning outcome, learning objective, learning task, self assessment and references. The learning process will be carried out for 4 weeks (20 days).
Due to this theme has been prepared for the second time, so many locking mill is available on it. Perhaps it will better in the future
CURRICULUM CONTENTS
Aims: Comprehend the biologic function of reproductive system in male and female.
Comprehend the pathological process of the reproductive disorders in male and female.
Diagnose and manage patient with male genital disorders.
Diagnose and manage patient with gynecologic and obstetric problem.
Educate patient and their family and community about reproductive disorders.
Learning outcome:
Explain (differentiate) the functional structure of male and female reproductive system.
Explain pathological process related to symptom and sign of male disorders.
Explain pathological process related to symptom and sign of gynecologic and obstetric disorders.
Interpret the common laboratory and imaging result in male genital disorders.
Interpret the common laboratory and imaging result in gynecologic and obstetric problems.
Diagnose and manage patient with male genital disorders. Diagnose and manage patient with normal pregnant
Diagnose and manage patient with infertility and family planning
Diagnose and manage patient with gynecologic and obstetric problems
Communicate the education principle in male genital problems, gynecologic and obstetric problems.
Curriculum contents:
Anatomy of male and female reproductive system Histology of male and female reproductive system Physiology of male and female reproductive system Male and female family planning
Normal labor and ANC Abnormal labor
Obstetric emergency
Common gynecologic and disorders/ morphology
Benign and malignant diseases of the breast/ morphology Puerperium and disorders
Male and female sexual dysfunction Male and female infertility
Pharmacology
PLANNERS TEAM
NO
NAME
DEPARTEMENT
1. dr. A. A.A.N. Susraini, Sp.PA Anatomy Pathology 2. dr. I.G.A Sri Darmayani, SpOG Medical Education (DME) 3. Prof.Dr.dr. Wimpie Pangkahila, Sp.And. FAAC Andrology
4. dr. Wayan Sudarsa, Sp.B - K.Onk Oncology Surgery 5. dr. Wayan Sugiritama. M.Kes Histology 6. dr. I Gusti Ayu Widianti, M.Biomed Anatomy 7. Dr. dr. Susi Purnawati.M.KK Physiology
LECTURERS
NO
NAME
DEPARTEMENT
PHONE
1. dr. A.A.A.N. Susraini, Sp.PA(K) Anatomy Pathology
0811398913
2. dr. I.G.A Sri Darmayani, SpOG DME 081338644411 3. dr. I Gusti Ayu Widianti, M.Biomed Anatomy 08123921765 4. Dr. dr. Susi Purnawati.M.KK Physiology 08123989891 5. dr. I Wayan Artana Putra,Sp.OG (K) Obgyn 08123927235 6. dr.I.G.P Mayun Mayura, Sp.OG Obgyn 08123800923 7. dr. Tjok GA Suwardewa,Sp.OG(K) Obgyn 0811387482 8. dr. I Gede Ngurah Harry Wijaya
Surya,Sp.OG
Obgyn 0811386935
9. dr.Anom Suardika,Sp.OG(K) Obgyn 08123809218
10. dr. I.B Putra Adnyana,Sp.OG(K) Obgyn 0811387564 11. Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS Andrology andsexology 0811395694 12. dr. I Made Oka Negara, S.ked Andrology and
sexology
08123979397
FACILITATORS
Regular Class (Class A)No Name Group Departement Phone Venue
(2nd floor)
1 dr. I G A Sri Darmayani,
Sp.OG A1 DME 081338644411
2nd floor
R.2.09 2 Dr.dr. Susy Purnawati, MKK A2 Fisiology 08123989891 2R.2.11nd floor
3 dr. Putu Anda Tusta Adiputra
, Sp.B(K)Onk A3 Surgery 08123826430
2nd floor
R.2.12 4 Dr.dr. Ni Made Linawati,M.Si A4 Histology 081337222567 2nd floor
R.2.13
5
dr. I Gusti Lanang Ngurah Agung Artha Wiguna, Sp.OT (K)
A5 Orthopaedi 0811388859 2nd floor R.2.14
6 dr. I Made Pande Dwipayana,
Sp.PD A6 Interna 08123657130
2nd floor
R.2.15 7 dr. I Made Dwijaputra
Ayustha, Sp.Rad A7 Radiology 08123670196
2nd floor
R.2.16 8 dr. I Putu Kurniyanta, Sp.An A8 Anasthesi 081805755222 2R.2.20nd floor
9 dr. I Nyoman Gede Wardana, M Biomed A9 Anatomy 087860405625 2R.2.21nd floor
10 dr. I Made Krisna Dinata,
S.Ked A10 Fisiology 08174742566
2nd floor
R.2.22
English Class (Class B)
No Name Group Departement Phone (2Venue nd floor)
1 dr. I Made Susila Utama, Sp.PD-KPTI B1 Interna 08123815025 2R.2.09nd floor
2 dr. I Made Suka Adnyana, Sp.BP B2 Surgery 081236288975 2R.2.11nd floor
3 dr. I Made Sudipta,
Sp.THT-KL B3 ENT 08123937063
2nd floor
R.2.12 4 dr. I Nyoman Arcana, Sp.Biok B4 Biochemistry 0811397960 2R.2.13nd floor
5 dr. I Putu Eka Widyadharma, M.Sc,SpS B5 Neurology 081328049360 2R.2.14nd floor
6 dr. I Made Oka Negara,
S.Ked B6 Andrology 08123979397
2nd floor
R.2.15 7 dr. I Made Muliarta, M.Kes B7 Fisiology 081338505350 2R.2.16nd floor
8 dr. I G Kamasan Nyoman Arijana, M.Si.Med B8 Histology 085339644145 2R.2.20nd floor 9 dr. I Nyoman Gede Budiana, B9 Obgyn 08123997401 2nd floor
Sp.OG (K) R.2.21 10 dr. I Made Bagiada, Sp.PD B10 Interna 08123607874 2R.2.22 nd floor
TIME TABLE
English Class (B)
DAY
DATE
TIME
LEARNING
ACTIVITY
VENUE
CONVEYER
1. Fri 12 June
2015
08.00-08.10 Introduction to the Block The Reproductive System and Disorders
4.02 dr.A.A.A.N.Susraini.Sp.PA(K)
08.10-09.00 Lecture 1.
Anatomy of female genital system
4.02 dr. IGA Widianti. M.Biomed
09.00-10.30 Individual Learning
10.30-12.00 SGD 1 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr. IGA Widianti. M.Biomed 2.
Mon 15 June
2015
08.00-09.00 Lecture 2.
Histology of male and female genital system
4.02 dr. I.W. Sugiritama, MKes
09.00-10.30 Individual Learning
10.30-12.00 SGD 2 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr. I.W. Sugiritama, MKes 3.
Tue 16 June
2015
08.00-09.00 Lecture 3.
Physiology of male genital system
4.02 dr Luh Putu Ratna Sundari, MBiomed
09.00-10.30 Individual Learning
10.30-12.00 SGD 3 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr Luh Putu Ratna Sundari, MBiomed
4. Wed 17 June
2015
08.00-09.00 Lecture 4.
Physiology of female genital system
4.02 Dr. dr. Susi Purnawati.M.KK
09.00-10.30 Individual Learning
10.30-12.00 SGD 4 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
DAY
DATE
TIME
LEARNING
ACTIVITY
VENUE
CONVEYER
5. Thu 18 June
2015
08.00-09.00 Lecture 5.
Antenatal Care and Normal labor
4.02 dr. I Wayan Artana Putra,SpOG(K)
09.00-10.30 Individual Learning
10.30-12.00 SGD 5 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr. I Wayan Artana Putra,SpOG(K) 6.
