Pregnancy

JP Slovak
Texas A &M University Commerce

10/20/09
Introduction
42 mitotic cell divisions
cell differentiation
Definition
Texts and legal ruling

◆pregnancy starts at conception

◆9.5 months
medical profession

◆calculated from day 1 of LMP

◆10 months
public

◆2 weeks after conception(time of missed period)

1
10/20/09

◆9 months
Signs of Pregnancy
 Presumptive signs
◆ missed menstrual period

◆ nausea

◆ increase in size and tenderness of

breasts
 Probable signs
◆ increased urination

◆ increase in size of abdomen

◆ Hegar’s sign - cervix becomes softer

 Positive signs
◆ fetal heartbeat

◆ movement

◆ ultrasound
2
Pregnancy tests
 Detect hormones
◆ hCG

◆ used to inject urine into animals

◆ Ab to hCG
 cause color reaction
 3% false positive

 20% false negative

3
Process of Pregnancy
 Implantation
◆ fertilization (32 cells by 3rd day)

◆ morula

◆ 3-4 days - potential embryo enters uterus

 now is a blastocyst
 blastocoel

 trophoblast - outer layer of cells

◆ embryo remains in uterine cavity for 2-3 days

◆ uterus secretes proteases which dissolve zona
◆ inner cell mass attaches to uterine wall
◆ nidation

4
 7-10 days after fertilization
Process of Pregnancy
 Differentiation
◆ trophoblast
 syncytiotrophoblast - outer
 breaks down endometrium

 mass of cells with single membrane

 cytotrophoblast - inner

◆ deciduoma response
 cells of uterus form a cup that grows over blastocyst
 Implantation
◆ if not blastocyst degenerates

◆ must have proper amounts of estradiol and

progesterone
◆ prog - causes protease secretion of uterus 5
◆ zona may protect b.c. from immunologic response
Early Embryonic Development
 Endoderm, mesoderm, ectoderm
 Extraembryonic membranes
◆ Yolk sac-surrounds the blastocoel

◆ Amnion – formed from inner cell mass

 Grows over forming embryo
◆ Allantois – small pouch for wastes
◆ Chorion - surrounds embryo
 Eventually fuses with amnion
 Yolk sac plays minor role in most mammals
◆ Supplies RBC and primordial germ cells

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Placenta
 O2 and glucose
 Eliminate wastes
 Cytotrophoblast forms chorionic villi
◆ Enzymes dissolve vessels of uterus
◆ Forms hemochorial placenta
◆ Uterine blood bathes the villi
 Mother’s blood does not mix with fetal
 Molecules > 500 molecular weight will not pass
◆ Most proteins do not reach fetus
◆ Maternal Ab will reach
◆ Steroids degraded by placental enzymes
◆ Viruses can cross
◆ Cocaine crosses 7
Placenta
 4th week placenta 200g, fetus 500g
 Term placenta 700g,
 Near term placenta responsible for 10% of mothers blood flow
 Structures
◆ Decidua basalis – maternal part of placenta

◆ Decidua capsularis – overgrowth of endometrium

◆ Decidua parietalis – endometrium away from the fetus

◆ Umbilical cord – connects fetus and placenta

 Umbilical vein – carries oxygenated blood to fetus
 Umbilical artery – carry deoxygenated blood to placenta

 Whartons jelly – cushions vessels

Twin Pregnancies
 Dizygotic
◆ 2 zygotes
◆ Implant separately – 2 placentas, chorions and amnions
 If implantation is close these structures may fuse
◆ More prevalent than monozygotic
◆ Highest in those of African descent
◆ Lowest in Japanese
◆ 4x as many twins concieved as as born (spontaneous
abortion)
 Monozygotic
◆ Separation of inner cell mass
◆ Common placenta and chorion
◆ Separate amnion
 Embryonic and Fetal
Development
 1st month
◆ Heart formed and beating
◆ Most organ systems developing
 End of embryonic period
◆ Distinct limbs and digits
◆ End of embryonic period (8th week)
 End of first trimester
◆ Large head
◆ Well formed face
◆ Heart beat with stethoscope
 End of second trimester
◆ Vernix caseosa – oily layer of cells
◆ Fetal movement (4 or 5 months
◆ lanugo
 Digestive / urinary System
 Late pregnancy – fetus swallows 500ml of amniotic fluid
 Fluid
◆ Water, salt, glucose, urea

◆ Provide some nourishment

◆ Waste combine with bile to form feces

 Meconium

◆ Fetal kidneys functional

 Produce 450 ml of urine a day
Circulatory System
 Placenta is respiratory organ
 Oxygenated blood shunted from lungs
 Ductus arteriosis – shunt blood from pulmonary artery to
aorta

