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Physiology of Pregnancy

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Normal PregnancyPregnancy The course that the embryo and the fetus grow in the maternal bodyStages of pregnancyEarly pregnancy: ≤12 weeksMid pregnancy: ≥13 weeks,≤27 weeks Late pregnancy:≥28 weeksTerm pregnancy:≥37 weeks,

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Слайд 1Physiology of Pregnancy

Physiology of Pregnancy

Слайд 2Normal Pregnancy
Pregnancy
The course that the embryo and

the fetus grow in the maternal body
Stages of pregnancy
Early pregnancy:

≤12 weeks
Mid pregnancy: ≥13 weeks,≤27 weeks
Late pregnancy:≥28 weeks
Term pregnancy:≥37 weeks,<42 weeks
Normal PregnancyPregnancy   The course that the embryo and the fetus grow in the maternal bodyStages

Слайд 3Formation of Embryo
Fertilization
Place: oviduct (ampulla)
Process
capacitation →

acrosome reaction→ penetrate the zona pellucida→ second meiosis →zygote

Formation of Embryo FertilizationPlace: oviduct (ampulla)Process   capacitation → acrosome reaction→ penetrate the zona pellucida→ second

Слайд 4Formation of Embryo
Implantation
requirement
Disappear of zona pellucida
Formation of syncytiotrophoblast
Synchronized development of

blastocyst and endometrium
Adequate progesterone

Formation of EmbryoImplantationrequirementDisappear of zona pellucidaFormation of syncytiotrophoblastSynchronized development of blastocyst and endometriumAdequate progesterone

Слайд 5Formation of Embryo
Process
morula (day 3) → enter uterine cavity (day

4) → early blastocyst→ late blastocyst (day 6-7) → implantation
location→

adherence→ penetration
Formation of EmbryoProcessmorula (day 3) → enter uterine cavity (day 4) → early blastocyst→ late blastocyst (day

Слайд 6Development of embryo and fetus
Definition
embryo: ≤ 8 weeks
Fetus: ≥ 9

weeks, human shape

Development of embryo and fetusDefinitionembryo: ≤ 8 weeksFetus: ≥ 9 weeks, human shape

Слайд 7Development of embryo and fetus
Physiology of fetus
Circulation
fetus ←→placenta←→ mater
1 umbilical

vein (full of oxygen), 2 umbilical artery (lack of oxygen)
Mixed

blood (vein and artery)
Development of embryo and fetusPhysiology of fetusCirculationfetus ←→placenta←→ mater1 umbilical vein (full of oxygen), 2 umbilical artery

Слайд 8Development of embryo and fetus

Development of embryo and fetus

Слайд 9Development of embryo and fetus
Hematology
Erythropoiesis
From yolk sac: 3 weeks
From liver:

10 weeks
From bone marrow and spleen: term (90%)
EPO production: 32nd

week
Development of embryo and fetusHematologyErythropoiesisFrom yolk sac: 3 weeksFrom liver: 10 weeksFrom bone marrow and spleen: term

Слайд 10Development of embryo and fetus
Fetal hemoglobin
Fetal hemoglobin: early pregnancy
Adult hemoglobin:

32nd week
Term: fetal type Hb 25%
White cells
Leukocytes: 8 week
Lymphocytes (antibody

production): 12 week, thymus and spleen
Development of embryo and fetusFetal hemoglobinFetal hemoglobin: early pregnancyAdult hemoglobin: 32nd weekTerm: fetal type Hb 25%White cellsLeukocytes:

Слайд 11Development of embryo and fetus
Gastrointestinal tract
drink amniotic fluid: 4th month
no

proteolytic activity
enzymatic deficiencies in liver:
bilirubin is not easy to

be clear.
Development of embryo and fetusGastrointestinal tractdrink amniotic fluid: 4th monthno proteolytic activityenzymatic deficiencies in liver: bilirubin is

