PHYSIOLOGY OF

PREGNANCY
By
Dr.M.Anthony David MD
Professor of Physiology
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 WHEN DOES LIFE BEGIN?:
EMBRYOGENESIS
MANY SPERMS BIND SPERMS MOVE THROUGH
TO ZONA PELLUCIDA THE ZONA PELLUCIDA

ONE SPERM BINDS TO THE OVUM

OVUM RELEASES IT IS DRAWN OVUM ENZYMES

VESICLE CONTENTS INTO THE OVUM ACTIVATED

ENZYMES BLOCK OVUM COMPLETES

POLYSPERMY II MEIOSIS

NUCLEI OF OVUM & SPERM UNITE

ZYGOTE FORMED
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EMBRYOGENESIS: AN
ANIMATION

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 PREGNANCY BEGINS
 THIS RESULTS IN THE ONSET OF A
NINE-MONTH RELATION SHIP
BETWEEN THE EMBRYO-FETUS, AND
THE MOTHER.
 THIS PHYSIOLOGICAL STATE IS
CALLED PREGNANCY.
 IT IS DIVIDED INTO THREE
TRIMESTERS OF THREE MONTHS
EACH.
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PREGNANCY: URINARY HORMONES

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FETO PLACENTAL UNIT
PLACENTA FETAL ADRENAL

CHOLESTEROL
DHEAS

PREGNENOLONE 16-OH- DHEAS

PROGESTERONE CORTISOL &

CORTICOSTERONE

ESTRADIOL DHEAS

ESTRIOL 16-0H-DHEAS
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TESTS OF PREGNANCY
1. ASCHEIM ZONDEK TEST
2. FRIEDMAN TEST
3. GALLI-MAININI TEST
4. IMMUNOLOGICAL TESTS
a) SHEEP RBC AGGLUTINATION
b) LATEX PARTICLE
AGGLUTINATION
c) GRAVINDEX TEST
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 TESTS OF PREGNANCY
1. ASCHEIM ZONDEK TEST
2. FRIEDMAN TEST
3. GALLI-MAININI TEST
4. IMMUNOLOGICAL TESTS
a) SHEEP RBC AGGLUTINATION
b) LATEX PARTICLE
AGGLUTINATION
c) GRAVINDEX TEST
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1. ASCHEIM ZONDEK TEST
 URINE FROM THE WOMAN IS
INJECTED INTO IMMATURE MICE
 0.5 ml b.d FOR THREE DAYS
 ON THE FIFTH DAY THE MICE ARE
SACRIFICED.
 THEY ARE DISSECTED TO LOOK FOR
CORPUS HEMORRHAGICUM.
 IF IT IS THERE, THE WOMAN IS
PREGNANT.
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 TESTS OF PREGNANCY
1. ASCHEIM ZONDEK TEST
2. FRIEDMAN TEST
3. GALLI-MAININI TEST
4. IMMUNOLOGICAL TESTS
a) SHEEP RBC AGGLUTINATION
b) LATEX PARTICLE
AGGLUTINATION
c) GRAVINDEX TEST
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 2. FRIEDMAN TEST
 10 -15 ml OF THE WOMANS URINE
IS GIVEN I.V TO A MATURE
FEMALE RABBIT.
 THE RABBITS OVARIES ARE
EXAMINED AFTER 24/48 HRS FOR
EVIDENCE OF OVULATION.
 RABBITS HAVE REFLEX
OVULATION.
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 TESTS OF PREGNANCY
1. ASCHEIM ZONDEK TEST
2. FRIEDMAN TEST
3. GALLI-MAININI TEST
4. IMMUNOLOGICAL TESTS
a) SHEEP RBC AGGLUTINATION
b) LATEX PARTICLE
AGGLUTINATION
c) GRAVINDEX TEST
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3. GALLI – MAININI TEST
A SIMPLE AND INEXPENSIVE
TEST.
 5 ml OF THE WOMAN’S URINE IS
PUT INTO THE DORSAL LYMPH
SAC OF A MALE TOAD.
 1-2 HRS LATER, IT’S CLOACAL
FLUID IS EXAMINED FOR
SPERMATOZOA.
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 TESTS OF PREGNANCY
1. ASCHEIM ZONDEK TEST
2. FRIEDMAN TEST
3. GALLI-MAININI TEST
4. IMMUNOLOGICAL TESTS
a) SHEEP RBC AGGLUTINATION
b) LATEX PARTICLE
AGGLUTINATION
c) GRAVINDEX TEST
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 4. IMMUNOLOGICAL
TESTS
 MOSTLY BEING USED THESE DAYS.
 BASIS:
 REACTION BETWEEN ANTIGENS AND
ANTIBODIES OF HUMAN CHORIONIC
GONADOTROPHIN (HCG)
 HCG ANTIBODIES ARE PRODUCED FROM
RABBITS

