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DR NILESH KATE
MBBS,MD
PROFESSOR
DEPT. OF PHYSIOLOGY
PHYSIOLOGY
OF
PREGNANCY.
OBJECTIVES.
 FETILIZATION & IMPLANTATION
 PHYSIOLOGICAL CHANGES DURING PREGNANCY.
 PHYSIOLOGY OF PARURITION.
 PLACENTA...
INTRODUCTION.
 Maternal adaptation to provide ideal
atmosphere for fertilization, nutrition to
growing fetus, safe child ...
Fertilization and implantation.
 Transportation of ovum
 Transportation of sperm in female genital
tract.
 Sperm capaci...
Transportation of ovum
 Fertilization – fusion of male & female
gametes.
 Site – Middle segment (Ampulla) of fallopian
t...
Transportation of ovum
 Transport of ovum – from peritoneal cavity
after expulsion enters fallopian tube through
fimbria ...
Ovum
 Mature ovum – consists of Oocyte (23
unpaired chromosomes) surrounded by Zona
pellucida & Granulosa cells in multil...
Fate of ovum.
 Held at ampulla isthmic junction for 2-3 days
 After ovulation ovum viable for 6-24 hrs.
 If fuses with ...
Transportation of sperm in
female genital tract.
 Each ejaculate contains 200 million cells.
 Out of these only 50-100 m...
Motility of sperms.
 pH of fluid medium
 Cervical mucus secretions
 Fluid currents
 Temperature.
 Hormones.
Friday, M...
pH of fluid medium
 Neutraline & alkaline – enhances activity.
 But vaginal fluid is acidic so immediately after
ejacula...
Cervical mucus secretions
 Acts like a mechanical barrier.
 Depend on hormonal levels
 Proliferative phase & near ovula...
Fluid currents
 Vaginal & uterine cavity currents are setup
by ciliary movements.
 Direction – opposite towards external...
Temperature.
 With increase temperature activity
increases but life span decreases.
 Can be stored at -100 0
c for many ...
Hormones.
 Oxytocin – release during coitus causes
propulsive movements of uterus which
aspirate fluid from vagina into f...
Sperm capacitation
 Process which makes
sperms capable to
fertilize ovum
 Takes 1-10 hrs
 Cholesterol content of
acroso...
Sperm capacitation
 Calcium ions permeability of sperms membrane increases.
 Influx of Ca causes-
 Flagellar movements ...
Fusion of Gametes.
 Chemoattraction –
 Penetration of sperm
through ovum
coverings.
 Fusion of sperm with
oocyte.
Frida...
Chemoattraction
 By substances produced by ovum.
Friday, May 10, 2019
Penetration of sperm through
ovum coverings.
 Through 2 layers.
 Corona radiata –
 Acrosome of sperm head releases Hyal...
Penetration of sperm through
ovum coverings.
 Through 2nd
layers.
 Zona pellucida –
 When reach zone pellucida acts on ...
ACROSOMAL REACTION.
 Acrosome releases acrosin.
 Opens penetrating pathway for sperms into
perivitteline space
 For eff...
Friday, May 10, 2019
Fusion of sperm with oocyte.
 Site of contact - equatorial
region of Acrosome.
 Fertilin on activated
sperms contact wit...
Activation of ovum.
 Membrane potential of ovum
decreases – Zona pellucida
--structural changes
 Release of Ca
 Vitelli...
Friday, May 10, 2019
IMPLANTATION.
 Formation of
blastocyst
 Transportation of
blastocyst in uterine
cavity.
 Implantation of
blastocyst in ...
PHYSIOLOGICAL CHANGES IN
MOTHER DURING PREGNANCY
 Changes in genital
organ
 Weight gain
 Haematological
Changes
 CVS c...
Changes in Genital organ
 Uterus
 Ovaries
 Cervix
 Fallopiab tubes
 Mammary glands.
Friday, May 10, 2019
Uterus
 Size – increases
 Due to Hypertrophy & hyperplasia of
myometrium.
 Weight – changes from 30-50 to 1000-1200 gms...
