The document summarizes the physiological changes that occur in a woman's body during pregnancy across multiple body systems. In the reproductive system, the uterus increases dramatically in size from 70g to 1100g by term as the myocyte arrangement changes. Blood flow to the uterus and placenta increases substantially to support fetal growth. The cervix softens and other changes occur to facilitate delivery. Metabolic changes include increased weight gain of 12.5kg on average, water retention of 3.5L for the fetus and fluids, and increased protein, carbohydrate, fat, electrolyte and mineral needs to support the growing fetus and maternal reserves. Hematological changes include a 40-45% increase in blood volume by the third trimester
Gametogenesis is the process by which germ cells undergo meiosis and differentiation to form gametes. Primordial germ cells migrate to the developing gonads, where they differentiate into male or female gametes. In females, primordial germ cells become oogonia then oocytes through oogenesis. In males, they become spermatogonia and undergo spermatogenesis to become spermatozoa. Both processes involve mitosis, meiosis, and cellular changes to produce haploid gametes from diploid germ cells. Fertilization restores the diploid number through the union of male and female gametes.
Genetics is the study of genes, heredity, and inherited traits. Medical genetics deals with genetic causes of human diseases. The document discusses several types of chromosomal abnormalities including trisomies like Down syndrome, Edwards syndrome, and Patau syndrome. It also discusses sex chromosome abnormalities such as Turner syndrome, Klinefelter syndrome, and other conditions. Structural abnormalities of chromosomes including deletions, duplications, translocations, and microdeletions are also summarized. Chromosomal abnormalities are a major cause of genetic diseases and pregnancy complications.
The perineum is the diamond-shaped region between the pelvic outlet and the thighs. It is divided into an anterior urogenital triangle and a posterior anal triangle by an imaginary line between the ischial tuberosities. The anal triangle contains the external anal sphincter and is supplied by the inferior rectal branches of the pudendal nerve. The urogenital triangle contains erectile tissue that forms the clitoris or penis, as well as muscles and glands. The main blood supply is from the internal pudendal artery and its branches, while lymphatic drainage involves the superficial and deep inguinal nodes as well as internal iliac nodes.
The document summarizes the anatomy of the abdominal wall and abdominal viscera. It describes the layers of the abdominal wall from the skin to the peritoneum. It details the five anterolateral muscles - external oblique, internal oblique, transversus abdominis, rectus abdominis, and pyramidalis. It also discusses the innervation, blood supply, and lymphatic drainage of the abdominal wall. Finally, it summarizes the peritoneal folds including the omenta, mesenteries, and ligaments that support the abdominal organs.
Embryology is the study of the complex process of development from a single cell to a baby. It includes investigations of the molecular, cellular, and structural factors that contribute to organism formation. The first 8 weeks of human development is called embryogenesis, where organs form. From then until birth is the fetal period. Studying causes of birth defects is called teratology. There are approximately 23,000 genes in the human genome, but gene expression is regulated at several levels, including transcription, messenger RNA, and translation, which results in over 5 times as many proteins. Organ formation involves induction, where one group of cells causes another to change fate, and competence, the ability to respond. Many interactions occur between epithelial and me
The document provides information on fetal imaging techniques including sonography. It discusses:
1. How sonography is used in prenatal care to evaluate fetal anatomy and detect abnormalities in the first and second trimesters.
2. How digital ultrasound produces real-time images of the fetus, amniotic fluid, and placenta using sound wave reflections.
3. Guidelines that ultrasound exposure should be limited to medical purposes and that current evidence does not demonstrate adverse effects in humans from diagnostic ultrasound.
4. Evaluation of fetal anatomy including the brain, spine, heart, face and neck during the second and third trimesters and common abnormalities that can be detected through ultrasound.
The pelvic floor is formed by the pelvic diaphragm and the perineal membrane. The pelvic diaphragm consists of the levator ani and coccygeus muscles, which attach superiorly to the pelvic wall. The levator ani muscles originate from the pelvic wall and join together in the midline, forming a U-shaped defect anteriorly. The coccygeus muscles are triangular shaped and overlie the sacrum and coccyx. The perineal membrane is a thick fascia attached to the pubic arch, with a thin space above it called the deep perineal pouch containing muscles and vessels. The perineal body is a connective
The document summarizes key stages in human fertilization and early embryonic development. It describes:
1) How sperm capacitation and the acrosome reaction allow sperm to penetrate the zona pellucida and fuse with the egg.
2) The formation of pronuclei and how the zygote undergoes cell division to become a morula and then a blastocyst.
3) The process of blastocyst implantation in the uterine lining and how trophoblast cells mediate attachment to the endometrium.
Gametogenesis is the process by which germ cells undergo meiosis and differentiation to form gametes. Primordial germ cells migrate to the developing gonads, where they differentiate into male or female gametes. In females, primordial germ cells become oogonia then oocytes through oogenesis. In males, they become spermatogonia and undergo spermatogenesis to become spermatozoa. Both processes involve mitosis, meiosis, and cellular changes to produce haploid gametes from diploid germ cells. Fertilization restores the diploid number through the union of male and female gametes.
Genetics is the study of genes, heredity, and inherited traits. Medical genetics deals with genetic causes of human diseases. The document discusses several types of chromosomal abnormalities including trisomies like Down syndrome, Edwards syndrome, and Patau syndrome. It also discusses sex chromosome abnormalities such as Turner syndrome, Klinefelter syndrome, and other conditions. Structural abnormalities of chromosomes including deletions, duplications, translocations, and microdeletions are also summarized. Chromosomal abnormalities are a major cause of genetic diseases and pregnancy complications.
The perineum is the diamond-shaped region between the pelvic outlet and the thighs. It is divided into an anterior urogenital triangle and a posterior anal triangle by an imaginary line between the ischial tuberosities. The anal triangle contains the external anal sphincter and is supplied by the inferior rectal branches of the pudendal nerve. The urogenital triangle contains erectile tissue that forms the clitoris or penis, as well as muscles and glands. The main blood supply is from the internal pudendal artery and its branches, while lymphatic drainage involves the superficial and deep inguinal nodes as well as internal iliac nodes.
The document summarizes the anatomy of the abdominal wall and abdominal viscera. It describes the layers of the abdominal wall from the skin to the peritoneum. It details the five anterolateral muscles - external oblique, internal oblique, transversus abdominis, rectus abdominis, and pyramidalis. It also discusses the innervation, blood supply, and lymphatic drainage of the abdominal wall. Finally, it summarizes the peritoneal folds including the omenta, mesenteries, and ligaments that support the abdominal organs.
Embryology is the study of the complex process of development from a single cell to a baby. It includes investigations of the molecular, cellular, and structural factors that contribute to organism formation. The first 8 weeks of human development is called embryogenesis, where organs form. From then until birth is the fetal period. Studying causes of birth defects is called teratology. There are approximately 23,000 genes in the human genome, but gene expression is regulated at several levels, including transcription, messenger RNA, and translation, which results in over 5 times as many proteins. Organ formation involves induction, where one group of cells causes another to change fate, and competence, the ability to respond. Many interactions occur between epithelial and me
The document provides information on fetal imaging techniques including sonography. It discusses:
1. How sonography is used in prenatal care to evaluate fetal anatomy and detect abnormalities in the first and second trimesters.
2. How digital ultrasound produces real-time images of the fetus, amniotic fluid, and placenta using sound wave reflections.
3. Guidelines that ultrasound exposure should be limited to medical purposes and that current evidence does not demonstrate adverse effects in humans from diagnostic ultrasound.
4. Evaluation of fetal anatomy including the brain, spine, heart, face and neck during the second and third trimesters and common abnormalities that can be detected through ultrasound.
The pelvic floor is formed by the pelvic diaphragm and the perineal membrane. The pelvic diaphragm consists of the levator ani and coccygeus muscles, which attach superiorly to the pelvic wall. The levator ani muscles originate from the pelvic wall and join together in the midline, forming a U-shaped defect anteriorly. The coccygeus muscles are triangular shaped and overlie the sacrum and coccyx. The perineal membrane is a thick fascia attached to the pubic arch, with a thin space above it called the deep perineal pouch containing muscles and vessels. The perineal body is a connective
The document summarizes key stages in human fertilization and early embryonic development. It describes:
1) How sperm capacitation and the acrosome reaction allow sperm to penetrate the zona pellucida and fuse with the egg.
2) The formation of pronuclei and how the zygote undergoes cell division to become a morula and then a blastocyst.
3) The process of blastocyst implantation in the uterine lining and how trophoblast cells mediate attachment to the endometrium.
