Physiology of pregnancy


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Physiology of pregnancy

  1. 1. Physiology of pregnancy
  2. 2. Definition of pregnancy <ul><li>Pregnancy is defined as the course of embryo and fetal growth and development in uterine </li></ul><ul><li>It begain at the fertilization and end the delivery of the fetal and it’s attachment </li></ul>
  3. 3. Definition of fertilazation <ul><li>Fertilization is defined as the course of combination of the oocyte and sperm </li></ul><ul><li>It onset 12h after ovulation usually in ampulla of the oviduct(fallopian tube) </li></ul>
  4. 4. The Development of the fertilizated egg <ul><li>3 days after ovulation, the morula (early blast)is fomulated </li></ul><ul><li>4 days after ovulation, the late blast is fomulated </li></ul><ul><li>6-7 days after ovulation, the egg imbeds in the uterus </li></ul>
  5. 5. The stage of egg imbed <ul><li>Apposition </li></ul><ul><li>Adhesion </li></ul><ul><li>Penetration </li></ul>
  6. 6. The necessary conditions of imbed <ul><li>Disapearing of the pellucid zone </li></ul><ul><li>Syntrophoblast formed from the blast </li></ul><ul><li>Synchronizing development of blast and the endometriun </li></ul><ul><li>P Secretory enough </li></ul>
  7. 7. Changes of endometrium after the egg imbed <ul><li>The endometrium changes into dicedua </li></ul><ul><li>Basal decidua </li></ul><ul><li>Capsular decidua </li></ul><ul><li>True decidua </li></ul>
  8. 8. Attachment of the fetal <ul><li>Placenta </li></ul><ul><li>Fetal membranes </li></ul><ul><li>Umbilical cord </li></ul><ul><li>Amniotic fluid </li></ul>
  9. 9. placenta <ul><li>It’s an exchange organ between maternal and fetal </li></ul><ul><li>Amniotic membrane </li></ul><ul><li>chorion frondosum </li></ul><ul><li>Basal decidua </li></ul>
  10. 10. chorion frondosum <ul><li>13-21 days after ovulation, villi fomulating gradually </li></ul><ul><li>Grade I viili </li></ul><ul><li>Grade II Iviili </li></ul><ul><li>Grade III viili </li></ul>
  11. 11. Structure of placenta <ul><li>Round </li></ul><ul><li>Weight:450-650g </li></ul><ul><li>Diameter:16-20cm </li></ul><ul><li>Thickness:1-3cm </li></ul><ul><li>thick in center and thin in margin </li></ul>
  12. 12. Function of placenta <ul><li>One important function of placenta is substance exchange between maternal and fetal </li></ul>
  13. 13. <ul><li>The position of exchange is VSM(vasculo-syncytial membrane) </li></ul><ul><li>VSM is comprised of </li></ul><ul><li>Syntrophoblastocyte </li></ul><ul><li>Basal membrane of Syntrophoblastocyte </li></ul><ul><li>Stroma of villi </li></ul><ul><li>Basal membrane of capillary </li></ul><ul><li>Endothelium of capillary </li></ul>
  14. 14. <ul><li>The way of substance exchange </li></ul><ul><li>Simple diffusion </li></ul><ul><li>Facilitated diffusion </li></ul><ul><li>Active transportion </li></ul><ul><li>phagocytosis </li></ul>
  15. 15. <ul><li>The functions of placenta </li></ul><ul><li>Gas exchange </li></ul><ul><li>Suply of nutrition </li></ul><ul><li>Depletion of fetal product of metabolisn </li></ul><ul><li>Defense function </li></ul><ul><li>Hormone synthesis </li></ul><ul><li>Human chorionic gonadotropin(HCG) </li></ul><ul><li>Human placental lactogen(HPL) </li></ul><ul><li>Pregnancy specific  -glycoprotein(PS  1G) </li></ul><ul><li>Human chorionic thyrotropin(HCT) </li></ul><ul><li>Estrogen, P, Oxytocinase, heat stable alkaline </li></ul><ul><li>phosphatase(HSAP) </li></ul>
  16. 16. <ul><li>Fetal membrane </li></ul><ul><li>Chorion </li></ul><ul><li>Amnion </li></ul><ul><li>Umbilical cord </li></ul><ul><li>Length:30-70cm average:50cm </li></ul><ul><li>Consist of 2 artery and 1 vein </li></ul>
