PHYSILOGY OF

PREGNANCY AND LABOR

 Outline
 Fertilization
 Development before Birth
 Fetal Circulation
 Embryonic Development
 Fetal Development
 Birth
 Conception
 A secondary oocyte can be fertilized for
about 24 hours after ovulation
 Sperm remain viable for up to 48 hours
within the female reproductive tract
 This gives a three day “window” for
intercourse to result in fertilization: two
days before to one day after ovulation
 Fertilization
 Steps of fertilization (Conception).
 Several sperm penetrate corona radiata.
 Several sperm attempt to penetrate zona
pellucida.
 One sperm enters egg and nuclei fuse,
producing a zygote.
 Egg’s
plasma membrane and zona pellucida
change to prevent polyspermy.
Fertilization
 Fertilization usually takes place in the
outer one-third of the uterine tube, but
can take place in the abdominal cavity
 Sperm swim up the female reproductive
tract, aided by muscular contractions of
the uterus stimulated by prostaglandins in
the semen.
 The oocyte may also secrete a chemical
that attracts sperm
 Occurrence of Pregnancy
 When a zygote begins dividing, it is termed an
embryo.
 Developing embryo travels down oviduct and
eventually implants in endometrium. (Implantation /
pregnancy)
 Presence of human gonadotropic hormone (HCG) in the
blood confirms pregnancy.
 If implantation does not occur, a woman never knows
fertilization took place.
Human Development before
Implantation
 Zygote undergoes rapid mitotic cell
division, but these do not increase the size
of the zygote – called cleavage divisions
 Cleavage produces a solid sphere of cells,
still surrounded by zona pellucida – now
called a morula.
 At 4.5 to 5 days, cells have developed into
a hollow ball of cells – blastocyst.
 It is at this stage that it enters the uterus.
 Cellular differentiation
 Embryonic membranes
 Amnion – inner layer
 Chorion – outer layer
Both membranes form bag of waters
 Amniotic fluid
 700-1000 cc normal
 < 400 ml oligohydramnios
 > 2000 ml polyhydramnios
 Fetus contributes to amniotic fluid volume thru fetal
urine
 Amniotic fluid important for fetal lung development

Wajed Hatamleh RN, MSN, PhD.

 Cellular differentiation
 Umbilical cord
 Wharton’s jelly
 2 arteries/ 1vein

 Placenta
 Siteof metabolic and nutritional exchange
 Maternal side – decidua basalis
 Fetal side – amnion
 15 – 20 cotyledons: contain the complex
vascular system of villi
Wajed Hatamleh RN, MSN, PhD.
Wajed Hatamleh RN, MSN, PhD.
 Implantation
 The blastocyst remains free in the uterus a
short time, during which the zona pellucida
disintegrates.
 Blastocyst nourished by glycogen from glands
of the endometrium.
 At about 6 days after ovulation blastocyst
implants – orients cell mass toward
endometrium, and secretes enzymes which
allow it to penetrate (digest) the endometrial
wall. This nourishes the blastocyst for about a
week after implantation.
• Following implantation, the placenta
originates from maternal and fetal
tissues.
• Placenta then produces human chorionic
gonadotropin (HCG) which maintains the
corpus luteum in the ovary until the
placenta begins its own production of
progesterone and estrogen.
• Physical signs of pregnancy include : no
menstruation, increased urination,
morning sickness, increased size of
breasts, and darkening of areolae.
 As early as 8 -12 days after fertilization,
the blastocyst begins to secrete human
chorionic gonadotropin or hCG.
 hCG keeps the corpus luteum active until
the placenta can produce estrogens and
progesterone.
 The presence of hCG is the basis for
pregnancy tests.
 Inner cell mass forms two cavities:
 Theyolk sac
 Amniotic cavity

 In humans the yolk sac produces blood

cells and future sex cells
 The amniotic cavity becomes the cavity in
which the embryo floats. Fluid is produced
from fetal urine, and secretions from the
skin, respiratory tract, and amniotic
membranes.
 Gestation period
 Divided into three trimesters.
 During first trimester individual starts out
as a zygote, then morula, blastocyst, and
after implantation, is called an embryo.
 Embryonic phase of development lasts
from fertilization until the 8th week of
gestation, when it becomes a fetus.
 By day 35 the heart is beating, and eye
and limb buds are present.
Five-Week-Old Embryo
Fetus at 14 and 20 weeks gestation

Wajed Hatamleh RN, MSN, PhD.

