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.

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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

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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

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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

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TERM FETUS IN THE UTERUS

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STAGE I OF LABOR

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STAGE I :FETUS COMES

OUT HEAD FIRST

STAGE III:PLACENTA

LOOSENS & ISSLOWLY

DELIVERED

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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

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TYPES OF DELIVERIES

FULL TERM NORMAL DELIVERY: FTND MOST COMMON. BABY IS DELIVERED HEAD FIRST DELIVERY IS FROM THE CERVIX &

VAGINA DELIVERY IS SPONTANEOUS

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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

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Nomad: Rep Physiol: Parturition 14

LET’S LEARN NOW…

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PHYSIOLOGY OF LACTATION

ByDr.M.Anthony David

MDProfessor of Physiology

Nomad: Rep Physiol: Parturition 16

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MAMMARY GLAND: HORMONES INFLUENCING

PRE PUBERTAL PHASE: RUDIMENTARY BREASTS: BREAST BUDS

PUBERTAL PHASE: HORMONES ACTING: ESTROGENS PROGESTERONE CORTISOL INSULIN GROWTH HORMONE PROLACTIN

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DURING PREGNANCY: ESTROGENSPROGESTERONECORTISOL INSULINGROWTH HORMONEPROLACTINPLACENTAL HORMONES: E, P &

HUMAN CHORIONIC SOMATOMAMMOTROPIN (HCS)

MAMMARY GLAND: HORMONES INFLUENCING

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DURING LACTATION: ESTROGEN PROGESTERONE CORTISOL INSULIN GH PROLACTIN OXYTOCIN.

MAMMARY GLAND: HORMONES INFLUENCING

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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

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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

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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

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BREAST MILK IS THE BEST MILK

BEST COMPOSITION:CHANGES WITH BABY’S AGE!

IMMUNOGENIC:CONVEYS IgA (SECRETORY)

NON INFECTIVE:NO RISK OF CONTAMINATION

INEXPENSIVE

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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

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APPLIED ASPECTS OF LACTATION

CHIARI-FROMMEL SYNDROME:GALACTORRHEAAMENORRHEAGENITAL ATROPHYPERSISTENT PROLACTIN LEVELSNO FSH/LHSEEN IN MOTHERS WHO DO NOT NURSE

THEIR BABIES

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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

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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.

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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