Fertilization,

Implantation and
Changes in pregnancy
GEM+ Answers
 4.

After about 2hrs

the sperm gets 3.
through the cervix
and there are only
a few thousand
left

2. PGs

1.
How many sperm are deposited in the
female? 40 – 150 million
 Cleavage
Morula

Blastocyst

Progesterone

hCG
Progesteron

Implantation

Luteal relaxin

Spiral arteries maintained stopping

stratum functionalis from sloughing off
Day 6-8 Day 9 Day 13
1. Attachment and implantation. 1. Spaces form in the syncitiotrophoblast 1. Extraembryonic mesoderm breaks down
2. Differentiation of trophoblast these a called lacunae. and forms the connecting stalk.
into cytotrophoblast which forms 2. Syncitiotrophoblast releases proteolytic 2. Cytotrophoblast moves up through the
syncytotrophoblast. enzymes and allows blood to drain into syncitiotrophoblast (primary villi) and
3. S.C. is multinucleated, lacks it’s the lacuna – these are called intervillous surround the intervillous spaces forming
own dividing capacity and spaces. They contain blood, glycogen an outer trophoblastic shell.
secretes hormones hCG, and other nutritional factors.
progesterone and HPL. Why are
these important???
4. The stratum functionalis is well
decidualized with swelling of
stromal cells with increased
glycogen granules

Day 12
1. Hypoblast forms extraembryonic Week 3-8
1. Outer layer of the of the chorionic mesoderm moves up and
mesoderm between cytotrophoblast and
rest of the embryo. through the cytotrophoblast. Forming a secondary villus.
(Layers: choroin -> cytotophoblast -> synctiotrophoblast.)
2. Extraembryonic mesoderm form:
- 2 umbilical arteries
– 1 umbilical vein
- Chorionic arteries on the chorionic plate. (Tertiary villus)
3. The maternal blood in the intervillous spaces moves
through the synsitiotrophoblast -> cyctotrophoblast ->
chorionic mesoderm -> chorionic arteries.
4. Central septa a formed in the 4th or 5th month
 These can also cross the placenta
Placental abruption
Placental lining separates from
the uterus prior to delivery.
Leading to placental
insufficiency.
Diagnosis
Through an ultrasound or MRI,
you can see how deeply the
placenta is implanted in the
uterine wall
Placenta accreta and percreta
Placenta grows too deep into uterine wall and
strongly attaches to uterine muscle layer – risk of
heavy bleeding during birth - Leads to large blood
loss durning child birth.

Placental insufficiency
Placenta praevia
Unable to supply enough
Placenta is too close to or blocks Ectopic Pregnancy
nutrients and oxygen – low the cervix delivered by c-section.
birth weight
Promote
Take over development Relaxes
corpus Reduces insulin CRH. Makes cortisol
of central pubic
leutium release from the because it promotes
nervous symphysis
function. pancreas. lung development and
system. for birth.
Endometrium Promotes lypolysis surfactant production
Pathology
thickening, and to open alveoli when
Cretinism.
vasculature, gluconeogenesis. born.
nutrition and Makes mothers
mucus plug. cells resistant to
insulin – Lots of Gestational diabetes
glucose and fatty Treat with Metformin.
acids to be
delivered over the
Increased risk of Type II after
placenta
Hematological Changes
• Progesterone acts on the RAAS system
to increase plasma volume by about 40-
50%
• More production of thrombin,
fibrinogen, and clotting factors VII, VIII,
IX, X
• Erythrocyte number increases but less
than plasma volume →Total Hb
decreases overall (Haemodilution)

What value on an FBC would tell you about

hemodilution?

Explain the FBC???

Respiratory Changes
• Uterus and grows increasing intra
abdominal pressure → Decreased lung
capacity but increased tidal volume
• 40% increase in ventilation due to
increased tidal volume.
• PCO2 lowered to increase concentration
gradient for foetus
• Progesterone relaxes skeletal muscles

CV Changes
Plasma volume increases
therefore SV increases.
This results in an
increase in CO.
Vasodilation occurs in
mother to reduce
pressure and to promote
the increase in blood
flow that’s needed during
pregnancy.
Parturition Process Physiological Changes Preterm Labor
Contractions between week 20-37.
PGE2 causes cervical Ripening…

Myometrium
In Quiescence:
PKA is kept high this stops the phosphorylation of MLC

In Parturition:
PGE2 acts on Myometrium...
• Stopping PKA production
• Increasing connexins so myometrium acts as a syncytium
• Increasing oxytocin receptors
• Pulling of sensory nerve fibres on cervix increased further
oxytocin release.
COX-2 inhibitors (Inhibit PGG production)
Preterm Rupture of membranes Spontaneous Preterm Labor
Nitric oxide (Increase pKA)
Rupture of amniotic sac before Where myometrial
labor begins. contractions start
Risk of infection to mother and prematurely.
baby: Antibiotics and - Normally triggered by a
Nifedipine CCB.
corticosteroids. bacterial infection from the
vagina that enters the
cervix.
- Can also be due to a short
cervix.

Treatment:
• Drugs????
Atosiban (OTR • Pessary
antagonist)