Fri 19 June
2015
08.00-09.00 Lecture 6. Abnormal labor
4.02 dr. Tjok GA
Suwardewa,SpOG(K) 09.00-10.30 Individual Learning
10.30-12.00 SGD 6 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr. Tjok GA
Suwardewa,SpOG(K) 7.
Mon 22 June
2015
08.00-09.00 Lecture 7.
Obstetric emergency
4.02 dr. Harry Wijaya Surya, SpOG
09.00-10.30 Individual Learning
10.30-12.00 SGD 7 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr. Harry Wijaya Surya, SpOG
8 Tue 23 June
2015
08.00-09.00 Lecture 8
Puerperium and disorders
4.02 Dr Made Bagus Dwi Aryana, SpOG (K)
09.00-10.30 Individual Learning
10.30-12.00 SGD 8 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 Dr Made Bagus Dwi Aryana, SpOG (K)
DAY
DATE
TIME
LEARNING
ACTIVITY
VENUE
CONVEYER
9 Wed 24 June 201508.00-09.00 Lecture 9
Benign and malignant diseases of the breast
4.02 dr. Wayan Sudarsa,SpB K.Onk
dr. AAAN Susraini,SpPA
09.00-10.30 Individual Learning
10.30-12.00 SGD 9 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr. Wayan Sudarsa,SpB K.Onk
dr. AAAN Susraini,SpPA 10
Thu 25 June
2015
08.00-09.00 Lecture 10
Common gynecologic and disorders
4.02 dr.IGP Mayun Mayura,SpOG
dr. AAAN Susraini,SpPA(K)
09.00-10.30 Individual Learning
10.30-12.00 SGD 10 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr.IGP Mayun Mayura,SpOG
dr. AAAN Susraini,SpPA(K) 11 Fri 26 June 2015 08.00- selesai
Basic clinical skill (1) Practical Session (Anatomy, Histology)
Anatomi Histologi
dr. IGA Widianti. M.Biomed dr. I.W. Sugiritama, MKes
12. Mon 29 June
2015
08.00-09.00 Lecture 11 Male and female sexual dysfunction
4.02 Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
09.00-10.30 Individual Learning
10.30-12.00 SGD 11 Disc room Fasilitator 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS 13.
Tue 30 June
2015
08.00-09.00 Lecture 12. Male infertility I
4.02 Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS 09.00-10.30 Individual Learning
10.30-12.00 SGD 12 Disc room Fasilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 Prof.Dr.dr.Wimpie
DAY
DATE
TIME
LEARNING ACTIVITY
VENUE
CONVEYER
14 Wed 1 Jul 2015
08.00-09.00 Lecture 13. Male Infertility II
4.02 dr. G Wirya Kusuma Duarsa,M.Kes,SpU
09.00-10.30 Individual Learning
10.30-12.00 SGD 13 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr. G Wirya Kusuma Duarsa,M.Kes,SpU
15 Thu 2 Jul 2015
08.00-15.00 Basic clinical skill (2) (Leopold, normal labor, puerperium)
4.02
Clinical skill lab
dr. Harry Wijaya Surya, SpOG dr I.G.A Sri Darmayani SpOG
16 Fri 3 Jul 2015
08.00-09.00 Lecture 14.
Female Infertility 4.02 dr.I.B Putra Adnyana,SpOG(K) 09.00-10.30 Individual Learning
10.30-12.00 SGD 14 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 dr.I.B Putra
Adnyana,SpOG(K)
17 Mon 6 Jul 2015
08.00-09.00 Lecture 15
Drugs Therapy In Pregnant and genital disorders
4.02 DR.dr. Bgs Km Satriyasa,M.Repro
09.00-10.30 Individual Learning
10.30-12.00 SGD 15 Disc room Facilitators 12.00-12.30 Break
12.30-14.00 Student Project
14.00-15.00 Plenary 4.02 DR.dr. Bgs Km
Satriyasa,M.Repro
18. Tue 7 Jul 2015
08.00-15.00 Basic clinical skill (3) Pap smear, IVA, swab
4.02
Clinical skill lab
dr. AAAN
Susraini,SpPA(K)
19. Wed 8 Jul 2015
08.00-15.00 Basic clinical skill (4) Breast examination, male genital examination, sperm analysis
4.02
Clinical skill lab
Dr Putu Anda Tusta Adiputra, SpB Dr I Made Oka Negara, S.ked
20. Thu 9 Jul 2015
08.00-15.00 Basic clinical skill (5) Male & female family planning
4.02
Clinical skill lab
dr. G Wirya Kusuma Duarsa,M.Kes,SpU dr. Anom
Suardika,SpOG (K)
21. Fri 10 Jul
2015
Silent day
22. Mon 13 Jul
2015
Regular Class (A)
DAY
DATE
TIME
LEARNING ACTIVITY
VENUE
CONVEYER
1. Fri 12 June
2015
09.00-09.10 Introduction to the Block The Reproductive System and Disorders
4.02 dr.A.A.A.N.Susraini.Sp.PA(K)
09.10-10.00 Lecture 1.
Anatomy of female genital system
4.02 dr. IGA Widianti. M.Biomed
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD Disc room Facilitators
15.00-16.00 Plenary 4.02 dr. IGA Widianti. M.Biomed 2.
Mon 15 June
2015
09.00-10.00 Lecture 2.
Histology of male and female genital system
4.02 dr. I.W. Sugiritama, MKes
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 2 Disc room Facilitators
15.00-16.00 Plenary 4.02 dr. I.W. Sugiritama, MKes 3.
Tue 16 June
2015
09.00-10.00 Lecture 3.
Physiology of male genital system
4.02 dr. Luh Putu Ratna Sundari, MBiomed
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 3 Disc room Facilitators
15.00-16.00 Plenary 4.02 dr. Luh Putu Ratna Sundari, MBiomed
4. Wed 17 June
2015
09.00-10.00 Lecture 4.
Physiology of female genital system
4.02 Dr. dr. Susi Purnawati.M.KK
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 4 Disc room Facilitators
15.00-16.00 Plenary 4.02 Dr. dr. Susi Purnawati.M.KK
DAY
DATE
TIME
LEARNING
ACTIVITY
VENUE
CONVEYER
5. Thu 18 June
2015
09.00-10.00 Lecture 5.
Antenatal Care and Normal labor
4.02 dr. I Wayan Artana Putra,SpOG(K)
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 5 Disc room Facilitators
15.00-16.00 Plenary 4.02 dr. I Wayan Artana Putra,SpOG(K) 6.
Fri 19 June
2015
09.00-10.00 Lecture 6. Abnormal labor
4.02 dr. Tjok GA
Suwardewa,SpOG(K) 10.00-11.30 Individual Learning
11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 6 Disc room Facilitators 15.00-16.00 Plenary 4.02 dr. Tjok GA
Suwardewa,SpOG(K) 7.
Mon 22 June
2015
09.00-10.00 Lecture 7.
Obstetric emergency
4.02 dr. Harry Wijaya Surya, SpOG
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 7 Disc room Facilitators
15.00-16.00 Plenary 4.02 dr. Harry Wijaya Surya, SpOG
8 Tue 23 June
2015
09.00-10.00 Lecture 8
Puerperium and disorders
4.02 Dr Made Bagus Dwi Aryana, SpOG (K)
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 8 Disc room Facilitators
DAY
DATE
TIME
LEARNING
ACTIVITY
VENUE
CONVEYER
9 Wed 24 June 201509.00-10.00 Lecture 9
Benign and malignant diseases of the breast
4.02 dr. Wayan Sudarsa,SpB K.Onk
dr. AAAN Susraini,SpPA
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 9 Disc room Facilitators
15.00-16.00 Plenary 4.02 dr. Wayan Sudarsa,SpB K.Onk
dr. AAAN Susraini,SpPA 10
Thu 25 June
2015
09.00-10.00 Lecture 10
Common gynecologic and disorders
4.02 dr.IGP Mayun Mayura,SpOG
dr. AAAN Susraini,SpPA(K)
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 10 Disc room Facilitators 15.00-16.00 Plenary 4.02 dr.IGP Mayun
Mayura,SpOG
dr. AAAN Susraini,SpPA(K) 11. Fri 26 June 2015 08.00-selesai
Basic clinical skill (1) Practical Session (Anatomy, Histology)
Anatomi Histologi
dr. IGA Widianti. M.Biomed dr. I.W. Sugiritama, MKes
12. Mon 29 June
2015
09.00-10.00 Lecture 11 Male and female sexual dysfunction
4.02 Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 11 Disc room Facilitators
15.00-16.00 Plenary 4.02 Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS 13.
