妊娠生理PPT英文课件

1、教学重点DefinitionPregnancypProcesspEmbryonic Development and Fetal GrowthLength of pregnancyStarting from the time of conception, this typical length of gestation and the fetal age at the end of pregnancy is 266 days or 38 weeks ( conceptual age受精龄受精龄)By convention, add a standard 2 weeks to derive ges

2、tational age. The typical length of pregnancy is 280 days or 40.0 weeks(menstrual age月经龄月经龄)First trimester（早孕）（早孕） 13th+6 weeksSecond trimester（中孕）（中孕）14th 27th+6 weeksThird trimester（晚孕）（晚孕）28th weeks Fertilization and The Development 、 Transit and Implantation of zygoteFertilization union of indi

3、vidual male and female gametesoccurs in the ampulla of the uterine tubefertilization of ovum must occur within 12hs after ovulationfertilization process needs 24hrs Sperm Capacitation（精子获能精子获能）The spermatozoa gain this ability during the transit through the female reproductive tractalpha, beta amyla

4、se acrosome surface glycoprotein degrade sperm can readily penetrate the cumulus7hrsAcrosome Reaction（AR,顶体反应）顶体反应） Sperm egg Fusion between the sperms plasma and acrosomal membrane rupture Exocytosis of the enzyme contents of the acrosome Dissolve the cumulus and zona pellucida Penetrate the cumulu

5、s and zona pellucidaZona Reaction（ZR,透明带反应）透明带反应）fusion of the egg and sperm membranes release of cortical granules in the oocytethe ZP alters its structureprevent further sperm bindingthe primary blocking mechanisms to polyspermy受精受精fertilization（sperm & ovum zygot)精子获能精子获能capacitation顶体反应顶体反应a

6、crosome reaction（AR）透明带反应透明带反应zona reaction（ZR）卵裂卵裂CleavagelCleavage occurs in stages and results in the formation of blastomeres. lThe morula is composed of 1216 blastomeres. (3d)lThe blastocyst forms when approximately 60 blastomeres are present. lThe zona pellucida has disappeared by the late bla

7、stocyst stage. lUntil the zona pellucida is shed, the developing embryo essentially does not increase in sizePGDPreimplantation and Implantation 4 days after fertilization, the developing blastocyst enters the uterus 56 days after fertilization, the zona pellucida disappears, the late blastocyst for

8、ms 1112 days after fertilization, the embryo is completely imbedded within the endometrium（implantation着床着床）Implantation(1)- Apposition定位定位the polartrophectoderm of the embryo apposes the endometrial epitheliumImplantation(2)- Adhesion粘附粘附differentiates into two cell types, the cytotrophoblast and t

9、he syncytiotrophoblastImplantation(3)- Penetration穿透穿透Syncytiotrophoblast produces specific molecules and other enzymes to degrade and remodel the epithelium and stroma. The embryo becomes completely embedded 713 days after ovulationZP must be shed prior to embryo implantationThe cytotrophoblast dif

10、ferentiates into the syncytiotrophoblastImmunobiologic adaptations of pregnancyEndometrium and blastocyst develop synchronouslyTransit of zygoteEndometrium Decidualization底蜕膜底蜕膜包蜕膜包蜕膜真蜕膜真蜕膜Normal embryonic andfetal developmentThe embryonic periodThe embryonic period extends from the beginning of the

11、 fourth week to the end of the eighth week (conceptual age). During this period, all the major internal and external structures begin their development.By the end of this period, the embryo has acquired characteristic human features.The fetal periodThe fetal period extends from the beginning of the

12、ninth week (conceptual age) until birth. The main features of this period are the growth and differentiation of those tissues and organs that began their development in the embryonic period. Few new structures (hairs, nails) appear. During this period, fetal movement begins, and the life-sustaining

13、reflexes (sucking, swallowing, etc.) are established.16th weeks110gGender can be correctly determined24th weeks630gThe bronchi and bronchioles enlarge and alveolar ducts develop.Attempt to breathe28th weeks1000g Eyes partially open.Moves the limbs quite energetically and cries weakly36th weeks2500gH

14、ave an excellent chance of survival40th weeks3400gFully developedFetal circulationUmbilical arteriesUmbilical veinDuctus venosusDuctus arteriosusForamen ovaleFetusMedial umbilical ligamentsLigamentum teres of the liverLigamentum venosumLigamentum arteriosumClosesInfantThree shuntsThe ductus arterios

