PREGNANCY

AND
LACTATION

CARINA C. GOMEZ, M.D.

OOGENESIS

SPEMATOGENESIS
ENTRY OF OVUM IN THE FALLOPIAN TUBE
FERTILIZATION
 Sex Determination

involves the
determination of
genetic sex
established at
fertilization
TRANSPORT OF ZYGOTE IN THE FALLOPIAN TUBE
BLASTOCYST
IMPLANTATION
 DEVELOPMENT OF PLACENTA

Attachment of blastocyst Placental villi (fetal blood)

to the uterus and sinuses (maternal blood)

Growth of blood vessels

from the developing embryo Tropoblastic cells send out
more projections (placental villi)

Blood is pumped by the fetal Maternal blood vessels sorround

heart at the 16th day the tropoblastic cord
Nutrition of the Embryo

Uterine milk
nutrients are obtained from the endometrial
secretions
used by the blastocyst (4th 6th day)
Decidua (decidual cells)
contains glycogen, proteins, lipids and other
nutrients
due to the action of progesterone to the endometrial
stromal cells
used by the embryo up to 8 weeks
Placenta
Function of the placenta
to provide for the diffusion of foodstuffs and
oxygen from the mothers blood into the fetal
blood and diffusion of excretory products from the
fetus back to the mother.
early months of pregnancy (placental membrane)
thick with small surface area
later months of pregnancy
thin with larger surface area
DIFFUSION OF OXYGEN THROUGH THE PLACENTAL MEMBRANE

PRESSURE GRADIENT

30 mmHg 20 mmHg 50 mmHg

SIMPLE DIFFUSION
Fetal blood transport oxygen at low
PO2 (30 mmHg)
Hemoglobin of the fetus is mainly fetal
hemoglobin (20 to 50%)
Hemoglobin concentration of the fetal
blood is about 50% greater than that of
the mother
Bohr effect
Hemoglobin carries more oxygen at low
PCO2.
Fetal blood ------ alkaline DOUBLE BOHR EFFECT
Maternal blood ------ acidic
DIFFUSION OF CO2 THROUGH THE PLACENTAL MEMBRANE

PRESSURE GRADIENT

47 - 48 mmHg 45 mmHg
2 -3 mmHg

CO2 (20X) DIFFUSION COEFFICIENT THAN O2

SIMPLE DIFFUSION
DIFFUSION OF FOODSTUFFS THROUGH THE PLACENTAL MEMBRAN

CONCENTRATION GRADIENT

LOWER HIGHER

Glucose Glucose
Fatty acids Fatty acids
Ketone bodies Ketone bodies
electrolytes electrolytes

SIMPLE DIFFUSION
FACILITATED DIFFUSION
EXCRETION OF WASTE PRODUCTS (PLACENTAL MEMBRANE)

CONCENTRATION GRADIENT

HIGHER LOWER

Urea Urea
Uric acid Uric acid
creatinine Creatrinine

SIMPLE DIFFUSION
Hormonal Factors
Hormones secreted by the placenta
Human Chorionic Gonadotropin (HCG)
Estrogen
Progesterone
Human Chorionic Somatomammotropin
Relaxin
Human Chorionic Thyrotropin
Human Chorionic Gonadotropin

secreted by syncytial tropoblastic cells

glycoprotein (FSH, LH and TSH)
alpha glycoprotein subunit
hormone specific beta subunit
half life is 24 to 30 hours
measured in the maternal blood
Ist ------------ (24 hours) 8 9 days
peak -------- 10 12 weeks
low level ----- 16 20 weeks
 Functions
prevent involution of the corpuz luteum at
the end of monthly sexual cycle
main function (+) LH receptors)
it causes corpuz luteum to secrete large
amount of estrogen and progesterone
(prevent menstruation and leads to the
formation of decidual cells)
it stimulates the interstitial cells of fetal testis
to secrete testosterone and adrenal
cortex(growth of male sex organ and descent
of the testis)
 responsible for morning
sickness
Corpuz luteum
normal involution during pregnancy
--- 13 to 17th week
if removed before 7 12th week
------ spontaneous abortion
Human Chorionic Somatomammotropin