Tue 30 June
2015
09.00-10.00 Lecture 12. Male infertility I
4.02 Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS 10.00-11.30 Individual Learning
11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 12 Disc room Facilitators
15.00-16.00 Plenary 4.02 Prof.Dr.dr.Wimpie
Pangkahila,Sp.And,FAACS
DAY
DATE
TIME
LEARNING ACTIVITY
VENUE
CONVEYER
14 Wed 1 Jul 2015
09.00-10.00 Lecture 13. Male Infertility II
4.02 dr. G Wirya Kusuma Duarsa,M.Kes,SpU
10.00-11.30 Individual Learning 11.30-12.00 Student Project
12.00-13.30 Break
13.30-15.00 SGD 13 Disc room Facilitators
15.00-16.00 Plenary 4.02 dr. G Wirya Kusuma Duarsa,M.Kes,SpU
15 Thu 2 Jul 2015
09.00-16.00 Basic clinical skill (2) Leopold, normal labor, puerperium
4.02
Clinical skill lab
dr. Harry Wijaya Surya, SpOG dr I.G.A Sri Darmayani SpOG
16 Fri 3 Jul 2015
09.00-10.00 Lecture 14. Female Infertility
4.02 dr.I.B Putra Adnyana,SpOG(K)
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 14 Disc room Facilitators
15.00-16.00 Plenary 4.02 dr.I.B Putra
Adnyana,SpOG(K)
17 Mon 6 Jul 2015
09.00-10.00 Lecture 15
Drugs Therapy In Pregnant and genital disorders
4.02 DR.dr. Bgs Km Satriyasa,M.Repro
10.00-11.30 Individual Learning 11.30-12.00 Student Project 12.00-13.30 Break
13.30-15.00 SGD 15 Disc room Facilitators
15.00-16.00 Plenary 4.02 DR.dr. Bgs Km
Satriyasa,M.Repro
18. Tue 7 Jul 2015
09.00-16.00 Basic clinical skill (3) Pap smear, IVA, swab
4.02
Clinical skill lab
dr. AAAN Susraini,SpPA(K) 19. Wed 8 Jul 2015
09.00-16.00 Basic clinical skill (4) Breast examination, male genital examination, sperm analysis
4.02
Clinical skill lab
20. Thu 9 Jul 2015
09.00-16.00 Basic clinical skill (5) Male & female family planning
4.02
Clinical skill lab
dr. G Wirya Kusuma Duarsa,M.Kes,SpU dr. Anom
Suardika,SpOG (K)
21. Fri 10 Jul
2015
Silent day
22. Mon 13 Jul
2015
Examination
BASIC CLINICAL SKILL
Jadwal Praktikum dan BCS Block Reproductive System
DayDate
Learning Activity
Group Time Venue Conveyer
Fri 26 June 2015
Praktikum
anatomi A1-A5 08.00 – 09.30 AnatomiLab.
dr. Widianti M.Biomed
A6-A10 09.30 – 11.00 B1-B5 11.00 – 13.30 B6-B10 13.30 – 14.00
Praktikum
Histologi A1-A5 09.30 – 11.00 HistologiLab. dr.Sugiritama, MKes A6-A10 11.00 – 13.30
B1-B5 13.30 – 14.00 B6-B10 08.00 – 09.30
Thu 2 Jul 2015 Pemeriksaaan Leopold, normal labor, puerperium
Kelas A 08.00 – 09.00
09.00 – 10.00 RuangKuliah 4.02
dr. Harry, SpOG dr. Sri, SpOG
Kelas B
10.00 – 11.00 11.00 – 12.00
dr. Harry, SpOG dr. Sri, SpOG
Kelas A 11.00 – 13.30
Skill lab Fasilitator Kelas B 13.30 – 15.00
Fasilitator Tue
7 Jul 2015
Pap smear, IVA,
swab Kelas A 08.00 – 09.30 RuangKuliah 4.02
dr. Susraini,SpPA(K)
Kelas B 09.30 – 11.00
dr. Susraini,SpPA(K)
Kelas A 11.00 – 13.30 Skill lab Fasilitator
Kelas B 13.30 – 15.00 Fasilitator
Wed 8 Jul 2015 Breast examination, male genital examination, sperm analysis
Kelas B 08.00 – 09.00 09.00 – 10.00
Ruang Kuliah 4.02
Skill lab
dr Anda Tusta, SpB dr Oka Negara
Kelas A 10.00 – 11.0011.00 – 12.00 dr Anda Tusta, SpBdr Oka Negara
Kelas B 11.00 – 13.30 Fasilitator
Kelas A 13.30 – 15.00 Fasilitator
Thu 9 Jul 2015
Male & female
family planning Kelas B 08.00 – 09.00 09.00 – 10.00
Ruang Kuliah 4.02
Skill lab
dr. Anom,SpOG (K) dr. G Wirya Kusuma Duarsa,M.Kes,SpU
Kelas A 10.00 – 11.0011.00 – 12.00 dr. G Wirya Kusuma Duarsa,M.Kes,SpU dr. Anom,SpOG (K)
Kelas B 11.00 – 13.30 Fasilitator
MEETING
Meeting of the student representatives
The meetings between block planers and student group representatives will be held 30 of June 2015, at 10.00 until 11.00 at class room. In this meeting, all of the student group representatives are expected to give suggestions and inputs or complaints the team planners for improvement. For this purpose, every student group should choose one student as their representative to attend the meeting.
Meeting of the facilitators
The meeting between block planners and facilitators will take place on 30 of June 2015, at 11.00 until 12.00 at class room. In this meeting all the facilitators are expected to give suggestions and inputs as evaluation to improve the study guide and the educational process. Because of the importance of this meeting, all facilitators are expected to attend the meeting.
ASSESSMENT METHOD
Assessment will be carried out on Monday 13th of July 2015. There will be 100 questions consisting of Multiple Choice Questions (MCQ). The minimal passing score for the assessment is 70. Other than the examinations score, your performance and attitude during group discussions will be consider in the calculation of your average final score. Final score will be sum up of student performance in small group discussion, student project and score in final assessment. Clinical skill will be assessed in form of Objective structured clinical examination (OSCE) at the end of semester as part of Basic Clinical Skill Block’s examination.
STUDENT PROJECT
Students have to write a paperwork with topic given by the lecturer. The topic will be chosen randomly on the first day. Each small group discussion must work on one paperwork with different tittle. The paperwork will be written based on the direction of respective lecturer. The paperwork is assigned as student project and will be presented in class. The paper and the presentation will be evaluated by respective facilitator and lecturer.
Format of the paper :
1. Cover Title (TNR 16)
Name Green coloured cover Student Registration Number
Faculty of Medicine, Udayana University 2013
2. Introduction
3. Journal critism/literature review 4. Conclusion
5. References
Example : Journal
Porrini M, Risso PL. 2005. Lymphocyte Lycopene Concentration and DNA Protection from Oxidative Damage is Increased in Woman. Am J Clin Nutr 11(1):79-84.
