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• Pituitary hormones: FSH and LH reach peak at about mid-point of the cycle, stimulating development of an ovarian follicle. Ova released, the follicle becomes the corpus luteum.
• Ovarian hormones: Ovarian follicle releases oestrogen which slowly rises and peaks just before mid-point. Corpus luteum releases progesterone which readies the uterus for pregnancy, and then release falls to the end of cycle.
• Endometrium:  Follicular phase as epithelium proliferates; in the luteal phase it continues to develop. As ovarian hormones fall to the lowest point, epithelium is shed through menstruation.

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•  Excitement/arousal: dilation of blood vessels. P and BP up

Male->growth of penis, female->swelling of external genitalia.

• Plateau: changes above continue

Penis 50% larger, breast swells by 25%.

• Orgasm: contractions in pelvic floor and genital muscles->orgasm

Male->ejaculation, female->intense/pleasurable release of tension.

• Resolution: returns to normal

Recovery for men – minutes to hours, female slowly returns to normal, can orgasm again quickly.

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• Endocrine system:
  
  • Progesterone and oestrogen levels rise.
  • Placenta takes over secretion of oestrogen, human chorionic gonadotrophin (hCG), progesterone.
  • Prolactin from pituitary prepares breasts for breast feeding.
  • Parathyroid hormone ↑ -> levels of calcium ↑.
  • Adrenal hormones (cortisol and aldosterone).
  • Human placental lactogen (hPL) stimulates fat metabolism. 

•  Immune system: baby susceptible to immune attack. Normally maternal tolerance prevents this, the placenta acts as a barrier between the foetus and mother’s immune system. 
• Physical changes:
  
  • Increase in weight due to growth of the foetus and placenta, amniotic fluid, increased breast size and increase in water and fat retention.
  • Changes in shape and posture of the woman’s body (Figure 16.21) ->change in centre of mass ->alterations in posture, gait, balance and increased risk of falls.
  • Oestrogen and relaxin ->remodelling of soft tissues, ligaments and cartilage.
  • Sacroiliac and symphysis pubis joints stretch and widen.

• Cardiovascular adaptation: plasma and blood volume increases, cardiac output ↑.
  
  • BP falls (weeks 12–26), returns to pre-pregnancy levels by week 36.
  • Increased erythropoietin secretion increases red blood cell numbers. 

• Homeostasis: increased nutrients for baby and mother.
  
  • Weight gain of about 20–30 lb (9.1 to 13.6 kg).

Additional protein for development of muscular tissues of the uterus and breast development for lactation and breast feeding.

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• Returning to non-pregnant state: puerperium (6 weeks post-delivery the body returns to normal).
• Vaginal discharge:
  
  • Lochia rubra (red): three to five days.
  • Lochia serosa (brownish/pink): up to ten days.
  • Lochia alba (white/yellow): 2nd through 3rd to 6th week.

• Infant feeding and nurturing:
  
  • Milk ‘comes in’ 2nd or 3rd day.
  • First colostrum with antibodies, then milk hormones involved.
  • Prolactin – stimulates milk production.

Oxytocin – contraction of lactiferous ducts, squeezes milk out of the breast.