Hormonal mechanisms of

pregnancy & regulation

of delivery
STUDENTS: LUKA-DINO PIRNAT, AMINA TIGANJ, LAMIJA IKALO, AHMED DERVIEVI
MENTOR: PROF. MIRZA IBRIIMOVI
Hormonal factors in pregnancy

In pregnancy placenta forms large quantities of:

Human chorionic gonadotropin
Estrogens
Progesterone
Human chorionic somatomammotropin
Essential for normal pregnancy!
 Human chorionic gonadotropin (hCG)

During menstruation endometrium of the

uterus sloughs away from uterine wall and is
expelled to the exterior

Sloughing is prevented by this hormone, by

the newly developing embryonic tissues

Secreted by the syncytial trophoblast cells

into the fluids of mother
FUNCTIONS

Same structure and function as luteinizing hormone secreted by pituitary gland

Prevents involution of corpus luteum at the end of menstrual cycle

Instead it secretes even greater amounts of progesterone and estrogens, which prevent menstruation

Endometrium grows and store large amounts of nutrition

Decidua-like cells become decidual cells (nutritious and swollen) at the time blastocyst implants

Continuous secretion of progesterone and estrogens maintains decidual nature of uterine endometrium
necessary for early development of fetus
If corpus luteum is removed before 7th week of pregnancy, spontaneous
abortion almost always occurs

After that time placenta will secrete sufficient amounts of

progesterone and estrogen to maintain pregnancy

HCG stimulates production of testosterone in male fetuses until the

time of birth

Small secretion causes male fetuses to grow male sex organs instead of
female organs
Secretion of estrogens by the placenta

Secreted by syncytial trophoblast cells of placenta

Estrogens secreted by the placenta are not synthetized de novo from basic substrates in placenta.

Formed entirely from adrogenic steroid compounds (dehydroepiandrosterone and 16-

hydroxydehydroepiandrosterone) formed in the mothers adrenal glands and in the andrenal glands in fetus
Functions

Enlargements of
Enlargement of the
Enlargement of mothers breasts and
mothers female
mothers uterus growth of breast ductal
external genitalia
structure

Relaxation of pelvic
ligaments so that
sacroiliac joints Easier passage of fetus
become limber and through birth canal
symphysis of pubis
elastic
Secretion of progesterone by the placenta
and its function

Important for successful pregnancy

Causes decidual cells to develop uterine endometrium (nutrition of embryo)

Prevents uterine contractions from causing spontaneous abortion by decreasing contractility

Development of conceptus before implantation, because it increases secretions of mothers

fallopian tubes and uterus to provide appropriate nutritive matter for the developing morula

Prepare mothers breasts for lactation

Human chorionic somatomammotropin

Secreted by placenta at 5th week of

pregnancy

Increase in secretion in proportion to

weight of placenta
Secreted in quantities several times
greater than all of the rest hormones
combined
 Decreased insulin
Causes formation of
sensitivity and
protein tissues in the
decreased utilization
same way growth
of glucose in the
hormone does, thus
mother, thus making
they have similar
larger amounts of
chemical structure
glucose for fetus

When administered Release of free fatty

to animals it causes
partial development
of breasts and in
some cases even
lactation
acids from fat stores
of mothers, thus
General providing alternative
metabolic energy sources for
hormone that has mothers metabolism
specific nutritional
implications for
both mother and
fetus
Other hormonal factors in pregnancy

Increased
corticosteroid Increased thyroid
secretion gland secretion
glucocorticosteroids thyroxine
and aldosterone

Increased
parathyroid gland Secretion of relaxin
secretion if by the ovaries and
mothers diet is palacenta
deficient in calcium
Between 500 milliliters and 1 liter or as much as several liters

On average, the water in amniotic fluid is replaced once every

three hours and electrolytes sodium and potassium are replaced
every 15 hours
Large portion of fluid is derived from renal excretion by the fetus

Certain amount of absorption occurs by way of gastrointestinal tract

and lungs of the fetus
 Preeclampsia and Eclampsia

5 percent of all pregnant women

Associated with leakage of large amounts of protein into the urine

Preeclampsia or toxemia of pregnancy

Characterized by excess salt and water retention by the mothers kidneys and
by weight gain and development of edema and hypertension in the mother

