Endocrinología del embarazo, parto, puerperio y lactancia
DOI:
https://doi.org/10.18597/rcog.2167Resumen
Inicialmente hacemos una descripción sobre la fisiología endocrina de la implantación y la importancia que juega el cuerpo lúteo en esta fase temprana de la gestación. Seguidamente entramos a considerar la endocrinología placentaria y su papel como órgano endocrino secretor de la gonadotropina coriónica, esteroides ováricos, corticosteroides, andrógenos, HPL y protaglandinas. Hacemos hincapié en el concepto de la unidad feto—placentaria como entidad sintetizadora del estriol, el más importante de los compuestos estrogénicos producidos en el embarazo y su valor como medio diagnóstico del ambiente fetal.
Posteriormente se describen los cambios endocrinos que sufre la madre al incorporarse la placenta a su organismo, lo cual significa que tiene un nuevo órgano secretor interno. Estos cambios se realizan en su función ovárica, en su hipófisis, en su tiroides, paratiroides, páncreas y corteza suprarrenal.
A medida que el feto alcanza su término, sus glándulas endocrinas empiezan a mostrar actividad. Se revisa entonces el sistema endocrino—fetal referente a todas las glándulas endocrinas clásicas (gonadas, hipófisis, tiroides, etc.) y en particular al timo.
A continuación se entra a considerar el parto, sus diferentes períodos y sus mecanismos desencadenantes (inervación motora autónoma, estrógenos, ambiente externo, stress fetal, ACTH, corticosteroides, estimulación mecánica, ocitocina, progesterona y prostaglandinas).
Después mencionamos brevemente los cambios que se observan el puerperio o sea el tiempo comprendido entre el parto y el retorno de los genitales externos e internos de la madre a su estado previo al embarazo. Este período dura de 6 a 8 semanas.
Finalmente entramos a considerar los aspectos endocrinos de la lactancia: la lactogénesis y la influencia que sobre ella tienen las hormonas hipofisiarias, la prolactina, los glucocorticoides y las hormonas ováricas y placentarias; el amamantamiento y estímulo de succión, y por último, la galactopoyesis.
Biografía del autor/a
Francisco L. García Conti, Hospital Universitario San Ignacio
Profesor Asociado de Ginecología y Obstetricia, Facultad de Medicina, Universidad Javeriana. Jefe, Sección de Endocrinología Femenina y Esterilidad Conyugal, Hospital Universitario San Ignacio, Bogotá, Colombia.
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