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.
+ 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:
Inhibits the contractile potential of the uterus
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
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
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:
– Gastric and intestinal function is slowed: the secretory activity is decreased; tone and intestinal motility is low => constipation
– Intrahepatic bile retention => cholestasis of pregnancy
– 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)
– 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)
– 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)
– 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.
* 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