PREGNANCY

AND
CHILD BIRTH COMPLICATIONS

Presented By: Soumya Ranjan Purohit

B.Sc.(H) Biomedical Sciences I Year
 GAMETOGENESIS
• Gametogenesis is a process of maturation of gametes. It includes
meiosis which reduces the number of chromosomes of a gamete
to haploid, and morphologically changes, which transform the
primitive germ cell to a mature gamete. In males, it is called
Spermatogenesis during which Primordial Germ Cells (PGCs)
mature into male gametes, the sperms and in females, it is called
Oogenesis during which the PGCs mature into female gametes,
the oocytes. The primordial germ cells are formed in the epiblast
layer during the second week of intrauterine life and move to the
wall of the yolk sac. During fourth week, they migrate from the
yolk sac to gonads, the PGCs undergo a number of mitotic
divisions to increase their number.
 OOGENESIS
• The process of formation of a mature female gamete is called oogenesis.
• Oogenesis is initiated during the embryonic development stage when 2 million
gamete mother cells (oogonia) are formed within each fetal ovary as no more
oogonia are formed after birth.
• These cells start division and enter into Prophase-I of the meiotic division and get
temporarily arrested at that stage called primary oocyte. Each primary oocyte then
gets surrounded by a layer of granulosa cells and is called primary follicle. The
primary follicle then get surrounded by more layers of granulosa cells and are called
secondary follicles.
• The secondary follicle soon transforms into a tertiary follicle which is characterised
by a fluid filled cavity called antrum.
• At this stage the primary oocyte within the tertiary follicle grows in size and
completes its first meiotic division.
• The tertiary follicle further changes into the mature follicle called Graafian follicle.
The secondary oocyte forms a new membrane called zona pellucida surrounding it.
• The Graafian follicle now ruptures to release the secondary oocyte (ovum) from the
ovary by the process of ovulation.
 SPERMATOGENESIS
• In testis, the immature male germ cells (spermatogonia) produce
sperms by spermatogenesis that begins at puberty.
• The spermatogonia present on the inside wall of seminiferous tubules
multiply by mitotic division and increase In numbers. Each
spermatogonia is diploid and contains 46 chromosomes.
• Some of the spermatogonia called primary spermatocytes periodically
undergo meiosis. A primary spermatocyte completes the first meiotic
division leading to formation of two equal, haploid cells called
secondary spermatocyte, which have 23 chromosomes each.
• The secondary spermatocytes undergo the second meiotic division to
produce four equal, haploid spermatids.
• The spermatids are transformed into spermatozoa (sperms) by the
process called spermiogenesis.
• The sperm is a microscopic structure composed of a head, neck, a
middle piece and a tail. The sperm head contains an elongated haploid
 FERTILISATION
• Fertilisation is a process by which the male
gamete, the spermatozoa, fuses withy the
female gamete, the ovum, to form the zygote.
• As soon as the spermatozoa enters the ovum,
the second meiotic division of ovum is
completed and second polar body is released.
• The spermatozoa is not able to fertilise the
ovum unless it goes through capacitation and
acrosomal reaction.
• CAPACITATION
It is a process of conditioning of the sperm in the female genital
tract. During this period, the glycoprotein layer and the seminal
plasma proteins covering the plasma membrane of acrosomal
region of the sperm are removed.

• ACROSOMAL REACTION
It occurs after the sperm binds with the ovum. This is achieved
by release of certain enzymes such as acrosin and trypsin like
substances, which help the sperm to penetrate the zona
pellucida.

• Fertilisation consists of three phases:

Phase 1- Penetration of corona radiate cells.
Phase 2- Penetration of zona pellucida.
PENETRATION OF CORONA RADIATA CELLS.

• Out of a few hundred of spermatozoa which

reach the site of fertilisation, only one
fertilises while the rest assist the fertilising
sperm to penetrate the barriers protecting
the ovum. Only capacitated sperm can pass
through corona radiata cells.
 Penetration through Zona pellucida.

