PHYSIOLOGY OF PREGNANCY

By Dr.M.Anthony David MD Professor of Physiology
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WHEN DOES LIFE BEGIN?: EMBRYOGENESIS
MANY SPERMS BIND TO ZONA PELLUCIDA SPERMS MOVE THROUGH THE ZONA PELLUCIDA ONE SPERM BINDS TO THE OVUM

OVUM RELEASES VESICLE CONTENTS

IT IS DRAWN INTO THE OVUM OVUM COMPLETES II MEIOSIS

OVUM ENZYMES ACTIVATED

ENZYMES BLOCK POLYSPERMY

NUCLEI OF OVUM & SPERM UNITE ZYGOTE FORMED
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EMBRYOGENESIS: AN ANIMATION

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PREGNANCY BEGINS
THIS RESULTS IN THE ONSET OF A NINE-MONTH RELATION SHIP BETWEEN THE EMBRYO-FETUS, AND THE MOTHER.  THIS PHYSIOLOGICAL STATE IS CALLED PREGNANCY.  IT IS DIVIDED INTO THREE TRIMESTERS OF THREE MONTHS EACH.

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PREGNANCY: URINARY HORMONES

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FETO PLACENTAL UNIT
PLACENTA
CHOLESTEROL PREGNENOLONE PROGESTERONE

FETAL ADRENAL
DHEAS 16-OH- DHEAS CORTISOL & CORTICOSTERONE

ESTRADIOL ESTRIOL
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DHEAS 16-0H-DHEAS
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TESTS OF PREGNANCY
1. 2. 3. 4. ASCHEIM ZONDEK TEST FRIEDMAN TEST GALLI-MAININI TEST IMMUNOLOGICAL TESTS a) SHEEP RBC AGGLUTINATION b) LATEX PARTICLE AGGLUTINATION c) GRAVINDEX TEST
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TESTS OF PREGNANCY
1. 2. 3. 4. ASCHEIM ZONDEK TEST FRIEDMAN TEST GALLI-MAININI TEST IMMUNOLOGICAL TESTS a) SHEEP RBC AGGLUTINATION b) LATEX PARTICLE AGGLUTINATION c) GRAVINDEX TEST
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1. ASCHEIM ZONDEK TEST
URINE FROM THE WOMAN IS INJECTED INTO IMMATURE MICE  0.5 ml b.d FOR THREE DAYS  ON THE FIFTH DAY THE MICE ARE SACRIFICED.  THEY ARE DISSECTED TO LOOK FOR CORPUS HEMORRHAGICUM.  IF IT IS THERE, THE WOMAN IS PREGNANT.

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TESTS OF PREGNANCY
1. 2. 3. 4. ASCHEIM ZONDEK TEST FRIEDMAN TEST GALLI-MAININI TEST IMMUNOLOGICAL TESTS a) SHEEP RBC AGGLUTINATION b) LATEX PARTICLE AGGLUTINATION c) GRAVINDEX TEST
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2. FRIEDMAN TEST
 10

-15 ml OF THE WOMANS URINE IS GIVEN I.V TO A MATURE FEMALE RABBIT.  THE RABBITS OVARIES ARE EXAMINED AFTER 24/48 HRS FOR EVIDENCE OF OVULATION.  RABBITS HAVE REFLEX OVULATION.
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TESTS OF PREGNANCY
1. 2. 3. 4. ASCHEIM ZONDEK TEST FRIEDMAN TEST GALLI-MAININI TEST IMMUNOLOGICAL TESTS a) SHEEP RBC AGGLUTINATION b) LATEX PARTICLE AGGLUTINATION c) GRAVINDEX TEST
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3. GALLI – MAININI TEST
A

SIMPLE AND INEXPENSIVE TEST.  5 ml OF THE WOMAN’S URINE IS PUT INTO THE DORSAL LYMPH SAC OF A MALE TOAD.  1-2 HRS LATER, IT’S CLOACAL FLUID IS EXAMINED FOR SPERMATOZOA.
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TESTS OF PREGNANCY
1. 2. 3. 4. ASCHEIM ZONDEK TEST FRIEDMAN TEST GALLI-MAININI TEST IMMUNOLOGICAL TESTS a) SHEEP RBC AGGLUTINATION b) LATEX PARTICLE AGGLUTINATION c) GRAVINDEX TEST
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4. IMMUNOLOGICAL TESTS
MOSTLY BEING USED THESE DAYS.  BASIS:

