study guide reproductive tayang by gextha 12 Juni 2015

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

Thank you. Planners

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 and_sexology 0811395694 12. dr. I Made Oka Negara, S.ked Andrology and

sexology

08123979397 13. dr.Gede Wirya Kusuma Duarsa M.Kes,SpU Surgery/Urology 08155753377 14. dr. Wayan Sudarsa, SpB.K.Onk Surgery/Oncology 0811398971 15. Dr.dr.Bagus Komang Satriyasa,M.Repro Pharmacology 081805368922 16. dr. I.W Sugiritama, M.Kes Histology 08164732743 17. dr. Putu Anda Tusta Adiputra, Sp.B (K) Onk Surgery/Oncology 08123826430 18. dr. Made Bagus Dwi Aryana, Sp.OG (K) Obgyn 081933145766 19. dr Luh Putu Ratna Sundari, MBiomed Physiology 0361-7860532

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 2_R.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 2_R.2.20nd floor 9 dr. I Nyoman Gede _{Wardana, M Biomed} A9 Anatomy 087860405625 2_R.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 2_R.2.09nd floor 2 dr. I Made Suka Adnyana, _Sp.BP B2 Surgery 081236288975 2_R.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 2_R.2.13nd floor 5 dr. I Putu Eka Widyadharma, _M.Sc,SpS B5 Neurology 081328049360 2_R.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 2_R.2.16nd floor 8 dr. I G Kamasan Nyoman _{Arijana, M.Si.Med} B8 Histology 085339644145 2_R.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 2_R.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 2015

08.00-09.00 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

15.00-16.00 Plenary 4.02 Dr Made Bagus Dwi Aryana, SpOG (K)

DAY

DATE

TIME

LEARNING

ACTIVITY

VENUE

CONVEYER

9 Wed 24 June 2015

09.00-10.00 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

Dr Putu Anda Tusta Adiputra, SpB Dr I Made Oka Negara, S.ked

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

Day

Date

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

Both males and females have breasts (mammae), normaly the mammary glands are well developed only in women. Mammary glands in women are accessory to reproduction, but in men they are functionless, consisting of only a few small ducts or cords. The mammary glands are modified sweat glands and therefore have no special capsule or sheath. The contour and volume of the breasts are produced by subcutaneous fat, except during pregnancy when the mammary glands enlarge and new glandular tissue forms. Breast size and shape result from genetic, racial, and dietary factors. The roughly circular base of the

female breast extends transversely from the lateral border of the sternum to the midaxillary line and vertically from the 2nd _{– 6}th _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.

Spermatozoa transported from seminiferous tubules to the ductus epididymidis by the intratesticular genital ducts (tubulus rectus, rete testis, and ductuli efferentes). Excretory genital ducts transport the spermatozoa produced in the testis toward the penile meatus. These ducts are the ductus epididymidis, the ductus (vas) deferens, and the urethra

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.

4.

Explain the role of autonomic nerve system which influence male sexual response.

Self assessment:

Explain the following items:

1.

Control of FSH, LH, testosterone on male reproduction

2.

Process of spermatogenesis.

3.

Sperm production and factors are related

Lecture 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

Antenatal Care and Normal labor (dr. dr. I Wayan Artana Putra,Sp.OG (K))

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 0_C.

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.

Corticosteroid therapy was effective in lowering the incidence of respiratory distress and neonatal mortality rates if birth was delayed for at least 24 hours after initiation of betamethasone. A National Institutes of Health Consensus Development Panel recommended corticosteroids for fetal lung maturation in threatened preterm birth

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

Except possibly when intrauterine and intravaginal accumulation of blood is not recognized, or in some instances of uterine rupture with intraperitoneal bleeding, the diagnosis of

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 outcome

Learning 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

Edition,2005 Page 232- 247 And 254- 268

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? II . Self Assesment :

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

infertility consist of ovulatory dysfunction ( 40 % ), tubal and pelvic pathology ( 40 % ), another cause – uterine pathology ( 10 % ) and unexplained ( 10 % ).

The evaluation or investigation of infertility focuses on the couple and not on one or the other partner. Any investigation of infertility begins with a careful clinical evaluation by taking history and physical examination , semen profile, ovulatory status, tubal patency, tuboperitoneal defect and cervical mucous hostility. In the female partner, particularly relevant medical history finding include : parity, cycle length and characteristic, coital frequency, duration of infertility, past surgery, exposure to sexually-transmitted infection, occupation and use of tobacco, alcohol, and other drugs, symptoms of thyroid disease, galactorrhea, hirsutism, dysparenia. For the physical examination finding include : weight and body mass index, any thyroid enlargement, breast secretion, signs of androgen excess, pelvic or abdominal tenderness, vaginal or cervical abnormality.

