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Event of oogenesis
Physiological Stages
Neonatal period: birth---4 weeks
Childhood: 4 weeks----12 years
Puberty: 12 years---18 years
Sexual maturation: 18 year---50 year
Perimenopause: decline of ovarian function
(40 years)----1 year postmenopause
Postmenopause:
Menstruation
1.
2.
3.
4.
Menstruation
cyclic endometrium sheds and bleeds due to cyclic
ovulation
Mense
Endometrium is sloughed (progesterone withdrawal)
Nonclotting menstrual blood mainly comes from
artery (75%)
Interval: 24-35 days (28 days). duration: 2-6 days. the
first day of menstrual bleeding is consideredy by day
1
Shedding: 30-50 ml
Hypothalamus-Pituitary-Ovary(H-P-O axis)
1.
1)
Neuroendocrine regulation
Gonadotropin-releasing hormone,GnRH
chemical structure
(pro)Glu-His-Trp-Ser-Tyr-Gly-Leu-Arg-Pro-Gly-NH2
2)
nerve cells
portal vein
hypothalamus
pitutary
anterior lobe
Regulation of GnRH
Hypothalams
GnRH
Pituitary
FSH, LH
Ovary
E,P
2)
Gonadotropins
Composition (glycoprotein)
Follicle stimulating hormone,FSH
Luteinizing hormone,LH
Synthesize and transport
Gonadotroph
(pulse)
Blood
circulation
ovary
1.
2.
Function of ovary
Reproduction
development and maturation of follicle; ovulation
Endocrine
estrogens, progesterone, testosterone
4)
Corpus luteum
follicle luteinized after ovulation: luteal cells
LH VEGF corpus hemorrhagicum
Regression
non fertilized corpus albicans
Luteal phase
Ovulation to day 1
b)
c)
Metabolism: liver
Cyclic change of E and P in ovary
Estrogen
E(day 7) E peak (pre-ovulate) E E (1
day after ovulate) E peak (day 7-8) E
theca interna cells (LH receptor) testosterone
Granulosa (FSH receptor) estrogen
granulosa
LH
progesterone
Ovarian responses
1.
2.
3.
Proliferative phase
E(mitogen) stroma thickens and glands
become elongated proliferative endometrium
Duration: 2 weeks
Thickness: 0.5mm 5mm
Cervix
Vagina
Pregnancy
1. Fertilization
2. Placenta development,
nutrition
3. Hormonal changes during
pregnancy
Fertilization
The sperm passes through the corona radiata, the outermost cell layer of the egg.
The sperm breaks through the zona pellucida.
This occurs with the aid of several enzymes possessed by the sperm that break
down the proteins of the zona pellucida, the most important one being acrosin.
When the sperm penetrates the zona pellucida, the Acrosome reaction occurs. This
makes the egg impermeable to any other sperms and prevents fertilization by more
than one sperm.
The cell membranes of the egg and sperm fuse together.
The female egg, also called a secondary oocyte at this stage, completes its second
meiotic division. This results in a mature ovum.
The sperm's tail and mitochondria degenerate with the formation of the male
pronucleus.
The male and female pronuclei fuse to form a new nucleus that is a combination of
the genetic material from both the sperm and egg.
Fertilization
Fertilization in
the ampulle of
the FT.
Prostaglandin
s
Oxytocin
Ectopic
(extrauterine)
gravidity
Fertilization
Transport into
the uterus - 35 days
Contraction
of the FT
isthmus
Relaxation progesteron
Fertilization
Implantation
5-7 days after
fertilization
Proteolytic
enzymes of
the
trophoblast
cells
Placenta
Placenta development
Early nutrition of the embryo - invasion of
trophoblastic cells into the decidua
Progesteron produced by CL - stimulates decidual
cells to concentrate glycogen, proteins and lipids
Placenta works as a
physiological A-V shunt
Placenta - oxygen
transport
Similarities betwen
placenta and lungs
Oxygen transport - simple difusion
Lungs
pO2 in alveoli..100mmHg
pO2 in the venous blood40mmHg
dO2 in (pressure gradient)60mmHg
Placenta:
pO2 in placental sinuses50mmHg
pO2 in fetal umbilical vein30mmHg
dO2 in (pressure gradient)20mmHg
How is a sufficient oxygenation of the fetus
possible?
