Dr Ahmed El-Gendy

Journey of Pregnancy

By

Dr.Ahmed El-Gendy

Objectives What’s meant by pregnancy?

Fertilization and implantation

Placenta

Physiological changes in mother

Dr Ahmed El-Gendy

What’s Pregnancy? It’s a physiological condition in a child

bearing woman in which a growth of

fertilized ovum occur leading to full term

baby.

38-42 weeks

Three trimesters

Dr Ahmed El-Gendy

Sex Cycles in Females Ovarian cycle :

Maturation of primordial follicle = Graffian follicle.

ovulation: rupture of the follicle

It occurs at 14 th day of the cycle

Development of corpus luteum:

it secrete large amount of estrogen &progestrone.

Dr Ahmed El-Gendy

Dr Ahmed El-Gendy

Fate of Corpus Luteum

IF Pregnancy doesn’t

occur

the corpus luteum

degenerate

Menstruation

If Pregnancy occurs

The corpus luteum continues

to grow &secretes

hormones

Dr Ahmed El-Gendy

The fimbriae of the fallopian tube picks up the ovum

after its release in the peritoneal cavity during

ovulation.

Transport of The Ovum

Dr Ahmed El-Gendy

Dr Ahmed El-Gendy

Dr Ahmed El-Gendy

Pregnancy

Fertilization Fusion of the sperm with the

membrane of the ovum

fusion initiates cell division & zygote formation

Implantation IT occurs about 7 days after

ovulation

The ovum becomes embedded in the endometrium

The zygote takes its nutrition from the decidua

Dr Ahmed El-Gendy

The site of

fertilization:

Outer third of fallopian

tube

Time of

fertilization:

14 days after first day of

last menstruation

The site of

implantation:

The endometrium of

uterus

Time of

implantation:

1week after fertilization

Dr Ahmed El-Gendy

a- Fetal part: chorion (derived from trophoblast).

b- Maternal part: decidua.

Formation of the placenta

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1-Respiratory function.

2-Nutrition & metabolic function.

3-Excretory function.

4-Protective function.

5-Endocrine function of placenta.

Functions of the Placenta

Dr Ahmed El-Gendy

The placenta secretes: 1. Human chorionic gonadotropin (HCG)

2. Estrogen

3. Progesterone

4. Human chorionic somatotropin

5. Relaxin.

Dr Ahmed El-Gendy

Endocrine Functions of Placenta

HCG

Site of release:

syncitiotrophoblast

Start of secretion:

after one week from fertilization

Its peak:

12-16 week

Its measurement:

in urine and blood

Dr Ahmed El-Gendy

Function of HCG

1. It maintains the function of C.L for 12 weeks (secret

estrogen & progesterone to prepare all

reproductive system for baby and cause inhibition

of FSH and LH from pitutary-------- inhibit further

ovulation

2. Stimulates male fetal testis to secrete testosterone

(causes the testis to descend into scrotum).

3. To test for pregnancy

Dr Ahmed El-Gendy

Progesterone: from CL

and placenta

• Formation of decidual cells

• Inhibit uterine contraction

• In the Breast : stimulate

the growth of lobule

&secretary alveoli

• Increase secretion of

fallopian tube

Estrogen: from CL and

placenta

• Enlargement of the uterus

• Effect on breast:

growth of the duct

system

Dr Ahmed El-Gendy

Progesterone relaxes all smooth

muscles.

Responsible for many minor disorders:

Heart burn, constipation, fainting, backache, frequency of

micturation, varicose veins……..

• Estrogen causes salt and fluid

retention : oedema

Dr Ahmed El-Gendy

Human Chorionic Somatotropin Functions:

1. Lactogenic effect

2. Has anabolic effect on protein metabolism like growth hormone

3. Mobilize free fatty acids from stores of the mother to spare

glucose for fetal tissues

Dr Ahmed El-Gendy

Function:

1- Relaxation of the pelvic ligaments & joints.

2- uterine contractions.

Relaxin Hormone

Dr Ahmed El-Gendy

Response of the Mother Body to

Pregnancy 1. Weight gain by an average 12.5Kg. 2. Increased B M R due to excess metabolism of the fetus. 3. G. I .T changes:

• Some women have nausea &vomiting this is related to level of (HCG).

• Increased level of progesterone lead to decreased motility of G.I.T -------------Constipation.

• Appetite is usually increased, sometimes with specific cravings.

• Progesterone causes relaxation of the lower oesophageal sphincter and increased reflux, making many women prone to heartburn.

• Gums become spongy, friable and prone to bleeding. Good dental care is important.

• Pregnancy also predisposes to the precipitation of cholesterol gallstones.

Dr Ahmed El-Gendy

Dr Ahmed El-Gendy

Response of the Mother Body to

Pregnancy 4-Urinary tract : renal blood flow GFR

Increase pores-----Glucosuria and Proteinuria

Ureters stretches -----relax----stasis of urine and urinary tract infection (UTI)

Pressure of uterus on bladder-----frequent urination

Approximately 5% of pregnant women have bacteriuria, often asymptomatic, and there is a greater risk of developing pyelonephritis in pregnancy.

