Download
huwensheng women s hospital school of medicine zhejiang university n.
Skip this Video
Loading SlideShow in 5 Seconds..
Normal pregnancy and birth defects PowerPoint Presentation
Download Presentation
Normal pregnancy and birth defects

Normal pregnancy and birth defects

360 Vues Download Presentation
Télécharger la présentation

Normal pregnancy and birth defects

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. HuWenSheng Women’s Hospital School of Medicine Zhejiang University Normal pregnancy and birth defects

  2. Normal Pregnancy-- Terminology • Pregnancy The course that the embryo and the fetus grow in the maternal body • Stages of pregnancy • Early pregnancy: ≤12 weeks • Mid pregnancy: ≥13 weeks,≤27 weeks • Late pregnancy:≥28 weeks • Term pregnancy:≥37 weeks,<42 weeks

  3. Part I Physiology of Pregnancy

  4. Formation of Embryo • Fertilization • Place: oviduct (ampulla) • Process capacitation → acrosome reaction→ penetrate the zona pellucida→ second meiosis →zygote

  5. Formation of Embryo • Implantation • requirement • Disappear of zona pellucida • Formation of syncytiotrophoblast • Synchronized development of blastocyst and endometrium • Adequate progesterone

  6. Formation of Embryo • Process • morula (day 3) → enter uterine cavity (day 4) → early blastocyst→ late blastocyst (day 6-7) → implantation • location→ adherence→ penetration

  7. Development of embryo and fetus • Definition • embryo: ≤ 8 weeks • Fetus: ≥ 9 weeks, human shape

  8. Development of embryo and fetus • Physiology of fetus • Circulation • fetus ←→placenta←→ mater • 1 umbilical vein (full of oxygen), 2 umbilical artery (lack of oxygen) • Mixed blood (vein and artery)

  9. Development of embryo and fetus • Hematology • Erythropoiesis From yolk sac: 3 weeks From liver: 10 weeks From bone marrow and spleen: term (90%) EPO production: 32nd week

  10. Development of embryo and fetus • Fetal hemoglobin Fetal hemoglobin: early pregnancy Adult hemoglobin: 32nd week Term: fetal type Hb 25% • White cells Leukocytes: 8 week Lymphocytes (antibody production): 12 week, thymus and spleen

  11. Development of embryo and fetus • Gastrointestinal tract • drink amniotic fluid: 4th month • no proteolytic activity • enzymatic deficiencies in liver: bilirubin is not easy to be clear.

  12. Development of embryo and fetus • Kidney Its function begins at 11-14th week • Endocrinology • Fetal thyroid: the first endocrine gland (6th week), synthesize thyroxine at 12th week • Fetal adrenal cortex: widen (20th week), a fetal zone. synthesize steroid hormones (E3, liver placenta mater)

  13. Placenta • Structure • Primary villus syncytiotrophoblast cytotrophoblast • Secondary villus • third class vilus fetal capillary enter the stroma

  14. Placenta • Function • metabolism • Exchange of O2 and CO2 • Exchange of nutritive factors and waste • Defensive Limited. IgG, virus, drug

  15. Placenta • Endocrine • HCG • HPL • E • P • Oxytocinase • Cytokines and Growth Factors • Immunity tolerance

  16. Fetal membranes • Structure chorion and amnion • Amnion A double-layered translucent membrane Become distended with fluid

  17. Umbilical Cord • Structure amnion, yolk sac, one vein, two artery and Wharton jelly • Length 30-70cm

  18. Amniotic fliud • Source • exudation of fetal membranes (early pregnancy) • Fetal urine • Fetal lung • Exudation of amnion and fetal skin

  19. Amniotic fliud • Absord • Fetal membrane • Umbilical cord • Fetal skin • Fetal drinking • Feature 1000-1500ml at 36th-38th week (peak), transparent → slightly turbid

  20. Amniotic Fliud • Function • Protect fetal move freely, warm • Protect mater prevent infection

  21. Physiologic changes in pregnant woman • Genital organs • Uterus • capacity: 5ml-5000ml.weight: 50g-1000g • Hypertrophy of muscle cells • Endometrium→decidua: basal decidua, capsular decidua, true decidua • Contraction: Braxton Hicks • Isthmus uteri: 1cm→ 7-10cm

  22. Physiologic changes in pregnant woman • Cervix: colored • Ovary: placenta replaces ovary (10th week) • Vagina: dilated and soft, pH↓(anti-bacteri bacteria) • Ligaments: relaxed

