Hamil Adenomyosis - HPA Cortisol - Estrogen Progesteron Oxy Reseptor - DR.dr.Kanadi, FER FK UI RSCM

Summary

The video script delves into the endocrinological perspective of pregnancy, focusing on the complex interplay of hormones like CRH, cortisol, and progesterone in fetal and placental development. It discusses the role of these elements in triggering parturition and the potential impact of factors such as smoking and preeclampsia. The transcript also explores the concept of 'steroidogenesis in pregnancy,' the transformation of cholesterol into progesterone, and its conversion to androgens and estrogens, which are critical in determining the timing of birth. Additionally, it touches on the implications of adenomyosis in pregnancy, suggesting a correlation between the condition and heightened uterine contractions due to increased oxytocin receptor expression.

Takeaways

• 🌟 The script discusses the endocrinological perspective on the process of parturition, highlighting the role of the fetal adrenal system and the activation of the HPA axis during pregnancy.
• 🔍 It mentions the importance of corticotropin-releasing hormone (CRH) in activating the adrenal system to release cortisol, which is crucial for the maturation process but is regulated by an enzyme in the placenta that deactivates cortisol to prevent premature birth.
• 🚫 The transcript addresses factors that can disturb the normal process of parturition, such as smoking and preeclampsia, and emphasizes the need to think beyond the obvious causes like periodontitis.
• 🤔 It raises the question of whether parturition is triggered by cortisol or other factors, suggesting that a complex interplay of hormones including progesterone and androgens is involved in the timing of birth.
• 🔄 The role of progesterone in maintaining pregnancy is highlighted, and its conversion to androgens and subsequently to estrogen in the placenta is discussed as a critical balance that determines the onset of labor.
• 🧬 The potential impact of placental enzymes on the conversion of progesterone to androgens is considered, noting that the lack of certain enzymes could lead to an imbalance and possibly premature birth.
• 🔍 The transcript suggests that an increase in estrogen compared to progesterone can trigger the formation of prostaglandins, which in turn can induce labor by causing uterine contractions.
• 🤰 It discusses the importance of considering the patient's overall health, including metabolic factors, in understanding the causes of preterm labor or complications in pregnancy.
• 🧐 The role of endometriosis and adenomyosis in causing irregular uterine contractions is explored, with a focus on how these conditions can lead to a disruption in the normal hormonal balance and potentially affect fertility and pregnancy.
• 🛑 The potential use of medications to inhibit uterine contractions is mentioned, with a discussion on the mechanisms of action and the importance of considering the selective use of such drugs to avoid side effects.
• 💡 The importance of a holistic approach to understanding and treating pregnancy complications is emphasized, suggesting that practitioners should consider a wide range of factors beyond just the obvious symptoms.

Q & A

What is the role of the CRH (Corticotropin-Releasing Hormone) during pregnancy?

CRH plays a significant role in activating the fetal adrenal system, leading to the release of cortisol. However, despite high levels of CRH from the placenta, parturition does not occur due to an enzyme in the placenta that deactivates cortisol.

How does the placenta contribute to the regulation of cortisol during pregnancy?

The placenta contains an enzyme that deactivates cortisol, preventing the active form of cortisol from being released, which is crucial in avoiding premature parturition despite high CRH levels.

What factors can disrupt the normal process of parturition?

Factors such as smoking and preeclampsia can disrupt the normal process of parturition, potentially leading to preterm birth or other complications.

How is cholesterol related to the process of parturition?

Cholesterol in the mother's body is converted into progesterone, which can then be converted into androgens in the placenta. These androgens are then converted into estrogen, which plays a role in parturition.

Why is the ratio of progesterone to estrogen important in determining the timing of parturition?

The ratio between progesterone and estrogen is crucial as it influences the readiness for parturition. As pregnancy progresses, a shift in this ratio due to placental aging can trigger parturition.

What is the role of prostaglandins in the process of parturition?

Prostaglandins are triggered by an increase in estrogen and they induce the formation of oxytocin, which leads to effective uterine contractions necessary for parturition.

How does the concept of 'thinking beyond the flora' apply to cases of preterm delivery?

The concept encourages healthcare providers to consider a broader range of factors beyond just the presence of infection or inflammation, such as smoking or periodontitis, that could contribute to preterm delivery.

What is the significance of the junctional zone in the context of adenomyosis?

The junctional zone is significant because its irregularity or disruption can indicate the involvement of adenomyosis, which can affect uterine contractions and potentially lead to issues such as dysmenorrhea.

How does adenomyosis affect the expression of oxytocin receptors?

In cases of adenomyosis, the expression of oxytocin receptors is much higher compared to normal conditions, which can lead to increased uterine contractions and contribute to symptoms like dysmenorrhea.

What is the potential impact of endometriosis on pregnancy and parturition?

Endometriosis, particularly when associated with adenomyosis, can lead to disregulated uterine contractions that may affect implantation and pregnancy maintenance, potentially increasing the risk of preterm birth.

Why is it important for reproductive endocrinologists to understand the function of uterine contractions in both non-pregnant and pregnant states?

Understanding uterine contractions in both states is crucial for reproductive endocrinologists to diagnose and manage conditions that may affect fertility and pregnancy, such as endometriosis or preterm labor.