Слайд 12Development of embryo and fetus
Kidney
Its function begins

at 11-14th week
Endocrinology
Fetal thyroid: the first endocrine gland (6th week),

synthesize thyroxine at 12th week
Fetal adrenal cortex: widen (20th week), a fetal zone. synthesize steroid hormones (E3, liver placenta mater)
Development of embryo and fetusKidney   Its function begins at 11-14th weekEndocrinologyFetal thyroid: the first endocrine

Слайд 13Placenta
Structure
Primary villus
syncytiotrophoblast cytotrophoblast
Secondary villus
third class vilus
fetal capillary

enter the stroma

PlacentaStructurePrimary villus   syncytiotrophoblast cytotrophoblastSecondary villusthird class vilusfetal capillary enter the stroma

Слайд 14Placenta: Villi
a. These structures, the functioning units of the

placenta, are formed by invading placental tissue (trophoblast) and contain

the terminal fetal capillaries of the umbilical arteries.
b. The villi are surrounded by the intervillous space into which maternal blood from the decidual (uterine) arteries is forced by maternal arterial pressure.
c. Gases and nutrients pass from the maternal blood in the intervillous space, across the membrane of the trophoblast to the basement membrane of the fetal capillary, and then through the single endothelial cell layer of the fetal capillary to the fetal blood.
The fetal capillaries drain into the fetal veins that join to form the umbilical vein.
Maternal blood drains from the intervillous space into the maternal veins.

Placenta: Villi  a. These structures, the functioning units of the placenta, are formed by invading placental

Слайд 15Placenta: cotyledons
Placental cotyledons (lobes) are formed from the branching villi

supplied by one terminal arterial branch and its partner venous

branch of the fetal umbilical vessels.
On average, about 20 cotyledons make up the fetal side of the placenta.
The maternal side of the placenta is divided by
septa into lobes.

Placenta: cotyledonsPlacental cotyledons (lobes) are formed from the branching villi supplied by one terminal arterial branch and

Слайд 17Placenta: structure
1 – umbilical arteries,
2 – stem villus,
3

– decidual septa,
4 – decidual layer,
5 –myometrium,
6

– veins,
7 – spiral arteries,
8 – chorion,
9 – amnion,
10 – intervillous space, 11 – umbilical vein,
12 – cotyledon.
Placenta: structure1 – umbilical arteries, 2 – stem villus, 3 – decidual septa, 4 – decidual layer,

Слайд 18Scheme of placental circulation.

Scheme of placental circulation.

Слайд 20Feto-placental circulation
1- uterine artery
2- arcade arteries
3- spiral arteries
4- intervillous

space
5- placental vessels
6- vessels of the umbilical cord



Feto-placental circulation1- uterine artery2- arcade arteries 3- spiral arteries4- intervillous space5- placental   vessels6- vessels of

Слайд 21Placenta
Function
Exchange of nutritive factors and waste
Exchange of O2 and CO2
Secretion

of proteins and steroid hormones
Immunology
metabolism
Defensive - Limited.

IgG, virus, drug
PlacentaFunctionExchange of nutritive factors and wasteExchange of O2 and CO2Secretion of proteins and steroid hormones Immunology metabolism

Слайд 22Placenta: functions
The placenta transfers nutrition and oxygen from the mother

to the fetus, removes metabolic waste products from the fetus

to be eliminated by the mother, and synthesizes proteins and hormones that support fetal development and important maternal physiologic changes.

Placenta: functionsThe placenta transfers nutrition and oxygen from the mother to the fetus, removes metabolic waste products

Слайд 231. Mother-to-fetus transfer of nutrients
a. The essential substances for growth

and development move from the mother to the fetus in

four ways:
(1) Active transport: amino acids, calcium
(2) Facilitated transport: glucose
(3) Endocytosis: cholesterol, insulin, iron, immunoglobulin G (IgG)
(4) Sodium pumps and chloride channels: ions
b. Solute size and lipid solubility are also important factors that influence transport.

