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PHYSIOLOGY OF PREGNANCY

 

Ovulation Each month, in one of a woman's two ovaries, a group of immature eggs start to develop in small fluid-filled cysts called follicles. Normally, one of the follicles is selected to complete development (maturation). This "dominant follicle" suppresses the growth of all of the other follicles, which stop growing and degenerate. The mature follicle ruptures and releases the egg from the ovary (ovulation). Ovulation generally occurs about two weeks before a woman's next menstrual period begins.

 

Development of Corpus Luteum After ovulation, the ruptured follicle develops into a structure called the corpus luteum, which secretes two hormones, progesterone and estrogen. The progesterone helps prepare the endometrium (lining of the uterus) for the embryo to implant by thickening it.

 

Release of Egg The egg is released and travels into the fallopian tube where it remains until a single sperm penetrates it during fertilization (the union of egg and sperm; see below). The egg can be fertilized for about 24 hours after ovulation. On average, ovulation and fertilization occurs about two weeks after your last menstrual period.

 

Menses If no sperm is around to fertilize the egg, it and the corpus luteum will degenerate, removing the high level of hormones. This causes the endometrium to slough off, resulting in menstrual bleeding. Then the cycle repeats itself.

 

Fertilization If sperm does meet and penetrate a mature egg after ovulation, it will fertilize it. When the sperm penetrates the egg, changes occur in the protein coating around it to prevent other sperm from entering. At the moment of fertilization, your baby's genetic make-up is complete, including its sex. Since the mother can provide only X chromosomes (she's XX), if a Y sperm fertilizes the egg, your baby will be a boy (XY); if an X sperm fertilizes the egg, your baby will be a girl (XX).

 

Implantation Within 24-hours after fertilization, the egg begins dividing rapidly into many cells. It remains in the fallopian tube for about three days. The fertilized egg (called a zygote) continues to divide as it passes slowly through the fallopian tube to the uterus where its next job is to attach to the endometrium (a process called implantation). First the zygote becomes a solid ball of cells, then it becomes a hollow ball of cells called a blastocyst. Before implantation, the blastocyst breaks out of its protective covering. When the blastocyst establishes contact with the endometrium, an exchange of hormones helps the blastocyst attach. Some women notice spotting (or slight bleeding) for one or two days around the time of implantation. The endometrium becomes thicker and the cervix is sealed by a plug of mucus.

Within three weeks, the blastocyst cells begin to grow as clumps of cells within that little ball, and the baby's first nerve cells have already formed. Your developing baby is called an embryo from the moment of conception to the eighth week of pregnancy. After the eighth week and until the moment of birth, your developing baby is called a fetus.

 

Pregnancy Hormones Human Chorionic Gonadotrophin (hCG) is a pregnancy hormone present in your blood from the time of conception and is produced by the cells that form the placenta. This is the hormone detected in a pregnancy test; but, it usually takes three to four weeks from the first day of your last period for the levels of hCG to be high enough to be detected by pregnancy tests. The development stages of pregnancy are called trimesters, or three-month periods, because of the distinct changes that occur in each stage.

DEFINITIONS
Fertilization


Union of egg and sperm in the fallopian tube within 2 minutes up to about 72 hours after ovulation

Zygote


Cell that results from the fertilization of the ovum by a spermatozoa

Blastomere


Daughter cells arising from mitotic division of the zyote (cleavage)

DEFINITIONS
Morula


Solid ball of cells formed by 16 or more blastomeres

Blastocyst
 

Morula with a fluid-filled cavity Stage of human development withing the uterine cavity

Embryo


Made up of cells grouped as inner cell mass

DEFINITIONS
Embryonic Period
 

5 8 weeks after fertilization Major structures are formed in this period

Fetus/Fetal Period  Period after embryonic period to delivery

Conceptus
 

All tissues of product of conception Embryo/fetus, fetal membranes and placenta

DEFINITIONS
Gestational Age
 

Menstrual Age and Age of Gestation (AOG) Calculated from the 1st day of the last menstrual period (LMP) Generally used during the fetal period, in UTZ, and in clinical practice

DEFINITIONS
Previable Period


11 20 weeks AOG

Viable Period  21 40 weeks AOG

PREGNANCY
  

280 days 40 weeks 9 calendar months (calculation is made from ovulation) 10 lunar months (based on LMP)

PREGNANCY
PREGNANCY/GESTATIONAL DIVISION
  

Divided into 3 trimesters Each lasting for 3 calendar months Each having important obstetrical milestones

Ovulation Each month, a mature egg is released from one of the women's two ovaries -- this is called ovulation. Ovulation takes place about two weeks after the first day of the last menstrual period.

Close up of an ovary releasing an egg in the direction of the opening of the uterine (Fallopian) tube

Close-up of inside of uterine tube showing egg traveling through

spermatozoa traveling through the fallopian tube

0 3 days fertilization (2 minutes 72 hours)

Fertilized human egg.

