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Updated: Aug 21 2022


  • Overview
    • Fertilization and implantation
      • ovum is fertilized in ampulla of Fallopian tube several hours after ovulation
      • blastocyst implants in endometrium 6 to 7 days after ovulation
        • syncytiotrophoblast cells secrete hCG that rescues corpus luteum
      • hCG
        • in first trimester,hCG sustains corpus luteum in presence of falling LH levels
          • corpus luteum produces progesterone
            • progresterone is necessary for maintenance of pregnancy
        • hCG levels detectable in blood (1 week post-conception)
        • hCG levels detectable in urine (2 weeks post-conception)
          • e.g., home pregnancy test
      • in second and third trimesters, placenta produces estrogen and progesterone
        • corpus luteum degenerates
      • hCG levels elevated in certain pathologies
        • hydatidiform moles
        • choriocarcinoma
    • Lactation
      • post-delivery, ↓ progesterone levels, prolactin promotes lactation
        • initiation of milk production by alveolar cells
    • Suckling
      • stimulates sensory nerves that carry suckling signal from breast to hypothalamus via spinal cord, a process that mediates prolactin and oxytocin release
    • Prolactin
      • suckling sends signal from breast (nipple) to hypothalamus
        • suckling input in arcuate nucleus of hypothalamus inhibits dopamine release
          • dopamine travels via hypothalamic-portal system to anterior pituitary to inhibit prolactin (PRL) release by lactotrophs
          • suckling inhibits release of dopamine and causes ↑ PRL
      • prolactin promotes lactation and maintains lactation once established
      • prolactin → (-) hypothalamus → ↓ GnRH → ↓ FSH and ↓ LH
        • prolactin inhibits reproductive function
    • Oxytocin
      • suckling sends signal from breast (nipple) to hypothalamus
        • suckling input in supraoptic and paraventricular nuclei of hypothalamus triggers oxytocin release via posterior pituitary
      • oxytocin promotes contraction of myoepithelial cells → promotes milk letdown
      • oxytocin may promote uterine contractions in childbirth
    • Relaxin
      • leads to sacroiliac joint laxity and widening of the pubic symphysis in preparation for delivery
    • Physiologic changes
      • increased red blood cell mass
      • increased plasma volume
      • increased cardiac output
      • decreased vascular resistance
      • mild respiratory alkalosis due to increased tidal volume
      • hypercoagulability
      • increased glomerular filtration rate
      • supine positioning can result in hypotension
        • due to compression of the IVC by the gravid uterus
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