Ovaries
 First 12- 16 weeks
corpus leuteum
enlarges
 Then as HCG levels
decreases it
degenerate
 Its function taken ove...
Cervix
 Endocervix –
hypertrophied
 Cervical gland
secretions increases
form a plug which
closes cervix
 Tough cervix b...
Fallopian tubes
 Due to enlargement of
uterus – pushed
upwards
 Blood supply
increases
 Causes hyperplasia of
epithelia...
Mammary glands.
 Hyperplasia of ductal & alveolar tissue
 Areola – Pigmented.
 Sebaceous glands becomes prominent in
ar...
Weight gain
 Total weight gain – 10-12 kg.
 Fetus – 3kg
 Placenta & amniotic fluid – 1.5 kg
 Uterus & breast enlargeme...
Haematological Changes
 Blood volume – 30%
 Blood indices -
 Plasma proteins
 Leucocytes
 Platelets
 Coagulation fac...
CVS changes
 Position of heart – more laterally & upward & LAD
 Heart rate – Tachycardia (Hyperdynamic circulation)
 Ca...
RS changes
 Anatomical changes – Diaphargm elevation
 Hyperventilation – progesterone increases
sensitivity to CO2 -
 V...
Urinary system changes
 Renal blood flow
 Effective renal plasma flow
 GFR
 Renal tubular absorptive capacity
 Cleara...
GIT Changes
 GIT secretion & motility
 Gall bladder function
 Liver function – fibrinogen albumin
 Morning sickness – ...
Metabolic changes
 BMR –
 Protein metabolism – nitrogen retention & positive
nitrogen balance
 Carbohydrate - BSL, glyc...
Endocrine changes
 Pituitary - prolactin, ACTH, TSH & GnRH
 Thyroid - thyroid binding globulin.
 Parathyroid - active f...
Changes in skin.
 Hyperpigmentation – cloasma, linea alba,
 Stria gravidarum – linear scar on lower
abdomen.
Friday, May...
PSYCHOLOGICAL CHANGES
 Craving for particular food
 Alterartion in behaviour, emotion & mood
 In some cases true Psycho...
Friday, May 10, 2019
THANK YOU
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PHYSIOLOGY OF PREGNANCY

  1. 1. DR NILESH KATE MBBS,MD PROFESSOR DEPT. OF PHYSIOLOGY PHYSIOLOGY OF PREGNANCY.
  2. 2. OBJECTIVES.  FETILIZATION & IMPLANTATION  PHYSIOLOGICAL CHANGES DURING PREGNANCY.  PHYSIOLOGY OF PARURITION.  PLACENTA & PREGNANCY TESTS
  3. 3. INTRODUCTION.  Maternal adaptation to provide ideal atmosphere for fertilization, nutrition to growing fetus, safe child birth and to fulfil nutritional needs of newborn. Friday, May 10, 2019
  4. 4. Fertilization and implantation.  Transportation of ovum  Transportation of sperm in female genital tract.  Sperm capacitation  Fusion of gamets.  Activation of ovum. Friday, May 10, 2019
  5. 5. Transportation of ovum  Fertilization – fusion of male & female gametes.  Site – Middle segment (Ampulla) of fallopian tube. Friday, May 10, 2019
  6. 6. Transportation of ovum  Transport of ovum – from peritoneal cavity after expulsion enters fallopian tube through fimbria of infundibulum  Helped by – smooth muscles of tube & ciliated epithelium. Friday, May 10, 2019
  7. 7. Ovum  Mature ovum – consists of Oocyte (23 unpaired chromosomes) surrounded by Zona pellucida & Granulosa cells in multilayer called Corona Radiata. Friday, May 10, 2019
  8. 8. Fate of ovum.  Held at ampulla isthmic junction for 2-3 days  After ovulation ovum viable for 6-24 hrs.  If fuses with sperm fertilization occurs if not dies and degenerate. Friday, May 10, 2019
  9. 9. Transportation of sperm in female genital tract.  Each ejaculate contains 200 million cells.  Out of these only 50-100 manage to reach ovum  Only 1 penetrate. Friday, May 10, 2019
  10. 10. Motility of sperms.  pH of fluid medium  Cervical mucus secretions  Fluid currents  Temperature.  Hormones. Friday, May 10, 2019
