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Stress in Early Pregnancy: The Role of Endocrine Immune System and Management Noor Pramono Noerpramana Fakultas Kedokteran Universitas Diponegoro Actual Management in Complicated Pregnancy FK. Universitas Sebelas Maret , Surakarta 15 Juli 2012. Contents. Stress Hypothalamus hormones

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  1. Stress in Early Pregnancy:The Role of Endocrine Immune System and ManagementNoor Pramono NoerpramanaFakultas Kedokteran Universitas DiponegoroActual Management in Complicated PregnancyFK. Universitas Sebelas Maret ,Surakarta 15 Juli 2012

  2. Contents • Stress • Hypothalamus hormones • Pituitary anterior hormones • HPA • HPG • Thyroid hormones • ADH • Stress  CRH (HPA), GnRH (HPG), TRH, GHRH • Desidual prolactin, circulation prolactin • Stress  Th1, Th2, immune system • Pregnancy failure, fetal programming • Management stress in early pregnancy

  3. Stres • Stres : Proses adaptasi • Stres : - Aksis hypothalamo-pituitary-adrenal (HPA) - Aksis hypothalamo-pituitary-gonadal (HPG) - Sistem imun

  4. Hormones of the hypothalamus

  5. Hormone of the anterior pituitary • The hormone secreted by anterior pituitary are large peptides ( about 200 amino acid residues) or glycopeptides • The six main hormones are • Growth hormone (GH) • Thyroid stimulating hormone (TSH also called thyrotrophin). • Adrenocorticotrophic hormone (ACTH) • Luteinizing hormone (LH) • Follicle stimulating hormone (FSH) • Prolactin (PRL)

  6. Hormones of the anterior pituitary gland

  7. Hormones of the anterior pituitary gland and their receptive target organs

  8. HPA : Hormonal regulation of cortisol.(ACTH, adrenocorticotropic hormone;CRH,corticotrophin releasing hormone)

  9. HPG : Regulasi hormon FSH , LH, Prolaktin, Estrogen, Progesterone

  10. prolactin Hormonal regulation of the thyroid hormones. (T3, Tri- iodothyronine; T4,thyroxine;TRH,thyrotrophin;releasing hormone; TSH, thyroid stimulating hormone

  11. Hormonal regulation of plasma osmolarity by antidiuretic hormone (ADH)

  12. Hormonal regulation of growth hormone

  13. HPA Stress Hypothalamus CRH ACTH Adrenal Cortex Medula Glucocorticoid (cortisol), mineralocorticoid, androgen Catecholamin : adrenalin. noradrenalin Metabolic effect • Immune system : • Immune activity • Cytokines • Inflammation

  14. S t r e s s • Growth • Anabolisme Prolactin Stimulate LH progesterone Inhibit 20α-HSD progesterone • Immune • System • Regulation • cytokine • - IL10, IL12 Corpusluteum Reproductive Function

  15. Desidua (Maternal) • Prolaktin didalam Desidua : 1. Implantasi dan plasentasi - Deferensiasi sel epitel - Pertumbuhan trofoblast - Angiogenesis - Regulasi Immun 2. Gen yang berbahaya untuk kehamilan dilawan (termasuk IL6 dan 20α-HSD) • Prolaktin didalam Sirkulasi : Efek pada desidua ?

  16. Pregnancy Stress Progesterone PIBF Progesterone Receptor Fetomaternal Interface Th 1 Th 2 Dendritic Cells ( IL2, 12, 18, IFNγ, TNF ) ( IL4, 5,6, 10, 13) Note : Glucocorticoid ( cortisol ) & 11β-HSD Decidua Progesterone, Prolactin ??

  17. 3 Compartment of Human Abortion / Parturition

  18. Diagram manifestasi hormonal akibat stres maternal

  19. Diagram gangguan keseimbangan hormonal maternal akibat stres

  20. Managemen Stres pada Kehamilan • Stres : 1. Berupa fisik, psikik, hormonal, lingkungan 2. Bersifat berat/ringan, akut/kronis • Penyakit (kelainan) mental : akibat dari rangsangan stres yang cukup kuat dan lama.

  21. Managemen Stres pada Kehamilan • Terapi Stres : 1. Prinsip menghindari stres 2. Dukungan sosial 3. Konseling 4. Psikoterapi 5. Medikomentosa (untung rugi efek samping)

  22. Ringkasan • Stres  interaksi kompleks sistem neuro–endokrin-imun (HPA-HPG-Imun). • Stres awal kehamilan  : 1. Progesterone 2. PIBF 3. Prolactin 4. Th1 cytokines : Th2 cytokines 5. GC (Glucocorticoid / Cortisol) ? • Berakibat : kegagalan pregnancy or fetal programming

  23. Terima Kasih Matur Nuwun

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