Pregnancy and Lactation Dr. Zahoor Dr. Shaikh Mujeeb Ahmed 1

Fertilization Normal site of fertilization is ampulla of oviduct upper third of oviduct Must occur within 24 hours after ovulation – Viability of ovum – 24 hrs. – Sperm usually survive about 48 hours but can survive up to 5 days in female reproductive tract Sperm deposited in vagina travel through cervical canal, uterus, and to upper third of oviduct 2

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Fertilization First sperm to reach ovum – Sperm binds with specific site on zona pellucida on ovum – The sperm undergo the “Acrosomal reaction ” and secretes powerful enzymes that helps it to pierce through the corona radiata and zona pellucida of the ovum. – Fuses with plasma membrane of ovum – This fusion Triggers chemical change in ovum’s surrounding membrane that makes outer layer impermeable to entry of any more sperm – Within hour, sperm and egg nuclei fuse Fertilized ovum now called a zygote 4

Fertilization 5

IMPORTANT Only sperm of same species can bind with zona pellucida of ovum. In human it has ZP3 receptors. 6

Fertilization and Implantation Fertilized ovum( zygote ) having 46 chromosomes divides mitotically – Within week zygote grows and differentiates into blastocyst capable of implantation The blastocyst implants in the posterior wall of uterus on 6-7th day after fertilization. The blastocyst has inner cell mass that becomes embryo and outer cellular layer, Trophoblast (fetal portion of placenta). At site of implantation Endometrium transforms into Decidual layer.(maternal portion of placenta). 7

Early Stages of Development from Fertilization to Implantation 8

Fertilization and Implantation Blastocyst implants in endometrial lining by means of enzymes released by trophoblasts Trophoblastic layer in embryo is called Chorion 9

FUNCTIONS OF PLACENTA Physiological functions :Placenta performs the functions of Digestive system, Respiratory system and Kidney for the fetus. Nutritional Functions: Nutrition and O 2 move to fetus from maternal blood across the placental barrier. Barrier Function APPLIED Many drugs, chemical agents and micro organism can cross the placental barrier and harm the fetus (Aspirin, alcohol, cigarette smoking).There is History of babies born without limbs due to exposure to Thalidomide, a tranquilizer which was prescribed for pregnant women 10

Functions of Placenta (Cont) Endocrinal functions Acts as transient, complex endocrine organ that secretes essential pregnancy hormones 1. Human chorionic gonadotropin( HCG) 2. Estrogen 3. Progesterone – Human Chorionic Somatotrophin: 11

1. Human chorionic gonadotropin(HCG) Peptide hormone that prolongs the life span of corpus luteum Appears in blood within 1 week and urine within 2 weeks of conception. HCG -Reaches peak at 8-10 weeks then declines Actions of HCG : Similar to LH. Maintains Corpus Luteum of pregnancy to secrete Progesterone. At 8-10 weeks Placenta is fully developed and takes over the secretion of Progesterone. In male fetus-stimulate secretion of testosterone Presence in urine forms the basis of pregnancy test. 12

2. ESTROGEN 1st trimester – secreted from Corpus Luteum After that Placenta secretes Estriol. Actions During Pregnancy:- Stimulates growth of myometrium--increasing uterine strength for parturition Promotes development of ducts in mammary gland- prepare for lactation. 13

3. PROGESTERONE – 1st Trimester – secreted from Corpus Luteum: after that from Placenta. Actions During Pregnancy – Inhibits uterine contractions “Hormone of pregnancy”. Stimulates alveolar development in Mammary gland- prepares for lactation. Promotes formation of mucus plug in cervical canal – prevention of uterine contamination. 14

Secretion Rates of Placental Hormones 15

Human Placental Lactogen(HPL) /Human Chorionic Somatotrophin Protein hormone secreted by syncytiotrophoblast Similar in structure to GH and Prolactin Actions – Mobilizes nutrients from mother to fetus. Helps prepare the mammary glands for lactation (similar to prolactin) 16

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Parturition or Labor Labor, delivery, birth Requires – Dilation of cervical canal to accommodate passage of fetus from uterus through vagina and to the outside – Contraction of uterine myometrium that are sufficiently strong to expel fetus Exact factors triggering increase in uterine contractility and initiating parturition not fully established 18

Factors that triggers the onset of labor  Role of high Estrogen levels: Rising estrogen level with gestation – Makes the uterus more excitable by Increase the number of gap junctions between myometrial cells Increases oxytocin receptors in myometrium – contributes to cervical softening by Increase local prostaglandin production 19

Factors that triggers the onset of labor  Role of Oxytocin: Produced by hypothalamus, & released by posterior pituitary on neural stimulation – A powerful uterine muscle stimulant labor is initiated when the myometrial responsiveness to oxytocin reaches a critical threshold that permits the onset of strong, coordinated contractions in response to ordinary levels of circulating oxytocin. 20

Parturition Once contractions begin at labor onset, positive-feedback cycle progressively increases force of contraction Pressure of fetus against cervix reflexly increases oxytocin secretion. Which further pushes the fetus against the cervix This cycle is reinforced as oxytocin stimulates prostaglandin secretion by decidua. 21

Factors that triggers the onset of labor  Role of corticotropin releasing hormone(CRH): secreted by the fetal portion of the placenta into both the maternal and fetal circulations when a critical level of placental CRH is reached, parturition is triggered. 22

LACTATION Structure of mammary gland – Made up of lobules which contain alveoli/acini lined by epithelial cells. – Myoepithelial cells lie in between. – Ducts arise from each alveoli and converge to form lactiferous duct which open on the nipple. 23

Preparation of mammary gland for lactation Hormones acting on mammary gland Estrogen : Ductal development. Progesterone – Causes alveolar development. Prolactin - Lactogenic hormone responsible for milk secretion. Oxytocin – causes milk ejection ( let down). Other hormones like cortisol, insulin, parathyroid hormone& growth hormone are also necessary for milk production. 24

Prevention of Lactation During Gestation During pregnancy estrogen, progesterone and prolactin prepare alveoli for milk production. But actual milk flow takes place after parturition. Why ? 25

Prevention of Lactation During Gestation Blocks 26 High Estrogen & Progesterone during pregnancy PROLACTIN Milk Secretion Stimulatory action At parturition sudden fall of estrogen and progesterone initiates lactation

Stimulation of lactation by suckling Oxytocin is necessary to causes contraction of myoepithelial cells – milk ejection. Oxytocin secretion increased by suckling reflex. Suckling also increases prolactin secretion which maintains milk production. – Prolactin Promotes Milk Secretion – Oxytocin Milk Ejection 27

Sucking Reflexes 28

Factors affecting lactation Adrenaline inhibits contraction of myopeithelial cells. Therefore emotional disturbances will inhibit milk ejection. Other stimuli e.g. Crying of infant etc. can stimulate milk flow(condition reflex). During lactation Menstrual cycle is absent in mother due to high levels of Prolactin which inhibit Pituitary Gonadotrophins - Locational Amenorrhea 29

THANK YOU 30