The embryonic stage occurs from 3-8 weeks of development. During this stage, the three germ layers (ectoderm, mesoderm, endoderm) give rise to major organ systems. By the end of the embryonic period, the main organ systems are established. The ectoderm forms the central nervous system and skin/hair/nails. Neural crest cells migrate from the ectoderm to form many structures. The mesoderm forms muscles, bones, and the circulatory system. The endoderm forms the lining of the digestive tract and respiratory system. Neurulation occurs during the third week, forming the neural tube which will become the brain and spinal cord.
This document summarizes the processes of gametogenesis and ovulation. It discusses folliculogenesis, from primordial follicles to the pre-ovulatory development of the dominant follicle. The luteal phase and corpus luteum formation after ovulation is also described. Finally, it provides an overview of the hormonal regulation of the menstrual cycle by the hypothalamic-pituitary-ovarian axis, and the correlated endometrial changes through the proliferative, secretory and menstrual phases.
- Amniotic fluid serves several important roles in fetal development including allowing movement, swallowing, breathing and protecting the fetus.
- The normal volume of amniotic fluid increases throughout pregnancy reaching around 800mL by the mid-third trimester. Abnormally low (oligohydramnios) or high (hydramnios) volumes can occur.
- Hydramnios, which complicates 1-2% of pregnancies, has many potential causes including fetal anomalies, diabetes or infections. It can lead to pregnancy complications like cesarean delivery. Oligohydramnios also has various causes like renal abnormalities and medications and is associated with adverse outcomes such as pulmonary hypoplasia
Teratology is the study of birth defects and their causes. Some key points:
- Around 5% of newborns have a detectable birth defect, though the cause is unknown for 70% of cases. Less than 1% are due to medications.
- Teratogens are agents that cause permanent changes to embryonic or fetal development, and can cause malformations (teratogen), altered growth (trophogen), or interference with organ maturation (hadegen).
- Studying teratogenicity in humans is difficult due to ethical concerns, so animal studies are also used but not definitive. Counseling women exposed to potential teratogens is important to avoid anxiety.
The pelvis consists of bones that form the pelvic cavity and outlet. The bones include the sacrum, coccyx, and two innominate bones formed from the fusion of the ilium, pubis, and ischium. These bones articulate at the sacroiliac joints and pubic symphysis. The pelvic cavity contains organs and is divided into the lesser pelvis and greater pelvis. The pelvic outlet is bounded by ligaments and muscles and contains three apertures.
The document summarizes the development of the digestive system from the primitive gut tube. It describes how the gut tube is divided into the foregut, midgut, and hindgut. It explains how each section develops and gives rise to different parts of the digestive system. It also discusses the rotation and folding of the midgut and how the mesenteries that suspend the gut tube from the body wall develop and change throughout this process.
The document summarizes key developments during the 2nd week (days 8-13) of embryonic development:
- By day 8, the blastocyst is partially embedded and cells in the cytotrophoblast migrate and fuse to form the syncytiotrophoblast. The embryoblast also differentiates into the hypoblast and epiblast layers.
- By days 11-12, the blastocyst is completely embedded and the syncytiotrophoblast forms lacunar spaces that connect to maternal blood sinusoids, establishing uteroplacental circulation. Extraembryonic mesoderm also develops.
- By day 13, the implantation site has usually healed and the trophoblast develops villous structures
The pituitary gland lies at the base of the brain and coordinates many endocrine glands. It has an anterior and posterior lobe. The anterior lobe secretes hormones like TSH, ACTH, LH, and FSH which respond to signals from the hypothalamus. The posterior lobe stores and releases oxytocin and vasopressin from nerve cell bodies in the hypothalamus. The anterior pituitary contains five major cell types that secrete different hormones like growth hormone, prolactin, and gonadotropins.
This document summarizes several abdominal organs:
- The stomach is J-shaped and located in the epigastric, umbilical and hypochondrium regions. It has sections including the cardia, fundus, body, and pyloric part.
- The small intestine consists of the duodenum, jejunum, and ileum. The duodenum is C-shaped and adjacent to the pancreas. The jejunum is in the left upper quadrant and the ileum is in the right lower quadrant.
- The large intestine extends from the ileum to the anus. It includes the cecum, appendix, colon, rectum, and anal canal.
The document summarizes key aspects of renal and urinary system anatomy and physiology. It describes the basic unit of the kidney, the nephron, and its components including the glomerulus and tubules. It explains renal circulation and the mechanisms of glomerular filtration, tubular reabsorption and secretion. Specific topics covered include regulation of sodium, water, glucose, potassium and urea, as well as the roles of diuretics and hormones like vasopressin and erythropoietin. The document concludes with descriptions of urine transport through the ureters and bladder filling and emptying during urination.
The document summarizes various abnormalities that can occur during labour and their management. It discusses prolonged latent phase of labour, poor progress in the active phase, meconium staining of amniotic fluid, prolonged second stage of labour, vacuum extraction, fetal distress, cord prolapse, and shoulder dystocia. For each issue, it provides details on how to assess and manage the situation, including administering drugs, changing positioning, accelerating delivery, or transferring to a hospital if needed. The goal is to safely resolve any problems and deliver a healthy baby.
The respiratory system develops from the foregut. Around 4 weeks, lung buds appear and expand into the trachea and bronchi. Cartilage develops from pharyngeal arches while epithelium comes from endoderm. The trachea and lungs separate from the esophagus. Bronchial branching occurs through interactions between endoderm and surrounding mesoderm. Alveoli continue developing through pregnancy and after birth as surfactant production increases, allowing for breathing. Postnatally, alveoli and bronchioles continue multiplying to mature the lungs.
The abdominal aorta supplies the abdomen with blood vessels that branch into three main arteries:
(1) The celiac trunk which branches further into the left gastric, splenic, and common hepatic arteries.
(2) The superior mesenteric artery which supplies the small intestine and branches into jejunal, ileal, and colic arteries.
(3) The inferior mesenteric artery which supplies the descending colon, sigmoid colon, and rectum through branches like the left colic and superior rectal arteries.
Venous drainage of the abdominal organs is carried by the portal vein, formed by the union of the splenic and superior mesenteric veins. It delivers blood to the liver
The document summarizes key aspects of fetal and placental development from 8 weeks gestation through birth. It describes how the fetus grows in length and weight over time. The placenta facilitates nutrient and gas exchange between mother and fetus. As pregnancy progresses, the placenta enlarges and the fetal membranes thin to increase exchange. The umbilical cord contains the vessels connecting the fetus and placenta. Amniotic fluid volume increases throughout pregnancy, providing cushioning and allowing fetal movement.
The posterior abdominal region contains several important structures. The lumbar vertebrae and sacrum form the bony framework in the midline. The psoas major and minor muscles cover the sides of the lumbar vertebrae and attach to the femur. The quadratus lumborum muscles fill the space between rib 12 and the iliac crest laterally. The suprarenal glands are located superior to each kidney within the perinephric fat. Major blood vessels include the abdominal aorta, which bifurcates into the common iliac arteries at L4, and the inferior vena cava, which returns blood to the heart. Nerves in the region include the sympathetic trunks and splanchnic
1. The document discusses fetal maturity and intrauterine growth restriction (IUGR), including definitions, clinical symptoms, signs, biochemical markers, and fetal maturity tests. Fetal maturity tests assess surfactant levels in amniotic fluid to predict risk of respiratory distress syndrome in newborns.
2. IUGR is defined as fetal weight below the 10th percentile and can be symmetric or asymmetric, early or late onset. It increases risks of complications. Management depends on gestational age and Doppler ultrasound results, with delivery generally between 34-37 weeks.
3. There is no worldwide consensus on specific management strategies for IUGR, and guidelines from organizations like RCOG and ACOG have some differences.
The cardiovascular system develops from progenitor heart cells that migrate to form the primary heart field (PHF). The PHF forms the atria, left ventricle and most of the right ventricle. The secondary heart field (SHF) forms the remainder of the right ventricle and outflow tract. These cells cluster to form the cardiogenic region and blood islands, which unite to form the heart tube. As the heart tube elongates due to SHF cell addition, it bends to form the cardiac loop. Septa then form to divide the heart into chambers, while cushions form valves and vessels. At birth, circulatory changes occur as the ductus arteriosus and foramen ovale close due
The document summarizes the development of the urogenital system from the early embryonic stages through fetal development. It describes how the urinary and genital systems develop from a common ridge in the intermediate mesoderm and initially share a common cavity, the cloaca. It then details the development of the pronephros, mesonephros, and metanephros kidney systems. It discusses the development of the permanent kidney from the metanephric mesoderm and ureteric bud. It also summarizes the development of the bladder, urethra, gonads, genital ducts, and external genitalia in both males and females.