  11. 11. pH of fluid medium  Neutraline & alkaline – enhances activity.  But vaginal fluid is acidic so immediately after ejaculation sperms become inactive  Then alkaline semen neutralizes vaginal fluid – sperms becomes active again for next 24 to 40 hrs. Friday, May 10, 2019
  12. 12. Cervical mucus secretions  Acts like a mechanical barrier.  Depend on hormonal levels  Proliferative phase & near ovulation – more oestrogen – secretions more thin – allow entry of sperms. Friday, May 10, 2019
  13. 13. Fluid currents  Vaginal & uterine cavity currents are setup by ciliary movements.  Direction – opposite towards externally.  Opposes movements. Friday, May 10, 2019
  14. 14. Temperature.  With increase temperature activity increases but life span decreases.  Can be stored at -100 0 c for many years. Friday, May 10, 2019
  15. 15. Hormones.  Oxytocin – release during coitus causes propulsive movements of uterus which aspirate fluid from vagina into fallopian tube.  Oestrogen – make cervical secretions thin and watery so favors transport of sperms.  Prostaglandins- in semen increases female genital tract movements.  Progesterone- in follicular fluid affects sperms motility. Friday, May 10, 2019
  16. 16. Sperm capacitation  Process which makes sperms capable to fertilize ovum  Takes 1-10 hrs  Cholesterol content of acrosomal membrane decreases –leads to easy release of enzymes from head. Friday, May 10, 2019
  17. 17. Sperm capacitation  Calcium ions permeability of sperms membrane increases.  Influx of Ca causes-  Flagellar movements strong & whipish  Triggers release of enzymes from acrosome. Friday, May 10, 2019
  18. 18. Fusion of Gametes.  Chemoattraction –  Penetration of sperm through ovum coverings.  Fusion of sperm with oocyte. Friday, May 10, 2019
  19. 19. Chemoattraction  By substances produced by ovum. Friday, May 10, 2019
  20. 20. Penetration of sperm through ovum coverings.  Through 2 layers.  Corona radiata –  Acrosome of sperm head releases Hyaluronidase enzyme & other proteolytic enzyme.  Hyaluronidase enzyme – polymerizes Hyaluronic acid  Proteolytic enzyme – digest proteins of structural tissue. Friday, May 10, 2019
  21. 21. Penetration of sperm through ovum coverings.  Through 2nd layers.  Zona pellucida –  When reach zone pellucida acts on receptor – Zona pellucida glycoprotein.  Triggers Acrosomal reaction. Friday, May 10, 2019
  22. 22. ACROSOMAL REACTION.  Acrosome releases acrosin.  Opens penetrating pathway for sperms into perivitteline space  For effective penetartion this reaction takes place at zona pellucida.  Also important for actual fusion of sperm cell with oocyte membrane. Friday, May 10, 2019
  23. 23. Friday, May 10, 2019
  24. 24. Fusion of sperm with oocyte.  Site of contact - equatorial region of Acrosome.  Fertilin on activated sperms contact with protein on vitelline membrane  With 30 min membrane fuses-genetic material enters & embryo develops. Friday, May 10, 2019
  25. 25. Activation of ovum.  Membrane potential of ovum decreases – Zona pellucida --structural changes  Release of Ca  Vitelline block to polyspermy  Zona blockade to polyspermy - by glucosidase & protease. Friday, May 10, 2019
  26. 26. Friday, May 10, 2019
  27. 27. IMPLANTATION.  Formation of blastocyst  Transportation of blastocyst in uterine cavity.  Implantation of blastocyst in the endometrium.  Decidual reaction. Friday, May 10, 2019
  28. 28. PHYSIOLOGICAL CHANGES IN MOTHER DURING PREGNANCY  Changes in genital organ  Weight gain  Haematological Changes  CVS changes  RS changes  Urinary system changes  GIT Changes  Metabolic changes  Endocrine changes  Changes in skin. Friday, May 10, 2019
