2. Review
obstetrics & gynecologyobstetrics & gynecology
FemaleFemale physiologicalphysiological
StagesStages
Control of the menstrualControl of the menstrual
cyclecycle
The Ovarian cycle andThe Ovarian cycle and
controlcontrol
Sexual hormonesSexual hormones
3. Physiology of PregnancyPhysiology of Pregnancy
Yu HongYu Hong
Department of Ob & Gy,Department of Ob & Gy, The Affiliated Zhongda Hospital of Southeast UniversityThe Affiliated Zhongda Hospital of Southeast University
4. Pregnancy PhysiologyPregnancy Physiology
Fetal Growth And DevelopmentFetal Growth And Development
Fetal appendage
Maternal physiology during pregancyMaternal physiology during pregancy
synopsis
5. Pregnancy PhysiologyPregnancy Physiology
Pregnancy (gestation) :Pregnancy (gestation) : The courseThe course
that the embryo and the fetus grow inthat the embryo and the fetus grow in
the maternal bodythe maternal body
Begins:Begins: Mature follicle fertilizationMature follicle fertilization
Termination :Termination :fetus and fetalfetus and fetal
appendages discharged from theappendages discharged from the
maternal bodymaternal body
6. Pregnancy PhysiologyPregnancy Physiology
Embryo:Embryo: ≤≤ 8 weeks.8 weeks. conceptus from fertilizationconceptus from fertilization
through the eighth week of pregnancythrough the eighth week of pregnancy
Fetus:Fetus: ≥≥ 9 weeks.9 weeks. from thefrom the ninth week until deliveryweek until delivery
further growth and organ maturationfurther growth and organ maturation
gestational age:gestational age: the first day of the last ( normal)the first day of the last ( normal)
menstrual period (LMP) , assuming a 28 -day cycle.menstrual period (LMP) , assuming a 28 -day cycle.
7. Teratogenic fetal organs of the sensitive period mapTeratogenic fetal organs of the sensitive period map
8. Formation of EmbryoFormation of Embryo
FertilizationFertilization
Place:Place:
fallopian tubes(ampulla)fallopian tubes(ampulla)
ProcessProcess
capacitation → acrosomecapacitation → acrosome
reaction→ penetrate thereaction→ penetrate the
zona pellucida→ secondzona pellucida→ second
meiosis →zygotemeiosis →zygote
9. Formation of EmbryoFormation of Embryo
ImplantationImplantation
1.1. requirementrequirement
Disappear of zona pellucidaDisappear of zona pellucida
Formation of syncytiotrophoblastFormation of syncytiotrophoblast
Synchronized development ofSynchronized development of
blastocyst and endometriumblastocyst and endometrium
Adequate progesteroneAdequate progesterone
10. Formation of EmbryoFormation of Embryo
2.2. ProcessProcess
zygote → morula (dayzygote → morula (day
3) → enter uterine3) → enter uterine
cavity (day 4) → earlycavity (day 4) → early
blastocyst→ lateblastocyst→ late
blastocyst (day 6-7) →blastocyst (day 6-7) →
implantationimplantation
12. The gestational age fetus features:The gestational age fetus features:
9 weeks:9 weeks: organs begin to form.organs begin to form.
1212 weeks:weeks: external genitalia may be recognizeexternal genitalia may be recognize
16 weeks: sex as male or female16 weeks: sex as male or female
20 weeks: Heart tones by stethoscope20 weeks: Heart tones by stethoscope
24 weeks: Viability , survival relatively rare.24 weeks: Viability , survival relatively rare.
28 weeks: survive, respiratory distress28 weeks: survive, respiratory distress
32 weeks: weight1700g. born 5 of 6 infants survive.32 weeks: weight1700g. born 5 of 6 infants survive.
36 weeks: weight2500g ,length 45cm. survival good.36 weeks: weight2500g ,length 45cm. survival good.