Textbook
Abbas AK, Lichtman AH, Pober JS. 2004. Cellular and Molecular Immunology. 4th ed.
Pennysylvania: WB Saunders Co. Pp 1636-1642.
Note.
~ STUDENT PROJECT ~
Regular Class (Class A)
No Group Topic
1 A1 Inkontinensia urine
2 A2 Polip cerviks
3 A3 Ectopic pregnancy
4 A4 Preterm pregnancy
5 A5 Endometriosis
6 A6 Carsinoma cerviks
7 A7 Dermoid cyst
8 A8 Intra uterine Fetal Death (IUFD)
9 A9 Myoma uteri
10 A10 Ruptur Uteri
English Class (Class B)
No Group Topic
1 B1 Inkontinensia urine
2 B2 Polip serviks
3 B3 Ectopic pregnancy
4 B4 Preterm pregnancy
5 B5 Endometriosis
6 B6 Carsinoma cerviks
7 B7 Dermoid cyst
8 B8 Intra uterine Fetal Death (IUFD)
9 B9 Myoma Uteri
10 B10 Ruptur Uteri
LEARNING PROGRAMS
ABSTRACT AND TASK OF LECTURES
Lecture 1
Anatomy of Female Genital System
( dr. IGA Widianti, M.Biomed )
FEMALE GENITAL ORGANS ABSTRACT:
The female internal genital organs
The female internal genital organs include the vagina, uterus, uterine tubes and ovaries. The vagina, a musculomembranous tube, extends from yhe cervix of the uterus to the vestibule, the cleft between the labia minora into which the vagina and urethra open. The superior end of the vagina surrounds the cervix of the uterus. The vagina is usually collapsed so its anterior and posterior walls are in contact, except at its superior end, where the cervix holds them apart. The vagina : serves as a canal for menstrual fluid, form the inferior part of the pelvic (birth) canal, receives the penis and ejaculate during sexual intercourse.
The uterus is a thick-walled, pear-shaped, hollow muscular organ. The uterus usually lies in the lesser pelvis, with its body lying on the urinary bladder and its cervix between the urinary bladder and the rectum. The adult uterus is usually anteverted and anteflexed so that its mass lies over the bladder. The uterus is divisible into two main part : the body and the cervix. The wall of the body of the uterus consist of the three layers : perimetrium, myometrium and endometrium.
The uterine tubes extend laterally from the uterine horns and open inyo the peritoneal cavity near the ovaries. The uterine tubes lie in the mesosalphinx in the free edges of the broad ligament. Each uterine tube is divisible into four parts : the infundibulum, ampulla, isthmus and the uterine part.
Ovaries : the almond-shaped ovaries are typically near the attachment of the broad ligament to the lateral pelvic walls, suspended from both by peritoneal folds, the mesovarium from the posterosuperior aspect of the broad ligament and the suspensory ligament of the ovary from the pelvic wall.
The female external genitalia organs
The female external genitalia include the mons pubis and labia majora (enclosing the pudendal cleft), labia minora (enclosing the vestibule), clitoris, bulbs of the vestibule and greater and lesser vestibular glands. The synonymous terms pudendum and vulva include all these parts. The vulva serves as sensory and erectile tissue for sexual arousal and intercourse, direct the flow of urine and prevent entry of foreign material into the urogenital tract.
Breasts
female breast extends transversely from the lateral border of the sternum to the midaxillary line and vertically from the 2nd – 6th ribs.
LEARNING TASK: CASE 1:
A 42-year-old woman is referred for vaginal sonography to rule out a luteal cyst. The sonic probe is placed in the anterior vaginal fornix and aimed anteriorly.
1. What is the normal position of the uterus and its relation to other structure in pelvic cavity?
2. How much of the uterus can normally be felt per rectum? 3. What is the normal support of the uterus?
4. Why do you think the uterus is in that position?
5. Describe the ovaries, uterine tubes, uterus and broad ligaments 6. Describe the peritoneal relationships of the ovary and the uterine tube
7. Describe the walls, fornices and the immediate visceral relations of the vagina 8. To describe the blood supply and lymph drainage of the female genital tract 9. To describe general anatomy, vascularisation and lymphatic system of the breast 10. Explain the anatomical feature of the female pelvis and its difference the male pelvis 11. Describe the pelvic diaphragm and perineum
SELF ASSESSEMENT :
1. To describe the component parts of the uterine tube 2. To identify the female external genitalia
3. Describe the vascularisation, inervation and limphatic drinage of internal and external female genital organs.
4. Discuss with your colleagues the growth and development and their anomalies of female genital organs.
Lecture 2
Histology of Male & Female Genital System
( dr. I Wayan Sugiritama, M.Kes )
ABSTRACT
The Female Genital System
The female reproductive system consists of the internal reproductive organs (the paired ovaries and oviducts, the uterus and the vagina) and the external genitalia (the clitoris, the labia majora, and the labia minora).
The ovaries are indistinctly divided into a cortex and medulla. Cortex is composed of connective tissue stroma that houses ovarian follicles in various stages of development (primordial, primary, secondary and graafian follicles). During the follicle growth, fibroblast of the stroma around the follicle differentiate to form the theca folliculi and it subsequently differentiates into theca interna and theca externa. The cells of theca interna responsible for synthesize a steroid hormone.
The oviducts are paired muscular-walled tubular structures, their walls are composed of mucosa, muscularis and serosa. The mucosa layer lines by two different cells : (1) non ciliated peg cells which is facilitated capacitation of spermatozoa, and (2) ciliated cells which is responsible for transport of the fertilized ovum to the uterus. The oviducts act as a conduit for spermatozoa to reach the primary oocyte and convey the fertilized egg to uterus.
The uterine wall of uterus composed by an endometrium, myometrium, and serosa. The endometrium consists of two layer, the superficial functionalis which is sloughed at menstruation, and deeper basalis whose glands and connective tissue elements. Myometrium is composed of inner longitudinal, middle circular and outer longitudinal layers of smooth muscle.
The vagina, a fibromuscular tubular structure, is compose of three layers that are : mucosa, muscularis, and adventitia.
The mammary glands, although not strictly a part of the female reproductive tract their physiology and function are so closely associated with the reproductive system. The mammary gland is a compound tubuloalveolar gland of 15-20 lobes.
The reproductive organs are incompletely development and remain in a state of rest until gonadotropic hormones secreted by the pituitary gland signal the initiation of puberty. Thereafter, many changes take places in the entire reproductive system, culminating in menarche. After the first menstrual flow (menarche), the menstrual cycle which involves many hormonal and histological changes is repeated each month. Around the middle of each cycle, a single ovum is released from one of the ovaries (ovulation) and passes in to the oviduct, where it may, or may not, encounter a spermatozoon for its fertilization. The menstrual cycle ceases after menopause, there is a slow involution of reproductive organ.
The Male Genital System
The male reproductive system is composed of the testes, genital ducts, accessory glands, and penis . The dual function of the testis is to produce spermatozoa and hormones. The genital ducts and accessory glands produce secretions that, conduct spermatozoa toward the exterior. Spermatozoa and the secretions of the genital ducts and accessory glands make up the semen.
Each testis is surrounded by tunica albuginea. The testis divide into 250 pyramidal compartments called the testicular lobules. Each lobule is occupied by one to four seminiferous tubules enmeshed in a web of loose connective tissue that is rich in blood and lymphatic vessels, nerves, and Leydig cells. Seminiferous tubules produce spermatozoa, whereas Ledig cells secrete testicular androgens.
These seminiferous tubules are enclosed by a thick basal lamina and surrounded by 3-4 layers of smooth muscle cells. The lumen are lined with seminiferous epithelium (germinal epithelium), which consists of two types of cells: spermatogenic cells and Sertoli cells.The cells of the spermatogenic lineage produce spermatozoa.