The modalities of diagnostic tool for evaluating the cause of infertility include: Ultrasonografi (transvaginal sonografi) to evaluate the ovarial reserve, follicle development and ovulation, tubal and uterine patology; laboratory medical machine to evaluate the hormonal status, hystrerosalpingografi (HSG) to evaluatetubal patency and pathology of uterine cavity, hysteroscopy and laparoscopy to evaluate the pathology of uterine cavity, tubal patency and any abnormality of the pelvic cavity, microscope to evaluate the semen profile and cervical mucous hostility.

Based on the result of these investigations, couples are to be selected for treatment at different levels of infertility care unit. Depending on the personnel competence and availability of facilities for investigations and treatment, there should be three levels of infertility care units. Primary infertility care unit responsible for completion of basic investigations, treatment of minor anatomical defect, medical management of minimal and mild endometriosis, induction ovulation in nonovulation women and to refer couples to secondary or tertiary infertility care unit. Secondary infertility care unit responsible for further in-depth investigations and extended treatment of infertility except assisted reproductive technique. For instance, immunological test for infertility, hysteroscopy, laparoscopy and TVS, facilities for semen preparation, conservative surgery. Tertiary infertility care unit responsible for advanced diagnostic procedures, therapeutic and research. For instance, endocrine assay, color doppler for growing follicle, all varieties of assisted reproductive technologies including ICSI, special procedure of IUI, sperm or oocyte banking and embryo cryopeservation.

FEMALE INFERTILITY LEARNING

OUTCOME LEARNING OBJECTIVE PIC

STUDENT REFERENCE

Manage,establish tentative diagnosis, provide initial management, and/or refer patien with infertility

Female Infertility

 Capable to explain the definition of infertility

 Capable to explain some factor that influence the fertility couples.

 Capable to explain the specific cause of female infertility

 Capable to establish the diagnosis of female infertility

 Capable to explain the fisiologi and abnormality of the servix, uterus, fallopian tubes, ovarium and, peritoneum.

 Capable to plan the treatment of female infertility on primary healt services

 Capable to refer the female infertility to the second/tertier healt service for getting spesialistic treatment

dr. I.B Putra Adnyana,SpOG(K)

Texts Books of Assisted Reproductive Techniques The Infertility Manual Kamini A Rao Peter k Brinsden Sperof

Contraception is not new, but its widespread development and application are new. The need to use contraception is not only to provide pregnancy prevention but also give prevention of unwanted pregnancy and to decrease maternal mortality rate.

General practitioners are often best placed to offer good contraceptive advice because they already know the patien’s health and family circumstances.

For that reason, they should know how to manage, provide and prescribing female family planning devices and also provide initial management and/or refer unwanted effects of female family planning devices.

Some of the female family planning metode are female condoms, spermicides, LAM,IUD, hormonal and operative.

LEARNING TASK OF FEMALE INFERTILITY

Woman 31 years old. Her husband 34 years old. Has been married for about 5 years. They are routinly sexual intercourse twice a weeks without protection , but until now never getting pregnant. Husband job as a bus driver and frequently have a uninary tract problem.

She come to the public health centre to need some help for getting pregnant.

After checking the health status, who are doing by the doctor, she has some medical problem data that is consist of :

 Irreguler menstrual period starting for one year ago.

 Frequntly vaginal discharge with some what of lower abdominal point.

 Body mass index > 29

 On gynecology examinitaion : -Flour (+) intra vagina

-Uterin corpus : normal size

-Litle bit pain on the left & right adnexa, but not mass palpable.

Questions :

1. List the medical & reproductive problem of this patien 2. List the risk factor of reproductive disorder for this couple 3. What is the the diagnosis of this patien

4. What is the probability cause of difficulty to get a pregnant

5. What is the next examination should be doing to supporting the diagnosis 6. What is your suggestion for this patien to treat the main problem

Self Assessment :

1. What is the definition of infertility 2. Explain the risk factor of infertility 3. Explain the cause of infertility

4. Explain the examination method of male & female infertility 5. Explain the treatment method of male and female infertility

Lecture 15

Drugs Therapy in Pregnant and Genital Disorders

Dr. dr. Bgs Komang Satriyasa, M.Repro

Pregnant women commonly use medications. Although most drugs have an excellent safety profile, some have unproven safety or are known to adversely affect the fetus. The safety profile of some medications may change according to the gestational age of the fetus. Because an estimated 10 percent or more of birth defects result from maternal drug exposure.