Zygote during first cleavage stage (24 hours)

Zygote

Morula stage (2 4 days)

Blastocyst stage (4 6 days)

1 week after -- implantation

DEVELOPMENT OF THE HUMAN PLACENTA


BLASTOCYST Inner Cell Mass  Destined to produce the embryo Outer Cell Mass  Destined to be the trophoblast placenta

EMBRYONIC AND FETAL STRUCTURES


DECIDUA  Specialized, highly modified endometrium of pregnancy  Influenced by estrogen and progesterone  Some is shed at parturition  Anatomical site of blastocyst implantation and placental development

FUNCTIONS OF DECIDUA


Pregnancy is the cardinal function of the endometrium and decidua Optimal site for blastocyst implantation and development of embryo and fetus Sperm capacitation

EMBRYONIC AND FETAL STRUCTURES


3 PORTIONS OF DECIDUA DECIDUA BASALIS  Site of blastocyst implantation DECIDUA CAPSULARIS  Portion that overlies the enlarging blastocyst DECIDUA VERA  Remainder of the uterus

EMBRYONIC AND FETAL STRUCTURES


CHORIONIC VILLI  Miniature, probing, finger-like structures that creep into the endometrium during implantation


Can be distinguished in the placenta by the 12th week AOG 2 layers of trophoblast cells

EMBRYONIC AND FETAL STRUCTURES


CHORIONIC VILLI Syncytiotrophoblast  Outer layer  produce placental hormones (hCG, HPL, estrogen and progesterone) Cytotrophoblast  Inner layer; disappears at 20-24th week  Protect the embryo/fetus from certain infectious disease (syphilis)

EMBRYONIC AND FETAL STRUCTURES


PLACENTA  Arises from the trophoblast


Generally located in the uterus anteriorly or posteriorly near the fundus

PLACENTA


Growth parallels that of fetal growth A term


   

500 gm in average weight 20 cm in dm 2-3 cm in thickness 10 38 cotyledons

PLACENTA
Fetal surface  Shiny side; SCHULTZ Maternal surface  divided into irregular lobes by septa  Dirty side; DUNCAN

PLACENTA
ROLES  Fetal lungs and kidneys


Metabolism (fetal GIT) Endocrinology Immunology

PLACENTA


3rd week, O2 and other nutrients transported from maternal blood to embryo/fetus by selective osmosis through chorionic villi Almost all drugs can cross into fetal circulation

PLACENTA
ENDOCRINE FUNCTION  Human Chorionic Gonadotropin  Human Placental Lactogen  Estrogen  Progesterone

PLACENTA
Human Chorionic Gonadotropin (hCG)  First hormone produced as early as 1 week of missed menses  Greatest concentration found at 8-10 wks AOG  Lowest concentration at about 20 wks AOG  Completely gone 2 weeks postpartum  Commonly used for pregnancy testing  Biologic activity similar to LH

PLACENTA
Human Chorionic Gonadotropin (hCG) FUNCTIONS  Rescues and maintains corpus luteum in early pregnancy to produce progesterone (only until 8 weeks AOG)


Stimulates fetal testes to synthesize testosterone and promote male sexual differentiation

PLACENTA
Human Placental Lactogen (HPL)  Produced as early as the 6th wk AOG  Chorionic growth hormone  Has lactogenic properties
 

Not required for a successful pregnancy outcome Functions primarily to ensure nutrient supply to the fetus

PLACENTA
Human Placental Lactogen (HPL) FUNCTIONS  Promotes growth of mammary gland in preparation for lactation  Promotes lipolysis to provide energy for maternal metabolism and fetal secretion


Regulates maternal glucose and protein levels

PLACENTA
Estrogen (Estriol)  Very high concentration near term (hyperestrogenic state)


Mammary gland development for lactation Stimulates uterine growth to accommodate the growing fetus

PLACENTA
Progesterone  Initially produced by corpus luteum then syncitiotrophoblast


Maintains the endometrial lining of the uterus during pregnancy Reduce uterine contractility during pregnancy

UMBILICAL CORD
 

Formed from the amnion and chorion Extends from the fetal umbilicus to the fetal surface of the placenta 50 55cm long at term 2cm thick 1 vein carries oxygenated blood from the placenta to the fetus 2 arteries carry deoxygenated blood from the fetus 350ml/min rate of blood flow

  

UMBILICAL CORD


Bulk of the cord (extracellular matrix) is the Whartons Jelly Provides a circulatory pathway connecting the embryo to the chorionic villi

FETAL MEMBRANES


Chorionic membrane outermost fetal membrane Amniotic membrane beneath chorion Produces amniotic fluid

AMNIOTIC FLUID
  

Constantly formed and reabsorbed Alkaline (pH 7.2) At term 1000ml Shields fetus against pressure or trauma to maternal abdomen Protects fetus from changes in temperature Protects umbilical cord from pressure Allows fetus freedom to move

  

AMNIOTIC FLUID
Hydramnios (polyhydramnios)  Excesssive amount (>2L)  Failure of fetal swallowing  Maternal diabetes Oligohydramnios  Reduced amount (<300ml)  Fetal renal failure

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