  29. 29. Changes in Genital organ  Uterus  Ovaries  Cervix  Fallopiab tubes  Mammary glands. Friday, May 10, 2019
  30. 30. Uterus  Size – increases  Due to Hypertrophy & hyperplasia of myometrium.  Weight – changes from 30-50 to 1000-1200 gms  Length – 7.5 to 35 cm  Thickness from 1.25 cm to 5 mm  Volume – few ml to 5-7 lit  Shape – Pyriform to globular. Friday, May 10, 2019
  31. 31. Ovaries  First 12- 16 weeks corpus leuteum enlarges  Then as HCG levels decreases it degenerate  Its function taken over by placenta. Friday, May 10, 2019
  32. 32. Cervix  Endocervix – hypertrophied  Cervical gland secretions increases form a plug which closes cervix  Tough cervix becomes soft. Friday, May 10, 2019
  33. 33. Fallopian tubes  Due to enlargement of uterus – pushed upwards  Blood supply increases  Causes hyperplasia of epithelial cells. Friday, May 10, 2019
  34. 34. Mammary glands.  Hyperplasia of ductal & alveolar tissue  Areola – Pigmented.  Sebaceous glands becomes prominent in areola  Nipples become larger & pigmented. Friday, May 10, 2019
  35. 35. Weight gain  Total weight gain – 10-12 kg.  Fetus – 3kg  Placenta & amniotic fluid – 1.5 kg  Uterus & breast enlargement – 1.5 kg  Blood volume & interstitai fluid 1.5 kg  Fat deposition- 3-4 kg. Friday, May 10, 2019
  36. 36. Haematological Changes  Blood volume – 30%  Blood indices -  Plasma proteins  Leucocytes  Platelets  Coagulation factors (VII,VIII,IX & X) Friday, May 10, 2019
  37. 37. CVS changes  Position of heart – more laterally & upward & LAD  Heart rate – Tachycardia (Hyperdynamic circulation)  Cardiac output. - due to blood volume  Blood pressure – both decreases mainly due to vasodilation.  Venous pressure – due to gravid uterus rises causes oedema of feet, varicose veins, piles & peripheral thrombosis.  Blood flow - to uterus, kidney & skin. Friday, May 10, 2019
  38. 38. RS changes  Anatomical changes – Diaphargm elevation  Hyperventilation – progesterone increases sensitivity to CO2 -  Ventilatory functions - TV & IC and RV & FRC  Gas exchange due to pulmonary blood flow  Oxygen consumption by 15%. Friday, May 10, 2019
  39. 39. Urinary system changes  Renal blood flow  Effective renal plasma flow  GFR  Renal tubular absorptive capacity  Clearance rate  Glycosuria  Proteinuria  Water balance  Acid base balance Hyperventilation causes respiratory alkalosis Friday, May 10, 2019
  40. 40. GIT Changes  GIT secretion & motility  Gall bladder function  Liver function – fibrinogen albumin  Morning sickness – anorexia, nausia & vomiting.  GTT – Diabetic type Friday, May 10, 2019
  41. 41. Metabolic changes  BMR –  Protein metabolism – nitrogen retention & positive nitrogen balance  Carbohydrate - BSL, glycosuria, hepatic glycogen.  fat - in cholesterol, TG, PL  Mineral - Ca & P retention, iron metabolism. Friday, May 10, 2019
  42. 42. Endocrine changes  Pituitary - prolactin, ACTH, TSH & GnRH  Thyroid - thyroid binding globulin.  Parathyroid - active form of Vit D3  Adrenal cortex - all  Pancreas - Insulin. Friday, May 10, 2019
  43. 43. Changes in skin.  Hyperpigmentation – cloasma, linea alba,  Stria gravidarum – linear scar on lower abdomen. Friday, May 10, 2019
  44. 44. PSYCHOLOGICAL CHANGES  Craving for particular food  Alterartion in behaviour, emotion & mood  In some cases true Psychosis. Friday, May 10, 2019
  45. 45. Friday, May 10, 2019 THANK YOU
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PHYSIOLOGY OF PREGNANCY

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