NUR81011 OBSTETRICS LECTURE

• Human development from ovulation to implantation

FETAL DEVELOPMENT
contents:
I. Time Period
II. Conception
a. Ovulation
b. Fertilization
c. Implantation
III. Embryonic Fetal Structures
a. Decidua or Uterine Lining
b. Chorionic Villi
c. Placenta
d. Amniotic Membranes
e. Umbilical Cord
IV. Origin of Organ System Ovulation
V. Development of Organ System • Release of mature egg from ovary for possible
VI. Milestones of Fetal Growth and Development fertilization
• When – about 14 days before next period
I. TIME PERIOD • Where – in the fallopian tube
1. Pre- embryonic Stage – fertilization up to 2 weeks of • How long – 12 – 24 hours
pregnancy
2. Embryonic Stage – 3rd to 8th week Fertilization
3. Fetal Stage – 8th week up to birth a. Concepts:
• Also known as conception or impregnation
• Union of sperm and egg; mature ovum only last
for 24-48 hours and will be fertilized if intercourse
happens
• When – during 12-24 hours since ovulation
• Where – in the outer third of the fallopian tube
near the ovary (ampulla)
• How long – up to 24 hours
b. Parts of a fertilized egg
• Zona Pellucida - fluid surrounding egg
• Corona Radiata - cells surrounding the mature
ovum

*abortion is legal if there are valid reasons, but in the PH it is

illegal

II. CONCEPTION
Understanding how does pregnancy occur can help a c. Factors to consider for fertilization to occur:
couple have more control of the baby-making process • Equal maturation of both sperm and ovum
and approach it less anxiously • Ability of the sperm to reach the ovum - motile
• Ability of the sperm to penetrate to zona pellucida
and cell membrane and achieve fertilization

*Only one sperm will successfully penetrate, the zona pellucida

and corona radiata makes egg impervious - no other sperm can
penetrate
*Sperm count - every ejaculation of 1 ml of seminal fluid, 50 to
200 million sperm; may be decreased resulting to infertility
*H-mole or hydatidiform mole – a disorder in pregnancy wherein
a lot of sperms penetrate the mature ovum; growth of an
abnormal fertilized egg or an overgrowth of tissue from the
placenta
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 Implantation b. Functions
• Attachment of the fertilized egg, or blastocyst, in the 1. Circulation
uterine wall; contact between the growing structure o As early as 12 days of pregnancy, maternal
and the uterine endometrium blood begins to collect in the intervillous
• When – about 6 – 11 days after fertilization spaces of the endometrium surrounding the
• Where – in the uterine lining (posterior surface) chorionic villi
o Blastocyst - thin-walled hollow o 3rd week oxygen and other nutrients (glucose,
structure in early embryonic amino acids, fatty acids, minerals, vitamins and
water) are transported to developing embryo
development that contains a
o Uteroplacental blood flow increases from
cluster of cells called the inner about 50mL/ min at 10 weeks to 500-600 mL/
cell mass from which the min at term
embryo arises o Maternal veins – sends blood back to the
o Placenta Previa - implanted in mother
low-lying segment, and o Maternal arteries – sends blood to the fetus
placenta forms; since it is highly vascularized,
pressure on lower segment results to bleeding
• How long – up to 48 hours
• Mitotic cell division (cleavage) begins

III. EMBRYONIC FETAL STRUCTURES

Placenta and the membranes → fetal lungs, kidneys and
digestive tract
*important for pregnant mothers, especially primigravida, to be
educated about the fetal development, due to congenital abnormalities
that may occur when exposed to teratogens e.g. measle virus

2. Endocrine Function
o Human Chorionic Gonadotropin (HCG)
§ First placental hormone produced -
checked in pregnancy tests, urine or
blood
§ Ensures corpus luteum of the ovaries
continue to produce progesterone and
estrogen which maintain endometrium of
uterus
§ Suppresses immunologic response of the
mother so placental tissue is not detected
Decidua or Uterine Lining
and rejected as a foreign substance
• Trophoblast cells → human chorionic gonadotropin o Progesterone
(HCG) → Uterine endometrium grow in thickness
§ Hormone that maintains pregnancy
§ Maintains the endometrial lining of the
Chorionic Villi uterus during pregnancy
• Miniature villi § Reduces contractility of the uterus during
resembling pregnancy, preventing preterm labor
probing fingers (term - 37 - 42 AOG)
• supplies baby o Estrogen
with nutrients § Contributes to the woman’s mammary
and oxygen gland development in preparation for
from mother lactation
§ Stimulates uterine growth to
Placenta accommodate the developing fetus
a. Definition o Human Placental Lactogen (Human Chorionic
• Latin for ‘pancake’ Somatomammotropin)
• Grows from a few identifiable trophoblastic cells § With growth promoting and lactogenic
at the beginning of pregnancy (milk producing) properties

