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1. Physiology of PregnancyPhysiology of Pregnancy

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

11. Fetal Growth And DevelopmentFetal Growth And Development

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

17. Fetal growth characteristicsFetal growth characteristics
 36 Weeks ： weight 2500g
length 45cm. survival good.
 40 Weeks ： weight 3000g
length 50cm. After birth,
crying loudly, sucking ability

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

22.  Fetal appendage
 Placenta
 Amniochorionic membraneAmniochorionic membrane
 Umbilical Cord
 AAmniotic fluid

23. PlacentaPlacenta
 AmnionAmnion
 Chorion frondosumChorion frondosum
 DeciduateDeciduate

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.

28. ovulation
(day 14)
hCG (day 7)
onset of menstruation
(day 1)
CL regresses
(days 8-10)

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

36. Amniotic fluidAmniotic fluid
 SourceSource
 Exudation ofExudation of
amnion /fetal skinamnion /fetal skin
 Fetal urineFetal urine
 Fetal lungFetal lung
 AbsordAbsord
Fetal membraneFetal membrane
Umbilical cordUmbilical cord
Fetal skinFetal skin
Fetal drinkingFetal drinking

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.

40. Maternal physiology during pregancyMaternal physiology during pregancy

41. Maternal physiology during pregancyMaternal physiology during pregancy

42. Maternal physiology during pregancyMaternal physiology during pregancy
 Genital organsGenital organs
 UterusUterus
 capacity: 5-5000ml.weight:capacity: 5-5000ml.weight: 50-50-
1000g1000g
 EndometriumEndometrium→→decidua:decidua:
basal decidua, capsular decidua,basal decidua, capsular decidua,
true deciduatrue decidua
 Ovary: placenta replaces ovaryOvary: placenta replaces ovary
(after 10 weeks)(after 10 weeks)
 Vagina and Perineum: dilated andVagina and Perineum: dilated and
soft, pHsoft, pH↓↓(anti-bacteri)(anti-bacteri)

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

45. CardioVascularCardioVascular
• Stroke volumeStroke volume
• Heart rateHeart rate
• SVRSVR
• Systolic BPSystolic BP
• Diastolic BPDiastolic BP
• Mean BPMean BP
• O2 ConsumptionO2 Consumption
( 30%)( 30%)
( 15%)( 15%)
( 5%)( 5%)
( 10 mmHg)( 10 mmHg)
( 15 mmHg)( 15 mmHg)
( 15 mmHg)( 15 mmHg)
( 20%)( 20%)

46. Maternal physiology during pregancyMaternal physiology during pregancy
 HematologyHematology
 Blood volumeBlood volume
 Increase by 30%-45% at 32Increase by 30%-45% at 32ndnd
–34–34thth
(peak)(peak)
 Relatively dilutedRelatively diluted
 CompositionComposition
 Red cells Hb:130Red cells Hb:130→→110g/L, HCT:38%110g/L, HCT:38%→→ 31%.31%.
 White cells: slightly increaseWhite cells: slightly increase
 Coagulating power of blood:Coagulating power of blood: ↑↑
 Albumin:Albumin: ↓,↓,35 g/L35 g/L

47. Maternal physiology during pregancyMaternal physiology during pregancy
 The Respiratory systemThe Respiratory system
 R rate: slightlyR rate: slightly ↑↑
 vital capacity: no changevital capacity: no change
 Tidal volume:Tidal volume: ↑↑ 40%40%
 Functional residual capacity:Functional residual capacity:↓↓
 OO22 consumption:consumption: ↑↑ 20%20%

48. Maternal physiology during pregancyMaternal physiology during pregancy
 The urinary systemThe urinary system
 KidneyKidney
 Renal plasma flow (RFP):Renal plasma flow (RFP):↑↑35%35%
 Glomerular filtration rate (GFR)Glomerular filtration rate (GFR)↑↑ 50%50%
 UreterUreter
 Dilated (PDilated (P↑↑))
 BladderBladder
 Frequent micturationFrequent micturation

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

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