The Growing Fetus

Stages of Fetal Development

Fetal Growth and Development are divided into 3 periods :

Preembryonic

First 2 weeks , beginning c fertilization

Embryonic

3rd to 8th week

Fetal

8th week through birth

Terms used to Denote Fetal Growth

Ovum

From ovulation to fertilization

Zygote

From fertilization to implantation

Embryo

From implantation to 5-8 weeks

Fetus

From 5-8 weeks until term

Conceptus

Developing embryo or fetus and placental structures throughout

pregnancy

Age of Viability

The earliest age at w/c fetuses could survive if they were born at that
time
Generally accepted as 24 weeks
Fetuses weighing > 400 g

I. Fertilization : The beginning of pregnancy

Fertilization
- Also referred to as conception and impregnation
- Union of an ovum and spermatozoon
- Usually occurs in the outer 3rd layer of a fallopian tube , the ampullar portion
- Never a certain occurrence because it depends on at least 3 separate factors :
> Equal maturation of both sperm and ovum
> Ability of the sperm to reach the ovum
> Ability of sperm to penetrate the zona pellucida and cell membrane and achieve fertilization

Only one of a womans ova will reach

maturity each month

Ovum is capable of
fertilization for only 24 h
(48 h at the most

Once the mature ovum is released ,

fertilization must occur fairly quickly

As the ovum is extruded from graafian follicle of an

ovary c ovulation, it is surrounded by a ring of
polysaccharide fluid (zona pellucid) and a circle of cells
(corona radiata) w/c increases the bulk of ovum and
serve as protective buffers against injury

Life of spermatozoon is about

48 h , possibly as long as 72 h

Ovum and its surrounding cells are propelled into a nearby

fallopian tube by currents initiated by fimbriae

A combination of peristaltic action of the tube and movements of

the tube cilia help propel ovum along the length of the tube

An ejaculation of semen averages 2.5 mL of

fluid containing 50 to 200 million spermatozoa
per mL or an ave. of 400 million sperm per
ejaculaton

At the time of ovulation, there is a reduction

in the viscosity of cervical mucus w/c makes it
easy for sperm to penetrate it

Douching is not an effective

contraceptive measure

Sperm transport is so efficient close to

ovulation

sperm deposited in the vagina generally

reach the cervix w/in 90 sec. and the outer
end of fallopian tube w/in 5 min

Capacitation is a final process that sperm must

undergo to be ready for fertilization

Sperm move toward the ovum, consists of

changes in the plasma membrane of the sperm
head w/c reveal the sperm-binding receptor
sites

All of the sperm that achieve capacitation

reach the ovum and cluster around the
protective layer of corona cells

Hyaluronidase , a proteolytic enzyme is

released by sperm and dissolves layer of cells
protecting the ovum

One reason that ejaculation contains such large

number of sperm is prolly to provide sufficient
enzyme to dissolve corona cells

Only 1 sperm is able to penetrate the cell

membrane of the ovum

Once sperm penetrate the cell , cell

membrane changes composition to become
impervious to other sperm

An exception is the formation of Hydatidiform

mole in w/c multiple sperm enter an ovum , this
leads to abnormal zygote formation

Immediately after penetration ,

chromosomal material of ovum and perm
fuse to form a zygote

Fertilized ovum has now 46 chromosomes

(22 autosomes and 1 sex chromosomes each
from sperm and ovum)

X-carrying sperm = Female child (XX)

Y carryng sperm = Male child (XY)

II. Implantation
- Usually high in the uterus, on the posterior surface
- If point of implantation is low in uterus, the growing placenta may occlude the cervix and make birth of child difficult (placenta previa)
- An important step in pregnancy because as many as 50 % of zygotes never achieve it

Once fertilization complete, zygote migrates

over the next 3 to 4 days toward the body
of uterus

During this time, mitotic cell division

or cleavage begins

By the time zygote reaches the body of

uterus , it consists of 16 to 50 cells termed
as morula

Morula continues to multiply as it floats free

in the uterine cavity for 3 to 4 additional
days

Large cells tend to collect at the periphery

of the ball , leaving a fluid space surrounding
an inner cell mass termed blastocyst