Spermatogenesis is the process by which spermatozoids are formed. It begins with spermatogonium, at sexual maturity spermatogonia begin dividing, producing two type cells: type A spermatogonia and type B spermatogonia. Type B spermatogonia will differentiate into primary spermatocytes. After their formation, these cells divide into secondary spermatocytes . Division of each secondary spermatocyte results in spermatids.
Spermiogenesis is the final stage of production of spermatozoids. Spermiogenesis is a complex process that includes formation of the acrosome , condensation and elongation of the nucleus, development of the flagellum, and loss of much of the cytoplasm. The end result is the mature spermatozoon, which is then released into the lumen of the seminiferous tubule.
The Sertoli cells are important for the function of the testes. These cells are elongated pyramidal cells that partially envelop cells of the spermatogenic lineage. Adjacent Sertoli cells are bound together by occluding junctions at the basolateral part of the cell, forming a blood-testis barrier . Sertoli cells has another function are : Support, protection, and nutritional regulation of the developing spermatozoa, Phagocytosis, Secretion of an ABP and inhibin, Production of the anti-mullerian hormone and inhibin B.
Case :
A couple came to a doctor with complaints not having children. The couple has been married for three years. Doctor recommend to do some examination to find out the etiology. From the history taking is known that the woman had regular menstruation. 1. Describe the structure of the ovaries in each stage of the menstrual cycle!
2. If the endometrial biopsy was performed on the every stages of menstrual cycle, try to describe the results!
3. Describe the changes in the cervix at each stage of the menstrual cycle!
HSG (Hystero Salpingo Graphy) was done to examination the patency of Tuba Fallopian. Examination found there is no abnormalities
4. Describe the structure of the Tuba Fallopian !
5. Explain the structure of the Tuba Fallopian which plays an important role in oocyte transport!
Semen examination results showed that the number of spermatozoa is low (Oligospermia).
a. Describe the microscopic structure of organs that play a role in the formation of semen!
b. Explain the process of spermatogenesis?
c. Explain the importance of Sertoli and Leydig cells in spermatogenesis?
On physical examination and additional tests are found abnormalities in his testes, known as varicocele. His doctor suspected it as the cause of the low number of sperm (oligospermia) on the semen.
d. Describe the structure that transports semen from the seminiferous tubules to the meatus penis!
e. Explain the process of sperm maturation that occurs on genital duct!
Self Assessment
1. Describe the histological structure of the ovary ! 2. Describe the stages of ovarian follicular development !
3. Describe the histological structure of the endometrium on menstrual, follicular and luteal phase!
4. Describe the histological structure of oviduct ! 5. Describe the histological structure of the vagina!
6. Describe the histological structure of the external genital system!
7. Describe the histological structure of mammary gland on the following : (a) before puberty, (b) after puberty but nonpregnant, and (c) during pregnancy !
8. Describe the histological structure of the testis ! 9. Describe the process of spermatogenesis !
10. Describe the structure and function of Blood-Testis Barrier ! 11. Describe the intratesticular and external genital duct ! 12. Describe the structure of accessory gland !
13. Describe the structure of Penis !
Lecture 3
Physiology of Male Genital System
(
dr. Luh Putu Ratna Sundari, MBiomed)ABSTRACT
The Male Reproduction system has two functions. First is the production of the male gamete, called sperm, by a process called spermatogenesis. The second is the production of the male sex hormones, a class of steroid, hormones called the androgens, which are necessary for spermatogenesis to occur and also maintain sexual potency and secondary sex characteristics. The testes or testicle are the pair of male gonads and the principal androgen is testosterone. Testicular function is controlled by the hyphothalamo-pituitary-testicular axis which regulates both androgen synthesis and spermatogenesis.
Testosterone is the most potent and important of these androgens, and by far the highest production of testosterone is in the testes. The testis is not a highly vascular tissue like the adrenal cortex, and the presence of the blood testis barrier and a specific androgen binding protein in the interstitial fluid of testis means that high concentrations of testosterone accumulate. These high local level of testosterone in the testis are important for spermatogenesis.
Spermatogenesis I the process by which the germ cells in the seminiferous tubules develop into mature sperm. There are three distinct stages to this process: proliferation of the spermatogonia, reduction of number of chromosomes (meiosis) and development of the mature sperm structure. The whole process, from start of spermatogonium differentiation to the formation of a mature sperm, takes 70 days, with a further 12-21 days required for transport of the sperm through the epididymis to the ejaculatory duct.
Both spermatogenesis and androgen secretion are controlled by the hypothalamus and pituitary glands. The hypothalamic hormone, gonadotropin releasing hormone (GnRH), is secreted in a pulsatile manner to stimulate luteinizing hormone (LH) and follicle stimulating hormone (FSH ) secretion. This pulsatile pattern of secretion is important: if Gn RH is given as constant infusion it actually inhibit secretion of these hormones.
LEARNING OBJECTIVES
After studying this chapter, student should be able to: 1. Describe the structure and function of the testes.
2. Explain the control of steroid hormone production by the testes
3. Describe of the hormonal regulation of spermatogenesis
CASE
Could mine be bigger?
Arman, 35 years old, a bank worker, visited “Mak Erot” (alternative healer practical) to enlarge his penis. He received information from his friend that the healer could make the penis bigger and longer as needed for better function.
Learning task
1.
Explain the role of androgens influence primary and secondary sex characteristics of male.2.
Explain about hormonal control of testicular function.3.
Explain the possibility of Arman’s penis to be bigger and longer.Self assessment:
Explain the following items:
1.
Control of FSH, LH, testosterone on male reproduction2.
Process of spermatogenesis.3.
Sperm production and factors are relatedLecture 4
Physiology of Female Genital System
(Dr. dr. Susi Purnawati.M.KK)Abstract
The female reproductive system has gonad that produce egg or ovum and sex organs. The system experience maturation of their reproductive organs, which become functional during puberty as a result of the gonads secreting sex hormones. Female Reproductive System functions are: produces eggs (ova), secretes sex hormones, receives the male spermatozoa, protects and nourishes the fertilized egg until it is fully developed, delivers fetus through birth canal, and provides nourishment to the baby through milk secreted by mammary glands in the breast.
The development of women's "eggs" are arrested during fetal development. At about 5 months gestation, the ovaries contain approximately six to seven million oogonia, which initiate meiosis. The oogonia produce primary oocytes that are arrested in prophase I of meiosis from the time of birth until puberty. After puberty, during each menstrual cycle, one or several oocytes resume meiosis and undergo their first meiotic division during ovulation. The ovaries of a newborn baby girl contain about one million oocytes. This number declines to 400,000 to 500,000 by the time puberty is reached. On average, 500-1000 oocytes are ovulated during a woman's reproductive lifetime. Towards the end of puberty, girls begin to release eggs as part of a monthly period called the female reproductive cycle, or menstrual cycle (menstrual referring to "monthly"). Approximately every 28 days, during ovulation, an ovary sends a tiny egg into one of the fallopian tubes. Unless the egg is fertilized by a sperm while in the fallopian in the two to three days following ovulation, the egg dries up and leaves the body about two weeks later through the vagina. This process is called menstruation. Blood and tissues from the inner lining of the uterus (the endometrium) combine to form the menstrual flow, which generally lasts from four to seven days. The first period is called menarche. During menstruation arteries that supply the lining of the uterus constrict and capillaries weaken. Blood spilling from the damaged vessels detaches layers of the lining, not all at once but in random patches. Endometrium mucus and blood descending from the uterus, through the liquid creates the menstruation flow. The reproductive cycle can be divided into an ovarian cycle and a uterine cycle. During the uterine cycle, the endometrial lining of the uterus builds up under the influence of increasing levels of estrogen (labeled as estradiol in the image). Follicles develop, and within a few days one matures into an ovum, or egg. The ovary then releases this egg, at the time of ovulation. After ovulation the uterine lining enters a secretory phase, or the ovarian cycle, in preparation for implantation, under the influence of progesterone. Progesterone is produced by the corpus luteum (the follicle after ovulation) and enriches the uterus with a thick lining
of blood vessels and capillaries so that it can sustain the growing fetus. If fertilization and implantation occur, the embryo produces Human Chorionic Gonadotropin (HCG), which maintains the corpus luteum and causes it to continue producing progesterone until the placenta can take over production of progesterone. Hence, progesterone is "pro gestational" and maintains the uterine lining during all of pregnancy. If fertilization and implantation do not occur the corpus luteum degenerates into a corpus albicans, and progesterone levels fall. This fall in progesterone levels cause the endometrium lining to break down and sluff off through the vagina. This is called menstruation, which marks the low point for estrogen activity and is the starting point of a new cycle.