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 4. IMMUNOLOGICAL TESTS
a) SHEEP RBC AGGLUTINATION TEST:
 Sheep RBCs are coated with the antibodies.
 They get agglutinated when exposed to
urine containing HCG.
b) LATEX PARTICLE AGGLUTINATION.
c) GRAVINDEX TEST:
Most commonly used test today.

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GRAVINDEX: HCG TEST
KIT

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PHYSIOLOGICAL CHANGES
IN PREGNANCY
 CNS:
I Trimester:
 Excitement

 Depression

 Irritability

II Trimester:
 Euphoria: a sense of ‘well
being’
III Trimester:
 Worries and anxieties
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 CHANGES IN
CARDIOVASCULAR SYSTEM
 BLOOD VOLUME INCREASED BY 25%
 HEMODILUTION.
 ANEMIA
 CARDIAC OUTPUT INCREASED BY 30%
 PULSE RATE INCREASED.
 PERIPHERAL RESISTANCE DECREASES
 BP IS MAINTAINED NORMAL.

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 CHANGES IN
GASTROINTESTINAL SYSTEM
 MORNING SICKNESS: HYPEREMESIS
GRAVIDARUM
 CONSTIPATION
 HEARTBURN
  ACIDITY DUE TO LES TONE

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 CUTANEOUS CHANGES
 INCREASED PIGMENTATION
 PURPLE STRIA: STRIAE
GRAVIDARUM
RENAL CHANGES
 INCREASED FREQUENCY.
 SLIGHT ALBUMINURIA.
 SODIUM & WATER RETENTION.
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CHANGES IN RESPIRATORY
SYSTEM
  TIDAL VOLUME.
  PULMONARY VENTILATION
 OXYGEN UTILISATION INCREASES.
BLOOD CHANGES
  ERYTHROCYTE SEDIMENTATION RATE.
  COLLOID ONCOTIC PRESSURE
 EDEMA
 LOSS OF 1/8th TO 1/10th IRON.

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 CHANGES IN ENDOCRINES
 HYPOTHALAMO-HYPOPHYSIAL AXIS
STOPPED.
 HCG TAKES OVER.
 CORPUS LUTEUM AND PLACENTA
BECOME MAJOR ENDOCRINE GLANDS
PRODUCING ESTROGENS &
PROGESTERONE.
 INCREASED LEVELS OF:
 PTH, CORTISOL, PROLACTIN & OXYTOCIN.

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 CHANGES IN METABOLISM
 BMR INCREASED BY 25%.
 WEIGHT GAIN: 12.5 kg.
 POSITIVE CALCIUM BALANCE.
 PROTEIN ANABOLISM
 POSITIVE NITROGEN BALANCE.
 HYPER GLYCEMIA
 INABILITY TO TOLERATE
FASTING.
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 CHANGES IN MAMMARY
GLANDS
 BREASTS ARE ENLARGED.
 THE AREOLA AND NIPPLES ARE
DARKENED & SWOLLEN.

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 CHANGES IN
REPRODUCTIVE ORGANS
 PROFOUND CHANGES OCCUR.
 UTERUS INCREASES IN WEIGHT &
SIZE.
 BOTH HYPERPLASIA & HYPERTROPHY
OCCUR OF BOTH ENDO &
MYOMETRIA.
 WEAK CONTRACTIONS OCCUR IN THE
UTERUS
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CHANGES IN REPRODUCTIVE ORGANS contd.

 CERVIX BEGINS TO SOFTEN.

 OVARIES: NO OVULATION
 CORPUS LUTEUM OF PREGNANCY
INCREASES IN SIZE WITHIN THE
OVARY.
 VAGINA BECOMES
HYPERVASCULAR.
 MUCOSA BECOMES PURPLISH
  ACIDITY IN THE VAGINA.
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NOMAD: REP PHYSIOL: PREGNANCY 28