32 - Physiology of Pregnancy Physiology Liu Wei Department...

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Unformatted text preview: Physiology of Pregnancy Physiology Liu Wei Department of Ob & Gy Renji hospital Normal Pregnancy Normal • • 1. 2. 3. 3. 4. Pregnancy The course that the embryo and the fetus grow in the maternal body fetus Stages of pregnancy Early pregnancy: ≤12 weeks Mid pregnancy: ≥13 weeks,≤27 weeks Mid Late pregnancy:≥28 weeks Term pregnancy:≥37 weeks,<42 weeks Term Formation of Embryo Formation • Fertilization 1. Place: oviduct (ampulla) 2. Process capacitation → acrosome reaction→ penetrate the zona pellucida→ second meiosis →zygote second Formation of Embryo Formation • 1. 1) Implantation requirement Disappear of zona pellucida pellucida Disappear 2) Formation of syncytiotrophoblast Formation syncytiotrophoblast 3) Synchronized development of Synchronized blastocyst and endometrium blastocyst 4) Adequate progesterone Adequate Formation of Embryo Formation 2. Process 1) morula (day 3) → enter uterine morula cavity (day 4) → early blastocyst→ late blastocyst (day 6-7) → implantation (day 2) location→ adherence→ penetration penetration Development of embryo and fetus Development • 1. 2. Definition embryo: ≤ 8 weeks embryo: weeks Fetus: ≥ 9 weeks, human shape Fetus: Development of embryo and fetus Development • 1. 1) 2) Physiology of fetus Circulation fetus ←→placenta←→ mater 1 umbilical vein (full of oxygen), umbilical 2 umbilical artery (lack of oxygen) oxygen) 3) Mixed blood (vein and artery) Development of embryo and fetus Development Development of embryo and fetus Development 2. Hematology 1) Erythropoiesis From yolk sac: 3 weeks From liver: 10 weeks From bone marrow and spleen: From term (90%) term EPO production: 32nd week Development of embryo and fetus Development 2) Fetal hemoglobin Fetal hemoglobin: early pregnancy Adult hemoglobin: 32nd week Term: fetal type Hb 25% 3) White cells Leukocytes: 8 week Lymphocytes (antibody production): 12 Lymphocytes week, thymus and spleen week, Development of embryo and fetus Development 3. Gastrointestinal tract 1) drink amniotic fluid: 4th month 2) no proteolytic activity 3) enzymatic deficiencies in liver: enzymatic bilirubin is not easy to be clear. bilirubin Development of embryo and fetus Development 4. Kidney Its function begins at 11-14th week Its 5) Endocrinology 1) Fetal thyroid: the first endocrine Fetal gland (6th week), synthesize gland thyroxine at 12th week thyroxine 2) Fetal adrenal cortex: widen (20th week), a fetal zone. synthesize steroid hormones (E3, liver placenta mater) mater) Placenta Placenta • Structure 1. Primary villus syncytiotrophoblast cytotrophoblast cytotrophoblast 2. Secondary villus 3. third class vilus fetal capillary enter the stroma Placenta Placenta • Function 1. metabolism 1) Exchange of O2 and CO2 2) Exchange of nutritive factors and Exchange waste waste 2. Defensive Limited. IgG, virus, drug Limited. Placenta Placenta 3. 1) 2) 3) 4) 5) 6) 4. Endocrine HCG HPL E P Oxytocinase Cytokines and Growth Factors Immunity tolerance Fetal membranes Fetal • Structure chorion and amnion chorion • Amnion A double-layered translucent membrane membrane Become distended with fluid Become Umbilical Cord Umbilical • Structure amnion, yolk sac, one vein, two artery and Wharton jelly artery • Length 30-70cm 30-70cm Amniotic fliud Amniotic • Source 1. exudation of fetal membranes exudation (early pregnancy) (early 2. Fetal urine 3. Fetal lung 4. Exudation of amnion and fetal Exudation skin skin Amniotic fliud Amniotic • Absord 1. Fetal membrane 2. Umbilical cord 3. Fetal skin 4. Fetal drinking • Feature 1000-1500ml at 36th-38th week (peak), transparent → slightly turbid Amniotic Fliud Amniotic • Function 1. Protect fetal move freely, warm move 2. Protect mater prevent infection prevent Physiologic changes in pregnant woman Physiologic • 1. 1) 2) 3) 4) 5) Genital organs Uterus capacity: 5ml-5000ml.weight: 50g1000g Hypertrophy of muscle cells Endometrium→decidua: basal decidua: decidua, capsular decidua, true decidua decidua Contraction: Braxton Hicks Isthmus uteri: 1cm→ 7-10cm Physiologic changes in pregnant woman Physiologic 6) Cervix: colored 7) Ovary: placenta replaces ovary (10th week) week) 8) Vagina: dilated and soft, pH↓(antibacteri bacteria) 9) Ligaments: relaxed Physiologic changes in pregnant woman Physiologic • Cardiovascular system 1. Heart: move upward, hypertrophy of cardiac muscle cardiac 2. Cardiac Output Cardiac increase by 30%, reach to peak at 32nd –34th week 32 3. Blood pressure early or mid pregnancy Bp↓.late early late pregnancy Bp↑ .Supine hypotensive syndrome syndrome Physiologic changes in pregnant woman Physiologic • 1. 1) 2) 2. 1) 2) 3) 4) 4) Hematology Blood volume Increase by 30%-45% at 32nd –34th (peak) (peak) Relatively diluted Composition Red cells Hb:130→110g/L, HCT:38%→ 31%. Hb:130 White cells: slightly increase Coagulating power of blood: ↑ Coagulating Albumin: ↓,35 g/L Albumin: ↓, Physiologic changes in pregnant woman Physiologic • 1. 2. 3. 4. 5. 5. The Respiratory system R rate: slightly ↑ rate: vital capacity: no change Tidal volume: ↑ 40% Tidal Functional residual capacity:↓ O2 consumption: ↑ 20% Physiologic changes in pregnant woman Physiologic • 1. 1) 2) The urinary system Kidney Renal plasma flow (RFP):↑35% Glomerular filtration rate (GFR):↑ 50% 50% 2. Ureter Dilated (P↑) Dilated 3. Bladder Frequent micturation Frequent Physiologic changes in pregnant woman Physiologic • Gastrointestinal system 1) Gastric emptying time is Gastric prolonged→ nausea. prolonged 2) The motility of large bowel is 2) The diminished → constipation 3) Liver function: unchanged Liver Physiologic changes in pregnant woman Physiologic • 1. 1) 2) 3) 2. 1) 2) Endocrine Pituitary (hypertrophy) LH/FSH: ↓ LH/FSH: PRL:↑ TSH and ACTH:↑ Thyroid enlarged (TSH and HCG↑) thyroxine↑ and TBG↑ → free T3 T4 unchanged unchanged END END ...
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