40 weeks: weight3000g ,length 50cm head maximal transverse (biparietal)diameter9.5cm40 weeks: weight3000g ,length 50cm head maximal transverse (biparietal)diameter9.5cm
Embryo, fetal growth characteristicsEmbryo, fetal growth characteristics
13. Embryo growth characteristics
4 Weeks4 Weeks :: Identifiable embryonic discIdentifiable embryonic disc
8 Weeks8 Weeks :: Embryo human formEmbryo human form
heart beat by B-modeheart beat by B-mode
ultrasoundultrasound
14. Fetal growth characteristicsFetal growth characteristics
12 Weeks12 Weeks ::length 7-9cm weight 12-15 glength 7-9cm weight 12-15 g
16 Weeks16 Weeks ::
length 14-17cm weightlength 14-17cm weight 100g,
sex recognize as male or female
15. Fetal growth characteristicsFetal growth characteristics
20 Weeks20 Weeks :: weight 300 gweight 300 g
Heart tones by stethoscopeHeart tones by stethoscope
24 Weeks24 Weeks :: weight 600 g.weight 600 g.
Viability survival still relativelyViability survival still relatively
rarerare
16. Fetal growth characteristicsFetal growth characteristics
28 Weeks : weight 1000g
survival possible by NICUby NICU
32 Weeks :weight1700g
survival take care of after birth
18. Fetal PhysiologyFetal Physiology
CirculationCirculation
fetus ←→placenta←→ materfetus ←→placenta←→ mater
1 umbilical vein (full of1 umbilical vein (full of
oxygen), 2 umbilical arteryoxygen), 2 umbilical artery
(lack of oxygen)(lack of oxygen)
Mixed blood (vein and artery)Mixed blood (vein and artery)
19. Fetal PhysiologyFetal Physiology
HematologyHematology
ErythropoiesisErythropoiesis
From yolk sac3 weeks.Liver10 weeks. Bone marrow and spleen: term (90%)From yolk sac3 weeks.Liver10 weeks. Bone marrow and spleen: term (90%)
White cellsWhite cells
Leukocytes: 8 weekLeukocytes: 8 week
Lymphocytes : 12 week, thymus and spleenLymphocytes : 12 week, thymus and spleen
20. Fetal PhysiologyFetal Physiology
Respiratory FunctionRespiratory Function
Gas exchange in placenta.Gas exchange in placenta.
Gastrointestinal tractGastrointestinal tract
not truly functional until after birth,not truly functional until after birth, because the placenta is the organbecause the placenta is the organ
of alimentation during fetal life.of alimentation during fetal life.
21. Fetal PhysiologyFetal Physiology
Renal FunctionRenal Function
Formation of urine begin at 9-12 weeksFormation of urine begin at 9-12 weeks
EndocrinologyEndocrinology
• thyroid synthesize thyroxinethyroid synthesize thyroxine
• fetal adrenal cortex produces large quantities offetal adrenal cortex produces large quantities of
steroid hormonessteroid hormones
24. Development of the PlacentaDevelopment of the Placenta
Primary villusPrimary villus
syncytiotrophoblast cytotrophoblastsyncytiotrophoblast cytotrophoblast
Secondary villusSecondary villus
third vilusthird vilus
fetal capillary enter the stromafetal capillary enter the stroma
25. Functions of the Maternal Placental-FetalFunctions of the Maternal Placental-Fetal
UnitUnit
Internal secretion:Internal secretion:
releasing hormones and
enzymes
Transportion:Transportion:
exchange of all fetalexchange of all fetal
nutrients and metabolicnutrients and metabolic
productsproducts
26. Functions of the Maternal Placental-FetalFunctions of the Maternal Placental-Fetal
UnitUnit
EndocrineEndocrine FunctionFunction
Human chorionic gonadotropin (HCG)Human chorionic gonadotropin (HCG)
Human placental lactogen (HPL)Human placental lactogen (HPL)
Placental proteinsPlacental proteins
EstrogenEstrogen
27. Functions of the Maternal Placental-FetalFunctions of the Maternal Placental-Fetal
UnitUnit
EndocrineEndocrine FunctionFunction
Human chorionicHuman chorionic
gonadotropingonadotropin
glycoprotein by Syncytiotrophoblastglycoprotein by Syncytiotrophoblast
alpha and beta. the beta uniquealpha and beta. the beta unique
specificityspecificity
Method useful detect pregnancy onMethod useful detect pregnancy on
day 11 after fertilization.day 11 after fertilization.