15、us “shunts” blood from the pulmonary artery into the descending aortaThe foramen ovale allows the shunting of blood from the right to the left atriumThe ductus venosus normally allows part of umbilical venous return to flow directly into the inferior vena cavaUmbilical vein Fetal circulation Umbilic

16、al arteriesNo pure arterial bloodThe vessels to the heart, head and neck, and upper limbs receive rather well-oxygenated bloodFetal AppendagePlacentaStructural Characteristic A round disc-likeAverage measures at term : Diameter 22 cm Central thickness 2.5 cm Weight 450500 gTwo sides: fetal / materna

17、lThree layers structure: Amniotic membrane Chorion frondosum Basal deciduaFetal blood flows through the placenta about 500 ml/min 血管合体膜血管合体膜VSMVSM （绒毛合体滋养细胞（绒毛合体滋养细胞ST、合体滋养层基膜、绒毛间质、合体滋养层基膜、绒毛间质MC、毛细血管基膜、毛细血管内皮细胞、毛细血管基膜、毛细血管内皮细胞FEn） Placental Arm of the Fetal-maternal Communication SystemPlacental tr

18、ansferPlacental barrierPlacental endocrinepSteroid hormones(E3)pProtein and peptide hormones(hCG,hPL)pEnzyme(oxytocinase)pOthers(IGF,IL,EGF)Maternal Fetal Fetal membranesUmbilical cord：30-70cmAmniotic fluid：300-2000ml；2-8cm/50-80cm；pH 7.20Maternal Adaptations to PregnancyReproductive systemUterus (s

19、ize, shape, position, contractility, blood flow)pEnlargenment Volume 10ml 5000ml Weight 70g 1100g Not symmetrical (fundus, the portion surrounding the placental site)pDextrorotationpBraxton Hicks contractionspBlood Flow 450-650ml/minIsthmus of uterus Low segment of uterusCervix pSofteningpRedpBeadin

20、g pFriable and bleedsOvaries Ovulation ceases, Corpus luteum of pregnancyVagina and Perineum Softening, Violet colorCardiovascular systemThe heart is displaced to the left and upwardpChest X-ray: increase in the size of the cardiac silhouettepECG: slight deviation of the electrical axis to the leftS

21、upine hypotension occurs in 8% of women in late gestationThe venous pressure in the lower circulation rises for both mechanical and hydrodynamic reasonsCardiac output is believed to peak around 32 weeksHaematologyBlood Volume pExpands as early as 6 weekspIncrease 4045%(1450ml) over the course of ges

22、tationpPlasma volume increases 1000mlpRed blood cell volume increases 450mlpA fall in hemoglobin concentrationpPhysiologic anemia of pregnancy (RBC 3.61012/L, Hb 110g/L, HCT 0.31-0.34)pAnemia of pregnancy (RBC 3.51012/L, Hb 110g/L)Change in WBC populationsComponentChange in pregnancyWBCGranulocytesL

23、ymphocytesMonocytesTotal T cellsB cellsT-helper cellsT-suppressor cellsIncreaseIncreaseNo changeNo changeDecreaseNo changeDecreaseNo changeCoagulation components and test values in pregnancyComponent or testChangeNonpregnantPregnantPTPTTBleeding timePlatelet countFibrinogenNoneNoneNoneNoneIncrease11

24、12s2436s15min150400 109/L200 mg/dLSlightly increaseSlightly increaseNo changeNo change4050%Urinary tract systemThe dimensions of the kidneys increase with the increase in glomerular filtration rate (GFR, 30-50%)Serum creatinine(Cr) declines and blood urea nitrogen(BUN) decreasesGlycosuria during pre

25、gnancy is common(15%)Dilation of renal calices and ureters increases the risk of urinary tract infections ,often more on the right sideMetabolism ChangesWeight Gain during PregnancyTissues and FluidsCumulative Increase in Weight (g) Up to 40 WeeksFetusPlacentaAmnionic fluidUterusBreastsBloodExtravas

26、cular fluidMaternal stores(fat)Total340065080097040514501480334512,500Metabolism ChangesCarbohydrate metabolismpfasting hypoglycemiappostprandial hyperglycemiapHyperinsulinemiaInsulin does not cross the placentaThe concentrations of lipids in plasma increaseWhen fasting is prolonged, ketonemia rapidly appearsIron and calcium plasma levels decline中山大学附属第一医院妇产科蔡坚Pregnancy?Intrauterine?Duration of pregnancy?Normal?Diagnosis of the First Trimester Pregnancy Presumptive evidenceCessation of menstruationMorning sicknessVaginal blee