Increased water retention causes a reduction of plasma osmolality.

Dr Ahmed El-Gendy

5- Endocrine glands

Dr Ahmed El-Gendy

Dr Ahmed El-Gendy

Pituitary

Dr Ahmed El-Gendy

FSH/LH fall to low

levels.

ACTH and melanocyte-

stimulating hormone

increase.

Prolactin increases.

5- Endocrine glands

Serum calcium levels decrease in pregnancy, which stimulates an increase in parathyroid hormone (PTH). Colecalciferol (vitamin D3) is converted to its active metabolite, 1,25-dihydroxycolecalciferol, by placental 1α-hydroxylase.

Dr Ahmed El-Gendy

Parathormone Hormone &

Vitamin D3

5- Endocrine Glands

Response of the Mother Body to

Pregnancy

6-Hematological: • Increased blood volume----50%.

• Increased RBCs ----20%.

• Dilutional anaemia is caused by the rise in plasma volume. Elevated erythropoietin levels increase the total red cell mass by the end of the second trimester but haemoglobin concentrations never reach pre-pregnancy levels.

• A modest leukocytosis is observed.

• Increased need for iron about 1000 mg .

• Increased clotting factors(VII, VIII, IX and X) and fibrinogen increase

• Serum albumin decreases.

• Serum alkaline phosphatase increases during pregnancy - due to placental production.

•

.

Dr Ahmed El-Gendy

Response of the Mother Body to

Pregnancy

7-C.V.S: Heart rate (HR)

Stroke volume(SV)

Cardiac output(COP) increases by about 40%.

Edema in the lower extremities due to increased circulating angiotensin II .

Progesterone reduces systemic vascular resistance by about 20% early in pregnancy. Postural hypotension may result.

Diastolic and systolic blood pressure tend to fall during mid pregnancy and then return to normal by week 36.

Advise women not to take up unaccustomed, vigorous exercise in pregnancy as there is a risk of diversion of uterine blood flow to the skeletal muscles.

Dr Ahmed El-Gendy

Response of the Mother Body to

Pregnancy

8-Respiratory system: 40% in tidal volume

Decreased functional residual capacity.

The gravid uterus hinder the descent of diaphragm.

Dyspnea common complaint

Dr Ahmed El-Gendy

Tidal volume increases by about 200 ml, increasing vital capacity and decreasing residual volume. In later stages of pregnancy, splinting of the diaphragm may occur with some decrease in tidal volume. Respiratory rate does not alter significantly.

Increased oxygen consumption by approximately 20%.

State of compensated respiratory alkalosis - arterial pCO2 drops, arterial pO2 remains unchanged and decrease in bicarbonate prevents pH change. Lower maternal pCO2 facilitates oxygen/carbon-dioxide transfer to/from the fetus.

Dr Ahmed El-Gendy

8-Respiratory system

Response of the Mother Body to

Pregnancy

9- Metabolic Changes

Dr Ahmed El-Gendy

The basal metabolic rate increases slowly over the course of pregnancy, by 15-20%.

In women with normal BMIs, energy requirement does not increase significantly during the first trimester, increases by about 350 kcal/day in the second trimester and 500 kcal/day in the third.[7]

Active energy expenditure tends to fall over pregnancy.

Normal weight gain is approximately 12.5 kg (usually at a rate of 0.5 kg per week for the final 20 weeks). 5 kg is the fetus, placenta, membranes and amniotic fluid and the rest is maternal stores of fat and protein and increased intra- and extra-vascular volume.

10- Skin Changes

Dr Ahmed El-Gendy

Hyperpigmentation of the umbilicus, nipples,

abdominal midline (linea nigra) and face

(chloasma) are common due to the hormonal

changes of pregnancy.

Hyperdynamic circulation and high levels of

oestrogen may cause spider naevi and palmar

erythema.

Striae gravidarum ('stretch marks') are common.

11-Musculoskeletal Changes

Dr Ahmed El-Gendy

Increased ligamental laxity caused by increased levels of

relaxin contribute to back pain and pubic symphysis

dysfunction.

Shift in posture with exaggerated lumbar lordosis

leading to the typical gait of late pregnancy.

Integrated Medical Sciences :Shansa Prera , Stephen

Anderson, Ho Leung &Rousseau Gama , 2007 ,

pages 211-243

Dr Ahmed El-Gendy

References

1. Jamjute P, Ahmad A, Ghosh T, et al; Liver function test and pregnancy. J Matern Fetal Neonatal Med. 2009 Mar;22(3):274-83.

2. Lazarus JH, Premawardhana LD; Screening for thyroid disease in pregnancy; J Clin Pathol. 2005 May;58(5):449-52.

3. Butte NF; Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus.; Am J Clin Nutr. 2000 May;71(5 Suppl):1256S-61S.

4. Thornburg KL, Jacobson SL, Giraud GD, et al; Hemodynamic changes in pregnancy.; Semin Perinatol. 2000 Feb;24(1):11-4.

Dr Ahmed El-Gendy

Further Reading & References

Dr Ahmed El-Gendy