There are specific glycoprotein receptors on zona

pellucida, ZP2 and ZP3 which facilitate the sperm
binding. Once the capacitated sperm binds with
ZP3 receptor, the head of the sperm releases an
enzyme, the acrosin which digests the zona
pellucida and plasma membrane of the head of the
sperm.
Thus, the sperm gets entry into the perivitelline
space and comes in direct contact with the plasma
membrane of oocyte.
 ZONAL REACTION
The contact of sperm with plasma membrane of
oocyte brings about the release of lysosomal
enzymes from the cortical granules which line the
inner side of the plasma membrane of oocyte.
These enzymes change the properties of the zona
pellucida and the reaction is called zonal reaction,
during which, the polarity of zona pellucida is
altered and the species-specific receptor sites for
the sperms on the zona pellucida are inactivated.
 FUSION OF SPERM AND OOCYTE.

Once the sperm comes in direct contact with the

ovum, the plasma membrane of both fuse. Both the
head and tail of the sperm enter the oocyte and its
plasma membrane is left on the oocyte surface. The
sperm then comes close to female pronucleus, its
nucleus swells and forms male pronucleus. The tail
of the sperm detaches and degenerates. The male
and female haploid pronuclei lose their nuclear
membrane and fuse together to form a diploid
zygote. Soon a deep furrow appears on the cell
surface which deepens and divides the cytoplasm
 CLEAVAGE
• Once the zygote has reached two-cell stage, it
undergoes a no. of mitotic divisions thereby
increasing the no. of cells. These cells become
smaller in size with each cleavage division and are
called blastomeres.
• The compacted cells divide further to form a 16-cell
stage called morula.
• The inner cells of morula form the inner cell mass
which gives rise to the tissues of the embryo while
outer cells form the outer cell mass which forms the
trophoblast and contributes to the formation of
 BLASTOCYST FORMATION
• When the morula enters the uterine cavity, the fluid passes
through zona pellucida into the cells of the inner cell mass
creating spaces between the cells. These intercellular spaces
later fuse to form a single cavity called ‘blastocele’ and at this
stage the embryo is called ‘blastocyst’. The cells of inner cell
mass of blastocyst which are pushed towards one side are
called ‘embryoblast’.
• The zona pellucida has disappeared by fourth day and the
blastocyst is ready for ‘implantation’. The side of the blastocyst
where inner cell mass is located is called ‘embryonic pole’ while
the other side is called ‘abembryonic pole’. The trophoblast
covering the embryonic pole has the property of invading the
epithelial cells of uterine mucosa and finally gets attached to it.
 IMPLANTATION
• The blastocyst adheres to the uterine mucosa on sixth day after
fertilisation and implants there. The trophoblast of human
blastocyst keeps invading the uterine endometrium till whole of
it comes to be embedded deeper within the entire thickness of
the endometrium. During implantation, there are changes taking
place in the blastocyst, trophoblast and uterus.
• The human uterus has three layers namely;
‘perimetrium’(outermost), ‘myometrium’ and
‘endometrium’(which lines the cavity of uterus).
• At the time of implantation, the endometrium of uterus is in
secretory phase. It is thick, soft and highly vascular. Three distinct
layers of endometrium can be identified, a superficial compact
layer, an intermediate ‘spongy layer’ and a deep ‘basal layer’.
 FIRST TRIMESTER CHANGES IN
MOTHER’S BODY
• Levels of hCG can be detected in a woman's urine
about a week after she has a missed period.
• Rising levels of estrogen and hCG may be responsible
for the waves of nausea and vomiting known as
morning sickness that a woman typically feels during
her first few months of pregnancy.
• A pregnant woman's digestive system may slow down
to increase the absorption of beneficial nutrients.
• As more blood circulates to a woman's face, it will give
her skin a rosier complexion, described as a "pregnancy
glow."
 FIRST TRIMESTER DEVELOPMENT OF
EMBRYO
• During the first month of pregnancy the heart and lungs begin to develop,
and the arms, legs, brain, spinal cord and nerves begin to form.
• The embryo will be about the size of a pea around one month into a
pregnancy. Around the second month of pregnancy, the embryo has grown
to the size of a kidney bean. In addition, the ankles, wrists, fingers and
eyelids form, bones appear, and the genitals and inner ear begin to
develop.
• By the end of the second month, eight to 10 of the fetus' main organs will
have formed, Burch said. At this stage of pregnancy, it's extremely
