Lectured by: Paul Dexter C.

Santos, MD
PREGNANCY AND LACTATION
Transcribed by: Alyanna Mara Vidallo, PTRP

• Blastocyst implantation: 5 to 7 days after ovulation
FERTILIZATION and IMPLANTATION o Around day 19 of menstrual cycle sabi ni
FERTILIZATION Doc Bae <3
• Trophoblastic cells invade the endometrium
• Sperm cell penetrates the egg • Implantation bleeding – trophoblastic cells
• Acrosomal reaction – release of hydrolytic enzymes implantation may cause bleeding and can be
for penetration mistaken for menses
• Occurs normally at the ampulla of the uterine tube
although can happen anywhere in the female genital CLINICAL CORRELATION: TROPHOBLASTIC TUMORS
tract § Trophoblast: one of the most aggressive, highly
nd invasive cells of the human body
• Ovum completes 2 meiotic division after sperm
penetration § Malignancies arising from trophoblasts:
choriocarcinoma – highly invasive and malignant;
• Cortical reaction prevents polyspermy – upon entry
cannonball appearance in the lungs
of sperm cell, there is influx of calcium

• Granules empty contents in the vitelline space
CLINICAL CORRELATION: ECTOPIC PREGNANCY
• Sperm transport: aided by prostaglandins from the
§ Implantation outside the uterine cavity
semen and oxytocin released during orgasm
§ Most commonly in the fallopian tube (in anatomy:
• Early embryo gets nutrition from fallopian tube
m/c in the ampulla (dilated portion) of the fallopian
secretions
tube)
§ Almost all the ectopic pregnancies will have an
unhappy ending à but life will find a way ahihihi
(according to recent studies)

PREGNANCY
PLACENTAL HORMONES

A. Human Chorionic Gonadotropin (hCG)

B. Estrogen
C. Progesterone
D. Human sommato-mammotropin (previously known
IMPLANTATION:
as human placental lactogen)

A. HUMAN CHORIONIC GONADOTROPIN (hCG)

• Secreted by syncytio-trophoblasts cells of the

blastocyst
• Maintains the corpus luteum until the placenta can
secrete adequate amounts of progesterone to
maintain the secretory endometrium
• *without fertilization, no hCGà decline in
progesterone à menses”
• Pregnancy test kits rely on detecting hCG from the
urine or blood samples
• Can be detected 8-9 days post ovulation (about 2-3
days after implantation)
• Main function is the maintenance of the corpus
luteum which in turn secretes progesterone and
estrogen

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 • hCG à maintains corpus luteum à secretes CLINICAL CORRELATION: GESTATIONAL DIABETES
progesterone and estrogen à maintains a secretory
endometrium (decidual cells) AND prevents § For susceptible individuals, the decrease in insulin
menstruation sensitivity becomes exaggerated
§ Abnormally increased blood maternal blood glucose
• In males: LH-like effects stimulates testosterone
levels (causes endogenous insulin of the baby)
production
§ More fat deposition, more growth in general
§ Can cause fetal macrosomia that can cause problems
in delivery, thus, initiate CS =)

RELAXIN

• From corpus luteum and placenta

• Relaxes the pelvic ligaments (before delivery)

OTHER HORMONES

• Increase in:
o Corticosteroids
o Thyroid hormone
o Parathyroid hormone

*take home message in this illustration: the point of

intersection – placenta takes over as the hormone NUTRITION OF THE EMBRYO AND FETUS
producer • During zygote transit: (after fertilization)
ú Secretions of fallopian tubes
B. ESTROGEN ú Secretions of endometrium
• Sources: syncytio-trophoblasts, placenta ú Action of estrogen and progesterone
• Development of breast ductal structures and breast • Upon implantation:
enlargement ú Trophoblast invade decidual cells to get
• Enlargement of the uterus nutrients
ú Endometrium adequately prepared by
• Relaxation of the pelvic ligaments
progesterone
• Enlargement of the external genitalia

C. PROGESTERONE

• Sources: corpus luteum, syncytio-trophoblasts,
placenta
• Prevents uterine contractions
• Increases the secretions of the fallopian tubes for
the nourishment of the fertilized ovum
• Causes decidual cells to develop in the endometrium
that nourishes the early embryo (maintains
secretory endometrium)

D. HUMAN CHORIONIC SOMATO-MAMMOTROPIN
• Secreted by syncytio-trophoblasts *take home message from this figure: Placenta – interface
• Somato for gas/ nutrient exchange between the fetus and the mother
o decreases the mother’s insulin sensitivity à as well as elimination of waste products; around 12 wks AOG
more glucose available to fetus when placenta takes over
o Also releases fat stores from mother
• Mammo Dear Marco,
o helps in development of the breasts How do I unwrite the past? How do I undo the mistakes? How do I unlove
you?

