This is PPT describing hormones that controls the total period of pregnancy and puerperium

1. Hormonal regulation system of
Pregnancy
Dr Bhaskar J Paul
Associate professor
Obstetrics and Gynaecology

2. Rational
Maternal changes in pregnancy
Hormones responsible for those
changes

3. Learning objectives
8.
Endocrine change
in mother
10. Changes in
maternal
circulation
12.Consequences
of pregnancy on
respiration
• Physiological
symptoms (13)
• How pregnancy
is detected (14)

4. A trigger !
A 26 years old G1P0 at 35
weeks of pregnancy came to
Antenatal clinic with the
complaint of sudden blackout
while getting up from the
couch
she has noticed increasing
spell of breathing difficulty
and feels her heart moves
faster for no obvious reason .
she feels burning sensation
below the ribs and she has
bowel motion every two days .
A clinical
scenario
Her pulse is 90 /m
BP : 100/70
Respiration rate : 24/m
Mild pedal edema
Cardiac sound : S1, S2 normal
Chest : normal to auscultation
How do you plan to manage
advise this lady ?
Your
response
?

5. Outliner
Hormones of the placenta
fetal adrenal gland
Changes in the various systems
Hormones of the labor and
lactation

6. Section 1.
• Hormones
of the
placenta .
• Fetal
adrenal
gland
.
• Diagnosis
of
pregnancy

7. • Hormones : Graffian follicle & ovulation
• Maintenance : Corpus luteum
• Hormones of placenta : Luteo-placental shift

8. Maturation of graffian follicle and
ovulation

9. Maintenance of corpus luteum after
fertilization

10. Placenta as main endocrine organ
Luteo- placental shift
• Corpus luteum
• Placenta
New power house !

11. EM view of the placenta

12. Hormones of Placenta

13. Hormones of the placenta
Peptides
Steroids
Growth factors

14. Protein hormones
• Human chorionic gonadotropin
• Human placental lactogen
• Growth Factors
• Early pregnancy factor (EPF)
• Pregnancy specific B 1 Glycoprotein
• Pregnancy associated plasma protein (PAPPA)

15. Human Chorionic Gonadotropin
• Glycoprotein
• Molecular weight : 36K-40K Dalton
• Hormone Nonspecific unit : alpha (92amino A)
• Hormone specific unit : Beta (145 amino A)

16. HCG : Function
Stimulus for
• Corpus luteum
• Leydig cells
• Immuno suppression
• Adrenal / placental steroidogenesis
• Maternal thyroid
• Relaxin from CL

17. HCG level at different periods of
pregnancy

18. Human Placental Lactogen
• HC somato mammotropin
• Syn cytiotrophoblast
• similar to GH , Prolactin
• 3rd week
• 5 to 25 micg/ml ( 36 wks)
• Plasma conc placental mass

20. Function of HPL
• Antagonize insulin
• Maternal lipolysis
• Angiogesis : fetal vasculature
• growth of breast lactation

21. Steroids
• Progesteron
• Estrogen

22. Progesteron
• Corpus luteum
• trophoblast
• cholesterol pregnenolone
• Pregnolone progesterone
3 B- OH dehydrogenase
• 250 mg

23. Plasma level of steroids

24. Estrogen
• Estriol (E3) Estradiol (E2)
• syncytiotrophoblast
• Precursor: fetal maternal
• Diczfalusy : maternal feto placental unit

26. Estrogen
What placenta does not have ?
17,20-lyase (CYP17)
C21 C19
• helped fetal adrenal gland .
What placenta has ?

27. Function
Progesterone
• Maintenance of pregnancy
• uterine growth
•
• endometrim decidua
• myometrial contraction
• Development of breast
• Lobulo alveolar system
Estrogen
• Maintenance of pregnancy
• Hypertrophy
hyperplasia
• accomodation
blood flow
Development of breast
• Hypertrophy
proliferation of duct

28. Function
Progesteron
• quiescence
• lysosomal membranes
• prostaglandin synthesis
• Immuno modulatory
Estrogen
• Sensitize myometrium to
oxytocin and prostaglandin
• Ripens the cervix