Placenta - oxygen
transport
1. Fetal hemoglobin
2. Higher Hb
concentration in the
fetal blood
(50% more than in adults)
3. Double Bohr effect
- Hb can carry more
oxygen in low pCO2 than
in high pCO2
Placenta - CO2,
nutritients, waste
CO gradient - 2-3 mmHg, but extreme solubility
products
transport
(diffuses 20times faster than oxygen)
2
Hormonal
Changes During
Pregnancy
Hormonal changes
HCG
Human Chorionic
Gonadotropin
prevent involution
(pregesterone, estrogen)
HCS
Hormonal changes
Progesterone
development of
decidual cells
decreases uterus
contractility
preparation for the
lactation
Estrogens
enlargement of uterus
breasts development
relaxation of ligments
estriol level - indicator
of
vitality of the fetus
Hormonal changes
Placenta
CRH
HCG
HC thyrotropin
Mother
ACTH
aldosterone
cortisol
hypertension
edema
insulin resistan
hyperthyroidism
Calcium demands
gestational
diabetes
Hyperparathyroidism
Other
Physiological
Changes
Cardiovascular changes
Cardiac output (CO)
30 -50% above normal
placental circulation
increased metabolism
skin - thermoregulation
renal circulation
ECG changes
functional
murmurs
heart sounds
Hematologic changes
plasma volume increases (50%)
erythropoesis (RBC) increases (25%)
decreased Hb, hematocrite
Iron requirements increases significantly
Iron suplements needed
Respiratory changes
oxygen consumption increases
20% above normal
Progesterone increases
sensitivity
for CO2 in respiratory
centre
Growing uterus
Frequency
increases
Minute ventilation
increases (50%)
pCO2 decreases
slightly
Urinary system
Glomerulat filtration rate and renal plasma
flow increases
(up to 30 - 50 %)
Increased reabsorption of ions and water
- placental steroids
- aldosterone
Slight increase of urine formation
Postural changes affect renal functions
- upright position
- supine position
- lateral position during sleep
Preeclampsia, Eclampsia
Preeclampsia - pregnancy induced hypertension
+ proteinuria
Incresing BP since 20th week - hypertension
Salt and water retention - edema formation
RBF and GFR decreases
extensive secretion of placental hormones ?
insufficient blood supply to placenta - ischemia
- increased resistance
- TNF alfa, cytokines ?
Eclampsia - vascular spasms, chronic seizures, coma
Nutrition and
Metabolism
Mothe
6 kg
Maternal-Fetal
Metabolism
250 - 300 extra kcal/day should be ingested
- 85% fetal metabolism, 15% stored in maternal
fat
Extra protein intake - 30g/day
End of pregnancy - fetal glucose need 5mg/kg/min
(mother 2,5mg/kg/min)
2 phases of pregnancy:
1st - 20th week - mothers anabolic phase:
- anabolic metabolism of the mother
- quite small nutrition demands of the
conceptus
21 - 40 week (esp. last trimester):
- high metabolic demands of the fetus
Maternal-Fetal
Metabolism
Mothers anabolic phase:
- normal or increased sensitivity to insulin
- lower plasmatic glucose level
- lipogeneses, glycogen stores increases
- growth of breasts, uterus,weight gain
Catabolic phase (accelerated starvation):
- maternal insuln resistance
- increased transport of nutritients trough
placental
membrane
- lipolysis
Insulin resistance caused by HCS, cortisol and
growth hormone
Parturition
Birth of the baby
Both Biological and Social Event
Expected Day of Delivery
Your Favorite:
Hormones!
Fetal Hormones
High Estrogen vs.
Progesterone
Prostaglandins
Oxytocin
Relaxin
All combine for a
POSITIVE feedback
loop
Estrogen and
Progesterone
Progesterone
inhibits
contractibility
Estrogen increases
contractibility
At 7th month,
estrogen still
increasing but
progesterone
drops off slightly
High Estrogen:
Progesterone ratio
excites uterus
Two More!!
Prostagladins
Release stimulated
by estrogen and
oxytocin
Also stimulates
oxytocin (+ loop)
Promotes uterine
contractions
Relaxin
Peptide hormone
produced by the
corpus luteum
Looses ligaments
Softens cervix
Increases # of
oxytocin receptors
Dilation and
Effacement
Descent and
Expulsion
Expulsion of
Placenta
Intermittent
contractions < 10
minutes
Cervix dilating and
thinning
Average 12 hours
primigravidas, 7
hours for
multigravidas
Breech Presentation
Head Crowing
Working Hard
Mom and Baby
Stage 3: Placenta
Recovery Time
Indications:
Cord Prolapse
Tranverse Lie
Fetal Distress
Placenta Previa
Placenta Abruption
Failure to Progress
VBAC: risk of uterine
rupture
Cephlo-Pelvic
Disproportion
Warning: Midwife
Speaking
If we hope to create
a non-violent world
where respect and kindness
replace fear and hatred
We must begin
with how we treat each other
at the beginning of life.
For that is where
our deepest patterns are set.
From these roots
grow fear and alienation
~or love and trust.
~Suzanne Arms