1. Mother-to-fetus transfer of nutrientsa. The essential substances for growth and development move from the mother to

Слайд 242. Gas exchange
This process involves supplying oxygen to the fetus

and removing carbon dioxide
from the fetus.

2. Gas exchangeThis process involves supplying oxygen to the fetus and removing carbon dioxide  from the

Слайд 253. Secretion of proteins and steroid hormones
a. Progesterone is produced

by the placenta from maternal cholesterol, is secreted into the

maternal circulation, and is important for maintaining pregnancy.
b. Estrogen is converted from circulating fetal androgens (dehydroepiandrosterone sulfate [DHEAS] produced in the fetal adrenal glands. Estrogen plays an important role in maternal physiologic changes in pregnancy, labor, and lactation.
c. Numerous proteins, peptides, and growth factors are produced in the placenta. They are important for placental growth, fetal growth and development, and the maternal physiologic changes necessary to ensure adequate nutrition to the fetus.

3. Secretion of proteins and steroid hormones a. Progesterone is produced by the placenta from maternal cholesterol,

Слайд 264. Immunology.
Invading placental cells express a unique antigen, HLA-G, which

is not recognized as a "foreign" antigen by the mother.


Other unique antigens and local immune suppression contribute to the prevention of rejection of the fetal-placental unit.
5. Metabolism. Glucose is the primary substrate for placental aerobic metabolism.

4. Immunology.Invading placental cells express a unique antigen, HLA-G, which is not recognized as a

Слайд 27Fetal membranes
Structure
chorion and amnion
Amnion
A double-layered translucent

membrane
Become distended with fluid

Fetal membranesStructure  chorion and amnionAmnion  A double-layered translucent membrane  Become distended with fluid

Слайд 28Umbilical cord

Umbilical cord

Слайд 29Umbilical cord
A. Umbilical arteries. Two umbilical arteries originate from the

fetal aorta. They supply fetal blood to all portions of

the placenta for gas and solute exchange. A single umbilical artery is associated with low birth weight and chromosomal anomalies in about 10 to 15% of infants.
B. Umbilical vein. One umbilical vein returns nutrient-rich, oxygen-rich blood to the fetus.
Wharton jelly
Umbilical cord Length - 30-70cm


Umbilical cordA. Umbilical arteries. Two umbilical arteries originate from the fetal aorta. They supply fetal blood to

Слайд 30Umbilical cord
In most cases, the cord is about 20 inches

long and almost 1 inch in diameter. It usually appears

loosely coiled. Inside the cord are two arteries and one vein. The vein supplies the baby with oxygenated, nutrient-rich blood, and the arteries carry de-oxygenated, nutrient-depleted blood back to the placenta. On occasion, the umbilical cord will only have two vessels; one artery and one vein.
Umbilical cordIn most cases, the cord is about 20 inches long and almost 1 inch in diameter.

Слайд 31Here is a normal three vessel umbilical cord. Note that

there are two arteries toward the right and a single

vein at the left. Most of the parenchyma of the cord consists of a loose mesenchyme with intercellular ground substance (Wharton's jelly).
Here is a normal three vessel umbilical cord. Note that there are two arteries toward the right

Слайд 32Amniotic fluid

Amniotic fluid

Слайд 33Amniotic fluid
Amniotic fluid ( AF ) - the habitat of

the fetus, performs several functions simultaneously : the creation of

spaces for free movement of the growing fetus , protection from mechanical injury , maintaining temperature balance , preventing compression of the umbilical cord at birth , the implementation of the transport function and participation in metabolism .
AF is yellowish in early pregnancy, then lighter and transparent, and - cloudy , opalescent at the end of pregnancy ; pH - 6,98-7,23, specific gravity- 1007-1080 g / l , the protein content - 0.18-0.2 % glucose - 22 mg% urea - 23 mg%. AF may contain embryonic hair (lanugo), cells of the epidermis , sebaceous gland cells (vernix caseosa).
Amniotic fluidAmniotic fluid ( AF ) - the habitat of the fetus, performs several functions simultaneously :