 REACTION

BETWEEN ANTIGENS AND ANTIBODIES OF HUMAN CHORIONIC GONADOTROPHIN (HCG)  HCG ANTIBODIES ARE PRODUCED FROM RABBITS

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4. IMMUNOLOGICAL TESTS
a) SHEEP RBC AGGLUTINATION TEST:
 

Sheep RBCs are coated with the antibodies. They get agglutinated when exposed to urine containing HCG.

b) LATEX PARTICLE AGGLUTINATION. c) GRAVINDEX TEST: Most commonly used test today.

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GRAVINDEX: HCG TEST KIT

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PHYSIOLOGICAL CHANGES IN PREGNANCY
 CNS:
I

Trimester:
 Excitement  Depression  Irritability

II

Trimester:
being’ a sense of ‘well

 Euphoria:

III

Trimester:
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 Worries

and anxieties

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CHANGES IN CARDIOVASCULAR SYSTEM
      

BLOOD VOLUME INCREASED BY 25% HEMODILUTION. ANEMIA CARDIAC OUTPUT INCREASED BY 30% PULSE RATE INCREASED. PERIPHERAL RESISTANCE DECREASES BP IS MAINTAINED NORMAL.

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CHANGES IN GASTROINTESTINAL SYSTEM
MORNING SICKNESS: HYPEREMESIS GRAVIDARUM  CONSTIPATION  HEARTBURN   ACIDITY DUE TO LES TONE

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CUTANEOUS CHANGES
 INCREASED

PIGMENTATION  PURPLE STRIA: STRIAE GRAVIDARUM RENAL CHANGES  INCREASED FREQUENCY.  SLIGHT ALBUMINURIA.  SODIUM & WATER RETENTION.
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CHANGES IN RESPIRATORY SYSTEM
  

   

 TIDAL VOLUME.  PULMONARY VENTILATION OXYGEN UTILISATION INCREASES. BLOOD CHANGES  ERYTHROCYTE SEDIMENTATION RATE.  COLLOID ONCOTIC PRESSURE EDEMA LOSS OF 1/8th TO 1/10th IRON.
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CHANGES IN ENDOCRINES

 

HYPOTHALAMO-HYPOPHYSIAL AXIS STOPPED. HCG TAKES OVER. CORPUS LUTEUM AND PLACENTA BECOME MAJOR ENDOCRINE GLANDS PRODUCING ESTROGENS & PROGESTERONE. INCREASED LEVELS OF:
 PTH,

CORTISOL, PROLACTIN & OXYTOCIN.
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CHANGES IN METABOLISM
BMR INCREASED BY 25%.  WEIGHT GAIN: 12.5 kg.  POSITIVE CALCIUM BALANCE.  PROTEIN ANABOLISM  POSITIVE NITROGEN BALANCE.  HYPER GLYCEMIA  INABILITY TO TOLERATE FASTING.

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CHANGES IN MAMMARY GLANDS
BREASTS ARE ENLARGED.  THE AREOLA AND NIPPLES ARE DARKENED & SWOLLEN.

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CHANGES IN REPRODUCTIVE ORGANS
PROFOUND CHANGES OCCUR.  UTERUS INCREASES IN WEIGHT & SIZE.  BOTH HYPERPLASIA & HYPERTROPHY OCCUR OF BOTH ENDO & MYOMETRIA.  WEAK CONTRACTIONS OCCUR IN THE UTERUS

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CHANGES IN REPRODUCTIVE ORGANS contd.

CERVIX BEGINS TO SOFTEN.  OVARIES: NO OVULATION  CORPUS LUTEUM OF PREGNANCY INCREASES IN SIZE WITHIN THE OVARY.  VAGINA BECOMES HYPERVASCULAR.  MUCOSA BECOMES PURPLISH   ACIDITY IN THE VAGINA.

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