Impaired function of the vascular endothelium and arterial spasms occur in

many parts of the mothers body (kidneys, brain, liver)

RBF and GFR are decreased

Eclampsia extreme degree of preeclampsia, characterized by vascular

spasm throughout the body

Clonic seizures in the mother, greatly decreased kidney output, malfunction of

the liver, extreme hypertension, generalized toxic condition of the body
 PARTURITION
Birth of the baby
Increased excitability of the uterus
Two major categories of effects lead up to intense contractions responsible
for parturition: (1) progressive hormonal changes that cause increased
excitability of the uterine musculature and (2) progressive mechanical
changes

Hormonal factors that increase uterine

contractility
Increased ratio of estrogens to
progesteron
Oxytocin causing contractions of the
uterus
Effect of fetal hormones on the uterus
Mechanical factors that increase uterine contractility
Stretch of the uterine
musculature
Stretch or irritation of the cervix
Onset of labor A positive feedback mechanism for its
initiation

Braxton Hicks contractions

Labor contractions
Theory for explaining the onset of labor positive
feedback
It is suggested that stretching of the cervix by the
fetuss head finally becomes great enough to
elict a strong reflex increase in contractility of the
uterine body; the process is repeated until the
baby is expelled
Abdominal muscle contractions during
labor

Pain signals from the uterus and birth

canal
Neurogenic reflexes in the spinal cord
Mechanics of parturition

Contractions begin mainly at the top of the uterine fundus and

spread downward over the body of the uterus

Intensity of contractions is great in the top and body of the

uterus, but weak in the lower segment adjacent to the cervix

Contractions occur every 30 minutes at first and then every

1 to 3 minutes as the labor progresses

Contractions occur intermittently

Strong contractions impede or stop the blood flow through

the placenta

95 % of births head is the firts part to be expelled

Breech presentation
 Cramping pain in early labor due to hypoxia of uterine
muscle resulting from compression of the blood vessels in
the uterus
Much more severe pain during the second stage of labor
Cervical stretching, perineal stretching and stretching or
tearing of structures in the vaginal canal itself
Pain conducted by somatic nerves to the spinal cord

Weight of the uterus becomes less than half its immediate

postpartum weight within 1 week, and in 4 weeks, if the
mother lactates, the uterus becomes as small as it was
before pregnancy
This effect of lactation results from the supression of pituitary
gonadotropin and ovarian hormone secretion during the
first few months of lactation
During early involution, the placental site on the
endometrial surface autolyzes
Lactation is the process by which milk is synthesized and secreted from the
mammary glands of the postpartum female breast in response to an infant
sucking at the nipple.
Lactogenesis includes all processes necessary to transform the mammary
gland from its undifferentiated state in early pregnancy to its fully
differentiated state sometime after pregnancy, which allows full lactation.
There are two hormones that directly affect
breastfeeding: prolactin and oxytocin. A number of other hormones, such as
oestrogen, are involved indirectly in lactation
In pregnancy, the large quantities of estrogens secreted by placenta cause
the ductal system to grow and branch. Progesterone stimulates growth of
milk-producing cells in the glands
Estrogen and progesterone act synergistically to promote additional
growth of the breast lobules

For full development of the lobule-alveolar system are also important

growth hormone, prolactin, the adrenal glucocorticoids and insulin

Estrogen further stimulates growth by stimulating secretion of prolactin,

a hormone that promotes breast growth and milk production. However,
high levels of estrogen and progesterone prevent lactation during
pregnancy by inhibiting milk synthesis.