This document discusses how various diseases can affect drug pharmacokinetics and metabolism. It covers effects of gastrointestinal, cardiac, renal, liver and thyroid disorders. Key points include:
- Renal and liver diseases can significantly impact drug absorption, distribution, metabolism and excretion. Dose adjustments are often needed.
- Cardiac failure can alter drug distribution and decrease elimination due to reduced hepatic and renal perfusion.
- Monitoring drug levels can help optimize therapy for individual patients, especially when inter-individual variability is high or clinical effects are difficult to assess. Close monitoring of response is important when prescribing for patients with organ dysfunction.
The document summarizes key aspects of the cardiovascular system, including:
- The heartbeat originates from the cardiac conduction system which spreads electrical impulses through the heart.
- Cardiac muscle cells have specialized action potentials and gap junctions allow rapid spread of depolarization.
- The electrocardiogram records electrical activity and can detect arrhythmias and other abnormalities.
- The heart pumps blood through two main cycles, atrial systole which fills the ventricles followed by ventricular systole which pumps blood out of the heart into the arteries.
- Cardiac output, heart sounds, and pressure changes throughout the heart are also summarized.
This document discusses the physiological changes that occur during pregnancy to promote maternal health and support fetal development. It covers changes in various body systems including the reproductive, cardiovascular, respiratory, renal, gastrointestinal, endocrine, integumentary, and musculoskeletal systems. Key changes include increased blood volume and cardiac output, skin pigmentation, weight gain, and adaptations in organs and tissues to accommodate the growing fetus. The document provides information on signs and symptoms of pregnancy and details nutritional needs that increase to support the demands of pregnancy.
This document summarizes the normal physiological changes that occur during pregnancy across multiple body systems. It discusses changes in the reproductive, cardiovascular, respiratory, gastrointestinal, urinary, skeletal, endocrine and other systems. The purpose of these changes is to support the development of the fetus and meet its metabolic demands. Key adaptations include increased blood volume, cardiac output and respiration. The document provides detailed information on the stages of uterine growth and positioning of the fetus over the course of pregnancy.
The embryonic stage occurs from 3-8 weeks of development. During this stage, the three germ layers (ectoderm, mesoderm, endoderm) give rise to major organ systems. By the end of the embryonic period, the main organ systems are established. The ectoderm forms the central nervous system and skin/hair/nails. Neural crest cells migrate from the ectoderm to form many structures. The mesoderm forms muscles, bones, and the circulatory system. The endoderm forms the lining of the digestive tract and respiratory system. Neurulation occurs during the third week, forming the neural tube which will become the brain and spinal cord.
This document summarizes the processes of gametogenesis and ovulation. It discusses folliculogenesis, from primordial follicles to the pre-ovulatory development of the dominant follicle. The luteal phase and corpus luteum formation after ovulation is also described. Finally, it provides an overview of the hormonal regulation of the menstrual cycle by the hypothalamic-pituitary-ovarian axis, and the correlated endometrial changes through the proliferative, secretory and menstrual phases.
- Amniotic fluid serves several important roles in fetal development including allowing movement, swallowing, breathing and protecting the fetus.
- The normal volume of amniotic fluid increases throughout pregnancy reaching around 800mL by the mid-third trimester. Abnormally low (oligohydramnios) or high (hydramnios) volumes can occur.
- Hydramnios, which complicates 1-2% of pregnancies, has many potential causes including fetal anomalies, diabetes or infections. It can lead to pregnancy complications like cesarean delivery. Oligohydramnios also has various causes like renal abnormalities and medications and is associated with adverse outcomes such as pulmonary hypoplasia
Teratology is the study of birth defects and their causes. Some key points:
- Around 5% of newborns have a detectable birth defect, though the cause is unknown for 70% of cases. Less than 1% are due to medications.
- Teratogens are agents that cause permanent changes to embryonic or fetal development, and can cause malformations (teratogen), altered growth (trophogen), or interference with organ maturation (hadegen).
- Studying teratogenicity in humans is difficult due to ethical concerns, so animal studies are also used but not definitive. Counseling women exposed to potential teratogens is important to avoid anxiety.
The pelvis consists of bones that form the pelvic cavity and outlet. The bones include the sacrum, coccyx, and two innominate bones formed from the fusion of the ilium, pubis, and ischium. These bones articulate at the sacroiliac joints and pubic symphysis. The pelvic cavity contains organs and is divided into the lesser pelvis and greater pelvis. The pelvic outlet is bounded by ligaments and muscles and contains three apertures.
The document summarizes the development of the digestive system from the primitive gut tube. It describes how the gut tube is divided into the foregut, midgut, and hindgut. It explains how each section develops and gives rise to different parts of the digestive system. It also discusses the rotation and folding of the midgut and how the mesenteries that suspend the gut tube from the body wall develop and change throughout this process.
The document summarizes key developments during the 2nd week (days 8-13) of embryonic development:
- By day 8, the blastocyst is partially embedded and cells in the cytotrophoblast migrate and fuse to form the syncytiotrophoblast. The embryoblast also differentiates into the hypoblast and epiblast layers.
- By days 11-12, the blastocyst is completely embedded and the syncytiotrophoblast forms lacunar spaces that connect to maternal blood sinusoids, establishing uteroplacental circulation. Extraembryonic mesoderm also develops.
- By day 13, the implantation site has usually healed and the trophoblast develops villous structures
The pituitary gland lies at the base of the brain and coordinates many endocrine glands. It has an anterior and posterior lobe. The anterior lobe secretes hormones like TSH, ACTH, LH, and FSH which respond to signals from the hypothalamus. The posterior lobe stores and releases oxytocin and vasopressin from nerve cell bodies in the hypothalamus. The anterior pituitary contains five major cell types that secrete different hormones like growth hormone, prolactin, and gonadotropins.
This document summarizes several abdominal organs:
- The stomach is J-shaped and located in the epigastric, umbilical and hypochondrium regions. It has sections including the cardia, fundus, body, and pyloric part.
- The small intestine consists of the duodenum, jejunum, and ileum. The duodenum is C-shaped and adjacent to the pancreas. The jejunum is in the left upper quadrant and the ileum is in the right lower quadrant.
- The large intestine extends from the ileum to the anus. It includes the cecum, appendix, colon, rectum, and anal canal.
The document summarizes key aspects of renal and urinary system anatomy and physiology. It describes the basic unit of the kidney, the nephron, and its components including the glomerulus and tubules. It explains renal circulation and the mechanisms of glomerular filtration, tubular reabsorption and secretion. Specific topics covered include regulation of sodium, water, glucose, potassium and urea, as well as the roles of diuretics and hormones like vasopressin and erythropoietin. The document concludes with descriptions of urine transport through the ureters and bladder filling and emptying during urination.
The document summarizes various abnormalities that can occur during labour and their management. It discusses prolonged latent phase of labour, poor progress in the active phase, meconium staining of amniotic fluid, prolonged second stage of labour, vacuum extraction, fetal distress, cord prolapse, and shoulder dystocia. For each issue, it provides details on how to assess and manage the situation, including administering drugs, changing positioning, accelerating delivery, or transferring to a hospital if needed. The goal is to safely resolve any problems and deliver a healthy baby.
The respiratory system develops from the foregut. Around 4 weeks, lung buds appear and expand into the trachea and bronchi. Cartilage develops from pharyngeal arches while epithelium comes from endoderm. The trachea and lungs separate from the esophagus. Bronchial branching occurs through interactions between endoderm and surrounding mesoderm. Alveoli continue developing through pregnancy and after birth as surfactant production increases, allowing for breathing. Postnatally, alveoli and bronchioles continue multiplying to mature the lungs.
The abdominal aorta supplies the abdomen with blood vessels that branch into three main arteries:
(1) The celiac trunk which branches further into the left gastric, splenic, and common hepatic arteries.
(2) The superior mesenteric artery which supplies the small intestine and branches into jejunal, ileal, and colic arteries.
(3) The inferior mesenteric artery which supplies the descending colon, sigmoid colon, and rectum through branches like the left colic and superior rectal arteries.
Venous drainage of the abdominal organs is carried by the portal vein, formed by the union of the splenic and superior mesenteric veins. It delivers blood to the liver
The document summarizes key aspects of fetal and placental development from 8 weeks gestation through birth. It describes how the fetus grows in length and weight over time. The placenta facilitates nutrient and gas exchange between mother and fetus. As pregnancy progresses, the placenta enlarges and the fetal membranes thin to increase exchange. The umbilical cord contains the vessels connecting the fetus and placenta. Amniotic fluid volume increases throughout pregnancy, providing cushioning and allowing fetal movement.