  23. Physiologic changes in pregnant woman • Cardiovascular system • Heart: move upward, hypertrophy of cardiac muscle • Cardiac Output increase by 30%, reach to peak at 32nd –34th week • Blood pressure early or mid pregnancy Bp↓.late pregnancy Bp↑ .Supine hypotensive syndrome

  24. Physiologic changes in pregnant woman • Hematology • Blood volume • Increase by 30%-45% at 32nd –34th (peak) • Relatively diluted • Composition • Red cells Hb:130→110g/L, HCT:38%→ 31%. • White cells: slightly increase • Coagulating power of blood: ↑ • Albumin: ↓,35 g/L

  25. Physiologic changes in pregnant woman • The Respiratory system • R rate: slightly ↑ • vital capacity: no change • Tidal volume: ↑ 40% • Functional residual capacity:↓ • O2 consumption: ↑ 20%

  26. Physiologic changes in pregnant woman • The urinary system • Kidney • Renal plasma flow (RFP):↑35% • Glomerular filtration rate (GFR):↑ 50% • Ureter Dilated (P↑) • Bladder Frequent micturation

  27. Physiologic changes in pregnant woman • Gastrointestinal system • Gastric emptying time is prolonged→ nausea. • The motility of large bowel is diminished → constipation • Liver function: unchanged

  28. Physiologic changes in pregnant woman • Endocrine • Pituitary (hypertrophy) • LH/FSH: ↓ • PRL:↑ • TSH and ACTH:↑ • Thyroid • enlarged (TSH and HCG↑) • thyroxine↑ and TBG↑→ free T3 T4 unchanged

  29. Part Ⅱ Diagnoses of Pregnancy

  30. Presumptive Symptoms • Amenorrhea: strongly suggestive of pregnancy • Nausea and vomiting • Morning sickness of pregnancy • Results from rapidly rising serum levels of HCG (human chorionic gonadotropin) • Begin at 4 weeks and finish at 12 weeks

  31. Probable Signs • Pelvic organs • Chadwick’s sign: vaginal mucosa has bluish color (6-8w) • Goodell’s sign: cyanosis and softening of cervix(6w) • Hegar’s sign: softening between cervix and uterine fundus causes a sensation of separateness between these two structures

  32. Presumptive Symptoms • Breast changes • Tenderness and tingling • Enlargement (second month ) • Nodularity (sebaceous glands) • Colostrums secretion (begin after 16 w gestation) • Secondary breasts (Axillary breast tissue often cause a symptomatic lump in the axilla)

  33. Breast Enlargement Secondary breast

  34. Presumptive Symptoms • Urinary tract • Frequent urination and nocturia • Infection • Quickening • 16-20weeks in primigravidas • 14-16 weeks in multigravidas • Fatigue • one of the earliest symptoms of pregnancy • returns to normal by the 16th to 18th week

  35. Presumptive signs • Skin changes • Chloasma:darkening of the skin over forehead, bridge of the nose and cheekbones • Linea nigra: darkening of the nipples and lower midline of abdomen • Stretch marks: separation of the underling collagen tissue and appear as irregular scars • Spider telangiectases

  36. Pregnancy test • Urine pregnancy test • Positive around the first missed cycle • Serum pregnancy test: more sensitive • HCG may be detected in maternal serum in 7 days

  37. Presumptive signs • Increased basal body temperature (>18 days)

  38. Positive manifestations • Ultrasound examination of fetus is one of the most useful technical way • Cervicalmucus examination • Progestational challenge

  39. Probable Signs • Abdominal enlargement (the uterus rises out of the pelvis and into the abdomen) • Uterine contractions (Braxton hicks contractions)

  40. Ballottement (16-20w) • Uterine souffle It may be more easily accomplished by a vaginal examination

  41. Positive manifestations • Fetal heart tone (120-160 BPM) Doppler device can detect at 10 weeks

  42. Lie of fetus Longitudinal lie Transverse lie

  43. Fetal presentation • Determined by the portion of the fetus that can be felt through the cervix • Cephalic presentations Classified according to the position of the fetal head in relation to the body of the fetus • Breech presentations Classified according to the position the legs and buttocks which present first

  44. Fetal presentation • Cephalic presentation Vertex Face Brow

  45. Fetal presentation • Breech presentation Complete Incomplete frank

  46. 胎先露:最先进入骨盆入口的胎儿部分

  47. Fetal position

  48. 胎方位:胎儿先露部的指示点与母体骨盆的关系胎方位:胎儿先露部的指示点与母体骨盆的关系 枕左后(LOP) 枕右后(ROP)

  49. 胎方位:胎儿先露部的指示点与母体骨盆的关系胎方位:胎儿先露部的指示点与母体骨盆的关系 骶右后(RSP) 肩右前(RScA)