- Ginny (Starting Over Again, 2014)

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PLACENTA AMNIOTIC FLUID

• Progressive trophoblastic invasion then later – • 500-1 liter

organization • Large portion comes from fetal urine
• 2 umbilical arteries and 1 umbilical vein • Turn over of around 3 hours
• Maternal blood bathe the sinuses that surround the • Some fluids swallowed through GIT
placental villi
CLINICAL CORRELATION:
§ OLIGOHYDRAMNIOS
ú Low amniotic fluid levels
ú May signify renal agenesis
§ POLYHYDRAMNIOS
ú Abnormally high levels of amniotic fluid
ú May signify fetal esophageal atresia

CLINICAL CORRELATION: AMNIOCENTESIS

§ Amniotic fluid used to determine health of the baby

and can also be used to identify genetic abnormality
(basis IN SOME COUNTRIES WHERE IT IS LEGAL for
abortion)

PARTURITION

• Oxygen from mother to fetus à simple diffusion • Delivery of the baby

• Maternal pO2: 50mmHg • Uterus develop strong and rhythmic contractions
that will result in expulsion of contents (baby and
• Fetal pO2: 30mmHg
o Fetal hemoglobin (alpha and gamma chains placenta)
where gamma has increased affinity to Triggers:
oxygen) • Not fully understood
o Increased hemoglobin concentration (forms • Hormonal changes
a gradient about 18mg/dl)
• Mechanical factors
o Bohr effect
• Fetal factors

Hormones:

• Increased Estrogen relative to Progesterone

(progesterone: “the one that quiets the uterus)
• Oxytocin: released by posterior pituitary
o Stretching of cervix associated with reflex
release
o Baby progressively gets bigger and heavier

Fetal Factors:

• Oxytocin release
• Carbon Dioxide • Prostaglandins from membranes (misoprostol – a
o Fetal-Maternal Gradient of 2-3mm Hg prostaglandin analog that targets the cervix to abort
• Glucose baby)
• Facilitated diffusion • Increase in cortisol (mechanism unknown)
• Fatty acids
• Soluble in placental membranes
• Ketones
• Electrolytes (Na, K, Cl)
• Waste Products:
o Urea, creatinine, uric acid

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Mechanical Factors: CLINICAL CORRELATION: EPISIOTOMY

• Uterine muscle stretch § Pre-emptive cut / incision to facilitate delivery of the

o Multiple pregnancies often result in earlier baby
onset of labor § Prevents disorderly and jagged tearing of the
• Irritation and stretching of cervix perineum and adjacent structures
o Stretching of cervix brings about uterine










CLINICAL CORRELATION: EPIDURAL ANESTHESIA

*take home message: the stretching of the uterus and cervix § used sparingly to minimize pain and not to
brings about premature delivery of triplets or twins due to completely remove pain
the increase in stretch § not given too early – may stop the labor process

Positive Feedback Mechanism

• Cervical stretch à Stronger contractions à pushes
the fetal head à More Cervical Stretch à Much
stronger contractions à Until baby delivery
• Cervical stretch:
o causes local reflex causing uterine
contractions
o Causes pituitary reflex release of Oxytocin
• Cervix becomes soft towards the end of pregnancy
• Nipple stimulation: causes reflex oxytocin secretion DELIVERY OF PLACENTA
o Aids in parturition
• Progressive uterine contraction
• Placenta detaches from uterus
• Blood loss limited by uterine muscle contractions

UTERINE INVOLUTION

• Uterus goes back to normal size at 4 weeks

• Endometrial surface sloughs off : lochia
o Lochia Rubra 3-5d (reddish)
o Lochia Serosa 5-10d (yellowish)
o Lochia Alba 10d – weeks (whitish)

CLINICAL CORRELATION: ABRUPTIO PLACENTA

• Premature placental detachment (cause bleeding)

• Obstetric Emergency

• Abdominal Muscle contractions
o Reflex contractions from labor pains
• Pain of labor
o Caused by uterine hypoxia during
contractions (visceral nerves)
o Cervical and vaginal dilatation (somatic
nerves)
o Vaginal / perineal tears
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CLINICAL CORRELATION: ABNORMAL PLACENTAL DEPTH AND Nutritional Status:
ATTACHMENT
• Iron
• May lead to failure of delivery of placenta • Calcium
• increta and percreta – WILL NOT DETACH; if pulled • Vitamin D
forcefully, may cause uterine prolapse; removal of • Vitamin K
the placenta together with the uterus, thus, cannot • Protein and total calories
get pregnant anymore =( • Morning sickness: hCG, estrogen, progesterone