29. Functions of the Maternal Placental-FetalFunctions of the Maternal Placental-Fetal
UnitUnit
EndocrineEndocrine FunctionFunction
Human placental lactogen (hPL)Human placental lactogen (hPL)
protein hormone by syncytiotrophoblastic layerprotein hormone by syncytiotrophoblastic layer
the "growthhormone" of pregnancythe "growthhormone" of pregnancy
Placental proteinsPlacental proteins
produced by the placenta .produced by the placenta .
PAPP-A, -B , -CPAPP-A, -B , -C evaluate placenta functionplacenta function
30. Functions of the Maternal Placental-FetalFunctions of the Maternal Placental-Fetal
UnitUnit
EndocrineEndocrine FunctionFunction
EstrogenEstrogen
placenta and ovarianplacenta and ovarian
increased significantlyincreased significantly
corpus luteum earlycorpus luteum early
pregnancypregnancy
the fetal - placental unitthe fetal - placental unit
synthesis after 10 weekssynthesis after 10 weeks
31. progesteroneprogesterone
Synthesis corpus luteum earlySynthesis corpus luteum early
pregnancypregnancy
placental after 8 weeks of pregnancyplacental after 8 weeks of pregnancy
andrenal glandsandrenal glands
Combine estrogen to endometrialCombine estrogen to endometrial
myometrium /breastmyometrium /breast
Functions of the Maternal Placental-Fetal UnitFunctions of the Maternal Placental-Fetal Unit
32. Functions of the Maternal Placental-FetalFunctions of the Maternal Placental-Fetal
UnitUnit
EndocrineEndocrine FunctionFunction
othersothers
OxytocinaseOxytocinase
Cytokines and Growth FactorsCytokines and Growth Factors ::
EGFEGFEpidermal growth factor,Epidermal growth factor, NGFNGFnerve growth factor,nerve growth factor, IGFIGFinsulin-like growth factor,insulin-like growth factor,
TGFTGFtransforming growth factor-β,transforming growth factor-β,TNFTNF tumor necrosis factor-α,tumor necrosis factor-α, GM-CSFGM-CSFgranulocyte -granulocyte -
macrophage colony-stimulating factor,macrophage colony-stimulating factor, ILILinterleukin--1,2,6,8interleukin--1,2,6,8
33. Functions of the Maternal Placental-FetalFunctions of the Maternal Placental-Fetal
UnitUnit
Metabolite and Protective FunctionMetabolite and Protective Function
Exchange of OExchange of O22 and COand CO22
Exchange of nutritive factors and wasteExchange of nutritive factors and waste
Limited IgG, virus, drug ectLimited IgG, virus, drug ect
34. The Umbilical CordThe Umbilical Cord
StructureStructure
amnion, one vein, twoamnion, one vein, two
artery and Wharton jellyartery and Wharton jelly
Length andLength and diameterdiameter
30-70cm/30-70cm/12mm .12mm .
A long cord more than 100cmA long cord more than 100cm
A short cord less than 30cm.A short cord less than 30cm.
35. Amniochorionic membraneAmniochorionic membrane
StructureStructure
chorion and amnionchorion and amnion
AmnionAmnion
A double-layered translucentA double-layered translucent
membranemembrane
role in the onset of laborrole in the onset of labor
37. Amniotic fluidAmniotic fluid
FeatureFeature
At 36-38 weeks (peak):1000-1500mlAt 36-38 weeks (peak):1000-1500ml
At term:800mlAt term:800ml
specific gravityspecific gravity :: 1.0081.008
pHpH :: 7. 2. Neutral or weak7. 2. Neutral or weak
alkaline, containing a largealkaline, containing a large
number of hormones andnumber of hormones and
enzymesenzymes
38. Amniotic FluidAmniotic Fluid
FunctionFunction
Protect fetusProtect fetus :: move freely, warmmove freely, warm
Protect materProtect mater :: prevent infectionprevent infection
Studies have shown that the fetus near term drinks 400-500mL of amniotic fluid per day; this is about the same as the amountStudies have shown that the fetus near term drinks 400-500mL of amniotic fluid per day; this is about the same as the amount
of milk consumed by a newborn infant. To maintain a reasonable stability of volume, the fetus must excrete about the sameof milk consumed by a newborn infant. To maintain a reasonable stability of volume, the fetus must excrete about the same
volume of urine into the amniotic fluid each day.volume of urine into the amniotic fluid each day.
