Pregnancy

•When the ovum is fertilized, pregnancy ensues.

• It proceeds for 280 days or nine months and ten

days to terminate into parturition resulting in

the birth of a baby.
Physiological Changes
During pregnancy, a series of progressive changes take
place.
1. Uterus, its placenta, ovaries and breasts enlarge.
Vagina widens and pelvic ligaments relax.
2. Blood volume increases and plasma iron decreases.
3. Cardiac output is increased and blood pressure
decreased.
4. Digestive system: Morning sickness, i.e. nausea
vomiting occurs and constipation develops.
5. Respiration is increased and vital capacity also
increased.
6. Endocrine glands are stimulated. Thyroid,
parathyroid and adrenal cortex are enlarged.
7. carbohydrates, protein and fat metabolism are
stimulated and result in glycosuria, lipideamia and
water retention.
8. Excretory system: sometimes sugar appear in urine.
Oestrogens, progesterone and gonadotropic hormone
of placenta are also excreted in urine.
Examination of the foetus
 Can be done by method called Amniocentesis.
 After twelfth week of pregancy, a sterile needle is

inserted through woman’s abdomen into amniotic sac

that holds fluid surrounding the foetus.
 A small amount of fluid is withdrawn to be examined

by a geneticist.
 By examining chromosomal structures and enzyme

components of the cells in fluid, one can identify

various type of inherited defects.
 This fluid also used for determination of the sex of

the child based on its chromosomal set up.

Other method is ultrasonography which employs sound
waves to produce a two dimensional image of the foetus.
 Pregnancy Tests: Detection of placental
gonadotrophins is a sensitive test to detect early
pregnancy.
 It was carried out on animals by injecting urine of

pregnant woman.
 Now a days, sure, simple safe, immunological test for

early pregnancy diagnosis done.

 It confirms pregnancy in 20 seconds, 13 days after

the last missed menstrual period.

Placenta
 It is a round plate like structure which develops within
and underneath the uterine endometrium with a maternal
and foetal surface which serve as channel for nutritive,
respiratory, and excretory functions to the foetus.
 The maternal and foetal plates of placenta are full of
zigzag vessels that undergo gaseous and fluid exchanges
seperated by two very thin semipermeable membranes.
 Respiratory gas, nutrition, excretion pass out through
these channels.
 The foetus is bound to mother’s uterus through a
notocord a cord like structure with vessels and
lymphatics.
Function of Placenta
1. Nutritive
2. Respiratory
3. Storage
4. Hormonal
5. Excretory

The hormones are not only stored but secreted by the

placenta which are: Human chorionic
gonadotrophins, estrogens, progesterone, prolactin
or placental growth hormone, relaxin
PARTURITION
• Childbirth /labour/delivery is the process of
delivering the baby and placenta from the uterus
to the outside world after the gestation period
(about 280 days or 40 weeks in human female)
i.e., of about 9.5 months.

• Induced by a complex neuroendocrine

mechanism which is triggered by fully formed
foetus and the placenta.
• Each fetus is surrounded by its own amniotic
sac and has a separate placenta.

• This separates from the wall of the uterus

during labor and the fetus works its way
towards the birth canal.
Birth process:
Normal
birth
process is
divided
into 3 First stage
Third stage stages. Dilation
Delivery of and
the effacement
Placenta of the
Second Cervix
stage
Birthing
process
First stage is longest stage & involves 3 phases:
Early Labour Phase- time of onset of labour until the
cervix is dilated to 3 cm.
Active Labour Phase- continues from 3 cm. until the
cervix is dilated to 7 cm.
Transition Phase- continues from 7 cm. until the
cervix is fully dilated to 10 cm
 First stage Dilation and Effacement of the Cervix (2
to 12 hours.)
 Starts with a series of involuntary contractions of the

muscular walls of the uterus (Uterine contractions)

and gradual dilatation and effacement of the cervix.
 With each contraction and pain, the cervical opening

opens up until it is fully dilated to 10 cm.

 Further divided into 3 sub-stages
Latent phase/first time: mother can last up to 6-10
hours.
 contractions are mild & irregular
 As contractions begin, the walls of the uterus start to

contract through stimulation by the release of the

pituitary hormone oxytocin.
 The contractions cause the cervix to widen and begin

to open.
 Some pinkish discharge and feel a bit of abdominal

discomfort The 'Water" may "break" (rupture of

membranes)
Active Labor Phase: first time mother can last up to 3-
6 hours
 Pains more intense & occur with increased frequency
 cervix dilates from 4 up to 7 cm.

Transition Phase: lasts for 20-30 minutes &

contractions come on every one to three minutes &
are very intense in nature.
 Cervix dilates from 7 up to 10 cm (complete

dilatation.)
 Cervical Effacement and Dilatation
Second stage
Birthing Process (30 to 180 minutes)

 Begins when the cervix is fully dilated and baby has

descended further, lasts about an average of 1 to 2 hrs
in first-time moms.
 Pressing the abdomin, placenta, along with the head

and forelegs, is forced into the birth canal later

pushing by the mother expels the baby out through the
vagina & the baby is born with umbilical cord
attached.
 As pressure on the cervix increases, the Ferguson

reflex increases uterine contractions.

Third stage
Delivery of the Placenta
 Once the baby is out, the uterus will contract
spontaneously and the placenta along with the
umbilical cord will be delivered, lasts for half an hour
to a few minutes. complete expulsion will mark the
end of the third stage of labor process.
 The last stage, the baby is put to the mothers breast as

early skin to skin contact helps in promoting

breastfeeding.
 The suckling also causes uterine contractions and

helps in the spontaneous expulsion of the placenta.