Cardiovascular system
• Increased blood volume (around 30%)
• Increased red cell mass
• Peak of cardiovascular load happens at 28weeks
AOG
• Increased heart rate and cardiac output

Nutrition

• Folic Acid Supplementation

o Prevents Neural tube defects
o May prevent cleft lip and palate

CHANGES IN THE MOTHER’S BODY Pulmonary system

Increase in: • Progesterone increases CO2 sensitivity à increase in
minute respiration
• Size of Uterus • 20% more O2 consumed
• Size of Vagina • Mechanical impedance to breathing of enlarging
• Size of Breasts uterus especially in the last few weeks of pregnancy
• Over all weight (around 25-30 pounds) Renal system
• Appetite • Increased sodium and water reabsorption
• Metabolism (increase in thyroxine, cortisol, sex • Increased GFR
hormones) • Net of 4-5 pounds of water retained

Appearance: CLINICAL CORRELATION: PREECLAMPSIA
• Water retention/ edema § Also called ‘toxemia’
• Acne § Endothelial dysfunction
• Masculine features § Exact cause is unknown
§ Hypertension, edema, and excessive water retention
• Hyperpigmentation
CLINICAL CORRELATION: ECLAMPSIA
o Areola
§ Preeclampsia + neurologic symptoms (seizure) and
o Linea nigra
organ failure
o Melasma – mask of pregnancy
§ Renal and liver failure
§ Extreme hypertension
§ Fatal


BUJOY: Oh yes! Kaibigan mo ako! Kaibigan mo lang ako. And that’s all I
ever was to you, Ned. Your best friend. Takbuhan mo pag may problema
ka, taga-sunod, taga-bigay ng advice, taga-enroll, taga-gawa ng
assignment, nagpapatawa sa ‘yo pag nalulungkot ka… taga-tanggap ng
kahit na ano. And I’m so stupid to make the biggest mistake of falling in
love with my best friend. Dahil kahit kailan, hindi mo naman ako makikita e.
Kahit kailan hindi mo ako kayang mahalin na higit pa sa isang kaibigan.

Labs Kita, Okey Ka Lang? (1998)

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 Oxytocin
LACTATION

“Mother’s uterus is not an area of priority for the • “milk let down” reflex
cardiovascular system so if the mother has bleeding or ill • Causes myoepithelial cell contraction causing milk
(diarrhea, trauma), the blood is directed to essential areas ejection
like the brain, heart, and lungs so there is increased chances • Suckling on one breast also stimulates milk ejection
of miscarriage.” in the other breast

• 1.5 Liters of milk /day
Estrogen
• 700 kcal/ liter
• Ductal system development • Anti infective agents (especially colostrum):
• Increase in breast stroma and fat deposition antibodies (IgA), neutrophils and macrophages
• Actually inhibits milk secretion

Progesterone

• Lobules and alveoli

• Actually inhibits milk secretion

Prolactin

• Promotes milk secretion

• Inhibits GnRH secretion
• 700 calories transferred from mother to baby
• Offers temporary infertility
• Equivalent to jumping rope or running for over 1
• “No GnRH à no FSH, no LH à no pregnancy” hour (everytime the baby suckles, mother loses
PERFECTLY DESIGNED! More time to nurse the baby weight woohooo let’s all get pregnant!)
and create bonding J
Somatomammotropin Maternal benefits of breastfeeding:

• Lactogenic effect • Infertility for around 6 months. Prevents immediate

pregnancy
• Faster weight loss and return to pre-pregnant weight
and size (calories transferred from mother to baby)
• Increased bonding with child
• Keeps uterus contracted and prevents further
bleeding (oxytocin release)

END OF TRANSCRIPTION

References:
• Powerpoint presentation
• Lecture notes and recordings
Other hormones for milk production: • MY LOVE FOR DOC DEX

1. Growth hormone Hello. It’s me. I tried my best to take down notes during the lecture.
2. Insulin Don’t judge. Hahahaha!
3. Cortisol I’d like to share with you one of my favorite verses and it’s from Mt.
4. Parathyroid hormone 6:34 =)
“Therefore do not worry about tomorrow, for tomorrow will worry
(Affects the constitution of milk (proteins, fats, about itself. Each day has enough trouble of its own.”
carbohydrates, Ca, etc)
Total surrender (to the Big Guy up there and not to the tests duh)!
Prolactin Inhibitory Hormone Let’s go 2019!

• Secreted by hypothalamus Hello pala sa mga p@b3b€h gHur£z MD aka MARLOUnatics! Ehe ehe!
Nilagay ko na paboritong movie dialogue ng mga bestfriend-zoned
• Controls prolactin release
diyan char!! E!0W pHoUsXzC! O ano masaya na ba kayo ang jejemon
ko? aJ3jEje!

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