important that pregnant women do not take harmful medications, such as
illegal drugs. The first trimester is also the period when most miscarriages
and birth defects occur.
• During the third month of pregnancy, bones and muscles begin to grow,
buds for future teeth appear, and fingers and toes grow. The intestines
begin to form and the skin is almost transparent.
 SECOND TRIMESTER CHANGES IN
MOTHER’S BODY
• A more visible baby bump appears as the uterus grows beyond
a woman's pelvis, and the skin on her expanding belly may itch
as its stretches.
• As the fetus is getting bigger and a woman is gaining more
pregnancy weight in the front of her body, she may also
experience more back pain.
• Sometime between the 16th and 18th weeks of pregnancy, a
first-time mother may feel the first fluttering movements of the
fetus, known as quickening. If a woman has had a baby before,
she is likely to feel the fetus kicking, squirming or turning even
sooner because she knows what to expect, he explained.
• A woman is generally feeling pretty good at this point, there's a
 SECOND TRIMESTER
DEVELOPMENT OF FETUS
• In the second trimester, the fetus is growing a lot and will be between 3 and 5
inches long.
• The baby's bone marrow begins to make blood cells.
• If the baby is a boy, his testicles begin to descend into the scrotum. If the baby is
a girl, her uterus and ovaries are in place, and a lifetime supply of eggs has
formed in the ovaries.
• By the fourth month of pregnancy, eyebrows, eyelashes, fingernails and the neck
form, and the skin has a wrinkled appearance. During the fourth month the arms
and legs can bend, the kidneys start working and can produce urine, and the
fetus can swallow and hear.
• In the fifth month of pregnancy, the fetus is more active and a woman may be
able to feel its movements. The fetus also sleeps and wakes on regular cycles. A
fine hair (called lanugo) and a waxy coating (called vernix) cover and protect the
thin fetal skin.
• By the sixth month of pregnancy, hair begins to grow, the eyes begin to open and
the brain is rapidly developing.
 THIRD TRIMESTER CHANGES IN
MOTHER’S BODY
• During the third trimester, as a woman's enlarged uterus pushes
against her diaphragm, she may feel short of breath because the lungs
have less room to expand.
• A mother-to-be will need to pee more frequently because more
pressure will be placed on her bladder. She may also have more
backaches and more pain in the hips and pelvis, as these joints relax in
preparation for delivery.
• In the third trimester, a woman's breasts may experience some leakage
of colostrum, a yellow liquid, as they get ready for breastfeeding.
• False labor, known as Braxton-Hicks contraction, may begin to occur as
a woman gets closer to her due date.
• As your due date approaches, the cervix becomes thinner and softer in
a process called ‘effacement’ that helps the cervix open during
childbirth.
 THIRD TRIMESTER
DEVELOPMENT OF FETUS
• By the seventh month of pregnancy, the fetus kicks and stretches,
and can even respond to light and sound, like music.
• During the eighth month of pregnancy, the fetus gains weight very
quickly. Bones harden, but the skull remains soft and flexible to
make delivery easier.
• Different regions of the brain are forming, and the fetus is able to
hiccup. Lanugo (fine hair) begins to fall off. The protective waxy
coating (vernix) thickens.
• The ninth month is the home stretch of pregnancy, and the fetus is
getting ready for birth by turning into a head-down position in a
woman's pelvis. Lungs are not fully functional, but practice
"breathing" movements occur. The fetus is gaining about ½
pound a week, weighs about 4 to 4½ pounds, and is about 15 to 17
inches long.
 FALSE LABOR
• First of all the body normally gives some signs
ahead of time that labor is on its way, which may
include:
1. A sudden burst of energy or the ‘nesting effect’,
2. Lightening or dropping of the baby,
3. Bloody show,
4. Loss of the mucous plug,
5. An upset stomach,
6. Slight increase in blood pressure, etc.
 PARTURITION
• The most common way of childbirth is a vaginal delivery.
It involves three stages of labour: the shortening and
opening of the cervix, descent and birth of the baby, and
the delivery of the placenta.
• The first stage typically lasts 12-19 hours, the second
stage 20 mins-2 hours, and the third stage 15-30 mins..
• The first stage begins with crampy abdominal or back
pains that last around half a minute and occur every 10-
30 mins. The crampy pains become stronger and closer
together over time.
• During the second stage pushing with contractions may
occur. In the third stage delayed clamping of the
 SIX PHASES OF A TYPICAL VERTEX DELIVERY:

