Diabetes-Type 1
high blood sugar
Juvenile/insulin dependent 10%
Pancreas fails to make insulin
Diabetes: Type 2
High blood sugar
Adult onset/insulin resistance 90%
Cells don’t respond to insulin
Gestational diabetes: placental defect ‘type 2’
Produces hormones that interfere with insulin: E/cortisol/lactogen
High sugar in fetal circulation/high fetal insulin production
DYSTOCIA/HYPOGLYCEMIA
Placenta disorders; increased
Placenta penetrates uterine muscle
Placenta disorders: Accreta
Placenta Attaches to uterine muscle
Placenta disorders: Percreta
Placenta penetrates uterine wall into other organs
Placenta disorders: abruption
Placenta separates from the uterus
Placenta disorders: Previa
Placenta covers the cervix
How does immune system not reject the fetus?
- embryo implantation silences chemokine genes in decidua
- no chemokines= activated T cells are not recruited
- decide protects placenta/embryo
Mechanics of parturition
- myometrial contractions “labor”
- can be induced with pitocin
- cervix dilation= low collagen in response to: RLX/E2/PGF2a
- relaxation of pubis symphysis/RLX/widens birth canal
DYSTOCIA
Fetal causes: abnormal presentation/positions/twins
Maternal causes: uterine inertia/cervix probs
-small pelvis/large fetus
Hormones of parturition: P4
from CL
-inhibits myometrial contraction
-increases uterine glycogen
HORSES: P4 increases mid gestation
Hormones of parturition: E
From CL/placenta -oppose P4 actions Growth: UT/mammary Increases: OT/PGF2a -stimulates uterine contraction
hormones of parturition:RLX
Source: CL: pigs/rats/humans
UT: guinea pigs
Placenta: rabbits/dog/humans/horses
1.Relaxes myometrium
2.Dilates cervix
3.Fetal membrane rupture
4. UT growth
5.Mammary growthhormones of parturition:OT
Source: Hypo secreted by post pituitary
CL
-stimulates PGF2a
-UT/MAM smooth muscle contraction
DOES NOT RIPEN/DILATEhormones of parturition: prostaglandins
Source: decidua/placenta
- Myometrial contractions/induces OT
- levels in amniotic fluid/maternal plasma rise
- induce labor ANYTIME
Who controls birth?
FETUS-hypo/pituitary/adrenal axis necessary for birth
Fetal stress triggers cortisol production=birth
Early fetal stress can be from:
Low nutrients
Drugs/alc
Hypoxia
How does fetal cortisol initiate birth?
Conversion of P4 to E2
P4—>17a hydroxyprogesterone—>aromatase—>Es