The posterior abdominal region contains several important structures. The lumbar vertebrae and sacrum form the bony framework in the midline. The psoas major and minor muscles cover the sides of the lumbar vertebrae and attach to the femur. The quadratus lumborum muscles fill the space between rib 12 and the iliac crest laterally. The suprarenal glands are located superior to each kidney within the perinephric fat. Major blood vessels include the abdominal aorta, which bifurcates into the common iliac arteries at L4, and the inferior vena cava, which returns blood to the heart. Nerves in the region include the sympathetic trunks and splanchnic
1. The document discusses fetal maturity and intrauterine growth restriction (IUGR), including definitions, clinical symptoms, signs, biochemical markers, and fetal maturity tests. Fetal maturity tests assess surfactant levels in amniotic fluid to predict risk of respiratory distress syndrome in newborns.
2. IUGR is defined as fetal weight below the 10th percentile and can be symmetric or asymmetric, early or late onset. It increases risks of complications. Management depends on gestational age and Doppler ultrasound results, with delivery generally between 34-37 weeks.
3. There is no worldwide consensus on specific management strategies for IUGR, and guidelines from organizations like RCOG and ACOG have some differences.
The cardiovascular system develops from progenitor heart cells that migrate to form the primary heart field (PHF). The PHF forms the atria, left ventricle and most of the right ventricle. The secondary heart field (SHF) forms the remainder of the right ventricle and outflow tract. These cells cluster to form the cardiogenic region and blood islands, which unite to form the heart tube. As the heart tube elongates due to SHF cell addition, it bends to form the cardiac loop. Septa then form to divide the heart into chambers, while cushions form valves and vessels. At birth, circulatory changes occur as the ductus arteriosus and foramen ovale close due
The document summarizes the development of the urogenital system from the early embryonic stages through fetal development. It describes how the urinary and genital systems develop from a common ridge in the intermediate mesoderm and initially share a common cavity, the cloaca. It then details the development of the pronephros, mesonephros, and metanephros kidney systems. It discusses the development of the permanent kidney from the metanephric mesoderm and ureteric bud. It also summarizes the development of the bladder, urethra, gonads, genital ducts, and external genitalia in both males and females.
This document discusses how various diseases can affect drug pharmacokinetics and metabolism. It covers effects of gastrointestinal, cardiac, renal, liver and thyroid disorders. Key points include:
- Renal and liver diseases can significantly impact drug absorption, distribution, metabolism and excretion. Dose adjustments are often needed.
- Cardiac failure can alter drug distribution and decrease elimination due to reduced hepatic and renal perfusion.
- Monitoring drug levels can help optimize therapy for individual patients, especially when inter-individual variability is high or clinical effects are difficult to assess. Close monitoring of response is important when prescribing for patients with organ dysfunction.
The document summarizes key aspects of the cardiovascular system, including:
- The heartbeat originates from the cardiac conduction system which spreads electrical impulses through the heart.
- Cardiac muscle cells have specialized action potentials and gap junctions allow rapid spread of depolarization.
- The electrocardiogram records electrical activity and can detect arrhythmias and other abnormalities.
- The heart pumps blood through two main cycles, atrial systole which fills the ventricles followed by ventricular systole which pumps blood out of the heart into the arteries.
- Cardiac output, heart sounds, and pressure changes throughout the heart are also summarized.
This document discusses the physiological changes that occur during pregnancy to promote maternal health and support fetal development. It covers changes in various body systems including the reproductive, cardiovascular, respiratory, renal, gastrointestinal, endocrine, integumentary, and musculoskeletal systems. Key changes include increased blood volume and cardiac output, skin pigmentation, weight gain, and adaptations in organs and tissues to accommodate the growing fetus. The document provides information on signs and symptoms of pregnancy and details nutritional needs that increase to support the demands of pregnancy.
This document summarizes the normal physiological changes that occur during pregnancy across multiple body systems. It discusses changes in the reproductive, cardiovascular, respiratory, gastrointestinal, urinary, skeletal, endocrine and other systems. The purpose of these changes is to support the development of the fetus and meet its metabolic demands. Key adaptations include increased blood volume, cardiac output and respiration. The document provides detailed information on the stages of uterine growth and positioning of the fetus over the course of pregnancy.
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
The document summarizes key anatomical, physiological, and clinical aspects of the postpartum period known as the puerperium. It describes changes that occur in the vagina, uterus, cervix, breasts, blood, and other organs in the weeks following childbirth. These include uterine involution, endometrial regeneration, breastfeeding, weight loss, and the establishment of lactation and contraception. The summary provides an overview of the postpartum recovery process for new mothers.
RENAL and ALIMENTARY CHANGES IN PREGNANCY.pptxXavier875943
The document discusses changes to the renal and gastrointestinal systems during pregnancy. Key changes include increased kidney size and blood flow leading to higher glomerular filtration rate. Hormonal changes cause fluid retention and lower blood pressure. In the GI system, hormones cause increased reflux and salivation while relaxing the esophageal sphincter. The liver produces more bile and enzymes while the gallbladder's motility decreases, raising gallstone risk. Pregnancy displaces the organs which affects testing and symptoms.
Prenatal physiotherapy aims to achieve a healthy mother and baby by the end of pregnancy. During pregnancy, the mother's body undergoes many physiological changes in preparation for childbirth. These changes include increased blood volume, weight gain, skin pigmentation, joint laxity due to hormones, and enlarged organs like the uterus and breasts. Proper antenatal care and physiotherapy can help support these changes and promote overall maternal and fetal health.
PHYSIOLOGICAL CHANGES DURING PREGNANCY.pdf80DhwaniShah
This document summarizes various physiological changes that occur during pregnancy across multiple body systems. It discusses increased cutaneous pigmentation, breast changes, weight gain, increased blood volume, changes in metabolism of iron, proteins, carbohydrates and lipids, hematological changes including increased red blood cell mass and decreased hematocrit, and immune system modulation away from cytotoxic responses. The document provides detailed information on the timing and extent of changes in each system to support the normal development of the fetus during pregnancy.
Diagnosis of pregnancy and physiologic change during(1)Engidaw Ambelu
This document provides an overview of pregnancy diagnosis and physiologic changes during pregnancy. It begins with definitions of pregnancy terms and outlines methods for diagnosing pregnancy, including presumptive, probable, and positive signs and tests. The document then discusses the effects of pregnancy on specific organs like the uterus, cervix, and vagina. It concludes by summarizing systemic changes including increased blood volume, cardiovascular changes, respiratory changes, urinary changes, and more. The document comprehensively covers both local changes to reproductive organs and broader physiologic adaptations pregnancy requires.
A normal pregnancy lasts about 40 weeks or 280 days. During this time, the fertilized egg implants in the uterus and develops into a fetus. The woman's body undergoes many physiological changes to support the growing fetus. These include enlargement and thickening of the uterus; increased blood volume, cardiac output and iron levels; and softening of tissues in preparation for childbirth. The fetus is nourished through the placenta and surrounded by amniotic fluid and membranes within the uterus.
Physiological changes in pregnancy include increased blood volume, cardiac output, and respiration. The uterus grows significantly to accommodate the fetus, while other systems like renal and endocrine adapt to support the demands of pregnancy. Diagnosis involves tests to detect hCG in urine or blood from very early pregnancy, and ultrasound to visualize the developing fetus.
The document provides an overview of the physiological changes that occur throughout the maternal body during pregnancy. Key changes discussed include:
- Uterine growth and changes to support fetal development.
- Increased cardiac output, blood volume, and vascular changes to support nutrient/waste exchange between mother and fetus.
- Respiratory changes like increased tidal volume to support oxygen demands.
- Renal changes like increased GFR and kidney size to excrete wastes and support calcium/electrolyte balance.
- Metabolic changes to support fetal growth including increased lipids, proteins, and iron.
- Skin changes like line striae and pigmentation due to hormonal influences.
- Central nervous
New born baby and adjustment to extra uterineraveen mayi
The document summarizes the physiological adjustments that newborn babies undergo after birth as they transition from fetal to extra-uterine life. It discusses changes in major body systems like respiratory, circulatory, thermoregulation and others. The most critical changes are in establishing independent breathing and circulation as the placenta is no longer providing oxygen and removing carbon dioxide. Other key adjustments include thermoregulation, fluid and electrolyte balance, and development of digestive and renal functions.
New born baby and adjustment to extra uterineraveen mayi
This document summarizes the physiological adjustments that newborn babies undergo after birth as they transition from intrauterine to extrauterine life. It discusses changes in major body systems including respiratory, circulatory, thermoregulation, gastrointestinal, renal, integumentary, musculoskeletal, and neurological systems. The summary focuses on how newborns must quickly establish independent breathing and circulation after losing placental support, as well as how their immature organs such as the liver and kidneys impact fluid balance, temperature regulation and other functions in the first days of life.