Learning Objectives:
Student should be able to explain: 1. Female hormonal system 2. Ovarian and endometrial cycle
3. Regulation of the female monthly rhythm-interplay between the ovarian and hypothalamic-pituitary hormones
4. The female sexual act
Scenario:
Seven Days Period
Yunita, 29 years old, came for treatment to obstetrician because it was 7 days but her menses have not stopped. This complaint has been encountered several times before. But, only this time she visited doctor for treatment because she does not have enough money. Yunita worried because sometimes feels dizzy and are afraid of losing a lot of blood since the previous 7 days. Prior to the doctor Yunita already taking a Hemobion tablet once daily that she bought in pharmacy. Discuss with your group the following items: 1. Some explanation Yunita had from the obstetrician.
2. The monthly ovarian cycle. 3. The menstruation
4. The influence of estrogens on female secondary sex characteristics 5. The correlation of ovulation and orgasm with fertility
Self assessment
Explain the following items:
1. Ovarian function in adult women
2.Hormonal and ovarian changes that occur at menopause 3.Puberty and menarche
4.Environmental factors influence female reproduction.
Lecture 5
Labor is a sequence of uterine contractions that result in effacement and dilatation of the cervix and voluntary bearing down effort leading to expulsion pervagina of the product of conception. Delivery is the mode of expulsion of the fetus and placenta. Labor and delivery is a normal physiologic process that most women experience without complications.
Normal labor is a continuous process which has been devided into four stage of labor for purposes of study, with the first stage further subdivided into two phases, latent and active phase. The first stage of labor is the interval between the onset of labor and full cervical dilatation. The second stage is the interval between full cervical dilatation and delivery of the infant. The third stage of labor is the period between the delivery of the infant and the delivery of the placenta. The hour immediately following delivery is critical and it has been designated by some as the fourth stage of labor. Even thought oxytocins are administered, postpartum hemorrhage as the result of uterine atony is more likely at this time. The uterus frequently evaluated and perineum like wise is inspected frequently to detect excessive bleeding.
The mechanism of labor in the vertex position consists of engagement of the presenting part, flexion, descent, imternal rotation, extension and expulsion.
The partograph is a tool that can be used to assess the progress of labor and to identify when intervention is necessary. Using the partograph can be highly effective in reducing complications from prolonged labor for the mother and for the newborn.
The partograph is used to plot the following parameters for the progress of labor, monitoring fetal conditions, and monitoring maternal conditions.
Learning Outcome Learning Objective PIC SSR Manage,establish
tentative
diagnosis,management patient with normal labor and delivery by WHO partograph
1. Normal Labor , Delivery and WHO Partograph
- Describe the mechanism of normal labor and
delivery
- Apply to do anamnesis, physical examination
patients in labor
- Capable to establish the diagnosis of patients
In labor
- Capable to plan management of patients in
labor
- Describe the plan monitoring of patients in
labor
- Communicate all information about labor and
delivery to the patients and family - Describe the WHO partograph - Apply the WHO partograph to monitoring and
evaluation of patients in labor
Dr. I Wayan
Artana Putra -Williams Obstetrics text
Book. -WHO
Partograph
Guidelines.
Learning Task Case:
Woman, 25 years old, para I ( 2 years, spontaneous labor, 3000 gr ) at 9.00 am came with complaints of abdominal pain since two hour ago, she had complaints vaginal
discharge like blood slyms.Fetal movement was good,. Last menstrual period 3-12-2006, her menstrual period is normal. She is in good condition, compos mentis,Blood Presure 120/80 mmHg,Pulse 88 x/mnt, Respiration rate 20 x/mnt, temp.ax 36.5 0C.
Status generalis was normal Status obstetric ;
Abdominal : fundal uterine heigh 32 Cm, Head presentation 3/5, Back on the right Side, Uterine contraction 3x / 10 mnt, duration 40’’, Fetal heart rate 140 bpm.
Vaginal examination : Cervical dilatation 4 Cm,efficement 50%,amniotic membrane intack,Left occiput anterior, placenta and small part of fetus not palpable,
Lab : HGB 12 g/dl.
Questions :
1. What is the diagnosis of this patient?
2. What the anamnesis,sign and symptoms and examination to support the diagnosis?
3. What is the management of this patient? 4. How to use WHO partograph for this case?
5. What are the communication, education and counseling to patient and her family?
SELF ASSESSMENT :
1. How to diagnosis and confirmation of labor? 2. Explain the normal mechanism of labor? 3. Explain the stage and phase of labor?
4. How to assessment of engagement and descent of the fetus ? 5. How to identification of presentation and position of the fetus ? 6. How to assessment of progress of labor ?
7. How to assessment of fetal condition ? 8. What is the partograph ?
9. How to use the partograph ?
10. Explain the active management of the third stage of labor?
Lecture 6
Abnormal labor(dr. Tjok GA Suwardewa,SpOG(K))
Preterm labor
Preterm or premature births are terms used to define neonates who are born too early. Thus, infants born before term can be small or large for gestational age but still fit the definition of preterm. Low birthweight refers to births 500 to 2500 g; very low birthweight
refers to births 500 to 1500 g; and extremely low birthweight refers to births 500 to 1000 g. In the United States in 2005, 28,384 infants died in their first year of life Preterm birth, which is defined as delivery before 37 completed weeks, was implicated in approximately two thirds of these deaths.
A variety of morbidities, largely due to organ system immaturity, are significantly increased in infants born before 37 weeks' gestation compared with those delivered at term.
Major Short- and Long-Term Problems in Very-Low-Birthweight Infants
Organ or System Short-Term Problems Long-Term Problems Pulmonary Respiratory distress
syndrome, air leak,
bronchopulmonary dysplasia, apnea of prematurity
Bronchopulmonary dysplasia, reactive airway disease, asthma
Gastrointestinal or nutritional
Hyperbilirubinemia, feeding intolerance, necrotizing enterocolitis, growth failure
Failure to thrive, short-bowel syndrome, cholestasis
Immunological Hospital-acquired infection, immune deficiency, perinatal infection
Respiratory syncytial virus infection, bronchiolitis
Central nervous system
Intraventricular hemorrhage, periventricular leukomalacia, hydrocephalus
Cerebral palsy, hydrocephalus, cerebral atrophy,
neurodevelopmental delay, hearing loss
Ophthalmological Retinopathy of prematurity Blindness, retinal detachment, myopia, strabismus
Cardiovascular Hypotension, patent ductus arteriosus, pulmonary hypertension
Pulmonary hypertension, hypertension in adulthood
Renal Water and electrolyte imbalance, acid–base disturbances
Hypertension in adulthood
Hematological Iatrogenic anemia, need for frequent transfusions, anemia of prematurity
Endocrinological Hypoglycemia, transiently low thyroxine levels, cortisol deficiency
Impaired glucose regulation, increased insulin resistance
1. Placental abruption
Placental separation from its implantation site before delivery has been variously called
placental abruption, abruptio placentae, and in Great Britain, accidental hemorrhage. The Latin term abruptioplacentae means "rending asunder of the placenta" and denotes a sudden accident, which is a clinical characteristic of most cases. The cumbersome term
premature separation of the normally implanted placenta is most descriptive. It differentiates the placenta that separates prematurely but is implanted some distance beyond the cervical internal os from one that is implanted over the cervical internal os—that is, placenta previa.