NEUROENDOCRINE CONTROL
 Parturition is induced by a complex
neuroendocrine mechanism which is triggered by
fully formed foetus and the placenta called foetal
ejection complex.
 The foetal hypothalamo-pituitary-adrenal axis is

obligatory for the initiation of parturition.

 During Stage 2 of parturition, the foetus engages

the cervix.
 This initiates a neuroendocrine reflex, the Fergusson
reflex, an example of a positive feedback mechanism
which occurs when stretch receptors in the cervix are
stimulated.
 Sensory nerve endings in the cervix are stimulated

causing nerve impulses to be sent to the

hypothalamus.
 Neuroendocrine cells of the paraventricular and

supraoptic nuclei depolarise & oxytocin is secreted

from the pars nervosa. oxytocin enters the blood
circulation and acts on the oxytocin receptors in the
myometrium.
 Uterine contractions therefore, increase in strength
and frequency.
 Oxytocin concentrations continue to rise ,exhibiting

positive feedback until the foetus is expelled, thus the

cervical stimulation ceases.
Relaxin: (Protein hormone, Secreted by
Placenta)
 Towards the end of pregnancy relaxin promotes
rupture of the membranes surrounding the fetus and
the growth, opening and softening of the cervix and
vagina to aid the process of childbirth.
 This causes softening of the connective tissue in the

cervix and promotes elasticity of the pelvic

ligaments, thus preparing the birth canal so that the
passage of the foetus can occur with relative ease.
Estrogens is the most important hormone in preparation for parturition.

 At stimulates the synthesis of enzymes involved in

prostaglandin synthesis(phospholipase A2 (PLA2).)
labor, prostaglandins stimulate cervical ripening, the
breakdown of cervical connective tissue allowing it
to become soft and flexible and capable of dilation.
 During labour, prostaglandins stimulate myometrial

contractions. As the time of delivery approaches,

estrogen increases responsiveness to oxytocin by
increasing expression of oxytocin receptors.
Puerperium / Post partum period
 The period of about six weeks (42 days) after
childbirth during which the mother's reproductive
organs return to their original nonpregnant condition.
 Lactation is initiated
 During this stage ,body tissues especially the

reproductive system reverts back to pre-pregnant

state, both anatomically and physically. Recovering
from the stress of pregnancy & delivery.
ie
m
rStage of Puerperium
em
e
ae
m
rd
o
li
t
ya
e
t
e
P
p
h
h
aP
a
sh
s
ea
e
s
Immediate Puerperium
 The first 24 hours after birth uterus has to contract
well, in order to stop the bleeding from the site of
placental attachment.
 It is also the initiation of breastfeeding and bonding.
 Occasionally, time for most life threatening

complications of delivery manifest.

- postpartum excessive bleeding,
- collapse of the circulation,
- cardiac failure, etc.
 Risk in women with pre-existing medical conditions

like anaemia, hypertension or heart diseases.

Early Puerperium
 2nd to 7th day post-delivery where major
changes start in your genital tract.
 significant bodily changes include,

- Vaginal discharge
- Urination
- Breasts
Remote Puerperium
 Period of time required for involution of genital organs
throughout the rest weeks of post partum.
 Involution of uterus:
 Return to pelvis by about 2weeks
 Comes to normal size by 6 weeks
 Weight changes

- 1000g immediately after birth

- 500g 1 week after birth
- 300g 2 week after birth
- 50g 6 weeks after birth
 The endometrial lining rapidly regenerates (16days)

Contraction:
 During 1 to 2 hrs pf postpartum ,uterine contractions may

decrease in intensity & become uncoordinated.

 Lochi / Uterine discharge: initially it is
bright red changing later to pinkish red or
reddish brown.
 shedding of the inner lining of the uterus.
 first 4 days, there is fresh bleeding, like a

heavy menstrual flow.

Methods of Contraception
1. Control in sexual intercourse:
(i) Withdrawal of penis just before the discharge of
semen.
(ii) Rhythmic method: Avoidance of coitus between
12th to 18th day after the beginning of menstrual
bleeding.
Principal: Ovulation occurs on 14th day prior to the
onset of menstruation. Spermatozoa survive for
about 2-3 days, ovum for one day only.
 Risky days counted from the
Period of M.C. first day of menstruation

25 9-12
26 10-13
28 12-15
30 14-17
2. Barrier to the entry of sperms:
(i) Use of condom (nirodh) over penis.
(ii) Use of diaphragm at the cervix of the uterus.
 3. Sprmicidal agents:
(i) cream, pastes, jellies, foam tablets. These are to be
used before coitus and are applied in vagina.
(ii) Douching: use of mild irritating fluid like lactic
acid, common salt, lemon juice, soap to wash the
vagina after coitus.
4. Intra Uterine Devices (IUD)
If any forgein body is placed within the uterus, the
implantation of fertilized ovum becomes difficult.
This principle is used for the use of IUD e.g. loops,
copper T.
5.Surgical methods:
(i) Vasectomy in male
(ii) Tubectomy in female
(iii) Laparoscopy in female (passing of bright beam of light in the
fallopian tube)

6. Oral Contraceptives:
 More adopted by female than male.
 Oral contraceptives are hormonal pills.
 They contain estrogen and progesterone and inhibit the
ovulation by feed back mechanism.
 They may also prevent motility of sperms and make the vaginal
fluid viscid and thick.
Types of pills
 Combined pills: contain both oestrogen and
progesterone.
 Sequential pills: 10 pills which are to be taken for first

10 days contain only oestrogen and 12 tablets contain

both oestrogen and progesterone.
 Minipills: contain only progesterone.
 Morning after pills contain oestrogen.