Physiological changes in puerperium normal puerperium.pptxNeharikaKumari5
The document summarizes the anatomical and physiological changes that occur during the postpartum period known as the puerperium. Key points include: the puerperium lasts around 6 weeks as the reproductive organs return to their non-pregnant state (involution); the uterus decreases rapidly in size from 1000g immediately after delivery to 50g by 6 weeks; lactation is initiated by withdrawal of progesterone and estrogen allowing prolactin to stimulate milk production; oxytocin triggers milk ejection in response to suckling.
Physiological and psychosocial adaptations to pregnancySangeetha Francis
The document summarizes the physiological and psychosocial adaptations that occur during pregnancy. Physiologically, the reproductive, cardiovascular, respiratory, and endocrine systems undergo changes to support the developing fetus. This includes uterine growth, increased blood volume, hormonal changes, and metabolic adaptations. Psychosocially, both parents must accept their new roles, establish relationships with the fetus, and prepare for childbirth while adjusting personal relationships and daily routines. Proper nutrition, hygiene, exercise, and stress management are also important for maternal well-being during this period of adaptation.
The document summarizes several changes that occur in the body during pregnancy. In the respiratory system, the chest expands and the diaphragm is elevated due to the growing uterus. This can cause shortness of breath. The kidneys and bladder are also affected, with increased urinary frequency. Digestion is slowed, causing constipation, heartburn, and nausea in early pregnancy. Weight gain averages 12.5 kg by term, and joints loosen in preparation for birth. Skin pigmentation and vascular changes like linea nigra and palmar erythema also occur due to hormonal influences.
physiological changes during pregnancy
effect of pregnancy on physiological functions during pregnancy
cardiovascular, respiratory and hormonal changes
Shifa Riaz
gynecology
obstetrics
females
physiological effects on different systems of body during pregnancyshifanoor4
The document summarizes various physiological changes that occur during pregnancy across multiple body systems. Key changes include:
- Increased blood volume, cardiac output, and respiratory rate to support growth of the fetus and placenta.
- Softening of ligaments and joints due to relaxin to accommodate birth.
- Enlargement and changes in position of organs like the uterus, kidneys, and breasts to make room for the growing fetus.
- Increased progesterone and estrogen levels impacting muscles, metabolism, and other functions to sustain pregnancy.
- Common symptoms like nausea and back pain emerge from these systemic adaptations during each trimester.
Pregnancy causes many physiological changes in a woman's body to support the growth of the fetus. These include changes to the breasts, skin, genitals, weight gain and water retention, hematological and cardiovascular systems, metabolism, and more. The document discusses these changes in detail to provide an overview of the normal adaptations a woman's body undergoes during pregnancy.
Fetal monitoring aims to assess fetal wellbeing during pregnancy and labor. This document provides guidelines for interpreting cardiotocography (CTG) traces and responding to patterns. CTGs should consider gestational age, fetal growth, movements, and any conditions affecting fetal wellbeing. Antenatally, reduced fetal movements or abnormal fundal height measurements may warrant further assessment. During labor, CTG is recommended for high-risk pregnancies and can identify non-reassuring patterns like late decelerations indicating possible hypoxia. Interpretation requires evaluating baseline rate, variability, decelerations, and accelerations in the context of the clinical situation.
This document provides guidance on antenatal care. It discusses the importance of preconception care, screening and risk assessment during pregnancy, and the essential components of antenatal visits. The goals of antenatal care are to ensure the best outcomes for women and babies by screening for problems, assessing risk, treating issues, providing medications and information. Key aspects covered include taking a medical history, conducting physical exams, estimating gestation, performing essential screening tests, discussing medications and vaccines, creating a management plan, and covering topics for subsequent routine prenatal visits.
This document provides guidelines for preventing mother-to-child transmission of HIV (PMTCT) in antenatal care settings. There are four key elements of PMTCT care: primary HIV prevention, preventing unintended pregnancies among HIV+ women, preventing transmission from mother to child, and treatment/support for HIV+ women and their families. The goals of PMTCT in antenatal care are to identify all HIV+ women, provide same-day ART to optimize health and prevent transmission, and ensure viral suppression through treatment. All pregnant women should be tested for HIV and receive counseling. HIV+ women initiate lifelong ART regardless of CD4 count or clinical stage, while HIV- women receive repeat testing during pregnancy and breastfeeding.
This document provides guidance on performing and managing caesarean deliveries. It discusses:
- The need for caesarean delivery capabilities 24/7 at district hospitals and ability to perform emergency c-sections within 1 hour.
- Testing fetal lung maturity before elective c-sections if gestational age is uncertain.
- Preparation steps like consent, blood availability, and ensuring an experienced surgeon.
- Precautions against hemorrhage like oxytocin administration and careful surgical technique.
- Managing hemorrhage through measures like massaging the uterus, giving uterotonics, exploring for bleeding sources, and considering compression sutures.
- Postoperative orders around analgesia, fluids, thrombosis
Induction of labour is the artificial initiation of labour to achieve a vaginal delivery. Common indications include post-term pregnancy, hypertension disorders, and pre-labour rupture of membranes. The document discusses assessing the need for induction and balancing risks to the mother and baby. It provides guidance on methods for induction including membranes sweeping, prostaglandins, misoprostol, and oxytocin administration. Risks like uterine hyperstimulation are addressed. Special considerations for fetal demise, ruptured membranes, and scarred uteruses are also covered.
This document provides guidance on diagnosing and treating infections during pregnancy and the postpartum period. It discusses abnormal vaginal discharge, sexually transmitted infections like candidiasis, gonorrhea, chlamydia and trichomoniasis. It also addresses genital warts, ulcers, syphilis, urinary tract infections, acute pyelonephritis, and malaria. For each condition, it describes signs and symptoms, recommended testing, and treatment guidelines. It emphasizes treating sexually transmitted infections syndromically and the importance of notifying partners for examination and treatment.
This document provides guidelines for managing medical disorders in pregnancy, including anemia, diabetes mellitus, and cardiac disease. For anemia, it outlines screening, prevention, and treatment protocols. It describes gestational and pregestational diabetes and their management. For cardiac disease, it discusses referral criteria and managing labor and delivery for high-risk patients. The overall aim is to provide optimal care for both mother and baby's health outcomes.
1) Tuberculosis (TB) is a major cause of maternal mortality in South Africa. All pregnant women, especially those with HIV, should be screened for TB at antenatal visits.
2) Symptom screening involves asking about cough, fever, night sweats, and weight loss. A TB test (GeneXpert) is also required for pregnant women with new HIV diagnoses or known HIV.
3) If TB is diagnosed, treatment should begin promptly according to national guidelines. For drug-resistant TB, consultation with infectious disease specialists is recommended due to high mortality risk.
1) Bleeding in early pregnancy, defined as before 22 weeks, can be caused by miscarriage, ectopic pregnancy, molar pregnancy, or other issues. A rapid assessment including vital signs and exam is needed.
2) Miscarriages are categorized as safe, unsafe, threatening, inevitable, incomplete, or septic and management depends on the category and gestational age. Manual vacuum aspiration is preferred for evacuating the uterus under 16 weeks.
3) Post-miscarriage care involves screening for physical and mental health issues, providing counseling and information, and discussing family planning options.
Pregnant and postpartum women with COVID-19 should receive supportive care. While pregnant women are not more likely to get infected, those who do contract COVID-19, especially in the third trimester, are at higher risk of severe outcomes. COVID-19 testing criteria are the same for pregnant women as non-pregnant adults. Preventative measures include vaccination, masks, distancing, and hygiene. COVID-19 vaccination is recommended in pregnancy to protect both mother and baby. Mild cases can be isolated at home but moderate or severe cases require hospital admission. Mode of delivery depends on obstetric needs and maternal stability.
This document provides guidance on the management of antepartum haemorrhage (APH), or bleeding during pregnancy prior to delivery. It discusses causes of APH including placental abnormalities, infections, trauma, and unknown causes. It provides recommendations for emergency management at clinics, community health centers, and hospitals. Specific guidance is given for managing placenta praevia, abruptio placentae, and APH of unknown origin. Recommendations include IV fluids, blood transfusions, ultrasound exams, monitoring vital signs, and determining need for transfer or delivery.
