Presentation on theme: "L 34.

Adaptation to pregnancy, Physiology of

parturition & lactation"— Presentation transcript:
1  L 34. Adaptation to pregnancy, Physiology of parturition & lactation

2  Learning objectivesTo discuss the physiological adaptations during normal pregnancy,

cardiovascular, respiratory, gastrointestinal, renal and the uterine changes during pregnancy.

3  Learning outcomesAt the end of this lecture students should be abele to;Describe the
physiological adaptations during the normal course of pregnancyDescribe the cardiovascular &
respiratory changes during pregnancyDescribe the renal function and electrolyte balance during
pregnancy

4  Learning outcomes cont

Gastrointestinal changes during pregnancyUterine changes during pregnancyDescribe the
physiology of parturitionDescribe the role of hormones in functioning mammary glandDescribe the
physiology of lactation

5  MATERNAL CHANGES IN PREGNANCY

5

6  Duration of pregnancy is 280 days or 40 weeks from the first day of last menstrual period.
6

7  The uterus Uterus gains weight from 50g to 1000g.

Length, thickness and volumeMainly hypertrophy of existing muscle cell and hyperplasia.There is
increase in connective tissue and elastic tissue.7

8  Mammary Glands Hyperplasia of the ductal and alveolar tissue

Pigmentation of the nipple and the areola8

9  Changes in blood Blood volume increases by 30% Haematocrit decreases.

aldosterone and estrogens increased in pregnancyIncreased fluid retention by the
kidneysHaematocrit decreases.Plasma volume increases much more than RBC volumeIncrease in
fibrinogen levelIncrease in ESR.9

10  Changes in circulatory system

Cardiac output increases to 30 to 40% above normal.Blood volume increases by 30%.Blood
pressureSystolic remains sameThere is fall in diastolic pressureVasodilation (Kinin,Nitric
oxide,EDF)Increase in blood flow to uterus and kidneys10

11  Respiratory changes Increase in O2 consumption – 20% more than normal

Minute ventilation increases by 50%Respiratory rate is increased.Higher levels of progesterone
during pregnancyIncreased sensitivity of respiratory centre to CO2No change in vital capacity.11

12  CHANGES IN GIT Morning sickness Decrease in motility

Increase in absorptionIncreased appetite12
13  Changes in urinary system
Increased fluid intake and increased load of excretory productsGFR increases as much as
50%.Reabsorption capacity of renal tubules is increased by 50%Increased production of hormones
by the placenta and adrenal cortex13

14  Skin Hyperpigmentation
Increased secretion of ACTH and MSH during pregnancy14

15  CNSChanges in mood.Craving for unusual diet.15

16  Metabolism Increased basal metabolic rate (BMR) Increased secretion

Thyroxin,Adrenocortical hormones,Sex hormones16

17  Increased requirement of iron

Likely to develop iron deficiency without supplementationIncreased requirement of calcium and
phosphorus17

18  OTHER CHANGES Weight gain 10-12 kgs Water retention. Fetus

Uterus , mammary glandsPlacenta and amniotic fluidIncrease in blood volumeFat depositionWater
retention.18

19  Physiology of PARTURITION
19

20  Childbirthprocess of giving birthAlso called “labor”20

21  Increased uterine contractility

Hormonal factorsIncrease in estrogen to progesterone ratioOxytocinFetal hormonesMechanical
factorsStretch of uterine musculatureStretch of cervix21

22  Circulating estrogens
Increases the number of gap junctions between myometrial cellsProduction of
prostaglandinsIncrease in myometrial contractile proteinsIncrease in number of oxytocin receptors22

23  Effect of cortisol Increase in cortisol formation in the fetus.

CRH secretion by the fetal hypothalamus increasesIncreased placental production of CRH.This
increases circulating adrenocorticotropic hormone (ACTH) in the fetus23

24  Positive feedback theory for onset of labour

25  Head descends into the cervix Initiates the cervical stretch

Stretch of cervixHead descends into the cervixInitiates the cervical stretchIncrease in contractility of
the uterine bodyHead descends furtherCycle repeats25

26  Stretch of cervix and distention of vagina

Uterine contractionsStretch of cervix and distention of vaginaAfferents from cervix and
vaginapositive feedback to the hypothalmusOxytocin from posterior pituitaryFormation of
Prostaglandins in the decidua26
27  Two types of positive feedback mechanisms increase uterine contractions during labor:
Stretching of the cervix causes the entire body of the uterus to contractCervical stretching also
causes the pituitary gland to secrete oxytocin27

28  Parturition Intermittent contractions of the uterus

Delivery of the fetusSeparation and delivery of PlacentaShearing effect between walls of uterus and
placenta350 ml of blood loss

29  Physiology ofLACTATION

30  Role of estrogensCauses the ductal system of the breast to grow and branch.Stroma of the
breast increase in quantity and large quantities of fat are laid in the stroma.Growth hormone, adrenal
glucocoticoids, prolactin & insulin are also needed for ductal growth.

31  Role of progesteroneActs synergistically with estrogen causes additional growth of the breast
lobules,budding of alveolidevelopment of secretory characteristics in the cells of the alveoli.

33  Initiation of Lactation-Function of Prolactin

Estrogen and progesterone inhibits secretion of milk.Prolactin is required for actual secretion of milk.

34  Increase lactogenic effect

Function of prolactin:prolactinPromotes the secretion of milkEstrogen and
progesteroneBirthDecrease [estrogen + progesteroneIncrease lactogenic effect(prolactin)Increase
[milk] in the alveoli of theBreast – not the ducts!!!!!

35  Galactopoiesis (maintainance of lactation)

ProlactinGH, Cortisol, PTH, InsulinOxytocin

36  Milk Ejection Reflex 36

37  Ejection of Milk: Oxytocin

Milk let down reflex or Suckling reflexNeuroendocrine reflexspinal cordSuckling of breastAfferent
conduction of APsContraction of the myoepithelial cellsEjection of
milkOxytocinsecretionhypothalamusProlactinsecretionIncrease [milk] in the alveoli of the breast

39  Role of hormonesEstrogen & Progesterone specific effect of both these hormones is to inhibit
the actual secretion of milkProlactin: stimulates milk productionOxytocin: stimulates milk
releaseHuman chorionic somatomammotropin :Has lactogenic properties and supports the action of
prolactin

40  Effect of lactation on menstrual cycles

Lactation amenorrheaNursing stimulates prolactin secretionProlactin inhibits GnRH secretionAction
of gonadotropins on ovaries inhibited“No ovulation”