Alejandro Flores Aragon

24/11/10
Health
3°A
Report

In this report I´m going to talk about some health issues that evolves; Hormones,
Pregnancy, Child Birth and others. Well first we are going to talk about hormones,
specially female ones. Like estrogens, and progesterone. Estrogens are a group
of steroid compounds, named for their importance in the estrous cycle, and
functioning as the primary female sex hormone. Their name comes from the Greek
words estrus/οίστρος = sexual desire + gen/γόνο = to generate. Other female
hormone is progesterone. Progesterone also known as P4 (pregn-4-ene-3,20-
dione) is a C-21 steroid hormone involved in the female menstrual
cycle, pregnancy (supports gestation) and embryogenesis of humans and other
species. Progesterone belongs to a class of hormones called progestogens, and is
the major naturally occurring human progestogen.

Estrogens are produced in the ovaries and as all hormones has a difuse cell
membrane. While estrogens are present in both men and women, they are usually
present at significantly higher levels in women of reproductive age. They promote
the development of female secondary sexual characteristics, such as breasts, and
are also involved in the thickening of the endometrium and other aspects of
regulating the menstrual cycle. In males, estrogen regulates certain functions of the
reproductive system important to the maturation of sperm and may be necessary
for a healthy libido. Furthermore, there are several other structural changes
induced by estrogen in addition to other functions. In dentistry, it reduces
hyperkeratinization of the gingival and increase vascular permeability, exudation,
and edema.
Progesterone is produced in the ovaries also. Progesterone exerts its primary
action through the intracellular progesterone receptor although a distinct,
membrane bound progesterone receptor has also been postulated. Progesterone
has a number of physiological effects that are amplified in the presence of
estrogen. Estrogen through estrogen receptors upregulates the expression of
progesterone receptors. Also, elevated levels of progesterone potently reduce the
sodium-retaining activity of aldosterone, resulting in natriuresis and a reduction in
extracellular fluid volume. Progesterone withdrawal, on the other hand, is
associated with a temporary increase in sodium retention (reduced natriuresis, with
an increase in extracellular fluid volume) due to the compensatory increase in
aldosterone production, which combats the blockade of the mineralocorticoid
receptor by the previously elevated level of progesterone.

Progesterone is sometimes called the "hormone of pregnancy",[30] and it has many

roles relating to the development of the fetus:

 Progesterone converts the endometrium to its secretory stage to prepare

the uterus for implantation. At the same time progesterone affects the
vaginal epithelium and cervical mucus, making it thick and impenetrable
to sperm. If pregnancy does not occur, progesterone levels will decrease,
leading, in the human, to menstruation. Normal menstrual bleeding is
progesterone-withdrawal bleeding.
 During implantation and gestation, progesterone appears to decrease the
maternal immune response to allow for the acceptance of the pregnancy.
 Progesterone decreases contractility of the uterine smooth muscle.[30]
 In addition progesterone inhibits lactation during pregnancy. The fall in
progesterone levels following delivery is one of the triggers for milk production.
 A drop in progesterone levels is possibly one step that facilitates the onset
of labor.

The fetus metabolizes placental progesterone in the production of adrenal steroids.

Now we are going to talk about the menstrual cycle. The menstrual cycle is a
series of physiological changes that can occur in fertile females. Overt
menstruation (where there is blood flow from the uterus through the vagina) occurs
primarily in humans and some animals such as chimpanzees. Females of other
species of placental mammal undergo estrous cycles, in which the endometrium is
completely reabsorbed by the animal (covert menstruation) at the end of
its reproductive cycle. This article focuses on the human menstrual cycle.

The menstrual cycle, under the control of the endocrine system, is necessary
for reproduction. It is commonly divided into three phases: the follicular
phase, ovulation, and the lutheal phase; although some sources use a different set
of phases: menstruation, proliferative phase, and secretory phase. The length of
each phase varies from woman to woman and cycle to cycle, though the average
menstrual cycle is 28 days. Menstrual cycles are counted from the first day of
menstrual bleeding. Hormonal contraception interferes with the normal hormonal
changes with the aim of preventing reproduction.