Hypertensive disorders in pregnancy (HDP) are a common cause of maternal and infant health problems and death. HDP include gestational hypertension, preeclampsia, and eclampsia. Risk factors include being young, older than 35, having previous HDP, obesity, diabetes, or kidney disease. Symptoms of severe preeclampsia include headaches, vision issues, low platelets, elevated liver enzymes, pain in the upper right abdomen, HELLP syndrome, or high creatinine. All pregnant people should take calcium and those at higher risk may benefit from low-dose aspirin. HDP requires frequent monitoring, control of blood pressure, delivery by 38 weeks for gestational hypertension or earlier for pre
This document discusses gender-based violence and provides guidance for health workers in responding to GBV. It begins by defining GBV and noting that 1 in 4 women in South Africa experience GBV during pregnancy. It then outlines the negative health impacts of untreated GBV for women and children. The document describes possible signs that a woman is experiencing violence and provides a screening tool for health workers. It provides guidance on first line support, safety planning, and self-care for health workers responding to disclosures of GBV.
The document discusses how the fetus is able to survive as a semi-allograft within the mother's uterus despite having different genetic material. It was first proposed in 1953 that the fetus is able to evade maternal immune detection through lack of fetal antigen expression or maternal lymphocyte suppression. The document then explores various mechanisms by which the fetal-maternal interface avoids rejection, including lack of MHC class I expression on trophoblast cells, shifts in maternal immune cell profiles toward anti-inflammatory responses, and expression of inhibitory ligands on trophoblasts. Immune cells in both the peripheral maternal system and local decidua are adapted to tolerate the semi-allogeneic fetus through these various mechanisms.
This document discusses various fetal disorders, focusing on fetal anemia, hydrops fetalis, and thrombocytopenia. It describes the main causes of fetal anemia as red blood cell alloimmunization and various infections. Doppler evaluation and fetal blood sampling are used to identify and monitor anemia. Left untreated, anemia can lead to heart failure, hydrops, and death. However, intrauterine transfusions have dramatically improved survival rates. Hydrops fetalis refers to fluid accumulation and can result from immune or nonimmune causes. For immune hydrops, the main cause is red blood cell alloimmunization, while aneuploidy and infections are common nonimmune causes. Thrombocytopenia can
This document provides an overview of prenatal diagnosis. It discusses how major congenital abnormalities are identified in 2-3% of pregnancies and are a leading cause of infant death. Prenatal diagnosis aims to identify fetal malformations, disruptions, and genetic syndromes to improve counseling. Structural abnormalities can develop through malformation, deformation, or disruption. Neural tube defects are among the most common birth defects. Maternal serum screening for alpha-fetoprotein is an established screening test for neural tube defects. Advances in screening include first trimester screening using nuchal translucency and serum markers, as well as cell-free DNA screening. Sonographic screening can identify soft markers and structural abnormalities. Pregnancies at
3D and 4D sonography provide static or real-time 3D views of the fetus, respectively, but are not routinely used in standard exams. Doppler ultrasound evaluates blood flow in various fetal vessels like the umbilical artery, ductus arteriosus, uterine artery, middle cerebral artery, and ductus venosus to monitor fetal well-being. Abnormal flow patterns in these vessels can indicate conditions like fetal growth restriction. Fetal MRI provides superior anatomical images compared to ultrasound and can help further characterize abnormalities, guide fetal therapy, or assess complications in high-risk pregnancies.
This document discusses various techniques used to assess fetal well-being, including fetal heart rate, movement, breathing, and amniotic fluid production. It describes the clinical application of monitoring diminished fetal activity, fetal breathing patterns, contraction stress testing, nonstress testing, acoustic stimulation tests, and the biophysical profile. Doppler velocimetry of the umbilical artery, middle cerebral artery, and ductus venosus is also discussed as a way to determine fetal health and identify growth-restricted fetuses. Current recommendations are that no single test is best and testing should begin between 32-34 weeks depending on the prognosis for neonatal survival and severity of maternal disease.
This document summarizes key aspects of the host immune response to various types of infections. It describes both nonspecific resistance mechanisms like skin barriers and specialized immune cells, as well as adaptive immunity involving antibodies and T-cells. Specific pathways are discussed for bacterial, viral, fungal and parasitic infections. The immune system must recognize molecular patterns on infectious agents to mount an effective response, while some pathogens have developed ways to evade detection and clearance by the immune system through mechanisms like antigenic variation.
This document discusses autoimmune diseases from several perspectives. It notes that nearly 100 forms of autoimmune disease exist, affecting up to 3% of the population. Women are disproportionately affected, making up 75% of cases. Both genetic and environmental factors contribute to disease development. Autoimmunity, in which the immune system responds to self-antigens, is common and usually asymptomatic, whereas autoimmune disease causes inflammation and tissue damage. Treatment involves nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressants, biologic agents, and autologous stem cell transplantation in severe cases.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. Intro
• The anatomical, physiological, and biochemical adaptations to
pregnancy are profound.
• These remarkable changes begin soon after fertilization and most
occur in response to physiological stimuli provided by the fetus and
placenta
• Equally astounding is that the woman who was pregnant is returned
almost completely to her prepregnancy state after delivery and
lactation
• Many of these physiological adaptations could be perceived as
abnormal in the nonpregnant woman
3. REPRODUCTIVE TRACT
Uterus
• In the nonpregnant woman, the uterus weighs approximately 70g and
is almost solid, except for a cavity of 10mL or less
• During pregnancy, the uterus is transformed into a relatively thin-
walled muscular organ
• The total volume of the contents at term averages approximately 5L
but may be 20L or more
• The corresponding increase in is such that, by term, the organ weighs
nearly 1100 g.
4. REPRODUCTIVE TRACT
Myocyte Arrangement
• The uterine musculature during pregnancy is arranged in three strata
• The first is an outer hoodlike layer, which arches over the fundus and
extends into the various ligaments
• The middle layer is composed of a dense network of muscle fibers
perforated in all directions by blood vessels.
• Last is an internal layer, with sphincter-like fibers
5. REPRODUCTIVE TRACT
Uterine Size, Shape, and Position
• First few weeks, the uterus maintains its original piriform or pear
shape.
• But, as pregnancy advances, the corpus and fundus become more
globular and almost spherical by 12 weeks’ gestation
• Subsequently, the organ increases more rapidly in length than in
width and assumes an ovoid shape
• By the end of 12 weeks, the uterus has become too large to remain
entirely within the pelvis.
• With uterine ascent from the pelvis, it usually rotates to the right.
6. REPRODUCTIVE TRACT
Uterine Contractility
• Beginning in early pregnancy, the uterus undergoes irregular contractions
that are normally painless.
• During the second trimester, these contractions may be detected
• Because attention was first called to this phenomenon in 1872 by J.
Braxton Hicks, the contractions have been known by his name
• Such contractions appear unpredictably and sporadically and are usually
nonrhythmic
7. REPRODUCTIVE TRACT
Uteroplacental Blood Flow
• Delivery of most substances essential for fetal and placental growth,
metabolism, and waste removal is dependent on adequate perfusion
• Placental perfusion is dependent on total uterine blood flow
•
• Estimates range from 450 to 650 mL/min near term
• Uterine artery diameter doubled by 20 weeks and that concomitant mean
Doppler velocimetry was increased eightfold
8. REPRODUCTIVE TRACT
Cervix
• As early as 1 month after conception, the cervix begins to undergo
pronounced softening and cyanosis.
• These changes result from increased vascularity and edema, together
with hypertrophy and hyperplasia of the cervical glands
• Although the cervix contains a small amount of smooth muscle, its
major component is connective tissue
10. REPRODUCTIVE TRACT
Ovaries
• Ovulation ceases during pregnancy, and maturation of new follicles is
suspended.
• The single corpus luteum found in pregnant women functions
maximally during the first 6 to 7 weeks of pregnancy
• Diameter of the ovarian vascular pedicle increased during pregnancy
from 0.9 cm to approximately 2.6 cm at term
11. REPRODUCTIVE TRACT
Relaxin
• This protein hormone is secreted by the corpus luteum as well as the
decidua and the placenta in a pattern similar to that of human
chorionic gonadotropin (hCG)
• its secretion by the corpus luteum appears to play a key role in
facilitating many maternal physiological adaptations
•
• One of its biological actions appears to be remodeling of
reproductive-tract connective tissue to accommodate parturition
12. REPRODUCTIVE TRACT
Theca-Lutein Cysts
• These benign ovarian lesions result from exaggerated physiological follicle
stimulation—termed hyperreactio luteinalis
• Bilateral cystic ovaries are moderately to massively enlarged
• The reaction is usually associated with markedly elevated serum levels of
hCG
• And an exaggerated response of the ovaries to normal levels of circulating
hCG
13. REPRODUCTIVE TRACT
Fallopian Tubes
• Fallopian tube musculature undergoes little hypertrophy during pregnancy
• Rarely, the increasing size of the gravid uterus, especially in the presence of
paratubal or ovarian cysts, may result in fallopian tube torsion
Vagina and Perineum
• Increased vascularity and hyperemia develop in the skin and muscles of the
perineum and vulva, with softening of the underlying abundant connective
tissue
• The vaginal walls undergo striking changes including a considerable
increase in mucosal thickness, loosening of the connective tissue, and
smooth muscle cell hypertrophy
14. BREASTS
• In the early weeks of pregnancy, women often experience breast
tenderness and paresthesias
• After the second month, the breasts increase in size, and delicate veins
become visible just beneath the skin.
