Nomad : Parturition & Lactation
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Transcript of Nomad : Parturition & Lactation
Nomad: Rep Physiol: Parturition 1
PHYSIOLOGY OF PARTURITION
ByDr.M.Anthony David MDProfessor of Physiology
Nomad: Rep Physiol: Parturition 2
WHAT IS PARTURITION? The process of expulsion of the
mature fetus from the uterine cavity of the mother.
The fetus has been living in the cosy comfort of the mother’s womb.
It now has to face the harsh realities of life.
Physically speaking, it’s dependence on the mother is cut off suddenly.
Nomad: Rep Physiol: Parturition 3
PARTURITION ALSO CALLED DELIVERY, LABOR, OR
CONFINEMENT USUALLY OCCURS AT THE END OF THE
THIRD TRIMESTER OF PREGNANCY. IT TAKES MORE TIME AND MIGHT BE
DIFFICULT FOR THE PRIMIGRAVIDA. A WOMAN DELIVERING FOR THE FIRST
TIME IS CALLED A PRIMIGRAVIDA
Nomad: Rep Physiol: Parturition 4
PARTURITION HAS THREE STAGES: I STAGE:
THE CERVIX BEGINS TO DILATE .From 1 cm to 10cms.
II STAGE:THE FETUS IS DELIVERED, USUALLY
HEAD FIRST. III STAGE:
DELIVERY OF THE AFTERBIRTH OR THE PLACENTA
Nomad: Rep Physiol: Parturition 5
POSITIVE FEEDBACK IN PARTURITION
STRETCH OF THE UTERINE WALL
UTERINECONTRACTIONS
PG SECRETION
BY THE UTERUS
ESTROGEN
OT RECEPTORS
IN MYOMETRIUM
OXYTOCINSENT BY THE
POST PITUITARY
NEURAL AFFERENCEFROM THE CERVIX
Nomad: Rep Physiol: Parturition 6
TERM FETUS IN THE UTERUS
Nomad: Rep Physiol: Parturition 7
STAGE I OF LABOR
Nomad: Rep Physiol: Parturition 8
STAGE I :FETUS COMES
OUT HEAD FIRST
STAGE III:PLACENTA
LOOSENS & ISSLOWLY
DELIVERED
Nomad: Rep Physiol: Parturition 9
MAJOR FACTORS CAUSING LABOUR:
CIRCULATING ESTROGENS: OXYTOCIN RECEPTORS OXYTOCIN SENSITIVITY OF THE
UTERINE MYOMETRIUM. POSITIVE FEEDBACK MECHANISMS:
OXYTOCIN: NEURO-ENDOCRINE, POSITIVE FEEDBACK REFLEX
STRETCH LEADS TO CONTRACTIONS
Nomad: Rep Physiol: Parturition 10
SPINAL REFLEXESVOLUNTARY ABDOMINAL
MUSCLE CONTRACTIONS:“BEARING DOWN”
MINOR FACTORS CAUSING LABOUR
Nomad: Rep Physiol: Parturition 11
TYPES OF DELIVERIES
FULL TERM NORMAL DELIVERY: FTND MOST COMMON. BABY IS DELIVERED HEAD FIRST DELIVERY IS FROM THE CERVIX &
VAGINA DELIVERY IS SPONTANEOUS
Nomad: Rep Physiol: Parturition 12
TYPES OF DELIVERIES contd.
FORCEPS DELIVERIES:A FORCEPS IS USED TO HELP THE
FETUS TO BE DELIVERED. CAESARIAN DELIVERY:
DELIVERY BY OPERATION THROUGH THE ABDOMEN.
THE UTERUS IS CUT OPEN AND THE FETUS EXTRACTED.
IS DONE UNDER ANESTHESIA
Nomad: Rep Physiol: Parturition 13
Nomad: Rep Physiol: Parturition 14
LET’S LEARN NOW…
Nomad: Rep Physiol: Parturition 15
PHYSIOLOGY OF LACTATION
ByDr.M.Anthony David
MDProfessor of Physiology
Nomad: Rep Physiol: Parturition 16
Nomad: Rep Physiol: Parturition 17
MAMMARY GLAND: HORMONES INFLUENCING
PRE PUBERTAL PHASE: RUDIMENTARY BREASTS: BREAST BUDS
PUBERTAL PHASE: HORMONES ACTING: ESTROGENS PROGESTERONE CORTISOL INSULIN GROWTH HORMONE PROLACTIN
Nomad: Rep Physiol: Parturition 18
DURING PREGNANCY: ESTROGENSPROGESTERONECORTISOL INSULINGROWTH HORMONEPROLACTINPLACENTAL HORMONES: E, P &
HUMAN CHORIONIC SOMATOMAMMOTROPIN (HCS)
MAMMARY GLAND: HORMONES INFLUENCING
Nomad: Rep Physiol: Parturition 19
DURING LACTATION: ESTROGEN PROGESTERONE CORTISOL INSULIN GH PROLACTIN OXYTOCIN.