The bleeding of placental abruption typically insinuates itself between the membranes and uterus, ultimately escaping through the cervix, causing external hemorrhage (Fig. 35-3). Less often, the blood does not escape externally but is retained between the detached placenta and the uterus, leading to concealed hemorrhage.
Placental abruption may be total or partial. Concealed hemorrhage carries much greater maternal and fetal hazards. This is not only because of possible consumptive coagulopathy, but also because the extent of the hemorrhage is not readily appreciated, and the diagnosis typically is delayed
Predisposition factors for placental abruption are, hypertension, prematurely ruptured of the membrane, smoking, thrombophilias, traumatic abruption and leiomyomas.
Placental abruption is initiated by hemorrhage into the decidua basalis. The decidua then splits, leaving a thin layer adhered to the myometrium. Consequently, the process in its earliest stages consists of the development of a decidual hematoma that leads to separation, compression, and ultimate destruction of the placenta adjacent to it
2. Post partum hemorrhage
Traditionally, postpartum hemorrhage has been defined as the loss of 500 mL of blood or more after completion of the third stage of labor. This is problematic because half of all women delivered vaginally shed that amount of blood or more when losses are measured quantitatively
Pritchard and associates (1962) used precise methods and found that approximately 5 percent of women delivering vaginally lost more than 1000 mL of blood. They also reported that estimated blood loss is commonly only approximately half the actual loss. Because of this, estimated blood loss in excess of 500 mL should call attention to mothers who are bleeding excessively. Toledo and colleagues (2007) have shown that calibrated drape markings improve estimation accuracy. Still, as shown by the study of Sosa and associates (2009) cited above, even this technique underestimates blood loss when compared with more precise methods described by Pritchard and colleagues
It is therefore readily apparent that fatal postpartum hemorrhage can result from uterine atony despite normal coagulation. Conversely, if the myometrium within and adjacent to the denuded implantation site contracts vigorously, fatal hemorrhage from the placental implantation site is unlikely even in circumstances when coagulation may be severely impaired
postpartum hemorrhage should be obvious. The differentiation between bleeding from uterine atony and that from genital tract lacerations is tentatively determined by predisposing risk factors and the condition of the uterus. If bleeding persists despite a firm, well-contracted uterus, the cause of the hemorrhage most likely is from lacerations. Bright red blood also suggests arterial blood from lacerations. To confirm that lacerations are a cause of bleeding, careful inspection of the vagina, cervix, and uterus is essential.
Late Postpartum Hemorrhage is bleeding after the first 24 hours of birth. Most of cause was placental rest.
Vignette 1:
A 20 year-old woman came to hospital with abdominal cram, and vaginal blood spotting. She’s pregnancy of 29 weeks. The blood pressure 120/80 mmHg, pulse rate 80 bpm, RR 20 times/mt, Hb 11 g/dl. Abdominal examination: uterine fundal 29 cm, uterine contraction twice within 10 minutes. Cervical dilatation 2 cm. estimated fetal weight 1000 g.
Learning task 1:
1. What is the diagnosis this patient?
2. What do you plan to maturation of the fetal lung?
3. How to manage a patient that diagnose like a case above?
Self assessment 1:
1. What is the definition of preterm pregnancy?
2. What are the short term and long term complications of preterm birth? 3. How to minimize that complications?
4. Describe about fetal lung maturity.
Vignette 2:
A 35 year-old woman complain about severe abdominal pain. She’s 3rd pregnancy 37
weeks, singleton baby. and there was history of high blood pressure. Current conditions; BP 150/100 mmHg, pulse rate 96x/mt, RR 20x/mt, Hb 9 d/dl. Abdominal examination; uterine fundal 4 cm below procesus xiphoideus, difficulty palpation of baby part, fetal heart tone 170 bpm. There was dark brawn vaginal bleeding.
Learning task 2:
1. What the diagnosis these patient?
2. What are predisposition factors in a case above? 3. What are differential diagnosis a case like this? 4. How to manage the patient in case above?
Self assessment 2:
1. What the definition of placental abruption?
2. What does it mean: concealed hemorrhage, external hemorrhage, consumptive coagulopathy
3. Describe about pathogenesis of solutio placenta. 4. What are complications of the solution placenta?
Vignette 3:
A 30 year-old woman, with history of spontaneous vaginal birth one hour ago. She was referred by midwife at cause active vaginal bleeding. Blood pressure was 100/60 mmHg. Pulse rate 100x/minute, RR 22x/minute, uterine fundus as level as umbilical. Weakness uterine contraction. Vaginal examination, much of blood clot in vagina.
Learning task 3:
1. What is approximate diagnosis of this patient?
2. What are the predisposition factors in case like above?
3. What do you planning in “primary survey”?
4. Definitive management for this patient are?
Self assessment 3:
1. What is the definition of post partum hemorrhage?
2. The most frequents cause of post partum hemorrhage is?
3. Would you like explain about late post partum hemorrhage?
4. What kind of uterotonica usually need to make better uterine contraction?
Lecture 7
Obstetric Emergency
(dr. Harry Wijaya Surya, SpOG)Abortus is the termination of pregnancy, either spontaneous or intionally,before the fetus develops sufficiently to survive. By convention, abortion is usually define as pregnancy termination prior to 20 weeks gestation or less than 500 gram birthweight. Definitions vary, according to state laws for reprting abortions, fetal death and neonatal deaths. There are five category of spontaneous abortion according to its clinical manifestations, such as threatened abortion, inevitable abortion, complete / incomplete abortion , missed abortion and recurrent abortion. The management are consevatif and curettage depend on clinical manifestations.The other ante-partum bleeding of pregnancy that occurred in the 2nd
trimester of gestation are placenta previa and solutio placenta. Both may emerged the emergency to mother and fetus and therefore have to recognized and perform the prompt management.
ABORTION
Learning outcomeLearning Objective Student reference Manage,establ
ish tentative diagnosis,provi de initial management,a nd/or refer patient with Abortion
Spontaneous abortion.
Comprehend the clinical implications of spontaneous abortion
Apply basic principles of special investigation on patient with spontaneous abortion
Recognize clinically, management and refer patient with spontaneous abortion
Recognize clinically the subgroups of
Williams Obstetrics, 22nd
spontaneous abortion
Threatened abortion.
Comprehend the clinical implications of threatened abortion
Apply basic principles of clinical diagnosis of threatened abortion
Recognize management of patient with threatened abortion
Inevitable abortion.
Comprehend the clinical implications of inevitable abortion
Apply basic principles of clinical diagnosis of inevitable abortion
Recognize management of patient with inevitable abortion
Incomplete abortion.
Comprehend the clinical implications of Incmplete abortion
Apply basic principles of patient with incomplete abortion
Recognize clinically, management and refer patient with incomplete abortion
Complete abortion
Comprehend the clinical implication of complete abortion
Apply basic principle of patient with complete abortion
Recognize clinically, and management patient with complete abortion
Ectopic pregnancy
Comprehend the clinical implication of ectopic pregnancy
Recognize risk factors of ectopic pregnancy Recognize the patogenesis of ectopic
pregnancy
Apply basic principle and special investigation on patient with ectopic preganancy
Recognize medical and surgical
management and refer patient with ectopic pregnancy
Manage establish tentative diagnosis,provi
Placenta previa.