  17. 17. <ul><li>Amniotic fluid </li></ul><ul><li>Source: early from serum dialysis </li></ul><ul><li>late fron fetal urine </li></ul><ul><li>Absorse: by fetal membrane, fetal </li></ul><ul><li>swallowing(500ml/day) </li></ul><ul><li>Amniotic exchange: between maternal </li></ul><ul><li>and fetal 400ml/h </li></ul>
  18. 18. <ul><li>Volume of amniotic fluid </li></ul><ul><li>8 weeks:5-10ml </li></ul><ul><li>10 weeks:30ml </li></ul><ul><li>20 weeks:400ml </li></ul><ul><li>38 weeks:1000ml </li></ul>
  19. 19. <ul><li>Status of amniotic fluid </li></ul><ul><li>pH : 7.20 </li></ul><ul><li>Density : 1.007-1.025 </li></ul><ul><li>Contained : water(98-99%) </li></ul><ul><li>inorganic substance </li></ul><ul><li>organic substance(1-2%) </li></ul>
  20. 20. The function of amniotic fluid Protect maternal and fetal
  21. 21. Maternal changes during pregnancy The maternal system may produce a series of changes in order to adapt to the needing of fetal growth and development influenceed by placenta hormone and neuro-endocrine
  22. 22. Changes of reproductive system Uterus Body: become enlargement and soft from 7×5 ×3cm pre-pregnancy to 35×25 ×22cm at term Volume of uterus cavity: become enlargement from 5ml pre-pregnancy to 5000ml .at term
  23. 23. Weight: be increased from from 50g pre- pregnancy to 1000g at term Wall: become thickness and the thickist at mid- period from 1 cm pre-pregnancy to 2-2.5 cm at term Blood suply: blood flow increased significantly upto 500- 700ml/min ,increased 4-6 times and most of blood flow is transported to the placenta (80-85%)
  24. 24. Isthmus: be dialated and become soft from 1cm pre-pregnancy a portion of the uterus after 12 gestational weeks Cervix: be soft and coloration or stain secrete amount of mucus avoiding the uterus cavity suffer from infection
  25. 25. <ul><li>Changes of ovary </li></ul><ul><li>Stop ovulation </li></ul><ul><li>Corpus luteum formation and maintains for </li></ul><ul><li>10 weeks </li></ul><ul><li>And the function of corpus luteum is </li></ul><ul><li>substituted by the placenta </li></ul><ul><li>Corpus luteum atretic gradually after 3-4 </li></ul><ul><li>months gestation. </li></ul>
  26. 26. Changes of the circulation Heart border: become enlargement Heart rate: increased 10-15 beat per min at the late pregnancy Heart volume: increased 10% at the late pregnancy
  27. 27. Cardiac output Very important for fetal growth and development Incrased begain 10 weeks and upto the peak at 32 weeks 80ml/bp and keeps the level to the term pregancy
  28. 28. <ul><li>Blood pressure changes due to pregnancy </li></ul><ul><li>No obvious change in Systolic pressure </li></ul><ul><li>Mild decreased in diastolic pressure </li></ul><ul><li>Vein pressure </li></ul><ul><li>No significantly changes in Upper limb vein </li></ul><ul><li>pressure </li></ul><ul><li>Lower limb vein pressure increased because of </li></ul><ul><li>the disturbance of vein reflux </li></ul>
  29. 29. Changes of blood system Volume: increased (30-45% ) begain 6- 8 weeks and up to the peak at 32-34 weeks increased about 1500ml including plasma 1000ml and red cell 500ml
  30. 30. Changes of blood component Red cell: reticulocyte increased red cell decreased 3.6×1012(4.2×1012) Hb decreased 110g/L(130g/L) WBC: neutrophilic granulocyte increased lymphocyte mild increased no change in orther blood cells
  31. 31. Coagulation Hypercoagulability Factor ⅱⅴⅶ ⅷ Ⅸ ⅹ increased ESR increased significantly upto 100mm/h Plasma protein albumin decreased