MAMMARY GLAND: HORMONES INFLUENCING
Nomad: Rep Physiol: Parturition 20
PRE-PREGNANT PHASE:DUCTSFEW AND FAR BETWEEN ALVEOLI
EARLY PREGNANCY:ALVEOLI GROW
MID PREGNANCY:ALVEOLI ENLARGETHEY ACQUIRE LUMEN
DEVELOPMENT OF THE MAMMARY GLAND
Nomad: Rep Physiol: Parturition 21
LACTATION:ALVEOLI DILATETHEY ARE FILLED WITH MILKAFTER SUCKLING, THEY LET THE
MILK DOWN DUE TO THE MILK LET DOWN REFLEX.
AFTER WEANING:THE GLAND REGRESSES AS A WHOLE
DEVELOPMENT OF THE MAMMARY GLAND
Nomad: Rep Physiol: Parturition 22
MILK SECRETION/EJECTION REFLEX
SUCKLINGGENERAL SOMATIC
AFFERENCE THROUGH SPINOTHALAMIC TRACTS
PVN/ HYPOTHALAMUS
RELEASE OFOXYTOCIN PRODUCTION
OF PROLACTIN
MILK PRODUCTION
MILK LET DOWN
Nomad: Rep Physiol: Parturition 23
BREAST MILK : SYNTHESIS & SECRETION
SUCKLING
STIMULATION OF NIPPLE RECEPTORS
HYPOTHALAMUS
DOPAMINE(PIH)
POSTERIOR PITUITARY
OXYTOCIN SECRETION
PLASMA DOPAMINE(PIH)
ANTERIOR PITUITARY
PROLACTIN SECRETION
PLASMA PROLACTIN
PLASMA OXYTOCIN
BREASTS
GLANDULAR CELLS
CONTR.OF MYOEPITHELIAL CELLS
MILK SYNTHESIS
MILK EJECTION
Nomad: Rep Physiol: Parturition 24
Nomad: Rep Physiol: Parturition 25
A COMPARISON OF MILK
TYPE PROTEIN Gm%
LACTOSE Gm%
FAT Gm%
CALCIUM Gm%
Colustrum 8.5 3.5 2.5 -
Breast milk
1 to 2Lactalbumin
6.5 - 8 3 - 5 0.03
Cow’s milk
3.5Caseinogen
4.75 3.5 0.14
Nomad: Rep Physiol: Parturition 26
BREAST MILK IS THE BEST MILK
BEST COMPOSITION:CHANGES WITH BABY’S AGE!
IMMUNOGENIC:CONVEYS IgA (SECRETORY)
NON INFECTIVE:NO RISK OF CONTAMINATION
INEXPENSIVE
Nomad: Rep Physiol: Parturition 27
BEST FOR EMOTIONAL BONDING BETWEEN THE MOTHER & CHILD.
BEST FOR THE WOMAN TO LACTATE:REDUCES INCIDENCE OF BREAST
CARCINOMAPRODUCES A BETTER FIGURE.
NO INCONVENIENCE TO FEED AT ANYTIME.
BREAST MILK IS THE BEST MILK
Nomad: Rep Physiol: Parturition 28
Nomad: Rep Physiol: Parturition 29
APPLIED ASPECTS OF LACTATION
CHIARI-FROMMEL SYNDROME:GALACTORRHEAAMENORRHEAGENITAL ATROPHYPERSISTENT PROLACTIN LEVELSNO FSH/LHSEEN IN MOTHERS WHO DO NOT NURSE
THEIR BABIES
Nomad: Rep Physiol: Parturition 30
GYNECOMASTIA:DEVELOPMENT OF BREASTS IN
MALES75% NEONATES BOYS HAVE IT DUE
TO MATERNAL ESTROGEN.70% BOYS MAY HAVE SOME AT
PUBERTYCAN BE SEEN IN MEN OVER FIFTY
DUE TO ANDROGEN RESISTANCE.
APPLIED ASPECTS OF LACTATION
Nomad: Rep Physiol: Parturition 31
REVIEW PARTURITION TAKES PLACE
NORMALLY AT THE END OF THE PERIOD OF PREGNANCY.
IT HAS THREE STAGES:STAGE I : DILATATION OF THE
CERVIX.STAGE II : DELIVERY OF THE
FETUS/BABY.STAGE III : DELIVERY OF THE
PLACENTA.
Nomad: Rep Physiol: Parturition 32
REVIEW Estrogen and Progesterone primed breast
tissue is acted upon by various other hormones.
Prolactin is essential for production of milk. Oxytocin is essential for ejection of milk There is a Positive feed back, neuro-
hormonal reflex pathway by which milk is secreted and let down.
Nomad: Rep Physiol: Parturition 33