Comprehend the implication of placenta previa
Capable to establish and communicate to the
Williams
Obstetric, 22 nd Edition page 810- 823
de initial management,a nd/or refer patient with antepartum hemorrhage
family about the types,causes, effect and management of placenta previa
Capable to recognize clinical diagnosis and special investigation of placenta previa Comprehend the patogensesis of bleeding in
placenta previa
Comprehend the maternal and fetal and prognosis of placenta previa.
Capable to plan the management of placenta previa
Placenta abruption.
Comprehend the implication of Placenta abruption
Capable to establish and communicate to the family about the types,causes,effect and management of Placenta abruption
Capable to recognize clinical diagnosis and special investigation of placenta abruption Comprehend the patogenesis of bleeding in
placenta abruption
Comprehend the maternal and fetal complication and prognosis on placenta abruption
Capable to plan management of placenta abruption
Learning Task : Vignette 1
A 28 year-old woman para 0 came with complaint of vaginal bleeding and lower abdominal cramp since 1 hour. Her LMP was unknown . She in good general condition, compos mentis, Blood pressure 120/85 mmHg, pulse 90 x/minute, temp 37 C. No Abnormality in heart and lung.
Uterine fundal height 2 finger above the symphysis, no tenderness, no pain Gynecologic examination :
Inspic : v/v fl (- ), Flx( +) VT : v/v Flx (+),
Portio : opening 1 finger, with fetal tissue Soft , no pain
CU : AF 10-12 weeks APCD : Normal
Lab: Hemoglobin 10 gr/dl Questions :
1. What is the diagnosis of this patient?
2. What are the anamnesis, sign, symptoms and examination to support the diagnosis? 3. What is the planning treatment of this patient?
4. What complication may happen in this case? 5. What is the fertility prognosis of this patient?
1. What is the definition of Spontaneous abortion?
2. What is the subgroup/classification of spontaneous abortion ? 3. Explain the etiopatogenesis of spontaneous abortion
4. What is the definition of Induced abortion?
5. Expalin the surgical and medical techniques of abortion 6. Explain the impact of abortion on maternal mortality.
Vignette 2
A 32 year-old woman, Para 1 ( 4 year ), has been reffered by midwife with vaginal bleeding since 2 hours ago. Her LMP is unknown. Acording to the data from previous scan in OBGYN specialist she should be in 32-34 weeks of pregnancy. She in good general condition, compos mentis, blood pressure 110/70 mmHg, pulse 92 x/minute,temperature 37C. Heart and lung are normal.
Obstetric :
fundal height ½ procesus xiphoideus- umbilicus, longitudinal lie, head floating, single, fetal heart beat 12 11 12,uterine contraction negative.
Vaginal examination : vulva : blood clot (+) Lab : hemoglobin 11,5 gr/dl.
Questions :
1. What is the diagnosis of this patient ?
2. What are the anamnesis, sign, symptoms and examination support the diagnosis? 3. What is the planning treatment of the patient?
4. What is the complication may be happen in this patient?
II . Self Assesment:
1. What is the definition of antepartum hemorrhage?
2. What is the definition of placenta abruption and placenta previa? 3. What is the etiopatogenesis of placenta abruption and placenta previa? 4. Explain the clinical differentiation of placenta abruption and placenta previa
5. Explain the management of preterm and term pregnancy with placenta abruption and placenta previa
6. What is the complication of placenta abruption and placenta previa 7. What are the placenta associated conditions with placenta previa?
Lecture 8
Puerperium and Disorders
(Dr Made Bagus Dwi Aryana, SpOG (K))Lecture 9
Benign and Malignant Diseases Of The Breast
(dr.Wayan Sudarsa, SpBK.Onk & dr.A.A.A.N.Susraini,SpPA)LEARNING OUTCOME:
1. Able to manage the patients with benign disorders and diseases of THE BREAST 2. Able to manage the patients with Malignant Diseases of THE BREAST
CURRICULUM CONTENT:
1. To demonstrate an understanding the concept of ANDI (Aberration of Normal Development and Involution of the breast)
2. To identify the cause of benign palpable breast mass
3. To comprehend a systematic clinical diagnostic procedure of benign breast mass 4. To apply triple assessment as a diagnostic procedure of benign breast mass
5. To comprehend a systematic approach to the management of the patient with dominant solid breast mass including referal
6. To comprehend a systematic approach to the management of the patient with cystic breast mass
7. To recognize the clinical aspect (etiology, classification and evaluation) of breast pain 8. To Comprehend systematic approach to the management of patients with breast pain. 9. To demonstrate an understanding of the clinical aspect of nipple discharge and nipple
inversion and infections of the breast.
10. To comprehend systematic approach to the management of patients with breast pain. 11. To Recognize and to manage and refer the patients with other benign breast disorders
including: Hematome, fat necrosis, mondor disease, Gynecomastia, and abnormalities of the breast during pregnancy and lactation.
2.1 To reflect upon the incidence and mortality rates of breast cancer 2.2 To identify women at risk for breast cancer
2.3 To appraise breast self-examination and population screening for breast cancer . 2.4 To identify the three most important histopathologic types of breast cancer 2.5 To Outline the biological behavior of breast cancer
2.6 To mention a characteristic of lobular breast carcinoma
2.7 To identify the Familial/Hereditary breast cancer: The molecular genetics and syndromes.
2.8 To relate some clinical presentations of breast cancer to the site of the tumor in the breast and to characteristics of local growth.
2.9 To discuss complaints and symptoms concerning one or both breasts, with which a patient may present
2.10 To outline the medical history and the physical examination in the case of a patient with complaints and / or symptoms of one or both breasts
2.11 To describe clinical characteristics of potential benign and malignant lumps 2.12 To interpretate specific presenting problems
2.13 To discuss the policy how to arrive at the diagnosis 2.14 To discuss the latest TNM system of breast cancer
2.15 To argue why there is no standardized treatment for patients with breast cancer 2.16 To identify the options for treatment
2.17 To outline the components of surgical treatment and of breast conserving treatment 2.18 To compare advantages with disadvantages of breast conserving treatment and
mastectomy
2.19 To reflect upon a dilemma in the case of lobular breast carcinoma
2.20 To discuss the indications for adjuvant systemic treatment and for radiation therapy. 2.21 To indicate the value of hormone receptors in breast cancer
2.22 To identify potential complications of the primary treatment
2.23 To discuss three rehabilitative measures following primary treatment
2.25 To recognize the role of reconstructive surgery. 2.26 To outline the options for non-curative treatment
2.27 To outline the chances of cure for patients with breast cancer .
BENIGN AND MALIGNANT DISEASES OF THE BREAST
When a patient present with a breast problem the basic question for general practitioner is, “Is there a chance that cancer is present, and, if not, can I manage these symptoms myself?”
ABSTRACT
The Breast, or mammary glands, of mammals are important for the survival of the newborn and thus of species. An understanding of the morphology an physiology of the breast and the many endocrine interrelationships of both is essential to study of the pathophysiology of the breast and the management of benign and malignant disorders.
One woman in four is referred to a Breast Clinic at some time in her life, and breast problems constitute up to a quarter of all women in the general surgical workload. Although breast cancer is the most common malignancy in women, 80-90% of clinical evaluations for breast disorders are for benign conditions.
Triple assessment is most common used in the evaluation of patient with breast problem. This is combination of clinical examination, imaging, and pathologic examination. The goal is to avoid missing the diagnosis of a malignancy while providing reassurance for benign conditions.
Breast cancer are derived from the epithelial cells that are found in the terminal lobular unit (TDLU). Cancer cells that are remain within the basement membrane of the TDLU are classified as in situ or non-invasive. An Invasive cancers is one in which there is dissemination of cancer cells outside the basement membrane of the ducts and lobules into surrounding adjacent normal tissue.
Epidemiologically, breast cancer is the most common