Stage 1: occurs by mid pregnancy. In
stage 1, the mammary gland becomes
competent to secrete milk. Lactose, total
protein, and immunoglobulin
concentrations increase within the
secreted glandular fluid, whereas sodium
and chloride concentrations decrease.
The gland is now sufficiently differentiated
to secrete milk, as evidenced by the fact
that women often describe drops of
colostrum on their nipples in the second or
third trimester.
Stage 2 of lactogenesis occurs around the
time of delivery (ca 36 h, 72h is considered
as delay). It is defined as the onset of
copious milk secretion- transition from
colostrum to mature milk. In stage 2, blood
flow, oxygen, and mammary glucose
uptake increase, and citrate
concentration increases sharply.
Increased milk citrate is considered a
reliable marker for the second stage of
lactogenesis. Progesterone plays a key
role in this stage. Removal of the placenta
(ie, the source of progesterone during
pregnancy) is necessary for the initiation
of milk secretion.
Prolactin is necessary for the secretion of milk by
the cells of the alveoli, secreted by anterior
hypophysis

Its concentration in mothers blood rises steadily

from 5th week of pregnancy until birth of the baby,
at which time it has risen 10-20 times the normal
nonpregnant level
After delivery, levels of progesterone and
oestrogen fall rapidly, prolactin is no longer
blocked, and milk secretion begins.

Conditioned by suckling, highest about 30 minutes

after the beginning of the feed, so its most
important effect is to make milk for the next feed
 Prolactin

During the first few weeks, the more a

baby suckles and stimulates the nipple,
the more prolactin is produced, and the
more milk is produced
But as first 3-4 weeks pass, the basal level
of prolactin secretion is returning to
nonpregnant level.
However, each time the mother nurses
her baby, it is restored for a 1-hour spike
during each feeding to stimulate the
production of milk for the next feeding.
With each prolactin spike, estrogen and
progesterone also increase slightly.
 Oxytocin

Posterior pituitary gland

Oxytocin makes the myoepithelial cells around the alveoli contract. This makes the
milk, which has collected in the alveoli, flow along and fill the ducts

In humans, oxytocin induces a state of calm, and reduces stress. It may enhance
feelings of affection between mother and child, and promote bonding.

Suckling affects the release of other pituitary hormones, including gonadotrophin

releasing hormone (GnRH), follicle stimulating hormone, and luteinising hormone,
which results in suppression of ovulation and menstruation
The baby is latching on and suckling

Oxytocin Release

Releases Milk

Infant Empties Breast

Interference with this

Production Increases
cycle decreases the milk
supply!
Milk Production Occurs
Let-down reflex
The path of oxytocin release: The tactile sensations create impulses activate the dorsal
root ganglia via the intercostals nerves (T4, T5, T6). These impulses ascend the spinal
cord, creating an afferent neuronal pathway to both the paraventricular nuclei of the
hypothalamus where oxytocin is synthesized and secreted by the pituitary gland. The
stimulation of the nuclei causes the release of oxytocin down the pituitary stalk and into
the posterior pituitary gland, where oxytocin is stored.

Prolactin inhibitory hormone is dopamine, produced by the hypothalamus and has a

direct effect on adenohypophysis. It is trasported through the hypothalamic-
hypophysial portal system. In ejection reflex, the hypothalamus will send off signal to
PIH neurons, so that prolactin neurons in adenohypophysis can release prolactin.
Hormonal regulation of lactation
Breastfeeding

Thick and yellowish colostrum is secreted during

the first 4872 hours postpartum, only small
amounts in first 24 h (ca 37ml, but enough).
Milk-producing cells do not need insulin to take in
glucose, but new studies show that insulin has a
big effect on lactation, because mammary glands
become extremely sensitive on insulin
To ensure adequate milk production and flow for 6
months of exclusive breastfeeding, a baby needs
to feed as often and for as long as he or she
wants, both day and night
The 24-hour intake of milk varies between mother-
infant pairs from 4401220 ml, averaging about 800
ml per day throughout the first 6 months
Compositions of Human Colostrum, Mature Breast Milk, and Cows Milk (g/L) (Table 3)
Human colostrum Human breast milk Cows milk*
Total protein 23 11 31
Immunoglobulins 19 0.1 1
Fat 30 45 38
Lactose 57 71 47
Calcium 0.5 0.3 1.4
Phosphorus 0.16 0.14 0.90
Sodium 0.50 0.15 0.41
Questions
Sources:

Literature:
Hall, John E., and Arthur C. Guyton. Guyton and Hall Textbook of Medical
Physiology. 13th ed. Philadelphia, PA: Elsevier, 2015. 667. Print.