• The nipples become considerably larger, more deeply pigmented, and more
erectile
• During the same months, the areolae become broader and more deeply
pigmented.
16. SKIN
• Beginning after mid pregnancy, reddish, slightly depressed streaks
commonly develop in the abdominal skin and sometimes in the skin over
the breasts and thighs
• Hyperpigmentation: This develops in up to 90 percent of women.
• It is usually more accentuated in those with a darker complexion
• Occasionally, irregular brownish patches of varying size appear on the face
and neck, giving rise to chloasma or melasma gravidarum—the so-called
mask of pregnancy
17. Vascular Changes
• Angiomas, called vascular spiders, develop in approximately two
thirds of white women and approximately 10 % of black women.
• The condition is often designated as nevus, angioma, or telangiectasis
• Palmar erythema is encountered during pregnancy in approximately
two thirds of white women and one third of black women
• These two conditions are of no clinical significance and disappear in
most women shortly after pregnancy
18. METABOLIC CHANGES
• In response to the increased demands of the rapidly growing fetus
and placenta, the pregnant woman undergoes metabolic changes
that are numerous and intense
• By the third trimester, maternal basal metabolic rate is increased by
10 to 20 percent compared with that of the nonpregnant state
• This is increased by an additional 10 percent in women with a twin
gestation
19. Weight Gain
• Most of the normal increase in weight during pregnancy is
attributable to the uterus and its contents, the breasts, and increases
in blood volume and extravascular extracellular fluid
• A smaller fraction results from metabolic alterations that increase
accumulation of cellular water, fat, and protein—so called maternal
reserve
• Hytten (1991) reported that the average weight gain during
pregnancy is approximately 12.5 kg
20.
21.
22. Water Metabolism
• Increased water retention is a normal physiological alteration of pregnancy
• It is mediated, at least in part, by a fall in plasma osmolality of
approximately 10 mOsm/kg induced by a resetting of osmotic thresholds
for thirst and vasopressin secretion
• At term, the water content of the fetus, placenta, and amnionic fluid
approximates 3.5 L.
• Another 3.0 L accumulates from increases in maternal blood volume and in
the size of the uterus and breasts.
23. Protein Metabolism
• The products of conception, the uterus, and maternal blood are
relatively rich in protein rather than fat or carbohydrate
• At term, the fetus and placenta together weigh about 4kg and contain
approximately 500g of protein, or about half of the total pregnancy
increase
• The remaining 500g is added to the uterus as contractile protein, to
the breasts primarily in the glands, and to maternal blood as
hemoglobin and plasma proteins
• Amino acid concentrations are higher in the fetal than in the maternal
compartment
24. Carbohydrate Metabolism
• Normal pregnancy is characterized by mild fasting hypoglycemia,
postprandial hyperglycemia, and hyperinsulinemia
• This increased basal level of plasma insulin in normal pregnancy is
associated with several unique responses to glucose ingestion
• Pregnancy-induced state of peripheral insulin resistance, the purpose
of which is likely to ensure a sustained postprandial supply of glucose
to the fetus
• Insulin sensitivity in late normal pregnancy is 45 to 70 percent lower
than that of nonpregnant women
25. Fat Metabolism
• The concentrations of lipids, lipoproteins, and apolipoproteins in
plasma increase appreciably during pregnancy
• Increased insulin resistance and estrogen stimulation during
pregnancy are responsible for the maternal hyperlipidemia
• Maternal hyperlipidemia is one of the most consistent and striking
changes of lipid metabolism during late pregnancy
• In nonpregnant humans, this peptide hormone is primarily secreted
by adipose tissue.
• It plays a key role in body fat and energy expenditure regulation.
26. Electrolyte and Mineral Metabolism
• Although there are increased total accumulations of sodium and
potassium, their serum concentrations are decreased slightly because of
expanded plasma volume
• Total serum calcium levels, which include both ionized and nonionized
calcium, decline during pregnancy
• Serum phosphate levels lie within the nonpregnant range
• Serum magnesium levels also decline during pregnancy
• Iodine requirements increase during normal pregnancy for several reasons
• With respect to most other minerals, pregnancy induces little change in
their metabolism other than their retention in amounts equivalent to those
needed for growth
27. HEMATOLOGICAL CHANGES
• Hypervolemia associated with normal pregnancy averages 40 to 45%
above the nonpregnant blood volume after 32 to 34 weeks
• Although more plasma than erythrocytes is usually added to the
maternal circulation, the increase in erythrocyte volume is
considerable and averages 450mL
• Because of great plasma augmentation, hemoglobin concentration
and hematocrit decrease slightly during pregnancy
29. Iron Metabolism
• The total iron content of normal adult women ranges from 2.0 to 2.5g, or
approximately half that found normally in men.
• Of the approximate 1000 mg of iron required for normal pregnancy, about
300 mg are actively transferred to the fetus and placenta, and another
200mg are lost through various normal excretion routes
• The average increase in the total circulating erythrocyte volume—about
450 mL—requires another 500 mg
• Because most iron is used during the latter half of pregnancy, the iron
requirement becomes large after midpregnancy and averages 6 to 7mg/day
• In most women, this amount is usually not available from iron stores.
• Thus, without supplemental iron, the optimal increase in maternal
erythrocyte volume will not develop
30. Immunological Functions
• Pregnancy is thought to be associated with suppression of various humoral
and cell-mediated immunological functions to accommodate the “foreign”
semiallogeneic fetal graft
• Pregnancy is both a proinflammatory and antiinflammatory condition,
depending upon the stage of gestation
• Pregnancy can be divided into three distinct immunological phases. First,
early pregnancy is proinflammatory. During implantation and placentation
• Midpregnancy is antiinflammatory. During this period of rapid fetal growth
and development
• Last, parturition is characterized by an influx of immune cells into the
myometrium to promote recrudescence of an inflammatory process
31. Coagulation and Fibrinolysis
• During normal pregnancy, both coagulation and fibrinolysis are augmented but
remain balanced to maintain hemostasis
• Evidence of activation includes increased concentrations of all clotting factors
except factors XI and XIII
• The clotting time of whole blood, however, does not differ significantly in normal
pregnant women
• During normal pregnancy, fibrinogen concentration increases approximately 50%
• Some of the pregnancy-induced changes in the levels of coagulation factors can
be duplicated by the administration of estrogen plus progestin contraceptive
tablets to nonpregnant women
32. Coagulation and Fibrinolysis
• Tissue plasminogen activator (tPA) converts plasminogen into
plasmin, which causes fibrinolysis and produces fibrin-degradation
products such as d-dimers
• Most evidence suggests that fibrinolytic activity is actually reduced in
normal pregnancy
• tPA activity gradually decreases during normal pregnancy
• Moreover, plasminogen activator inhibitor type 1 (PAI-1) and type 2
(PAI-2), which inhibit tPA and regulate fibrin degradation by plasmin,
increase during normal pregnancy
33. Platelets
• Normal pregnancy also involves platelet changes.
• The average platelet count was decreased slightly during pregnancy
to 213,000/μL compared with 250,000/μL in nonpregnant control
women
• Thrombocytopenia defined as below the 2.5th percentile
corresponded to a platelet count of 116,000/μL
• Decreased platelet concentrations are partially due to hemodilutional
effects.
• There likely also is increased platelet consumption, leading to a
greater proportion of younger and therefore larger platelets
34. Regulatory Proteins
• There are several natural inhibitors of coagulation, including proteins
C and S and antithrombin
• Inherited or acquired deficiencies of these and other natural
regulatory proteins— collectively referred to as thrombophilias
• During pregnancy, resistance to activated proteinC increases
progressively and is related to a concomitant decrease in free
proteinS and increase in factor VIII levels.
• Levels of antithrombin remain relatively constant throughout
gestation and the early puerperium
35. Spleen
• By the end of normal pregnancy, the spleen enlarges by up to 50%
compared with that in the first trimester
• The cause of this splenomegaly is unknown, but it might follow the
increased blood volume and/or the hemodynamic changes of
pregnancy
• Sonographically, the echogenic appearance of the spleen remains
homogeneous throughout gestation
36. CARDIOVASCULAR SYSTEM
• Changes in cardiac function become apparent during the first 8 weeks
of pregnancy
• Cardiac output is increased as early as the fifth week and reflects a
reduced systemic vascular resistance and an increased heart rate
• The resting pulse rate increases approximately 10 beats/min during
pregnancy
• Ventricular performance during pregnancy is influenced by both the
decrease in systemic vascular resistance and changes in pulsatile
arterial flow.