29. Both
• adaptation of the maternal organs
increasing demand growing fetus
• activity of gonadotropin –gonadal axis

30. Fetal adrenal Gland
• largest
• unique fetal zone. (85%)
100 to 200 mg/d
30 to 40 mg/day (A)

31. Conversion of lipo protein to
cholesterol

32. Diagnostic value of the placental
hormone
• Diagnosis of pregnancy : HCG
• trophoblastic tumors : HCG
• Feto- placental unit :
HPL
Estradiol

33. Section 2
Regulatory activity
• Metabolism
• System
• Gland

34. Carbohydrate Metabolism
• E3 accumulation of glycogen
• hPL insulin reistance
• maternal glucose
Feto-placental unit

35. Protein/ NA metabolism
Protein and nucleic acid metabolism
• E3 :synthesis
• P : catabolism
• 1 kg
• 50 % :fetus /placenta
• uterus, breast, maternal hemoglobin , plasma
protein

36. Lipid Metabolism
• Lipoprotein, apo lipoproteins
• Early pregnancy : fat storage
• Later pregnancy:
FFA
Triglyseride
cholesterol

37. Section 2
Individual system

39. Cardiac out put
• Blood
volume
• SVR
Stroke volume
• Progesterone
• Vasodilatory
(NO, ANP)
Systemic
vascular
resistance

41. Progesteron
Increase the
sensitivity of
chemoreceptor
to CO2
Increased
ventilation and
fall in arterial
pH
Respiratory
alkalosis

42. Renal system
• Renal calyces , pelvis,
ureters dilate • Mech. compression
• Progesteron :relaxation

43. Gastrointestinal system
lowered
• Sphincter tone
decreased
• Gastrointestinal
molity
decreased
• Gall bladder
contractility
• Progesteron

44. • Morning sickness
• NVP
• Constipation
• Bleeding gums
• Epulis gravidarum
• Hemorrhoids
• HCG, progesterone
• relaxed smooth muscle
• Mechanical obstruction
of colon
•
• venous pressure

45. Skin changes
• Vascular spiders
• Palmar erythema
• Hyper pigmentation
• Mask of pregnacy
• Circulating estrogen
• Estrogen and MSH

46. Breast changes
• enlarges 25 % -50 %
• Nipple larger
• Mobile
• Areola larger ,
pigmented
• Blood flow
• Estrogen :Ductal growth
• Progesteron : alveolar
hypertrophy

47. •Changes in the individual
glands

48. Thyroid gland
• Enlarges
• HCG : rise in T4
• E2 :TBG
• Total T4 and T3
• Free T3 and T4

49. Adrenal Gland
• Estrogen : CBG
• serum cortisol
• plasma cortisol
• ACTH
• aldosterone
• deoxycorticosterone
• maternal DHEA
increases

50. Pituitary gland
• 30 % wt
• GH
• Prolactin
• ACTH , CRH
• ADH
• FSH, LH

51. Others
• PTH normal
• Does not cross the
placenta
• Calcitonin
Parathyroid
• Hyperinsulinemia
• Anti-insulin factors
• HPL , leptinPancreas

52. Uterine contractility
• Estrogen • Progesteron

53. Section 3
•Hormones of labour &
lactation

54. Initiation of labour
Activation of
fetal HPA
ACTH
cortisol
Estrogen
Oxytocin from
maternal
pituitary

55. Hormones of the lactation
• ejection
•oxytocin
• maintenance
•Prolactin
• synthesis and
secretion
•prolactin
•preparation
•Estrogen : duct
formation
Mammogenesis lactogenesis
galactokinesisgalactopoiesis

56. Answer to our case
The reason for
sudden black
out
The reason for
breathing
difficulty
The reason for
heart burn and
constipation

57. Summary
• Hormones liberated after conception are
responsible for establishment and
maintenance of a successful pregnancy and
lactation.
• These hormones regulate and help in
adaptations of various maternal systems .
• It may produce certain vexing symptoms of
pregnancy, which is physiological and
disappears immediately after the delivery .

58. A teaser for the day !
What is the reason for
increasing cardiac
output in later half of
the pregnancy ?
Circulatory volume
Decreased PRMaternal heart rate
Stroke volume

59. Reference
Chapter 5, 207th edition
Charles Beckmann
Obstetrics and
Gynecology
Dr Fehmida lecture

60. .
Thank you