39. Maternal physiology during pregancyMaternal physiology during pregancy
Those maternal adaptations maintain a healthy environment for the fetus.Those maternal adaptations maintain a healthy environment for the fetus.
43. Maternal physiology during pregancyMaternal physiology during pregancy
BreastsBreasts
symptoms: tenderness and tingling
Size :increase and nipples larger, more pigmented
Glands of Montgomery:
fatty sebaceous glands in the areolae
44. Maternal physiology during pregancyMaternal physiology during pregancy
Cardiovascular systemCardiovascular system
Heart:Heart:
move upward, hypertrophy of cardiac musclemove upward, hypertrophy of cardiac muscle
Cardiac OutputCardiac Output
increase by 30%, reach to peak at 32–34 weeksincrease by 30%, reach to peak at 32–34 weeks
Blood pressureBlood pressure
early or mid pregnancy Bpearly or mid pregnancy Bp↓.↓.late pregnancy Bp↑ .late pregnancy Bp↑ .
Supine hypotensive syndromeSupine hypotensive syndrome
49. Maternal physiology during pregancyMaternal physiology during pregancy
Gastrointestinal systemGastrointestinal system
Gastric emptying time prolongedGastric emptying time prolonged→→ nausea.nausea.
The motility of large bowel diminishedThe motility of large bowel diminished →→ constipationconstipation
Liver function: unchangedLiver function: unchanged
50. Maternal physiology during pregancyMaternal physiology during pregancy
EndocrineEndocrine
PituitaryPituitary
LH/FSH:LH/FSH: ↓↓
PRL:PRL:↑↑
TSH and ACTH:TSH and ACTH:↑↑
ThyroidThyroid
enlarged (TSH and HCGenlarged (TSH and HCG↑↑))
thyroxinethyroxine↑↑ and TBGand TBG↑↑ →→ free Tfree T33 TT44 unchangedunchanged
51. Summary
Pregnancy (gestation)Pregnancy (gestation)
Fetal Growth And DevelopmentFetal Growth And Development
Fetal appendage
Maternal physiology during pregancyMaternal physiology during pregancy
52. Thanks for Your AttentionThanks for Your Attention
第七版《妇产科学》配套课件第七版《妇产科学》配套课件
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THANKS FOR YOUR ATTENTION!THANKS FOR YOUR ATTENTION!
Editor's Notes
范畴
Stucture of organs and system has key period of development;For structural malformations,embryo is the most important, because all the major organs formed such as heart at 3.5-6 weeks;Continued development of functional is very important at fetus.
When sperm with mature follicle in female genital tract
Must have four conditions
Embryo or fetus begins with the fertilized egg. 8 weeks, said embryos, 9-40 weeks, said the fetus.
gram
Viable child
Include four parts
releasing hormones and enzymes into the maternal bloodstream. as well as oxygen / carbon dioxide.
Concentrations of hCG rise in gestation, with a doubling time of 1.3-2 days. Concentrations peak at 60-90 days' gestation. Afterwards, hCG levels decrease to a plateau that is maintained until delivery.
Syncytiotrophoblast secrete HCG , on day 11 after fertilization can 检测Detection check out.
Oxytocinase
perineum
dermatological皮肤
Hypertrophy of muscle cells
In the early weeks
SVRsystemic vascular resistance]全身血管阻力Systolic BP
the embryo and the fetus grow in the maternal body,from fertilization through the eighth week of pregnancy,from the nineth week until delivery further growth and organ maturation
Placenta Amniochorionic membrane Umbilical Cord Amniotic fluid 。Include three parts:Internal and external genitalia, breasts and other organs of the body