• Engagement of the fetal head in the transverse position. The

baby's head is facing across the pelvis at one or other of the
mother's hips.
• Descent and flexion of the fetal head.
• Internal rotation. The fetal head rotates 90 degrees to the
occipito-anterior position so that the baby's face is towards the
mother's rectum.
• Delivery by extension. The fetal head passes out of the birth
canal. Its head is tilted forwards so that the crown of its head
leads the way through the vagina.
• Restitution. The fetal head turns through 45 degrees to restore its
normal relationship with the shoulders, which are still at an angle.
• External rotation. The shoulders repeat the corkscrew
movements of the head, which can be seen in the final
 STAGES OF BIRTH
• FIRST STAGE: LATENT STAGE
 The latent phase is generally defined as beginning at the point at which the
woman perceives regular uterine contractions.
 Contractions become progressively stronger and more rhythmic discomfort is
minimal.
 The cervix thins and opens to about 1½ inches (4 cm).
 This phase lasts an average of 8½ hours in a first pregnancy and 5 hours in
subsequent pregnancies.
• FIRST STAGE: ACTIVE PHASE
 The cervix opens to the full 4 inches (10 cm).
 During the active phase, it is expected that the cervix should dilate at least 1cm
an hour in women who are having their first baby. The cervix in women who
have had a previous vaginal birth tends to dilate more quickly (about 2cm/hr).
 The duration of labour varies widely, but the active phase averages some 8
hours for women giving birth to their first child and shorter for women who
 SECOND STAGE: FETAL EXPULSION
 The expulsion stage begins when the cervix is fully dilated,
and ends when the baby is born. As pressure on the cervix
increases, women may have the sensation of pelvic
pressure and an urge to begin pushing.
 The fetal head then continues descent into the pelvis,
below the pubic arch and out through the vaginal introitus
(opening). This is assisted by the additional maternal
efforts of ‘bearing down’ or pushing.
 The appearance of the fetal head at the vaginal orifice is
termed the ‘crowning’. At this point, the woman will feel
an intense burning or stinging sensation.
 When the amniotic sac has not ruptured during labour or
pushing, the infant can be born with the membranes
intact. This is referred to as ‘delivery en caul’.
 THIRD STAGE: PLACENTA DELIVERY
• The period from just after the fetus is expelled
until just after the placenta is expelled is called
‘the third stage of labour’ or the ‘involution stage’.
Placental expulsion begins as a physiological
separation from the wall of the uterus. The
average time from delivery of the baby until
complete expulsion of the placenta is estimated to
be 15–30 mins dependent on whether active or
expectant management is employed. In as many as
3% of all vaginal deliveries, the duration of the
third stage is longer than 30 minutes and raises
 FOURTH STAGE: POSTPARTUM
• Postpartum or ‘postnatal’ is the period beginning immediately after
the birth of a child and extending for about six weeks. The woman's
body, including hormone levels and uterus size, return to a non-
pregnant state and the newborn adjusts to live outside the mother's
body.
• The World Health Organization (WHO) describes the postnatal
period as the most critical and yet the most neglected phase in the
lives of mothers and babies; most deaths occur during the postnatal
period.
• Following the birth, if the mother had an episiotomy or a tearing of
the perineum, it is stitched. Some women experience an
uncontrolled episode of shivering or postpartum chills, after the
birth.
• It is suggested to place the infant in ‘skin to skin’ contact with the
mother for 1-2 hours immediately after birth as it is said to enhance
and promote the likelihood and effectiveness of breastfeeding,
 LACTATION
• The mammary glands of the female undergo
differentiation during pregnancy and starts
producing milk towards the end of pregnancy
by the process called ‘lactation’. The milk
produced during initial few days of lactation
is called ‘colostrum’, which contains several
antibodies absolutely essential to develop
resistance for the new born babies.
 COMPLICATIONS
• The "natural" maternal mortality rate of childbirth
has been estimated at 1500 deaths per 100,000
births. Each year about 500,000 women die due to
pregnancy, 7 million have serious long term
complications, and 50 million have negative
outcomes following delivery.
• Modern medicine has decreased the risk of
childbirth complications. In Western countries, such
as the United States and Sweden, the current
maternal mortality rate is around 10 deaths per
 PRETERM LABOR
• One of the greatest dangers a baby faces is being born too early, before
his or her body is mature enough to survive outside the womb.
The lungs, for example, may not be able to breathe air, or the baby's
body may not generate enough heat to keep warm.
• Medical researchers find that neonates born before 39 weeks
experienced significantly more complications (2.5 times more in one
study) compared with those delivered at 39 to 40 weeks. Health
problems among babies delivered "pre-term" included respiratory
distress, jaundice and low blood sugar.