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 § Regulates maternal glucose, protein and *if only 1 artery, indicates cardiac or renal problem since both
fat levels so adequate amounts are arise from same germ cell
available to the fetus *twisting of umbilical cord may occur especially if it is long;
Nuchal Cord - cord coil around the fetal head
o Placental Proteins
§ Produces plasma proteins that contribute
to decreasing the immunologic impact of IV. ORIGIN OF ORGAN SYSTEM
the growing placenta and help prevent a. Stem Cells - begins at 4th day of life
hypertension of pregnancy • Totipotent - undifferentiated, e.g. genitals cannot
be identifies as male or female; potential to grow
Amniotic Membranes into any body cell
a. Definition • Pluripotent stem cells – show differentiation
• Dual- walled sac with
the chorion as the
outermost part and
the amnion as the
innermost
• Fluid- filled sac
covering the baby
b. Amniotic Fluid
• 800-1200 mL at term
• Amniotic fluid index - at least 5cm
o Measures pockets of fluid through an
ultrasound
• Appropriate amount ensures adequate kidney
function
o Amniotic fluid is less than normal = not
secreting urine à may indicate abnormal
kidneys
• Hydramnios - condition that occurs when too b. Zygote Growth - cephalocaudal, head is always
much amniotic fluid builds up during pregnancy; larger
more than 2000mL c. Primary Germ Layers
o Fetus normally swallows amniotic fluid • Ectoderm
o Tracheoesophageal Fistula - abnormal o Central nervous system (brain and spinal cord)
connection inability to swallow, poor sucking and peripheral nervous system
or swallowing reflex o Skin, hair, nails and tooth enamel
• Purposes o Sense organs
o Shield fetus against pressure, e.g. sudden o Mucous membranes of the anus, mouth, and
blow on abdomen, accidents nose
o Protects fetus from changes in temperature o Mammary glands
(helps in thermoregulation) • Mesoderm
o Aids in muscular development o Supporting structures of the body (connective
§ If there is adequate amount, baby can tissue, bones, cartilage, muscle, ligaments,
move freely in the womb and tendons)
o Protects umbilical cord from pressure, which o Upper portion of urinary systems (kidneys and
may impede circulation ureters)
o Reproductive system
*In case bag of water leaks, mother still consistently produces o Heart, lymph and circulatory systems and
amniotic fluid blood cells
• Endoderm (innermost)
Umbilical Cord o Lining of pericardial, pleura, and peritoneal
• Formed from the fetal membranes cavities
• Transports oxygen and nutrients to the fetus from the o Lining of the gastrointestinal tract, respiratory
placenta tract, tonsils, parathyroid, and thymus glands
• Return waste products from the fetus to the placenta o Lower urinary system (bladder and urethra)
• Contains AVA
o 1 vein - carrying blood from placental villi to fetus
o 2 arteries - carrying blood from the fetus back to
placental villi
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 V. DEVELOPMENT OF ORGAN SYSTEM Nervous System
• Begins to develop early in pregnancy
• Neural plate - serves as the basis for the nervous
system
• Parts of the brain
• Brain waves detected by electroencephalogram
(EEG) by 8th week
• Eye and inner ear develop
• By 24 weeks, ear is capable of responding to sound;
eyes exhibit pupillary reaction

Endocrine System
• Fetal pancreas produces insulin needed by the fetus
• Thyroid and parathyroid glands lay vital roles in fetal
metabolic function and calcium balance
• Fetal adrenal glands supply a precursor necessary
for estrogen synthesis by the placenta
*as early as 8 weeks, it begins to grow but only rudimentary
Digestive System
Cardiovascular System • About the 4th week of intrauterine life, digestive tract
• One of the first systems to become separates from the respiratory tract
functional in intrauterine life • GIT is sterile (no microorganism) before birth - this is
• The heartbeat may be heard with a why vitamin K is administered at birth
Doppler as early as 12 weeks of • Enzymes essential for protein and CHO digestion is
pregnancy mature at 36 weeks
• After the 28th week, consistent heart
rate of 110 to 160 bpm Musculoskeletal System
• Fetal circulation • First 2 weeks of fetal life - cartilage prototypes
o Foramen Ovale and Ductus Arteriosus - fetal provides position and support to fetus
shunts that close at birth; accessory structures for • About the 12 week = ossification of the cartilage into
circulation in utero bone begins