Stimulated by gradually increasing amounts of estrogen in the follicular phase,

discharges of blood (menses) slow then stop, and the lining of the uterus thickens.
Follicles in the ovary begin developing under the influence of a complex interplay of
hormones, and after several days one or occasionally two become dominant (non-
dominant follicles atrophy and die). Approximately mid-cycle, 24–36 hours after the
Luteinizing Hormone (LH) surges, the dominant follicle releases anovum, or e.gg in
an event called ovulation. After ovulation, the egg only lives for 24 hours or less
without | fertilization while the remains of the dominant follicle in the ovary become
a corpus luteum; this body has a primary function of producing large amounts
of progesterone. Under the influence of progesterone, the endometrium (uterine
lining) changes to prepare for potential implantation of an embryo to establish
a pregnancy.
Pregnancy is the carrying of one or more offspring, known as a fetus or embryo,
inside the womb of a female. In a pregnancy, there can be multiple gestations, as
in the case of twins or triplets. Human pregnancy is the most studied of
all mammalian pregnancies. Child birth usually occurs about 38 weeks after
conception; i.e., approximately 40 weeks from the last normal menstrual period
(LNMP) in humans. The World Health Organization defines normal term for
delivery as between 37 weeks and 42 weeks.

Pregnancy occurs as the result of the female gamete or oocyte merging with the
male gamete, spermatozoon, in a process referred to, in medicine, as fertilization,
or more commonly known as "conception". After the point of fertilization, it is
referred to as a zygote or fertilized egg. The fusion of male and female gametes
usually occurs through the act of sexual intercourse, resulting in spontaneous
pregnancy. However, the advent of artificial insemination and fertilization have also
made achieving pregnancy possible in cases where sexual intercourse does not
result in fertilization (e.g., through choice or male/femaleinfertility).

Prenatal defines the period occurring "around the time of birth", specifically from 22
completed weeks (154 days) of gestation (the time when birth weight is normally 500
g) to 7 completed days after birth.[12]

Legal regulations in different countries include gestation age beginning from 16 to 22

weeks (5 months) before birth.
Perinatal period
The perinatal period is immediately before to after birth. Depending on the definition,
it starts between the 20th to 28th week of gestation and ends between 1 to 4 weeks
after birth (the word "perinatal" is a hybrid of the Greek "peri-" meaning 'around or
about' and "natal" from the Latin "natus" meaning "birth.").
[edit]Duration

The expected date of delivery (EDD) is 40 weeks counting from the first day of the
last menstrual period (LMP), and birth usually occurs between 37 and 42 weeks.
[13]
The actual pregnancy duration is typically 38 weeks after conception. Though
pregnancy begins at conception, it is more convenient to date from the first day of a
woman's last menstrual period, or from the date of conception if known. Starting from
one of these dates, the expected date of delivery can be calculated using
the Naegele's rule for estimating date of delivery. A more accurate and sophisticated
algorithm takes into account other variables, such as whether this is the first or
subsequent child (i.e., pregnant woman is a primip or a multip, respectively), ethnicity,
parental age, length of menstrual cycle, and menstrual regularity.

Pregnancy is considered "at term" when gestation attains 37 complete weeks but is
less than 42 (between 259 and 294 days since LMP). Events before completion of 37
weeks (259 days) are considered preterm; from week 42 (294 days) events are
consideredpostterm.[14] When a pregnancy exceeds 42 weeks (294 days), the risk of
complications for both the woman and the fetus increases significantly.[13][15] As such,
obstetricians usually prefer to induce labour, in an uncomplicated pregnancy, at some
stage between 41 and 42 weeks.[16][17]

Recent medical literature prefers the

terminology preterm and postterm to premature and postmature. Preterm and postter
m are unambiguously defined as above, whereas premature and postmature have
historical meaning and relate more to the infant's size and state of development rather
than to the stage of pregnancy.[18][19]

Fewer than 5% of births occur on the due date; 50% of births are within a week of the
due date, and almost 90% within 2 weeks.[20] It is much more useful and accurate,
therefore, to consider a range of due dates, rather than one specific day, with some
online due date calculators providing this information.

Accurate dating of pregnancy is important, because it is used in calculating the results

of various prenatal tests (for example, in thetriple test). A decision may be made
to induce labour if a fetus is perceived to be overdue. Furthermore, if LMP and
ultrasound dating predict different respective due dates, with the latter being later, this
might signify slowed fetal growth and therefore require closer review.

