Hypothalamus

produces GnRH that stimulates the anterior

pituitary gland to release two important
hormones

FSH - Stimulates the primary follicles,

primary oocytes in the ovaries which are
present at the time the neonate was
born to be active by the time a woman is
in the adolescent stage

LH - Surge of LH is needed for ovulation

to happen

Ovaries
when stimulated two hormones produced
that stimulates the endometrium

Estrogen
Progesterone

Different processes that happens in the

ovaries with regards to follicles:
Cohort of follicles
Recruitment
Selection
One becomes dominant
Maturation
Ovulation
Rest becomes atrophic or atretic after
ovulation
FSH stimulates primary oocytes with LH
surge ovulation

Ovarian Cycle (upper part of diagram)

Endometrial Cycle (lower part of diagram)

Ovulation
-occur at around day 14
-release of the mature egg which is sucked in
by the fimbriae at the end of the fallopian
tube
-after release of egg, there will be corpus
luteum production
Corpus luteum
-source of progesterone
-life span of 12 14 or 9 11 days (maximum
of 2 weeks)
-after 2 weeks, when no fertilization takes
place corpus luteum will become atrophic
and then there will be decrease of
progesterone menstruation ensues

Ovarian Cycle (upper part of diagram)

Endometrial Cycle (lower part of diagram)

In Follicular phase

Estrogen is the predominant hormone

Endometrium is the target organ of
estrogen
After menstruation, theres sloughing off
becomes thin progesterone
increase early proliferation midproliferation late proliferative phase

With Ovulation

There will be progesterone which will be

responsible for the secretory phase of
the endometrium

With Fertilization

The secretory endometrium will be

decidualized

Ovarian Cycle (upper part of diagram)

Endometrial Cycle (lower part of diagram)

In Follicular phase

Estrogen is the predominant hormone

Endometrium is the target organ of
estrogen
After menstruation, theres sloughing off
becomes thin progesterone
increase early proliferation midproliferation late proliferative phase

With Ovulation

There will be progesterone which will be

responsible for the secretory phase of
the endometrium

With Fertilization

The secretory endometrium will be

decidualized

Ovarian Cycle (upper part of diagram)

Endometrial Cycle (lower part of diagram)

Intercourse sperm moves up and meet

the egg in the ampulla of the fallopian tube
(site of fertilization) product of the union
of egg and sperm is known as zygote
zygote will undergo division in the length of
the fallopian tube (7 - 8 cm) continue to
divide until it becomes a 2 cell stage 4 cell
stage 8 cell stage 16 cell stage 32
cell stage morula blastocyst (with
accumulation
of
fluid)
blastocyst
implanted in the uterine cavity (in the
decidua a specialized lining)
Normal implantation: upper middle third
of the uterine cavity

Due to pathologies in the lumen of fallopian

tube, cell is trapped ectopic pregnancy

Implantation of blastocyst is also known as

__________

Blastocyst implants and it burrows in the

decidua

Outer cell mass of blastocyst (the one

immediate to the endometrium) becomes
the future placenta

The one inner immediate to uterine cavity

becomes the embryo

How will placenta detach from the site if its

deeply embedded?

Nitabuchs layer
a fibrinous layer that has to be intact
the dividing membrane that during delivery,
it will detach easily
If defective, cannot pull placenta and not
deliver the baby
If adherent, condition known as placenta
accreta, increta, percreta
If forced or pulled hard, placenta might have
uterine inversion post partum
hemorrhage

Different types of decidua

1.
2.
3.
4.

Decidua capsularis - envelopes the embryo

Decidua basalis - area where in the
placenta will form
Decidua parietalis- opposite to the basalis
Decidua vera - as pregnancy becomes
bigger, capsule get attached with the
parietalis or get fused ( esp. at 4 months or
16 weeks AOG); significance is that for one
to know that theres a potential space that
might misinterpreted as blood clot
formation, hemorrhage might cause an
alarm to the patient

*also there is a cavity (amniotic sac?) that will

contain the amniotic fluid majority of contents
is urine of the baby when kidney is developed

8 weeks and below embryo

8 weeks and above fetus

Chorion Frondosum
- cells in area where placenta develop
- tree like / arborization that are vascular
- has to really invade the decidua basalis
for placental formation

Chorion Laeve
- cells on opposite side are lined also with
chorionic villi known as chorionic leave
- flattened due to compression because of
growth of baby
- avascular

Placenta
- an organ in OB,
- between the maternal side and fetal side,
where blood supply, nutrition, gas,
proteins from mother going to the fetal
side
- umbilical cord as conduit
*here, you have the placenta, the chorionic
frondosum attached to the decidua in the
maternal side, opposite is the fetal surface
and the umbilical vessels contained in the
umbilical cord meet and fuse

Placenta
- an organ in OB,
- between the maternal side and fetal side,
where blood supply, nutrition, gas,
proteins from mother going to the fetal
side
- umbilical cord as conduit
*here, you have the placenta, the chorionic
frondosum attached to the decidua in the
maternal side, opposite is the fetal surface
and the umbilical vessels contained in the
umbilical cord meet and fuse

