1- Hormonology:
A- MENSTRUAL CYCLE:
* FOLLICULAR PHASE: high FSH (low estrogen) => follicular maturation -> Graafian follicle -> secretion of estrogen (granulosa cells); theca interna secretes androgens which will be converted into estrogen in the granulosa cells.
– The increase in estrogen levels is accompanied by a low and slow LH surge
* PHASE ovular: estradiol increases max => sudden increase in LH => = progesterone discharge> ovulation
* Luteal phase: increasing estradiol inhibits the secretion of FSH and LH in pituitary secretes greater quantity => luteum which secretes progesterone (granulosa).
+ The simultaneous secretion of progesterone (dominant) and estrogen progesterone causes transformation of the endometrium (hyperplasia)
+ It is the elimination of the endometrial estrogenic impregnation with prostaglandin production which triggers menstruation.
B- PREGNANCY:
+ HCG appears 8 days after fertilization (5 days before the expected date of menstruation); it is max 2 ½ months and then decreased -> 4 months -> Tea -> delivery -> disappears after 4 days.
+ The growth hormone chorionic (placental lactogenic hormone) promotes fetal development by potentiating GH.
+ Steroids come in the first 2 months of the corpus luteum; placental secretion becomes exclusive in the last 2 quarters
+ The 3 types of estrogen secreted by the placenta (estradiol, estrone, estriol). Estriol is synthesized from the precursor of fetal origin. Estriol is the estrogen dominant; it reflects the growth and vitality of the fetus in the third quarter.
+ Progesterone: Fetal corticosteroids are dependent on the formation of progesterone placen-silent. The rate increases during pregnancy and collapses during childbirth. It is related to the placental growth.
Note: the FSH receptors are found in granulosa and those of LH in the theca interna
C- DETERMINISM LABOUR:
1- Progesterone:
Inhibits the contractile potential of the uterus
2- Estrogen:
Increased excitability of uterine fibers and are important in the development of myometrium. They augmentent concentration of uterine oxytocin receptor. They are also involved in prostaglandin synthesis
3- Reflex Fergusson:
Distention of the uterus (during labor) triggers a reflex and utero-hypothalamic increase secretion of oxytocin
4- Oxytocin:
They do not intervene in the work of the trigger mechanism; it is useful in the pursuit thereof and acts only after the cervical transformation due to prostaglandins
5- prostaglandins:
Ripening effect on the cervix and increases uterine contractility
6- fetal Role:
Fetal ACTH secretion plays a role in the induction of labor; adrenal hypertrophy is responsible for prematurity …
D- AFTER CHILDBIRTH:
– The lactation occurs 48 hours after delivery as a result of pituitary prolactin. During pregnancy prolactin is inhibited by estrogen and progesterone through the FIP.Oxytocin stimulates contraction of the myoepithelial cells
– Lactation sounds on balance the hormonal balance of the puerperium; the menstrual cycle and menstruation are often suspended (PRL inhibits the production of FSH). Menstruation may be the only suspended => ovulation (40th day).
2- Changes in the mother’s body:
A- DIGESTIVE:
– Gastric and intestinal function is slowed: the secretory activity is decreased; tone and intestinal motility is low => constipation
– Intrahepatic bile retention => cholestasis of pregnancy
B- PULMONARY:
– Tidal volume gradually increases; the residual volume was reduced by 20%
– The ventilatory rate increases by 40% without changing the respiratory rate
– Oxygen consumption increases by 15%; PCO2 decrease (30 mmHg)
C- CARDIOVASCULAR:
– ECG: electrical axis deviated to the left ….
– Cardiac output increases during the first 10 weeks of 1.5 L / min and it is maintained until the end (6L / min)
– Heart rate increases by 15 / min
– The PA decreases by 5 10 mmHg in the first half of pregnancy (by considerable decrease in peripheral resistance)
– PVC is not changed
– Stress response -> vasodilation (instead of the usual vasoconstriction)
D- KIDNEY:
– Dilatation of the renal pelvis and ureters
– Renal blood flow increases and decreases in supine position => inversion of the diurnal rhythm of salt and water excretion
– The glomerular filtration rate increases by 50% (decrease in creatinine and blood urea)
– Increased excretion of uric acid
– The balance is positive soda (by stimulation of the renin-angiotensin system) -> increase blood volume
– Decreased oncotic pressure (hypoalbuminemia by hemodilution)
E- BLOOD:
– The average plasma volume increases by 50% at 32 SA; Blood volume increases; The cell volume increases although the GR decreases
– Hemoglobin decreases; hematocrit decreases; serum iron decreases; capacity of transfer of oxygen increases
– Coagulation factors increases; fibrinolytic activity decreases and AT III => hypercoagulable
3- Diagnosis during pregnancy:
– The neck is not changed or in its dimensions or its form, barely in his position (posterior). It would be in its consistency: Softening
– The softening of the body is constant (at the isthmus -> Hegar’s sign); anteflexion exaggerated
– Fundus position: 3 months, it is equal distance between the pubis and the umbilicus; it reaches the navel to 4 ½ months (22 weeks).
– Uterine height: 20 cm 5th month (24 weeks); 24 cm at 6 months (28 weeks).
– Ultrasound: the best precision to date the beginning of the pregnancy is obtained 9-10 SA. Beyond the 15th SA it can no longer express the gestational age with such precision. The placenta appears on ultrasound to 9-10 SA.Morphological abnormalities (malformations) can be detected from the 19th SA by ultrasound
– At the beginning, a large number of placenta are inserted down (sometimes overlapping). After 20 weeks, the placenta seems to move away from the cervix.
– The ERCF is not systematic; a first time between 28 and 32 weeks and then every 15 days.
4- Work:
* EARLY WORK: it is defined by the combination of two phenomena
– Uterine contractions: involuntary; total; rhythmic; regular; progressively increasing and painful
– Cervical changes: softening, shortening, cervical dilation beginning; the lower segment is amplié
Other phenomena may herald the coming into work: loss of mucus plug (slimy leucorrhoea, thick, blood-tinged), which has little value; rupture of the amniotic sac (known rupture of membrane -> outside of work).
* CLEAR EXPANSION AND CERVICAL:
– The collar will delete then dilated (in multiparas dilatation is often accompanied by erasure). Full dilatation -> 10 cm
– The average length of expansion (1 -> 10cm) is 5 to 10 hours in primiparas; March-June pm in multiparas
– The normal RCF during this phase is between 120 and 160 / min, with oscillation> 5 beats / min (without deceleration) during or after contraction.
– The most effective witness a contraction pattern is a regular cervical dilatation
– Often it makes an artificial rupture of membranes, between 3 and 5 cm (when the presentation is sufficiently enforced -> commitment of the presentation