37.
38. Heart
• As the diaphragm becomes progressively elevated, the heart is
displaced to the left and upward and is rotated on its long axis
• Pregnant women normally have some degree of benign pericardial
effusion, which may increase the cardiac silhouette
• Normal pregnancy induces no characteristic electrocardiographic
changes other than slight left-axis deviation due to the altered heart
position.
• Many of the normal cardiac sounds are modified during pregnancy.
40. Heart
• Although it is widely held that there is physiological hypertrophy of
cardiac myocytes as a result of pregnancy, this has never been
absolutely proven
• Certainly for clinical purposes, ventricular function during pregnancy
is normal
• Normal indices are likely inaccurate when used to assess function in
pregnant women because they do not account for the spherical
eccentric hypertrophy characteristic of normal pregnancy
41. Cardiac Output
• Cardiac output at rest, when measured in the lateral recumbent
position, increases significantly beginning in early pregnancy
• Continues to increase and remains elevated during the remainder of
pregnancy
• Cardiac output at term to increase 1.2 L/min—almost 20 percent—
when a woman was moved from her back onto her left side
• Moreover, in the supine pregnant woman, uterine blood flow
estimated by Doppler velocimetry decreases by a third
• Upon standing, cardiac output falls to the same degree as in the
nonpregnant woman
43. Circulation and Blood Pressure
• Changes in posture affect arterial blood pressure.
• Brachial artery pressure when sitting is lower than that when in the
lateral recumbent supine position
• Arterial pressure usually decreases to a nadir at 24 to 26 weeks and
rises thereafter.
• Diastolic pressure decreases more than systolic
• The elevated venous pressure returns to normal when the pregnant
woman lies on her side and immediately after delivery
45. Renin, Angiotensin II, and Plasma Volume
• The renin-angiotensin-aldosterone axis is intimately involved in blood
pressure control via sodium and water balance
• All components of this system are increased in normal pregnancy
• Renin is produced by both the maternal kidney and the placenta, and
increased renin substrate (angiotensinogen) is produced by both
maternal and fetal liver
• The vascular responsiveness to angiotensin II may be progesterone
related
• Pregnant women lose their acquired vascular refractoriness to
angiotensin II within 15 to 30 minutes after the placenta is delivered
48. Acid–Base Equilibrium
• An increased awareness of a desire to breathe is common even early in
pregnancy
• This physiological dyspnea, which should not interfere with normal physical
activity, is thought to result from increased tidal volume that lowers the
blood Pco2 slightly
• Is likely induced in large part by progesterone and to a lesser degree by
estrogen.
• Progesterone appears to act centrally, where it lowers the threshold and
increases the sensitivity of the chemoreflex response to CO2
• To compensate for the resulting respiratory alkalosis, plasma bicarbonate
levels normally decrease from 26 to approximately 22 mmol/L
49. URINARY SYSTEM
• Kidney size increases approximately 1.5 cm
• The GFR increases as much as 25 percent by the second week after
conception and 50 percent by the beginning of the second trimester
• Primarily as a consequence of this elevated GFR, approximately 60
percent of women report urinary frequency during pregnancy
• Relaxin increases endothelin and nitric oxide production in the renal
circulation. This leads to renal vasodilation and decreased renal
afferent and efferent arteriolar resistance, with a resultant increase in
renal blood flow and GFR
51. Urinalysis
• Glucosuria during pregnancy may not be abnormal.
• The appreciable increase in GFR, together with impaired tubular
reabsorptive capacity for filtered glucose, accounts for most cases of
glucosuria
• About a sixth of pregnant women should spill glucose in the urine.
• Hematuria is often the result of contamination during collection. If not, it
most often suggests urinary tract disease.
• Proteinuria is typically defined in nonpregnant patients as a protein
excretion rate of more than 150 mg/day, significant proteinuria during
pregnancy is usually defined as a protein excretion rate of at least 300
mg/day
52. Measuring Urine Protein
• The three most commonly employed approaches for assessing proteinuria
are the qualitative classic dipstick, the quantitative 24-hour collection, and
the albumin/creatinine or protein/creatinine ratio
• The principal problem with dipstick assessment is that renal concentration
or dilution of urine is not accounted for
• The 24-hour urine collection is affected by urinary tract dilatation
• The protein/creatinine ratio is a promising approach because data can be
obtained quickly and collection errors are avoided.
• Disadvantageously, the amount of protein per unit of creatinine excreted
during a 24-hour period is not constant, and there are various thresholds.
53. Ureters
• After the uterus completely rises out of the pelvis, it rests on the
ureters, which laterally displaces and compresses them at the pelvic
brim
• Above this level, increased intraureteral tonus results, it to be greater
on the right side in 86% of women
• Ureteral elongation accompanies distention, and the ureter is
frequently thrown into curves of varying size, the smaller of which
may be sharply angulated
• That complication rates associated with ureteroscopy in pregnant and
nonpregnant patients do not differ significantly
54. GASTROINTESTINAL TRACT
• During pregnancy, the gums may become hyperemic and softened
and may bleed when mildly traumatized.
• This pregnancy gingivitis typically subsides postpartum
• Most evidence indicates that pregnancy does not incite tooth decay
• As pregnancy progresses, the stomach and intestines are displaced by
the enlarging uterus.
• Consequently, the physical findings in certain diseases are altered
• Pyrosis (heartburn) is common during pregnancy and is most likely
caused by reflux of acidic secretions into the lower esophagus
55. Liver
• Unlike in some animals, there is no increase in liver size during human
pregnancy
• Hepatic arterial and portal venous blood flow, however, increase
substantively
• Some laboratory test results of hepatic function are altered during
normal pregnancy, and some would be considered abnormal for
nonpregnant patient
• The serum albumin concentration decreases during pregnancy.
• During normal pregnancy, gallbladder contractility is reduced and
leads to increased residual volume
56. ENDOCRINE SYSTEM
• During normal pregnancy, the pituitary gland enlarges by
approximately 135%
• Maternal serum prolactin levels parallel the increasing size
• Gonadotrophs decline in number, and corticotrophs and thyrotrophs
remain constant
• By approximately 17 weeks, the placenta is the principal source of
growth hormone secretion
• Placental growth hormone—which differs from pituitary growth
hormone by 13 amino acid residues—is secreted by
syncytiotrophoblast in a nonpulsatile fashion
57. ENDOCRINE SYSTEM
• Placental growth hormone is a major determinant of maternal insulin
resistance after midpregnancy
• Maternal serum levels correlate positively with birthweight but negatively
with fetal-growth restriction and uterine artery resistance
• Maternal plasma prolactin levels increase markedly during normal
pregnancy, and concentrations are usually tenfold greater at term
• Levels of antidiuretic hormone, also called vasopressin, do not change
during pregnancy
• Physiological changes of pregnancy cause the thyroid gland to increase
production of thyroid hormones by 40 to 100 percent to meet maternal
and fetal need
59. Adrenal Glands
• The maternal adrenal glands undergo little, if any, morphological
change
• The serum concentration of circulating cortisol is increased, but much
of it is bound by transcortin, the cortisol binding globulin
• The adrenal secretion rate of this principal glucocorticoid is not
increased, and probably it is decreased compared with that of the
nonpregnant state
• The metabolic clearance rate of cortisol, however, is lower during
pregnancy because its half-life is nearly doubled compared with that
for nonpregnant women
60. MUSCULOSKELETAL SYSTEM
• Progressive lordosis is a characteristic feature of normal pregnancy
• Compensating for the anterior position of the enlarging uterus,
lordosis shifts the center of gravity back over the lower extremities
• The sacroiliac, sacrococcygeal, and pubic joints have increased
mobility during pregnancy
• Aching, numbness, and weakness also occasionally are experienced in
the upper extremities.
• This may result from the marked lordosis and associated anterior
neck flexion and shoulder girdle slumping, which produce traction on
the ulnar and median nerve
61. CENTRAL NERVOUS SYSTEM
• Changes in the central nervous center are relatively few and mostly subtle
• Women often report problems with attention, concentration, and memory
throughout pregnancy and the early puerperium.
• Rana and colleagues (2006) found that attention and memory were
improved in women with preeclampsia receiving magnesium sulfate
compared with normal pregnant women.
• Intraocular pressure decreases during pregnancy and is attributed in part
to increased vitreous outflow
• Beginning as early as approximately 12 weeks’ gestation and extending
through the first 2 months postpartum, women have difficulty with going
to sleep, frequent awakenings, fewer hours of night sleep, and reduced
sleep efficiency