Transcript Fisiologi Kehamilan - Biomedic Generation

Pregnancy
By
Sr. Siti Norhaiza Hadzir
Pregnancy
• If ovum is fertilized it may implant in
endometrium
• The function of LH is taking over by
human chorionic gonadotrophin (HCG)
• HCG is produced by placenta
• HCG prevent the involution of corpus
luteum
• Estrogen and progesteron raises and
endometrium sloughing is prevented
• Prolactin secretion increased after
eight weeks of pregnancy
• Prolactin, estrogen and progesteron
stimulates breast development
• High plasma estrogen inhibit milk
production
Fertilization
• Occur at the end of Fallopian tube
• Sperm motility is important
• Sperm half life 2-3 days
ovum 24 hours
• Pregnancy is counted from the first
day of last menses.
• Baby is almost 2 weeks younger than
pregnancy period.
• The duration is 9 months 10 days/280
days/40 weeks
• Zygote (ovum + sperm) is brought to
the uterus (within 4 days fertilization)
• Endometrial stabilization —amenorrhea.
• Human chorionic gonadotrophin (HCG)
can be detected after 10 days
fertilization.
• Positive pregnancy test.
Maternal Changes
• Weight gain (10-12 kg)
• Changes in the pelvic
• Cardiovascular changes
increase in stroke volume/ cardiac
output/heart rate/blood volume
• Changes in pulmonary function- to
supply oxygen to the fetus.
• Cause dyspnea
• The effect of pressure to the
abdomen
Veracious vein
Renal hypertension
gastritis (slowing in motility)
Leg edema
• Increase in the rate of metabolism
• Decrease GIT motility– constipation,
nausea, vomiting
• Skin-chloasma, linea alba, striae,
• Fat deposition especially
triglyceride
• Hypervolemia
• Increase in erytropoiesis
Monitoring pregnancy
Aim
• To detect fetus abnormality
• To monitor the progress of
pregnancy
Monitoring pregnancy
• HCG reaches peak at 13 weeks of
pregnancy
• Crude test of plasma and urine HCG
give positive result after one or two
weeks of missed period.
• Immunoassay detected soon after
implantation of ovum for pts treated
for infertility
• Human placenta lactogen (HPL)
produced at eight weeks of
pregnancy. To assess abortion or late
pregnancy
• Now assessment of fetal well being is
replace mainly by Ultrasound
Amniocentesis
• To obtained amniotic fluid
• Needle is inserted into uterus
through maternal abdomen
• Done after 14 weeks of pregnancy
• Done together with U/sound guide
• Perform only for strong clinical
indication and if diagnosis cannot be
made by un-invasive procedure
• Avoid
– Specimen contaminated with maternal,
or fetal blood and urine
– Not fresh
Amniocentesis
• Detection of neural tube defect
– AFP to detect neural tube defect such
as spinal bifida, anencephaly
– Alpha fetoprotein is produced by liver
and yolk sac
– AFP can also caused by multiple
pregnancy
• Down Syndrome
– Low AFP and raised HCG measured
between 16-18 weeks
• Assessment of fetomaternal blood
group incompatibility
– Measure fetus bilirubin
Maternal Biochemical
changes
• Increased in carrier protein
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– Increase in Total T4 and Cortisol (TBG and
CBG high, Free T4 and cortisol normal),
Increased transferrin or TIBC
Increased ALP (placenta isoenzyme)
Low Protein and albumin (dilution)
Glucosuria (increased GFR)
Low calcium (bcause bind to albumin)
Pregnancy and disease
Pregnancy induced
hypertension
PIH
• also be called preeclampsia
• pregnancy complication
• Characterized by high blood pressure,
oedema and proteinuria.
• One out of every 14 pregnant women
• Can also occur in subsequent pregnancies
• More common in pregnant teens and in
women over age 35
• develops usually after the 20th week, but
it can also develop at the time of delivery
or right after delivery.
Symptoms
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Rapid or sudden weight gain
High blood pressure.
Protein in the urine.
Swelling* in the hands, feet and face
Severe headaches
Change in reflexes
Reduced output of urine or no urine
Blood in the urine
Excessive vomiting and nausea.
Who is at risk of
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Is under age 20 or over age 35
Has a history of chronic hypertension
Has a previous history of PIH
Has a female relative with a history of PIH
Is underweight or overweight
Has diabetes before becoming pregnant
Has an immune system disorder, such as lupus or
rheumatoid arthritis
• Has kidney disease
• Has a history of alcohol, drug or tobacco use
• Is expecting twins or triplets
What is the danger of PIH?
• PIH can prevent the placenta from
receiving enough blood, which can cause low
birth weight in the baby.
• Placental abruption, a complication that
occurs when the placenta pulls away from
the wall of the uterus
• Severe bleeding
• Seizures
• Early delivery of premature baby
• Stillbirth
How is PIH treated?