For a drug to harm the fetus it must cross the placenta and be present in fetal tissue. The drugs in this list are those for which evidence is either conclusive or highly suggestive. Not included are drugs that are used infrequently during pregnancy or for which a teratogenic effect may occur but for which evidence is lacking. The list does not include the likely risk of fetal abnormality after exposure in the first trimester.

The risk of anatomic defects in the fetus recedes after the first trimester. For the remainder of pregnancy, the fetus undergoes growth and development. The impact of drugs after the first trimester moves from structural to physiologic effects. In addition, the long-term use of some agents can have adverse effects on the mother that, if not unique to pregnancy, are at least exaggerated by the State.

Many drugs have not been evaluated in controlled trials and probably will not be because of ethical considerations. Of the commonly used over-the-counter medications, acetaminophen, chlorpheniramine, kaolin and pectin preparations, and most antacids have a good safety record. Other drugs, such as histamine H2-receptor blockers,

pseudoephedrine, and atropine/diphenoxylate should be used with caution. With all over-the-counter medications used during pregnancy, the benefit of the drug should outweigh the risk to the fetus.

Learning Task drugs:

1. List commonly used drugs that have teratogenicity in humans! 2. Describe the teratogenic effect of warfarin in humans!

3. Describe the teratogenic effect of phenytoin in humans! 4. Describe clinical uses of estrogens and progestine!

5. List commonly used drugs and their function in male sexual disorders!

Self assessment

1. Describe sites of actions of several ovarian hormones and their analogs. 2. Describe clinical uses and toxicity of testosterone

3. Explain the control of androgen secretion and activity and some of actions of antiandrogens

MALE AND FEMALE FAMILY PLANNING

(dr. G Wirya Kusuma Duarsa,M.Kes,SpU and dr. Anom Suardika,SpOG)

Abstract

Family planning is a worldwide program to control the population growth. According to WHO, there are 9100.000 conception per day of which 50% are unplanned and 25% are involuntary. In order for men to take more responsibility for family planning, the male contraceptive methods applied must be effective, reversible, acceptable and cheap.

Despite research efforts, there are four methods of male contraception, i.e. condoms, periodic abstinence, withdrawal and vasectomy. The first three methods have been use for more than 100 years. Vasectomy is a safe and effective method of permanent contraception. Vasectomy can be safely performed as an outpatient procedure using local anesthetics. In the United States, it is employed by nearly 7% of all married couples and performed on approximately 0.5 million men per year, which is more than any other urologic surgical procedure is performed. Impressive as these numbers may seem, far fewer vasectomies are performed than female sterilizations by tubal ligation worldwide. This is in spite of the fact that vasectomy is less expensive and associated with much less morbidity and mortality than tubal ligation. Some men fear pain and complications, whereas others falsely equate vasectomy with castration or loss of masculinity.

Contraception is not new, but its widespread development and application are new. The need to use contraception is not only to provide pregnancy prevention but also give prevention of unwanted pregnancy and to decrease maternal mortality rate.

General practitioners are often best placed to offer good contraceptive advice because they already know the patien’s health and family circumstances.

For that reason, they should know how to manage, provide and prescribing female family planning devices and also provide initial management and/or refer unwanted effects of female family planning devices.

Some of the female family planning metode are female condoms, spermicides, LAM, IUD, hormonal and operative.

LEARNING TASK

A reproductive age couple come to your clinic to ask about contraception. They already have 4 healthy children and the youngest boy is 2 years old. She had been undergone SC for her last child. The mother has a strong family history of breast cancer. She removed he IUD (Intra Uterine Device) 2 weeks ago due to prolong vaginal bleeding and pain.

Question:

1. What kind of contraception will you offer to this couple?

2. If they ask for permanent contraception what will you offer to them and why?

SELF ASSESMENT

1. How many methods of male contraception that already exist? 2. What is the benefit of vasectomy over tuba ligation?

3. What are the advantages no scalpel vasectomy over scalpel vasectomy 4. What is the counseling that has to be understood by the acceptors? 5. What will you do if the vasectomy acceptors want to have a baby?

Moore KL, Agur AMR: Essential Clinical Anatomy, 3 nd _{ed. Philadelphia, Lippincott &}

Wilkins,2007.p. 130-135, 230-235, 248-254, 259-265, 56-60, 235-253, 266-270

Sadler TW : Langman’s Medical embryology, 10th _{ed. Philadelphia, Lippincott & Wilkins,}

2006. p. 239-256

Gartner.2007.color textbook of histologiy 3rd _{edition.p 489-510; 463-488}

Crooks R. and Baur K,2008. Our Sexuality. Tenth Edition. Thomson Wadsworth Eardley I and Krishna Sethia. 1998. Erectiloe Disfunction. Current Investigation and Management. Mosby-Wolf. Medical Communications

Kolodny R., Masters H and Johnson V. 1979.Texbook of Sexual Mediciine. Little, Brown and Company. Boston First Edition.