Слайд 34Amniotic fluid
AF volume depends on the term of pregnancy. Increase

in volume is uneven. The peak of AF volume fixed

at 33.8 weeks and is 931 ml. AF volume in the range 22-39 weeks does not change significantly (630 ml and 817 ml, respectively) and averaged 777 ml .
Amniotic fluidAF volume depends on the term of pregnancy. Increase in volume is uneven. The peak of

Слайд 35Amniotic Fliud
Towards the end pregnancy (term of labor) the volume

of amniotic fluid comes up to 1-1.5 liters, and every

three hours it is completely updated, with one-third recycled by fetus.
Amniotic FliudTowards the end pregnancy (term of labor) the volume of amniotic fluid comes up to 1-1.5

Слайд 36Amniotic Fluid Index (AFI)
An ultrasound procedure used to asses the

amount of amniotic fluid. The amniotic fluid index is measured

by dividing the uterus into four imaginary quadrants . The linea nigra is used to divide the uterus into right and left halves.The umbilicus serves as the dividing point for the upper and lower halves.


Amniotic Fluid Index (AFI)An ultrasound procedure used to asses the amount of amniotic fluid. The amniotic fluid

Слайд 37Amniotic fluid index
The transducer is kept parallel to the patient’s

longitudinal axis and perpendicular to the floor. The deepest, unobstructed,

vertical pocket of fluid is measured in each quadrant in centimeters.
Amniotic fluid indexThe transducer is kept parallel to the patient’s longitudinal axis and perpendicular to the floor.

Слайд 38AFI at different terms of pregnancy (Amniotic Fluid Index Percentile Values)

AFI at different terms of pregnancy (Amniotic Fluid Index Percentile Values)

Слайд 39Amniotic Fluid Index Percentile Values (mm)

Wks

2.5th 5th 50th 95th 97th
Amniotic Fluid Index Percentile Values (mm)          Wks

Слайд 40US - amniotic fluid

US - amniotic fluid

Слайд 41Amniotic Fliud
Function
Protect fetal
move freely, warm
Protect mater

prevent infection

Amniotic FliudFunctionProtect fetal   move freely, warmProtect mater   prevent infection

Слайд 42Amniotic fliud
Source
exudation of fetal membranes (early pregnancy)
Fetal urine
Fetal lung
Exudation of

amnion and fetal skin

Amniotic fliudSourceexudation of fetal membranes (early pregnancy)Fetal urineFetal lungExudation of amnion and fetal skin

Слайд 43Amniotic fliud
Absord
Fetal membrane
Umbilical cord
Fetal skin
Fetal drinking
Feature
1000-1500ml at 36th-38th week (peak),

transparent → slightly turbid

Amniotic fliudAbsordFetal membraneUmbilical cordFetal skinFetal drinkingFeature1000-1500ml at 36th-38th week (peak), transparent → slightly turbid

Слайд 44Critical periods of development:
1 - progenez - a meiosis

(step maturation of gametes) and fertilization process.
2 - in

the prenatal ontogenesis to critical periods include implantation (6-8 days), placentation and development of axial organ rudiments (3-8 week) during embryogenesis {};
3 - Fetal: the period of intensive development of the brain (15-20-th week), during the formation of the main functional systems of the body (20-24 week)
4 - the birth process.
Critical periods of development:  1 - progenez - a meiosis (step maturation of gametes) and fertilization

Слайд 45Physiologic changes in pregnant woman
Genital organs
Uterus
capacity: 5ml-5000ml.weight: 50g-1000g
Hypertrophy of muscle

cells
Endometrium→decidua: basal decidua, capsular decidua, true decidua
Contraction: Braxton Hicks
Isthmus uteri:

1cm→ 7-10cm
Physiologic changes in pregnant womanGenital organsUteruscapacity: 5ml-5000ml.weight: 50g-1000gHypertrophy of muscle cellsEndometrium→decidua: basal decidua, capsular decidua, true deciduaContraction:

Слайд 47Physiologic changes in pregnant woman
Cervix: colored
Ovary: placenta replaces ovary (10th

week)
Vagina: dilated and soft, pH↓(anti-bacteri bacteria)
Ligaments: relaxed

Physiologic changes in pregnant womanCervix: coloredOvary: placenta replaces ovary (10th week)Vagina: dilated and soft, pH↓(anti-bacteri bacteria)Ligaments: relaxed

Слайд 48Physiologic changes in pregnant woman
Cardiovascular system
Heart:
move upward,

hypertrophy of cardiac muscle
Cardiac Output
increase

by 30%, reach to peak at 32nd –34th week
Blood pressure
early or mid pregnancy Bp↓.late pregnancy Bp↑ .Supine hypotensive syndrome
Physiologic changes in pregnant womanCardiovascular systemHeart:   move upward, hypertrophy of cardiac muscleCardiac Output

Слайд 49Physiologic changes in pregnant woman
Hematology
Blood volume
Increase by 30%-45% at 32nd

–34th (peak)
Relatively diluted
Composition
Red cells
Hb:130→110g/L, HCT:38%→ 31%.
White cells:

slightly increase
Coagulating power of blood: ↑
Albumin: ↓,35 g/L
Physiologic changes in pregnant womanHematologyBlood volumeIncrease by 30%-45% at 32nd –34th (peak)Relatively dilutedCompositionRed cells   Hb:130→110g/L,

Слайд 50Physiologic changes in pregnant woman
The Respiratory system
R rate: slightly ↑
vital

capacity: no change
Tidal volume: ↑ 40%
Functional residual capacity:↓
O2 consumption:

↑ 20%
Physiologic changes in pregnant womanThe Respiratory systemR rate: slightly ↑vital capacity: no changeTidal volume: ↑ 40%Functional residual

Слайд 51Physiologic changes in pregnant woman
The urinary system
Kidney
Renal plasma flow (RFP):↑35%
Glomerular

filtration rate (GFR):↑ 50%
Ureter
Dilated (P↑)
Bladder

Frequent micturation
Physiologic changes in pregnant womanThe urinary systemKidneyRenal plasma flow (RFP):↑35%Glomerular filtration rate (GFR):↑ 50%Ureter   Dilated

Слайд 52Physiologic changes in pregnant woman
Gastrointestinal system
Gastric emptying time is prolonged→

nausea.
The motility of large bowel is diminished → constipation
Liver

function: unchanged
Physiologic changes in pregnant womanGastrointestinal systemGastric emptying time is prolonged→ nausea. The motility of large bowel is

Слайд 53Physiologic changes in pregnant woman
Endocrine
Pituitary (hypertrophy)
LH/FSH: ↓
PRL:↑
TSH and ACTH:↑
Thyroid
enlarged (TSH

and HCG↑)
thyroxine↑ and TBG↑ → free T3 T4 unchanged

Physiologic changes in pregnant womanEndocrinePituitary (hypertrophy)LH/FSH: ↓PRL:↑TSH and ACTH:↑Thyroidenlarged (TSH and HCG↑)thyroxine↑ and TBG↑ → free T3

Слайд 54Diagnosis of pregnancy
Questionable signs of pregnancy
Probable signs
True signs
Laboratory tests :

β-HCG, ptrogesterone
Additional methods : US

Diagnosis of pregnancyQuestionable signs of pregnancyProbable signsTrue signsLaboratory tests : β-HCG, ptrogesteroneAdditional methods : US

Слайд 55Questionable signs of pregnancy

Change of appetite.
Changes of smell (aversion

to perfume, tobacco, any other smells).
Changes of the nervous system:

quick fatigability, sleepiness, irritability, quick change of mood (instability of mood).