Mild PIH
• Can be treated at home.
• Need to maintain a quiet, restful
environment with limited activity or bed
rest.
• Follow the diet and fluid intake guidelines.
• Maintain scheduled Clinic appointments.
• Constant perception of fetal movement is
also important.
Severe PIH
• Hospitalization for closely monitoring.
• Health care provider will work with pt to
maintain the health of mother and the
baby.
• In severe cases, the baby may have to be
delivered.
• Both severe and mild PIH pt is given
antihypertensive drugs.
GESTATIONAL
DIABETES
Definition
• Gestational diabetes is a type of
diabetes that occurs only during
pregnancy.
• Like other forms of diabetes,
gestational diabetes affects the way
the body uses blood glucose
• Blood sugar level is too high.
Causes
• During pregnancy, the placenta produces hormones
that prevent insulin action.
• These hormones, which include estrogen, cortisol
and human placental lactogen, are vital to
preserving pregnancy.
• Yet they also make the cells more resistant to
insulin.
• As the placenta grows larger in the second and
third trimesters, it secretes even more of these
hormones, further increasing insulin resistance.
• Normally, the pancreas responds by producing
enough extra insulin to overcome this resistance.
• During pregnancy, the body need up to 3x
as much insulin as normal, and sometimes
the pancreas simply can't keep up.
• When this happens, intracellular glucose is
decrease, and too much stays in the blood.
• It usually occurs about the 20th to 24th
week of pregnancy and can be measured by
the 24th to 28th week of pregnancy.
• Blood sugar levels should quickly return to
normal after delivery.
Risk factors
• Age more than 25 yrs old
• Family or personal history of
diabetes
• Overweight before pregnancy
• Previous complicated pregnancy.
Unexplained stillbirth or a baby who
weighed more than 9 pounds.
Screening and diagnosis
• A urine sample isn't a reliable indicator of
gestational diabetes because the amount of sugar
in urine can vary throughout the day and as a
result of dietary
• In some places, screening for gestational diabetes
is a routine part of prenatal care for all women.
• To screen for gestational diabetes, most doctors
recommend a glucose challenge test (OGTT).
• This test is usually done between 24 and 28 weeks
of pregnancy, because the condition usually can't
be detected until then.
• However, if pts are at risk, the test may be
performed earlier.
Complications (baby)
• Macrosomia –big baby, a birth weight of
4.5kg (9 pounds, 14 ounces)
• Shoulder dystocia. Baby is too big to
move through the birth canal.
• Hypoglycemia. Sometimes babies of
mothers with gestational diabetes develop
low blood sugar (hypoglycemia) shortly
after birth
• Stillbirth or death
Complications to mothers
• Preeclampsia.
• Operative delivery
• Gestational diabetes in another
pregnancy
• Type 2 diabetes as they get older
Treatment
• Controlling blood sugar is essential to
keeping the baby healthy and avoiding
complications during delivery.
• Most women with gestational diabetes are
able to control their blood sugar with diet
and exercise.
• Some may need anti-diabetic drug.
• Monitoring blood sugar will tells whether
blood sugar is staying within a normal
range.
Patients Monitoring
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Monitoring own blood sugar.
Eating healthy diet
Diet consultation
Regular exercises
Taking medications (glyburide, metformin
may be safe and effective)
• Baby monitoring (prevent the pregnancy
from going longer than 40 weeks-complication)
HYPEREMESIS
GRAVIDARUM
• Hyperemesis gravidarum is a severe
and intractable form of nausea and
vomiting in pregnancy.
• The peak incidence is at 8-12 weeks
of pregnancy, and symptoms usually
resolve by week 16.
• It is a diagnosis of exclusion and may
result in weight loss; nutritional
deficiencies; and abnormalities in
fluids, electrolyte levels, and acidbase balance, acidosis.
• The prevalence increases in molar
pregnancies (hidatidiform mole) and
multiple pregnancies.
• The incidence is higher in younger
women than in older women
ANEMIA IN
PREGNANCY
• The most common cause of anemia in
pregnancy is iron deficiency.
• The baby will really start to draw on
iron reserves around week 20.
• Type hypocromic normocytic
Clinical features
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being tired
feeling weak
pale skin
palpitations
breathlessness
fainting spells
• 15mg of iron per day pre-conception
• Many women who aren't pregnant do
not even reach the RDA each day.
• Pregnant women need almost twice
the amount of iron per day.
• Taking iron supplements can often cause
constipation, nausea and vomiting,
• Iron-Rich Foods
liver
spinach
dried fruits
• Maximize Your Iron Absorption
Taking vitamin C-rich foods along with the
iron will increase absorption of the iron.
However, taking caffeinated beverages
along with high-iron foods will reduce the
amount of iron that your body absorbs.
Thank you