Surah: Al-Mumenoon(23) Ayat: 12-14

Surah: Al-Mumenoon(23) Ayat: 12-14

Pregnancy
Prof. Dr.
Anwar khan
Wazir
 Gestation
• If fertilization of ovum occurs a new phase
of female reproductive life starts known as
pregnancy or gestation
• Marked physiological changes in most of
the systems of female body occur
• Special changes in the reproductive
system
 Maturation of the ovum
• Primordial follicle contain primordial ova still in the primary
oocyte stage
• Just before ovulation 1st meiotic division is completed & 1st
polar body is shed
• Secondary oocyte- 23 chromosomes
• 2nd meiotic division is only completed if sperm enters the
oocyte- shedding of 2nd polar body- mature ovum- haploid
number of chromosomes
• 22 autosomes and one X-chromosome
• Sex of the offspring
– Female (XX) if fertilizing sperm contains X-chromosome
– Male (XY) if fertilizing sperm contains Y-chromosome
Oogenesis
 Entry into Fallopian tubes
• Ovulation into peritoneal cavity
• 100s of corona radiata cells around the ovum
• Fimbriated ends of FT near the ovaries
• Fimbria lined by ciliated epithelium
• Cilia beat towards the abdominal ostium of FT
• A current of fluid set by cilia
• 98% of ovulated ova enter the FT
• Ovum can enter into FT on opposite side
 Fertilization
• Sperm may reach the ampullae in 5-10 minutes
• Transport of sperm aided by contraction of
uterus and FT caused by
– Prostaglandins in the semen
– Oxytocin released during female orgasm
• ½ billion sperm/ejaculate
• 1000-3000 reach the ampulla
• Acrosomal reaction help dispersal of corona
radiata cells
 Fertilization
• Sperm binds with an then penetrates the Zona
Pellucida
• Only head containing the chromosomes enters
into ovum
• Head swells and forms the male pronucleus
• Ovum sheds the 2nd polar body
• Female pronucleus is formed
• Male and female pro-nuclei align to complete 23
paired chromosomes
Fertilization of the ovum
 Transport in FT
• Feeble current of fluid and secretion of FT
• Ciliated epithelium- beating of the cilia towards the
uterus
• Weak contraction of FT also help the transport
• Isthmus of the FT remains contracted for 3-4 days after
ovulation
• Isthmus relaxes due to progesterone from CL
• Fertilized ovum enters into the uterus
• Several cell division occur during this period
• Dividing ovum is in blastocyst stage
• Secretion of the FT glands provide nutrition
Transport through FT
 Implantation
• Remains un-implanted for 2-3 days in
uterine cavity
• Nutrition from the secretions of endometrial
glands- the uterine milk
• Implantation occurs by the trophoblastic
digestion of the thickened endometrium
• Trophoblasts secrete proteolytic enzymes
• After implantation trophoblasts excessively
proliferate and finally form placenta
Implantation
 Early intra-uterine nutrition
• Persistence of CL and continued secretion
of progesterone causes excessive
deposition of nutrients and swelling in the
endometrial stromal cells
• Decidual cells
• Trophoblasts digest and imbibe these
nutrients in the decidua
 Early intra-uterine nutrition
• This is the only way of nutrition in 1st
week after implantation
• Placenta starts supplying nutrition on
about 16th day of fertilization
• Trophoblastic nutrition continues for
8th week of pregnancy
Nutrition of the fetus
 Placenta
• Trophoblastic cord grow and branch deep
into the endometrium
• Fetal blood vessels grow into these cord
• Blood begins to flow on about 16th day of
fertilization
• The final branches of the trophoblastic cords
form placental villi
• Maternal blood sinuses surround these villi
Placenta
 Placental membrane
• Consists of
– Endothelium of the fetal capillaries
– Mesencymal tissue
– Layer of Cytotrophoblasts (early stages of placental
development)
– Layer of Syncytial trophoblasts
• Total surface area- a few square meters
• Thickness- 3.5 micrometer
• Diffusion across the placental membrane
– Nutrients and other requirements to the fetus
– Waste products from the fetus into the mother
 Placental permeability &
conductance
• Permeability
– Net quantity of substance diffusing through the placental
membrane /unit SA for a given concentration gradient across the
placental membrane
• Total conductance
– Permeability X Total SA
• Early pregnancy
– Permeability very low
• Less surface area
• Thick placental membrane
• Later pregnancy
– Tremendous permeability and total conductance
Placental conductance
 Diffusion of O2
• Mean pO2 in maternal blood = 50 mm Hg
• Mean pO2 in fetal oxygenated blood= 30 mm Hg
• Mean pressure gradient across the placental
membrane = 20 mm Hg
• O2 diffusing capacity= 1.2 ml/min/ml conc. Grd.
• Fetal oxygenated blood pO2 of only 30 mm Hg
sufficient to supply required O2 to fetus because
– HbF has more O2 carrying capacity
– Hb concentration is 50% more than adult
– Double Bohr effect across the placental membrane
• Oxygen carrying capacity is inversely proportional to Pco2
HbF carries more O2
 Diffusion of CO2
• CO2 continuously formed in the fetus
• Fetal lungs nonfunctional
• CO2 must be excreted through maternal lungs
• Estrogen and progesterone affect maternal
breathing to eliminate more CO2
• pCO2 in maternal blood = 40 mm Hg
• pCO2 in fetal blood is always 2-3 mm Hg higher
than maternal blood
• 20 times more rapid diffusion than O2
 Crossing of other substances
• Food stuffs
– Diffusion – FA, Ketone bodies, Na, K, Cl
– Facilitated diffusion – glucose
– Active transport – AA, Ca, PO4, ascorbic acid
• Waste products of fetus other than CO2
– Diffusion - Urea, Uric acid, creatinine