Questionable signs of pregnancyChange of appetite. Changes of smell (aversion to perfume, tobacco, any other smells).Changes of

Слайд 56Questionable signs
Morning sickness.
Pigmentation of the skin ( nipple and

areolae, linea alba, forehead and cheeks).
Increase of fatty tissue,

enlargement of abdomen.
Frequency of micturition- due to: 1) pressure of the bulky uterus on the fundus of the bladder because of excessive anteverted position of the uterus; 2) congestion of the bladder mucous membrane, 3) stretching of the bladder base due to backward displacement of the cervix.
Breast discomfort.

Questionable signsMorning sickness. Pigmentation of the skin ( nipple and areolae, linea alba, forehead and cheeks). Increase

Слайд 57Probable signs
Cessation of menses (or amenorrhea).
Breast changes - enlargement

of breasts with vascular engorgement evidenced by the delicate veins

visible under the skin. The nipple and areola become more pigmented and prominent. Thick yellowish secret (foremilk) usually appears.
Discolouration of the vestibule and anterior vaginal wall - cyanotic due to local vascular congestion.
Changes of size, shape and consistence of the uterus.
Probable signsCessation of menses (or amenorrhea). Breast changes - enlargement of breasts with vascular engorgement evidenced by

Слайд 58Pregnancy’ sign in VE:
Piskacek’s sign.
It is an asymmetrical
enlargement

of the
uterus due to the
lateral implantation
of fertilized

ovum.
In such cases one
half of the uterus is
larger than another.
As pregnancy advances,
symmetry is restored.
Pregnancy’ sign in VE:Piskacek’s sign. It is an asymmetrical enlargement of the uterus due to the lateral

Слайд 59Hegar’s sign.
It is present in two-thirds of cases. It can

be manifested at term of 6-10 weeks, or a little

earlier in multiparae. This sign is based on the fact that:
the upper part of the body of the uterus is enlarged by the growing ovum;
the lower part of the body is empty and extremely soft, and
the cervix is comparatively dense. Because of variation in consistency, on bimanual examination the abdominal and vaginal fingers seem to appose below the body of the uterus.

Pregnancy’ sign in VE:

Hegar’s sign.It is present in two-thirds of cases. It can be manifested at term of 6-10 weeks,

Слайд 60 Pregnancy’ sign in VE:
Early as 4-8 weeks Henter’s sign is

appear: expressed anteflexion of uterus due to softening of isthmus,

and at the same time the crest on the anterior wall of the uterus are palpable.

Pregnancy’ sign in VE: Early as 4-8 weeks Henter’s sign is appear:

Слайд 61Pregnancy’ sign in VE:
Haus-Gubarev’s sign - the cervix of the

uterus becomes very mobile, due to softening of the isthmus

of the uterus.
Snegiryov’s sign – Increased irritability of the uterus body presented with appearance of hypertonicity of the uterus under palpating fingers during bimanual examination.

Pregnancy’ sign in VE:Haus-Gubarev’s sign - the cervix of the uterus becomes very mobile, due to softening

Слайд 62Uterus sizes
Week 6: Plum or golf ball size (hen’s egg)
Week

8: Tennis ball size
Week 10: Large orange size
Week 12: Grapefruit

size (palpable at suprapubic area)
Week 14: Cantaloupe size
Week 16 : between the symphysis pubis and the navel
Uterus sizesWeek 6: Plum or golf ball size (hen’s egg)Week 8: Tennis ball sizeWeek 10: Large orange

Слайд 63Uterus sizes
Week 20: at the 2 cross fingers (4 cm)

below the navel
Week 24: uterus reaches the navel
Week 28:

2-3 cross fingers higher the navel
Week 32: midway between the umbilicus and xiphoid process of sternum
Week 36- 38: uterus reaches the xiphoid and costal arches
Week 40 : fundus of the uterus drops to the middle of the distance between the navel and the xiphoid process. At the end of pregnancy belly button sticks out.
Uterus sizesWeek 20: at the 2 cross fingers (4 cm) below the navel Week 24: uterus reaches