known as placental lactogen

structurally similar to growth hormone
and prolactin
secreted in greatest quantity at about the
3 - 5th week of gestation and increases
progressively throughout the remainder
of pregnancy.
 Possible functions
cause development of the breast but does not
promote lactation
has effect similar to growth hormone (weak
effect) ---- protein synthesis
decreases insulin sensitivity and glucose
utilization
it provides release of fatty acids from the fat
stores of the mother
general metabolic hormone
DIABETOGENICITYF PREGNANCY
Estrogen
secreted by syncytial tropoblastic cells
almost entirely from androgenic steroid
DHEA and 16 hydroxy DHEA (mother and
fetal adrenal gland) converted to estradiol,
estriol and estrone.
 Functions
enlargement of the mothers uterus
enlargement and development of the mothers
breast (ductal structure)
enlargement of the mothers external genitalia
it relaxes the mothers pelvic ligament
affect the general aspect of fetal development
Progesterone
secreted by syncytial tropoblastic cells
Functions
causes the development of decidual cells in the
endometrium.
decreases the contractility of the pregnant
contributes to the develoment of conceptus even
before implantation
helps in breast development during pregnancy
(lobular structure)
required for implantation and pregnancy
Other Hormonal Factors
Pituitary secretion (pituitary enlargement
50%)
ACTH, TSH and prolactin
FSH and LH
Corticosteroid
glucocorticoid and mineralocorticoid
Thyroid gland secretion
thyroxine (HCG and HCT)
 Parathyroid gland secretion
PTH secretion
Relaxin
secreted both by placenta and ovary
Response of the Mothers Body to
Pregnancy
Enlargement of the various sexual organs
Uterus ------- 50 1100 grams
Breast -------- 2X
Vagina
Development of edema, acne and
musculine and acromegalic features
 Weight gain (24 pounds)
Fetus ------------------------------ 7 pounds
Amniotic fluid, placenta
and fetal membranes --------- 4 pounds
Uterus -------------------------- 2 pounds
Breast --------------------------- 2 pounds
ECF ---------------------------- 6 pounds
Fat accumulation ------------- 3 pounds
Increased desire for food
 Increased basal metabolic rate (15%)
hormonal secretions (T4, adrenocortical
hormones and sex hormones)
Nutrition during pregnancy
needs calcium, iron, phosphate, vitamin D
and vitamin K supplements
absorption during pregnancy
Circulatory System
Increased cardiac output (30 40%)
Increased uterine blood flow
Increased total blood volume (30%)
Aldosterone and Estrogen
erythropoeisis
Respiratory System
Increased oxygen consumption ( BMR)
Increased carbon dioxide production
Increased minute ventilation (progesterone)
Total excursion of the diaphragm is
decreased.
Urinary system
Increased urine formation
fluid intake and excretory load
Na+, chloride and water reabsorption (
steroid hormone production)
Increased GFR
Preeclampsia
also known as toxemia of pregnancy
rapid rise in arterial blood pressure to
hypertensive levels during the last few months of
pregnancy
characterized by
excess salt and water retention
weight gain and development edema
hypertension
impaired vascular endothelium and vasospasm
renal blood flow and GFR
Eclampsia
extreme degree of preeclamsia
characterized by generalized vascular
spasm throughout the body, tonic clonic
seizures in the mother sometimes followed
by coma
Parturition

means birth of the

baby
due to intense
contraction of the
uterus
progressive hormonal
changes that cause
increased excitability of
the uterine musculature
progressive mechanical
changes
Hormonal factors that increase
uterine contractility
increased ratio of estrogen and
progesterone
effect of oxytocin on the uterus
distension of the cervix
effect of fetal hormones on the
uterus
fetus ------------ oxytocin
fetal adrenal gland -- cortisol
fetal membrane --- prostaglandin
Mechanical factors that increase
uterine contractility
stretch of the uterine musculature
stretch or irritation of the cervix
Onset of Labor
Braxton Hicks Contraction
periodic episodes of weak and slow rhytmical
contraction
Labor Contraction
strong contractions that result in final
parturition
Positive Feedback Mechanisms
Oxytocin secretion
MECHANICS OF PARTURITION

CONTRACTION OF FUNDAL AREA

CONTRACTION OF THE BODY

COMBINED CONTRACTION
OF THE UTERUS AND
ABDOMINALMUSCULATURE

DELIVERY OF THE BABY

Lactation

development of the
breast
Estrogen (growth of the
ductal system and
deposition of fats)
growth hormone
insulin
prolactin
Glucocorticoid
Progesterone
(development of the
lobule-alveolar duct
 prolactin
initiates lactation
breast development
promotes milk production and secretion

Colostrum
fluid secreted during the last few days before
and first few days after parturition.
COMPOSITION OF MILK
CONSTITUENT HUMAN MILK (%) COWS MILK (%)

Water 88.5 87.0

Fat 3.3 3.5
Lactose 6.8 4.8
Casein 0.9 2.7
Lactalbumi and other proteins 0.4 0.7
Ash 0.2 0.7
 HYPOTHALAMUS

PIF

ANTERIOR PITUITARY
(-) PROLACTIN

BREAST

LACTATION
Oxytocin
synthesized by the hypothalamus
causes
uterine contraction
milk ejection
 PROLACTIN DOPAMINE (-) GnRH FSH and LH
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