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Inner cell mass

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corpus luteum produces progesterone & estrogen to maintain lining of uterus ... Dystocia and prolonged labor. Dystocia = difficult labor. due to fetal position or size ... – PowerPoint PPT presentation

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Title: Inner cell mass


1
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2
Blastocoele
Becomes amniotic sac
Blastocyst (cross section)
Spermatozoa
Morula
Ovum (cross section)
Cleavage
Inner cell mass
Destined to become fetus
Fertilization
Trophoblast
Secondary oocyte (ovum)
Accomplishes implantation and develops into fetal
portions of placenta
Ovulation
Ovary
Implantation
Endometrium of uterus
3
Surface of uterine lining
Decidua
Inner cell mass
Cords of trophoblastic cells
4
Physiological and hormonal changes in pregnancy
  • Chorion
  • from day 8 until 4 months secretes hCG which
    keeps corpus luteum active
  • corpus luteum produces progesterone estrogen to
    maintain lining of uterus

5
hormonal changes in pregnancy (cont.)
  • Placenta
  • by 4th month produces enough progesterone
    estrogen
  • relaxin which relaxes tissues of pelvis and cervix

6
  • human chorionic somatomammotropoin (hCS) or human
    placental lactogen (hPL)
  • helps prepare mammary glands for lactation

7
  • corticotropin-releasing hormone (CRH) increases
    secretion of fetal cortisol (lung maturation)
    acts to establish timing of birth

8
Hormonal Secretion by the Placenta
9
Hormone Blood Levels
  • Human chorionic gonadotropin (hCG) produced by
    the chorion is less important after 4 months,
    because the placenta takes over the hormonal
    secretion of the corpus luteum.

10
Response of the mothers body to Pregnancy
  • Weight gain
  • Metabolism
  • Digestive System and nutrition

11
Response … continued
  • Cardiovascular System
  • blood volume 30 above normal
  • increased cardiac output, heart rate and blood
    pressure
  • Cardiovascular changes to meet needs of fetus
  • Respiratory System
  • diaphragm is raised
  • movement is restricted
  • rate is increased
  • increase in tidal volume 30

12
Response …
  • Urinary System
  • Increased glomerular filtration rate
  • increased urine formation

13
Labor and Parturition
  • Parturition means giving birth labor is the
    process of expelling the fetus
  • progesterone inhibits uterine contraction

14
  • Labor begins when progesterones inhibition is
    overcome by an increase in the levels of estrogen

15
Figure 20.27 Page 791
Human chorionic gonadotropin (hCG)
Estrogen
Progesterone
Fertilization
Delivery
16
Why estrogen level is increased?
  • placenta stimulates fetal anterior pituitary
    which causes fetal adrenal gland to secrete DHEA
  • placenta converts DHEA to estrogen
  • estrogen overcomes progesterone and labor begins

17
  • Hormonal Factors That Cause Increased Uterine
  • Contraction
  • Ratio of Estrogens to progesterone
  • from 7th month onward estrogen secretions
  • increased (progesterone remains constant)
  • Effect of oxytocin on the uterus
  • Effect of Fetal Hormones on the Uterus

18
  • Mechanical Factors That Increase the
    Contractility
  • of the Uterus
  • Stretch of the uterus
  • Stretch of the cervix
  • A positive feedback Theory

19
Positive Feedback during Labor
  • Uterine contraction forces fetal head into cervix
    (stretch)
  • Nerve impulses reach hypothalamus causing release
    of oxytocin

20
  • Oxytocin causes more contractions producing more
    stretch of cervix more nerve impulses

21
The blue arrows designate the sequence of events
leading to the onset of parturition. The green
arrows designate the positive-feedback
cycle responsible for the progression of
parturition.
Uterine contractions
Push fetus against cervix
Responsible for progression of parturition
(through neuroendocrine reflex)
Prostaglandin production
Oxytocin secretion
22
True Versus False Labor
  • True labor begins when contractions occur at
    regular intervals
  • produces pain
  • back pain increases with walking
  • dilation of cervix with a discharge of
    blood-containing mucus in the cervical canal

23
  • False labor produces pain at irregular intervals
    but there is no cervical dilation

24
3 stages of labor
  • Stage of dilation
  • 6-12 hours
  • from onset of labor to the complete dilation of
    the cervix
  • rupture of amniotic sac

25
Placenta
Umbilical cord
Partially dilated cervix
Uterus
First stage of labor Cervical dilation
Second stage of labor Delivery of the baby
Third stage of labor Delivery of the placenta
26
  • Stage of expulsion
  • from complete cervical dilation to delivery of
    the bacy
  • 10 minutes to hours

27
  • Placental stage
  • 5 30 minutes

28
Obstetrical Complications
  • Ante-partum
  • Intra-partum
  • Post-partum

29
Ante-partum complications
  • Pregnancy induced hypertension PET
    (pre-eclamptic toxemia) Toxemia of pregnancy
  • Dysfunctional labor patterns

30
contd.
  • Abnormal placenta position
  • Placenta previa
  • Abruptio placenta

31
Pregnancy-Induced Hypertension
  • Elevated blood pressure
  • Preeclampsia (PET)
  • sudden hypertension
  • large amounts of protein in the urine
  • generalized edema, blurred vision headaches
  • Eclampsia convulsions coma in mother

32
Dysfunctional Labor Patterns
  • Contraction insufficient to produce dilation and
    effacement
  • fetal malposition
  • excessive analgesia
  • fetal post maturity
  • increased maternal age

33
contd.
  • Premature rupture of the membranes
  • increased maternal age
  • cervical damage from surgical instrumentation

34
Abnormalities of the placenta
  • Placenta previa
  • placenta implantation at the lower segment of the
    uterus
  • obstructing the descent of the babys head
  • presented with antepartum hemorrhage

35
contd.
  • Abruptio placentae
  • premature separation of the placenta
  • bleeding may be concealed or revealed

36
Intra-partum complications
  • Dystocia and prolonged labor
  • Dystocia difficult labor
  • due to fetal position or size
  • breech presentation is butt or feet first in
    birth canal

37
contd.
  • Prolonged labor - ? consider…Cesarean section
    (C-section)
  • horizontal incision through lower abdominal wall
    and uterus

38
Post-partum complications
  • Retained placenta due to abnormal implantation of
    placenta (placenta accreta)
  • Post partum hemorrhage

39
  • Puerperium 6 week period following the birth of
    a baby
  • Physiological changes
  • uterus involution
  • menstruation resume by 9-12 weeks post partum in
    70 of women (not lactating)
  • weight loss to prepregnancy weight (6 weeks to 6
    months)

40
  • Most common complications
  • Urinary tract infection
  • Thromboembolism
  • Depression fourth day baby blues

41
Physiology of Lactation
  • Lactation production release of milk
  • After delivery, progesterone levels drop
    suckling increases the release of prolactin
    oxytocin (milk ejection reflex)

42
  • Colostrum cloudy fluid released for few days
  • True milk produced by 4th day

43
Benefits of Breast-feeding
  • Faster better absorption of the right
    nutrients
  • Beneficial cells
  • functional white blood cells
  • neutrophils help ingest bacteria in babys gut
  • macrophages produce lysozymes
  • plasma cells provides antibodies prevent
    gastroenteritis

44
contd.
  • Decreased incidence of diseases later in life
  • reduction in allergies, respiratory GI
    infections, ear infections diarrhea
  • Parent-child bonding

45
Complications of breast feeding
  • puerperal mastitis
  • lactation failure due to infrequent suckling
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