Слайд 64Uterus sizes at different terms of pregnancy

Uterus sizes at different terms of pregnancy

Слайд 65Uterus size at different term of gestation

Uterus size at different term of gestation

Слайд 66True (authentic) signs of pregnancy
Palpation of the fetal parts.
Evidently audible

fetal heart sounds.
Active movements of the fetus felt by examiner.
Cardiography

of the fetus.
The US examination of the fetus, which evidently shows fetal parts, or fertilized ovum in the uterus.
True (authentic) signs of pregnancyPalpation of the fetal parts.Evidently audible fetal heart sounds.Active movements of the fetus

Слайд 67Laboratory diagnosis - HCG
Immunological test of pregnancy - increased Beta-human

chorionic gonadotropin level in blood serum and in urine. Detection

in maternal serum and urine is evident only after implantation and vascular communication has been established with the decidua by the syncytiotrophoblast 8-10 days after conception.
Laboratory diagnosis - HCGImmunological test of pregnancy - increased Beta-human chorionic gonadotropin level in blood serum and

Слайд 68 hCG levels in weeks from the last normal menstrual period:
3

weeks LMP 5 – 50 mIU/ml
4 weeks LMP 5 – 426 mIU/ml
5

weeks LMP 18 – 7,340 mIU/ml
6 weeks LMP 1,080 – 56,500 mIU/ml
7-8 weeks LMP 7, 650 – 229,000 mIU/ml
9-12 weeks LMP 25,700 – 288,000 mIU/ml
13-16 weeks LMP 13,300 – 254,000 mIU/ml
17-24 weeks LMP 4,060 – 165,400 mIU/ml
25-40 weeks LMP 3,640 – 117,000 mIU/ml
Women who are not pregnant <5.0 mIU/ml
Women after menopause 9.5 mIU/ml
hCG levels in weeks from the last normal menstrual period: 3 weeks LMP	5 – 50 mIU/ml4

Слайд 69Laboratory diagnosis - Progesterone
Viable intrauterine pregnancy can be diagnosed if

the serum progesterone levels are greater than 25 ng/mL (>79.5

nmol/L).
Conversely, finding serum progesterone levels of less than 5 ng/mL (< 15.9 nmol/L) can aid in the diagnosis of a nonviable pregnancy.
Laboratory diagnosis - ProgesteroneViable intrauterine pregnancy can be diagnosed if the serum progesterone levels are greater than

Слайд 70Pregnancy diagnosis: Sonography
Transvaginal ultrasonography (TVUS), and transabdominal ultrasonography (TAUS) are

used to determine:
the fertiliezed ovum in the uterinbe cavity,


the size of the uterus (term of gestation),
cardiac motion can sometimes be identified in a 2- to 3-mm embryo but is almost always present when the embryo grows to 5 mm or longer. At 5-6 weeks' gestation, the fetal heart rate ranges from 100-115 beats per minute. At 9 week of gestation the heart rate ranges from 140 bpm.
Pregnancy diagnosis: SonographyTransvaginal ultrasonography (TVUS), and transabdominal ultrasonography (TAUS) are used to determine: the fertiliezed ovum in

Слайд 71Laboratory diagnosis - Progesterone
Viable intrauterine pregnancy can be diagnosed if

the serum progesterone levels are greater than 25 ng/mL (>79.5

nmol/L).
Conversely, finding serum progesterone levels of less than 5 ng/mL (< 15.9 nmol/L) can aid in the diagnosis of a nonviable pregnancy.
Laboratory diagnosis - ProgesteroneViable intrauterine pregnancy can be diagnosed if the serum progesterone levels are greater than

Слайд 72US exam
The yolk sac can be recognized by 4-5 weeks'

gestation and is seen until approximately 10 weeks' gestation. The

yolk sac is a small sphere with a hypoechoic center and is located within the GS
US examThe yolk sac can be recognized by 4-5 weeks' gestation and is seen until approximately 10

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