PROLONGED LABOR
• A small percentage of women, mostly first-time mothers, may have a
labor which lasts too long, sometimes called "failure to progress." Both
the mother and the baby are at risk for several complications, including
infections, if the amniotic sac has been ruptured for a long time and the
 ABNORMAL PRESENTATION
• ‘Presentation’ refers to the part of the baby that will appear first from the
birth canal. Ideally, for labor, the baby is positioned head-down, facing the
mother's back, with its chin tucked to its chest and the back of the head
ready to enter the pelvis. This normal presentation is called vertex (head
down) occiput anterior.

• But some babies present with their buttocks or feet pointed down toward
the birth canal. This is called a breech presentation.

• Types of breech presentation include:

– Frank breech. In a frank breech, the baby's buttocks
lead the way into the pelvis; the hips are flexed, the knees extended.
– Complete breech. In a complete breech, both knees and hips are
flexed, and the baby's buttocks or feet may enter the birth canal first.
– Incomplete breech. In an incomplete or footling breech, one or both
 TRANSVERSE LIE
• It is another type of presentation problem. A
few babies lie horizontally in the uterus
called a transverse lie, which usually means
the baby’s shoulder will lead the way into
the birth canal rather than the head. It is the
most serious abnormal presentation, and it
can lead to injury of the uterus (ruptured
uterus) as well as fetal injury.
 CEPHALOPELVIC DISPROPORTION

• In cephalopelvic disproportion the baby’s

head is too large to fit through the mother’s
pelvis, either because of the size or because
of the baby’s poor positioning. Sometimes
the baby is not facing the mother’s back, but
instead is turned towards her abdomen
(occiput posterior). This increases the chance
of a lengthy, painful childbirth, often called
‘back labor’ or ‘tearing of the birth canal’.
 PREMATURE RUPTURE OF
MEMBRANES
• Normally, the membranes surrounding the
baby in the uterus break and release
amniotic fluid (known as the ‘water
breaking’) either right before or during labor.
Premature rupture of membranes means
that these membranes have rupture too
early in pregnancy, meaning prior to the
onset of labor, this exposes the baby to a
high risk of infections.
 UMBILICAL CORD PROLAPSE
• Sometimes, before or during labor, the
umbilical cord can slip through the
cervix after the water breaks, preceding
the baby into the birth canal. The cord
may even protrude from the vagina
which is a dangerous situation because
the blood flow through the umbilical
cord can become blocked or stopped.
UMBILICAL CORD COMPRESSION

• Sometimes the umbilical cord gets stretched or

compressed during labor, leading to a brief decrease
in blood flow to the fetus. This can cause sudden,
short drops in fetal heart rate called ‘variable
decelerations’, which are usually picked up by
monitor during labor. Cord compression happens in
about one in 10 deliveries. In most cases these heart
rate changes are of no major concern, and the birth
proceeds normally. But a C-section may be necessary
if the baby’s heart rate worsens or the baby shows
other signs of distress.
 AMNIOTIC FLUID EMBOLISM
• This is one of the most serious complications
of labor and delivery. Very rarely, a small amount of
amniotic fluid enters the mother's bloodstream,
usually during a particularly difficult labor or a C-
section. The fluid travels to the woman's lungs and
may cause the arteries in the lungs to constrict. For
the mother, this constriction can result in a rapid
heart rate, irregular heart rhythm, collapse, shock,
or even cardiac arrest and death. Widespread blood
clotting is a common complication, requiring
emergency care.
 THE GIFT
OF
MOTHERHOOD
THANK YOU