 By month four, the rudiments of all organ
systems are formed and functioning, and
from then on, fetal development is
primarily a matter of growth.
 By the end of the third month the placenta
is functioning.
Three-to-Four Month-Old Fetus
 Fifth through Seventh Months
 Mother begins to feel fetal movement.
 Wrinkled skin covered by fine hair, lanugo,
is covered by a greasy substance vernix
caseosa.
 Lungs lack surfactant so if baby is born
prematurely it will have to be on a
respirator (respiratory distress syndrome).
Six-Month-Old-Fetus
 The placenta
 The chorion develops into the fetal part of the
placenta.
 The chorionic villi connect the fetal circulation
to the placenta
 Composed of both fetal and maternal tissues
 Functions of the placenta:
1 Transfer gasses
2 Transport nutrients
3 Excretion of wastes
4 Hormone production – temporary endocrine
organ – estrogen and progesterone
5 Formation of a barrier – incomplete,
nonselective – alcohol, steroids, narcotics,
anesthetics, some antibiotics and some
organisms can cross
 Placental functions
 Simple diffusion - water, oxygen, carbon
dioxide, sodium and chloride
 Facilitated transport – glucose and galactose
 Active transport – amino acids, calcium, iron,
iodine, vitamins, and glucose
 Pinocytosis – albumin and gamma globulin
 Hydrostatic and osmotic pressure
 Endocrine – hCG, hPL, estrogen and
progesterone

Wajed Hatamleh RN, MSN, PhD.

 ESTROGEN

 Produced in corpus luteum

 Produced by placenta after 12 weeks

 Responsible for growth particularly of

uterus and breasts
 Progesterone
 Produced in corpus luteum and then the
placenta

 Relaxes smooth muscle

 Inhibits uterine contractions until uterus is

prepared for labour

 Regulates storage of body fat

 Human chorionic gonadotrophic
 Secreted from trophoblast of the
developing embryo

 Maintains corpus luteum until placenta

takes over

 Used in tests to confirm pregnancy

 Human placental lactogen
 Alters maternal metabolism

 Diverts glucose to fetus

 Mobilises free fatty acids from maternal

stores
 RELAXIN

 Released by corpus luteum then the

Placenta

 Softens pelvic ligaments

 Reduces myometrial tone

 Cardiovascular changes
Cardiac output (CO)
• 30 -50% above normal
• placental circulation
• ECG changes
• increased metabolism
• functional murmurs
• skin - thermoregulation
• heart sounds
• renal circulation

• decreases in last 8 weeks (uterus compresses vena cava)

• incr. 30% more during labor

• Heart rate (HR) increases up to 90/min

• Blood pressure (BP) drops, periferal resistance decreases

• with twins CO increases more, BP drops more

 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
• Frequency increases

• Minute ventilation
• Progesterone increases sensitivity increases (50%)
for CO2 in respiratory centre
• pCO2 decreases slightly

• Growing uterus
 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
 The History of Childbirth
 Historically,
pregnancy has been
managed by women
(family, friends,
midwife) with
delivery in the home
 In the 14th-18th
Centuries medicine
was dominated by
men and the Church
 History of Childbirth
 Industrialization of
America brought
mothers from their
homes to hospitals
(“lying-in”) for birth
 Obstetrics was then
performed by
surgeons (not
midwives)
 What is labor?
 Labor = the act of uterine contractions
combined with cervical change
 Fetus is gradually pushed through the
birth canal (consisting of the cervix,
vagina and perineum)
 Placenta is extruded and uterus involutes
What is labor?
What is labor?
 What starts labor?
 An intricate and baffling association
between fetus and mother exist
 Several components are known, but many
are not – extrapolated from animals
 Involves hormonal communications
between mother and fetus
 In other words – we can speculate but
we’re not quite sure!
 How does the uterus contract?
 The uterus is made from a weave of
smooth muscle (myometrium) covered by
a smooth cellular surface (serosa) – all
formed by the joining of the two original
mullerian horns
 The cavity is hollow and lined by
vascular/stromal bed that is responsive to
hormonal stimulation (i.e. menstrual cycle)
 Stages of Labor
 First stage – Latent and active labor
 Second stage – Descent with pushing to
delivery of baby
 Third stage – Delivery of placenta
 Stages of Labor
 Stage 1 (Latent Phase)
 Uterus and cervix prepare for active labor
 Dilatation up to 4 cm
 Variable length of time
 Stages of Labor
 Stage 1
 The “Active” Phase – rapid cervical dilatation
from 4 centimeters to 10 centimeters (or
complete dilatation). Varies for nulliparous
vs. multiparous patients
 Nulliparous– 1.2 cm/hr
 Multiparous – 1.5 cm/hr
 Stages of Labor
 Stage 2 “Pushing”
 Starts from complete dilatation to delivery of
the fetus
 Variable depending on parity maternal forces
 Fetus has to make it’s way through the
curves of the pelvis
 Third Stage of Labor
 Stage 3
 From delivery of the fetus to delivery of the
placenta
 Variable amounts of time for placental
extrusion but generally within the first 20-30
minutes
 Medications can be used to augment placenta
delivery and post-partum bleeding