Respiratory System Reproductive System

• At the 3rd week of uterine life, the respiratory and • Child's sex is determined at moment of conception
digestive tracts exist as a single tube by a spermatozoan carrying X or Y chromosome
• By the end of the 4th week, a septum begins to divide • Can be ascertained as early as 8 weeks by
the esophagus from the trachea. At the same time, chromosomal analysis or analysis of fetal cells
lung buds appear on the trachea
• Until the 7th week of life, the diaphragm does not Urinary System
completely divide the thoracic cavity from the • By the 12th week, urine is formed
abdomen (remains open for the development of • By the 16 week of gestation, urine is excreted into the
intestines etc.) amniotic fluid - may be swallowed by baby, remains
• Developmental Milestones sterile
o Spontaneous respiratory practice movements
o Specific lung fluid with a low surface tension and Integumentary System
low viscosity forms in alveoli to aid in expansion of • Skin of fetus appears thin and almost translucent until
the alveoli at birth subcutaneous fat begins to be deposited
§ Without lung fluid, lung may collapse underneath it by 36th weeks
o Surfactant is formed and excreted by the alveolar
cells; phospholipids that help lungs expand and Immune System
mature • Immunoglobulin (Ig) G maternal antibodies cross the
§ Lecithin (2) - surge in production at 35 weeks placenta into the fetus as early as 20th week
§ Sphingomyelin (1) - chief component n the
early formation of surfactant
§ LS Ratio = 2:1

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 VI. DEVELOPMENT OF ORGAN SYSTEM End of the 28th Week of Gestation
End of the 4th Week of Gestation • Length of the fetus is 35-38 cm
• Length of embryo is about 0.75 cm • Weight is 1200 g
• Weight is about 400mg • Lung alveoli are almost mature
• Spinal cord is ford and fused at the midpoint • Surfactant can be demonstrated in amniotic fluid
• Arms and legs are bud-like structures • Testes begin to descend into the scrotal sac
• Rudimentary eyes, ears, and nose are discernible o Cryptorchidism - undescended testes, may be
related to cancer or infertility
End of the 8th Week of Gestation • Blood vessels of the retina are formed but are thin
• Length of fetus is 2.5 ( 1 inch) and susceptible to damage
• Weight is about 20 g *too much concentration of oxygen for preterm babies may
damage retina vessels
• Organogenesis is complete
• The heart with septum and valves beats rhythmically
• Facial features are discernible End of the 32nd Week of Gestation
• External genitalia are forming • Length of the fetus is 38-43 cm
• Weight is 1600 g
End of the 12th Week of Gestation • Fetus responds by movement to sounds outside the
• Length of the fetus is 7-8 cm mother’s body
• Weight is about 45 g • An active Moro reflex is present - indication of intact
• Nail beds are forming on fingers and toes CNS
• Sex is distinguishable on outward appearance • Subcutaneous fat begins to be deposited
• Some reflexes are present - Babinski, inverted J in • Iron stores are beginning to be built - because breast
sole of foot milk have no iron content, must be given iron
• Bone ossification centers begin to form supplements
• Urine secretion
• Heartbeat is audible through doppler End of the 36th Week of Gestation
• Length of the fetus is 42-48 cm
End of the 16 Week of Gestation
th • Weight is 1800 g
• Length of the fetus is 10-17 cm • Most fetuses turn into a vertex (head down(
• Weight is 55-120 g presentation during this month
• Fetal heart sounds are audible by an ordinary • Body stores of glycogen, iron, CHO and calcium are
stethoscope deposited
• Liver and pancreas are functioning End of the 40th Week of Gestation
• Fetus actively swallows amniotic fluid • Length of the fetus is 48 - 52 cm
• Urine present in amniotic fluid
• Weight is 3000 g (7 - 7.5 lbs)
• Sex is determined by ultrasound (US) • Fetus kicks actively
• Fetal hemoglobin begins its conversion to adult
End of the 20th Week of Gestation hemoglobin
• Length of the fetus is 25 cm • Vernix caseosa begins to decrease
• Weight is 223 g • Creases on the sole of the feet cover at least two-
• Quickening - spontaneous fetal movements can be thirds of the surface
sensed by the mother *when in doubt, sole creases are checked for weeks of gestation;
• Passive antibody transfer if absent, indication of preterm infant
• Brown fat - special fat that aids in temperature
regulation - kidneys, sternum, posterior neck

End of the 24th Week of Gestation

• Length of the fetus is 28-36 cm
• Weight is 550 g (low-end age of viability)
• Meconium is present as far as the rectum
• Active production of lung surfactant begins - lecithin,
sphingomyelin
• Eyelids open and reacts to light

Good luck, future nurses! ♡

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