The age of viability has been receding because of continued medical progress.
Whereas it used to be 28 weeks, it has been brought back to as early as 23, or even
22 weeks in some countries.
[edit]Childbirth
Main article: Childbirth

Childbirth is the process whereby an infant is born. It is considered by many[who?] to be

the beginning of the infant's life, and age is defined relative to this event in most
cultures.
A woman is considered to be in labour when she begins experiencing regular uterine
contractions, accompanied by changes of her cervix — primarily effacement and
dilation. While childbirth is widely experienced as painful, some women do report
painless labours, while others find that concentrating on the birth helps to quicken
labour and lessen the sensations. Most births are successful vaginal births, but
sometimes complications arise and a woman may undergo a cesarean section.

During the time immediately after birth, both the mother and the baby are hormonally
cued to bond, the mother through the release ofoxytocin, a hormone also released
during breastfeeding.

[edit]Diagnosis

Further information: Obstetrics

Linea nigra in a woman at 22 weeks pregnant.

The beginning of pregnancy[21] may be detected in a number of different ways, either

by a pregnant woman without medical testing, or by using medical tests with or without
the assistance of a medical professional.

Most pregnant women experience a number of symptoms,[22] which can signify

pregnancy. The symptoms can include nausea and vomiting, excessive tiredness and
fatigue, cravingsfor certain foods that are not normally sought out, and frequent
urination particularly during the night.
A number of early medical signs are associated with pregnancy.[23][24] These signs
typically appear, if at all, within the first few weeks after conception. Although not all of
these signs are universally present, nor are all of them diagnostic by themselves,
taken together they make a presumptive diagnosis of pregnancy. These signs include
the presence of human chorionic gonadotropin (hCG) in the blood and urine,
missed menstrual period, implantation bleeding that occurs at implantation of the
embryo in the uterus during the third or fourth week after last menstrual period,
increased basal body temperature sustained for over 2 weeks
afterovulation, Chadwick's sign (darkening of the cervix, vagina, and vulva), Goodell's
sign(softening of the vaginal portion of the cervix), Hegar's sign (softening of
the uterus isthmus), and pigmentation of linea alba – Linea nigra, (darkening of the
skin in a midline of theabdomen, caused by hyperpigmentation resulting from
hormonal changes, usually appearing around the middle of pregnancy).[23][24]

Pregnancy detection can be accomplished using one or more various

pregnancy[21] tests, which detect hormones generated by the newly formed placenta.
Clinical blood and urine tests can detect pregnancy 12 days after implantation.[25] Blood
pregnancy tests are more accurate than urine tests.[26] Home pregnancy
tests are urine tests, and normally cannot detect a pregnancy until at least 12 to 15
days after fertilization. A quantitative blood test can determine approximately the date
the embryo was conceived.

In the post-implantation phase, the blastocyst secretes a hormone named human

chorionic gonadotropin, which in turn stimulates thecorpus luteum in the woman's
ovary to continue producing progesterone. This acts to maintain the lining of the uterus
so that the embryo will continue to be nourished. The glands in the lining of the uterus
will swell in response to the blastocyst, and capillaries will be stimulated to grow in that
region. This allows the blastocyst to receive vital nutrients from the woman.

Despite all the signs, some women may not realize they are pregnant until they are
quite far along in their pregnancy. In some cases, a few women have not been aware
of their pregnancy until they begin labour. This can be caused by many factors,
including irregular periods (quite common in teenagers), certain medications (not
related to conceiving children), and obese women who disregard their weight gain.
Others may be in denial of their situation.

An early sonograph can determine the age of the pregnancy fairly accurately. In
practice, doctors typically express the age of a pregnancy (i.e., an "age" for
an embryo) in terms of "menstrual date" based on the first day of a woman's last
menstrual period, as the woman reports it. Unless a woman's recent sexual
activity has been limited, she has been charting her cycles, or the conception is the
result of some types of fertility treatment (such as IUI or IVF), the exact date of
fertilization is unknown. Without symptoms such asmorning sickness, often the only
visible sign of a pregnancy is an interruption of the woman's normal monthly
menstruation cycle, (i.e., a "late period"). Hence, the "menstrual date" is simply a
common educated estimate for the age of a fetus, which is an average of 2 weeks later
than the first day of the woman's last menstrual period. The term "conception date"
may sometimes be used when that date is more certain, though even medical
professionals can be imprecise with their use of the two distinct terms. The due date
can be calculated by using Naegele's rule. The expected date of delivery may also be
calculated from sonogram measurement of the fetus. This method is slightly more
accurate than methods based on LMP.[27]

Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a
period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to
around 100,000 mIU/mL by 10 weeks of gestation