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Physiology of Pregnancy

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Physiology of Pregnancy

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  1. Physiology of Pregnancy Liu Wei Department of Ob & Gy Renji hospital

  2. Normal Pregnancy • Pregnancy The course that the embryo and the fetus grow in the maternal body • Stages of pregnancy • Early pregnancy: ≤12 weeks • Mid pregnancy: ≥13 weeks,≤27 weeks • Late pregnancy:≥28 weeks • Term pregnancy:≥37 weeks,<42 weeks

  3. Formation of Embryo • Fertilization • Place: oviduct (ampulla) • Process capacitation → acrosome reaction→ penetrate the zona pellucida→ second meiosis →zygote

  4. Formation of Embryo • Implantation • requirement • Disappear of zona pellucida • Formation of syncytiotrophoblast • Synchronized development of blastocyst and endometrium • Adequate progesterone

  5. Formation of Embryo • Process • morula (day 3) → enter uterine cavity (day 4) → early blastocyst→ late blastocyst (day 6-7) → implantation • location→ adherence→ penetration

  6. Development of embryo and fetus • Definition • embryo: ≤ 8 weeks • Fetus: ≥ 9 weeks, human shape

  7. Development of embryo and fetus • Physiology of fetus • Circulation • fetus ←→placenta←→ mater • 1 umbilical vein (full of oxygen), 2 umbilical artery (lack of oxygen) • Mixed blood (vein and artery)

  8. Development of embryo and fetus

  9. Development of embryo and fetus • Hematology • Erythropoiesis From yolk sac: 3 weeks From liver: 10 weeks From bone marrow and spleen: term (90%) EPO production: 32nd week

  10. Development of embryo and fetus • Fetal hemoglobin Fetal hemoglobin: early pregnancy Adult hemoglobin: 32nd week Term: fetal type Hb 25% • White cells Leukocytes: 8 week Lymphocytes (antibody production): 12 week, thymus and spleen

  11. Development of embryo and fetus • Gastrointestinal tract • drink amniotic fluid: 4th month • no proteolytic activity • enzymatic deficiencies in liver: bilirubin is not easy to be clear.

  12. Development of embryo and fetus • Kidney Its function begins at 11-14th week • Endocrinology • Fetal thyroid: the first endocrine gland (6th week), synthesize thyroxine at 12th week • Fetal adrenal cortex: widen (20th week), a fetal zone. synthesize steroid hormones (E3, liver placenta mater)

  13. Placenta • Structure • Primary villus syncytiotrophoblast cytotrophoblast • Secondary villus • third class vilus fetal capillary enter the stroma

  14. Placenta • Function • metabolism • Exchange of O2 and CO2 • Exchange of nutritive factors and waste • Defensive Limited. IgG, virus, drug

  15. Placenta • Endocrine • HCG • HPL • E • P • Oxytocinase • Cytokines and Growth Factors • Immunity tolerance

  16. Fetal membranes • Structure chorion and amnion • Amnion A double-layered translucent membrane Become distended with fluid

  17. Umbilical Cord • Structure amnion, yolk sac, one vein, two artery and Wharton jelly • Length 30-70cm

  18. Amniotic fliud • Source • exudation of fetal membranes (early pregnancy) • Fetal urine • Fetal lung • Exudation of amnion and fetal skin

  19. Amniotic fliud • Absord • Fetal membrane • Umbilical cord • Fetal skin • Fetal drinking • Feature 1000-1500ml at 36th-38th week (peak), transparent → slightly turbid

  20. Amniotic Fliud • Function • Protect fetal move freely, warm • Protect mater prevent infection

  21. Physiologic changes in pregnant woman • Genital organs • Uterus • capacity: 5ml-5000ml.weight: 50g-1000g • Hypertrophy of muscle cells • Endometrium→decidua: basal decidua, capsular decidua, true decidua • Contraction: Braxton Hicks • Isthmus uteri: 1cm→ 7-10cm

  22. Physiologic changes in pregnant woman • Cervix: colored • Ovary: placenta replaces ovary (10th week) • Vagina: dilated and soft, pH↓(anti-bacteri bacteria) • Ligaments: relaxed

  23. Physiologic changes in pregnant woman • Cardiovascular system • Heart: move upward, hypertrophy of cardiac muscle • Cardiac Output increase by 30%, reach to peak at 32nd –34th week • Blood pressure early or mid pregnancy Bp↓.late pregnancy Bp↑ .Supine hypotensive syndrome

  24. Physiologic changes in pregnant woman • Hematology • Blood volume • Increase by 30%-45% at 32nd –34th (peak) • Relatively diluted • Composition • Red cells Hb:130→110g/L, HCT:38%→ 31%. • White cells: slightly increase • Coagulating power of blood: ↑ • Albumin: ↓,35 g/L

  25. Physiologic changes in pregnant woman • The Respiratory system • R rate: slightly ↑ • vital capacity: no change • Tidal volume: ↑ 40% • Functional residual capacity:↓ • O2 consumption: ↑ 20%

  26. Physiologic changes in pregnant woman • The urinary system • Kidney • Renal plasma flow (RFP):↑35% • Glomerular filtration rate (GFR):↑ 50% • Ureter Dilated (P↑) • Bladder Frequent micturation

  27. Physiologic changes in pregnant woman • Gastrointestinal system • Gastric emptying time is prolonged→ nausea. • The motility of large bowel is diminished → constipation • Liver function: unchanged

  28. Physiologic changes in pregnant woman • Endocrine • Pituitary (hypertrophy) • LH/FSH: ↓ • PRL:↑ • TSH and ACTH:↑ • Thyroid • enlarged (TSH and HCG↑) • thyroxine↑ and TBG↑→ free T3 T4 unchanged

  29. END