Silverthorn A C , Garrison C W and William C O. Edition. Page 745 – 761. Stuart, Ira fox. Human Physiology 2006 9th _{edition, p. 664 - 710}

Kumar, Cotran, Robbins.2003. Basic Pathology, Elsevier Inc. New York. 7th _{edition, p.}

Kolodny R., Masters H and Johnson V. 1979.Texbook of Sexual Mediciine. Little, Brown and Company. Boston 1st _Edition.

Silverthorn A C , Garrison C W and William C O. Edition, p. 745 – 761.

Kumar, Cotran, Robbins. 2003. Basic Pathology 7th _{edition., p.658 -670,679 - 717}

Dixon JM 2006. ABC The Breast Disease, 3th_{, p1-105}

EUA Guidelines on Paediatric Urology. 2008, p 44-47 Wein Alan J. Campbell’s Urology 2007, p. 1098-1127 Smith’s General Urology, 17th _{edition, 2008}

Berek J.S. 2002. Novaks Gynecology.13th _{edition, p. 351 -421, 1199 – 1345, 1353 - 1375}

Phillips NA.2000.American Family Physician.

Shill WB, Comhaire FH, HargreaveTB. Andrology for the Clinician.2007

Sperof Leon and Fritz Marc A. 2005. Cilinical Gynecologic Endocrinology and Infertility 7th

edition,

Gary Cuninggham. F. at al. 2005. Williams Obtetrics, 22nd _{edition, p.409 – 417}

WHO Partograph Guidelines.

Gary Cuninggham. F.at al. Williams Obtetrics, 2005, 21st _{edition, p. 689 - , 729 - ,743 - .}

Gary Cuninggham. F at al. Williams Obtetrics, 2007, 22nd _{edition, p. 232-247, 254-268,}

810 - 823

Rao AR, Peter K Brinsen. The infertility manual kamini.

Currerhers SG, Hoffman BB, Melmon KL, Nierenberg DW. 2000. Clinical Pharmacology,4th

edition.p1117 -1131

~ CURRICULUM MAP ~

10

Senior Clerkship

9

Senior Clerkship

8

Senior clerkship

7

Medical Emergency (3 weeks) BCS (1 weeks)

Special Topic: -Travel medicine (2 weeks)

Elective Study III (6 weeks)

Clinic Orientation (Clerkship) (6 weeks) 6 The Respiratory System and Disorders (4 weeks) BCS (1 weeks)

The

Cardiovascular System and Disorders (4 weeks) BCS (1 weeks)

The Urinary System and Disorders (3 weeks) BCS (1 weeks)

The Reproductive System and Disorders (3 weeks) BCS (1 weeks)

5 Elective Study II (1 weeks) Alimentary & hepato-biliary systems & disorders (4 Weeks) BCS (1 weeks)

The Endocrine System, Metabolism and Disorders (4 weeks) BCS (1 weeks)

Clinical Nutrition and Disorders (2 weeks) BCS (1 weeks)

Special Topic : - Palliative medicine -Compleme ntary & Alternative Medicine - Forensic (3 weeks) Elective Study II (1 weeks) 4 Musculoskeletal system & connective tissue disorders (4 weeks) BCS (1 weeks)

Neuroscience and

neurological disorders (4 weeks) BCS (1 weeks)

Behavior Change and disorders (4 weeks) BCS(1 weeks) The Visual system & disorders (2 weeks) BCS (1 weeks) 3 Hematologic system & disor-ders & clinical oncology (4 weeks) BCS (1 weeks)

Immune system & disorders (2 weeks) BCS(1 weeks) Infection & infectious diseases (5 weeks) BCS (1 weeks)

The skin & hearing system & disorders (3 weeks) BCS(1 weeks) 2 Medical Professionalism (2 weeks) BCS (1 weeks)

Evidence-based Medical Practice (3 weeks) Health System-based Practice (3 weeks) BCS (1 weeks)

Community-based practice (4 weeks) Special Topic - Ergonomi - Geriatri (2 weeks) Elective Study I (2 weeks) 1 Stadium Generale and Humaniora (3 weeks) Medical communication (3 weeks) BCS (1 weeks)

The cell as bioche-mical machinery (3 weeks) BCS(1 weeks) Growth & development (4 weeks) BCS: (1 weeks) Pendidikan Pancasila & Kewarganegaraan (3 weeks)