 Foramen ovale
◆ Between left and right atria

◆ Equalizes blood on both sides of heart

◆ No blood to left side

◆ Blood mixes
Nervous System
 Formed early in development
◆ CNS and PNS by 8th week

◆ Muscle sense and coordination appear early

◆ Fetus may suck thumb

 Environment not devoid of stimuli

◆ Noise level of quiet room

◆ Light of a dark room

◆ Many stimuli outside abdomen initiates fetal reactions

Endocrine System
 Functional most of pregnancy
◆ FSH and LH

◆ hCG reaches fetus

 May have a role in gonadal development
◆ Pancreas
 Secrete insulin
◆ Placenta
 Secretes prolactin
 Helps in na+ pump across membranes

◆ Neurohypophysis
 AVT

 Adultssecrete oxytocin and ADH

 AVT – aquatic mammals(water transport0
Fetal Disorders
 Rhesus Disease
◆ Rh incompatibility

◆ Possible damage to future pregnancies

◆ Problem Rh- mother Rh+ father

 Mother carries Rh+ fetus
 Forms Ab against Rh+ cells
◆ Next pregnancy
 Mothers immune system destroys RBC
 Jaundice
 Breakdown of RBC

 Increased bilirubin

 Can cause brain damage

 Erythroblastosis fetalis- immature RBC can cause anemic fetus

◆ Rhogam
 Destroys Rh+ blood cells if they make it to mothers circulation
 She does not form Ab’s
Viruses and bacteria
 AIDS, small pox, chicken pox, mumps
◆ Can damage or kill fetus

 German measles
◆ Heart defects, blindness, deafness, microencephaly,
spina bifida
 Syphilis, pnemonia, TB, typhoid
◆ Sponatneous abortion

◆ 16% of women have bacterial infection that leads to

premature birth
Environmental pollutants
 Teratogens and mutagens
 Between 4th and 7th weeks most susceptible
 Mercury, lead, cadmium, arsenic
 Minimata’s disease
◆ Mercury from fertilizers

◆ Fetal brain damage

Drugs
 Thalidomide
◆ Prescribed for morning sickness in 50’s and 60’s

◆ Phocomelia – hands and feet, but no limbs

 Bendectin
◆ Prescribed for morning sickness

◆ Heart defects, hernia of diaphragm, abnormal limbs

◆ Withdrawn in 1983

 DES
◆ Increased incidence of vaginal and uterine cancers

◆ Miscarriage and premature births

Alcohol
 2 drinks a week
◆ Increases chances of miscarriage

 Chronic use – FAS

◆ 3rd common cause of mental retardation

◆ Small infants, small heads

◆ Learning disabilities

◆ Mild use can constrict umbilical cord

Tobacco
 Nicotine constricts vessels in placenta
 CO binds to hemoglobin
 Lowers vitamin C levels
◆ Miscarriage risk

 Caffeine
◆ No effect?
◆ 3 cups a day 1 month prior to conception increases
miscarriage
 Aspirin
◆ Can harm fetal heart
◆ Ductus arteriosus kept open by PG
◆ Blood moves into collapsed lungs
◆ Persistent pulmonary hypertension
◆ 2 tablets a day for 4 or 5 days
Endocrinology of pregnancy
 CL continues to secrete progesterone
◆ Cause accumulation of fat

◆ Maintains placenta

◆ Inhibit GnRH secretion

 hCG prevents CL from regresssing

◆ Secreted 48 hrs after implantation

◆ Maternal recognition of pregnancy

 At 5 weeks placenta secretes

◆ estrone

◆ Estradiol

◆ Estriol

◆ Progesterone

 Maintains placenta, mammary glands and supresses ovulation

 CL no longer vital to maintain pregnancy
Feto-placental unit
 Placenta converts cholesterol to progesterone
◆ Fetus cannot perform this reaction

 Progesterone reaches fetal adrenal glands

 Converiosn of Pro to DHEA(weak androgen)
 DHEA converted to16 OH DHEA-sulfate in fetal liver
 16 OH DHEA-sufate carried to placenta
◆ Converted to estriol

 Secretions of placenta require fetal adrenals

 Fetal cortisol influnces placental hormone secretions
Other hormones
 Human placental lactogen
◆ Rises late in pregnancy

◆ Increases sugar in mothers blood

 Relaxin
◆ Secreted by corpus luteum

◆ Polypeptide

◆ Loosens the pubic symphysis

◆ Effaces cervix
Complications
 Toxemia
◆ More common in primiparous women

◆ And multiparous over 35

◆ Fat and cholesterol consumption increase risk

◆ Symptoms
 Rapid weight gain
 Edema

 Hypertension

 Proteinuria

◆ Preeclampsia and eclampsia

◆ Semen provide protective effect?

 Diabetes mellitus
 Ectopic pregnancy