Placenta
- discoid organ
- weight at term of placenta is 470 (mean)500 grams
- 22cm width
- 2.5cm thickness
Placenta has 2 surfaces:
Shiny surface
- where umbilical cord is
attached, once it reaches the insertion of cord
to the placenta, umbilical vessels has to branch
out as chorionic vessels (vessels from umbilical
arteries and veins and courses to fetal surface of
placenta)
Capsularis (?) still has the amnion and the
chorion

To know whether maternal or fetal surface, look

for where the umbilical cord is inserted (fetal
surface) and if theres plenty of vessels

Maternal Surface
-

attached to the decidua basalis

where cotyledons that are separated by

septae are located

rough in appearance

about 38 lobes dont count this, after

delivery all to do is gross infection of
placenta (always a policy) after delivery,
always inspect if its complete. There
should be no missing segments. If a part
is missing, remove the cotyledons thru
post partum curettage. Any fragment left
inside can lead to infection, hemorrhage
since uterus will not undergo involution

There are some with accessory lobe

check also for this if detached properly

Placental aging
- seen microscopically
- what can be appreciated grossly are
calcium and fibrin deposits
- if post term is reached, more fibrin
deposits more calcification less
blood flow death
- what is reflected if compromised blood
flow Intrauterine growth restriction
(IUGR)

Hydatidiform Mole
-

instead of a baby growing inside, its just

the placenta proliferating
here, woman is also pregnant,
experiences
amenorrhea,
vomiting,
breast tenderness, uterine enlargement
placenta here is not normal. the
chorionic villi are edematous like vesicles
which contains fluid
common manifestation is vaginal bleeding
(GRAPELIKE BLEEDING in the first 3
months) this is a differential diagnosis if
normal pregnancy or not
sometimes, partial h-mole (baby + hmole) evacuate

Umbilical Cord
-

should be attached centrally/paracentral

blood vessels are wide in diameter but as

it goes to periphery it becomes smaller

should not MARGINALIS lesser blood

flow possibility baby become IUGR

Normal length of UC 40-70 cm

Extremes of length bad

-

Short- IUGR, or if baby moving a lot

traction of UC UC is tagged with the
baby premature placental abruption
sudden fetal death
Long can strangulate; can entangle
around the neck, nuchal cord coil (trunk)

*On 5months onward, can feel baby moving

so tell patient to report if theres a change
in the movement of baby (decrease or too
much movement)

Umbilical cord strangulation also depends

on tightness:
- Loose nothing happens, can still be
compatible with vaginal delivery
- Tight problematic, can do a C- section
Long UC
- Not always bad
- Sometimes, can be redundant
tortuous (varicosities) FALSE KNOTS

If not pregnant, estrogen and progesterone

comes from the ovaries
If pregnant, production of hormones is
delegated to the placenta

Placenta
- Formed around 10 weeks onwards
- One that sustains the pregnancy is the
corpus luteum
-

The progesterone comes from this and CL

is important during 8th week 10th week
until placenta takes over

HCG
- Produced by the trophoblasts and
syncitiotrophoblasts
- Hormone of pregnancy
- Can also be seen in non gestational
situations (cancer)
- In normal women, HCG appears only
when one gets pregnant

HCG
- Basis of pregnancy kits
- Identification of presence of HCG
- HCG has the beta and alpha subunits
-

Beta subunit is the one identifiable in

pregnancy
Alpha cross reacts with TSH FSH and LH

Not pregnant 0-5 miu/mL

Pregnant thousands miu/mL ( increases
in 9-10th weeks where placenta is
developed
H-mole millions miu/Ml
With elevated HCG, can cross react with
-

TSH pregnant can have physiologic

thyroid enlargement, hyperthyroidism
FSH follicles become big can have
adnexal mass (ovarian cysts)
LH also ovarian cysts

HCG
- Related to the number of trophoblasts
for example, twin pregnancy more
trophoblasts, placenta is bigger, higher
HCG
*If normal pregnancy, HCG doubles every
two days
Pregnancy kits
- One counter where 3-5 drops of urine is
placed
- The bigger oval structure contains
antibodies to the hormone

Corpus luteum lives for only 2 weeks HCG rescues it and let it live for 8 weeks before the placenta takes over

HPL
- Pregnancy is a diabetogenic state
- When one is pregnant risk of
developing diabetes

Lipolysis good for fetus high amino acids

for fetus fetus will not starve even mother
will not eat for 12 hours

HPL
- Potential for diabetes
- Starts to increase at about 10 weeks or 2
months of pregnancy
- Peaks at 24 28th weeks (6-7 months)
- Continues to 8th months until term
*So if pregnant woman is in her 6-7th
months, should to tests to
check for
gestational diabetes even not obese, no
weight gain or family history
HCG
- Increases early part of pregnancy
- Peak at 8 to 10 weeks and goes down
- Plateaus at 20th week until term
- Causes morning sickness stimulates the
vomiting center