Trophoblast : Cells in the outer

ring that will later form the
placenta and membranes

Blastocyst is the structure thatll attach to

the uterine endometrium

Embryoblast : Inner cell mass

that will form the embryo

Implantation occurs app. 8 to 10 days after

fertilization

Apposition : Blastocyst sheds the

last residues of corona and zona
pellucida and brushes against the
rich uterine endometrium

Trophoblast cells produce proteolytic

enzymes that dissolve any tissue they
touch w/c allows the blastocyst to burrow
deeply into endometrium

Adhesion : Blastocyst attaches to

the surface of the endometrium

Invasion : Blastocyst settles down

into its soft folds

Zygote becomes now an embryo

Embryonic and Fetal Structures

Decidua

Chorionic villi

After fertilization, corpus luteum in ovary continues to function rather than atrophying because of influence of hCG
, a hormone secreted by trophoblast cells
hCG causes uterine endometrium to grow in thickness and vascularity instead of sloughing off as in a usual menstrual
cycle
Endometrium is now termed decidua
Has 3 separate areas :
o Decidua basalis Part of endometrium that lies directly under the embryo
o Decidua capsularis Encapsulates the surface of the trophoblast
o Decidua vera Remaining portion

Resemble probing fingers at 11th or 12th day that reach out from single layer of cells into uterine endometrium to
begin formation of placenta
At term, almost 200 villi will have formed
Double layer of trophoblast cells surrounds these :

Syncytiotrophoblast
A.k.a syncytial layer ; Outer layer
Produces various placental hormones: hCG, somatomammotropin, estrogen, progesterone
Cytotrophoblast
A.k.a Langhans layer ; Middle layer
To protect growing embryo and fetus from certain infectious organisms such as spirochete of syphilis
Disappears bet. 20th and 24th week

Placenta

Arises out of the continuing growth of trophoblast tissue

Covering about half the surface area of internal uterus at term

Circulation

(12th day ) Maternal blood begins to collect in intervillous spaces of endometrium surrounding the chorionic villi
(3rd week) Oxygen and other nutrients osmose from maternal blood through cell layers of chorionic villi into the villi
capillaries and from there, nutrients are transported to the embryo
Placental osmosis
o All except a few substances are able to cross from mother into the fetus
o All drugs are able to cross into fetal circulation
A potential complication of twins is that nutrient vessels may fuse in utero, causing one twin to receive more blood
than the other (twin to twin transfusion)
There is no direct exchange of blood bet. the embryo and mother during pregnancy
Cotyledon
o As the number of chorionic villi increases c pregnancy , villi form an increasingly complex communication
network c maternal blood
o Intervillous spaces grow larger and larger becoming separated by a series of partitions or septa
o In a mature placenta , there are as many as 30 separate segments /compartments
o These what makes the maternal side of placenta look rough and uneven
Increasing blood flow
o There are about 100 maternal uterine arteries supply the mature placenta
o Rate of uteroplacental blood flow increase throughout pregnancy : 50 mL/min at 10 weeks ; 500 to 600
mL/min at term
o No additional maternal arteries appear after first 3 mos. of pregnancy instead to accommodate the increase
blood flow , arteries increase in size
o Womans HR , CO, and blood volume increase to supply blood to placenta
In the Intervillous spaces :
o Maternal blood jets from the coiled or spiral arteries in stream and then is propelled from compartment to
compartment
o As blood circulates around the villi and nutrients osmose from maternal blood into the villi, the maternal
blood gradually loses its momentum and settles to the floor of cotyledons
o In the cotyledons, Blood enters the orifices of maternal veins and is returned to the maternal circulation
Braxton Hicks contraction
o Uterine contraction that are present from about 12th week
o Aid in maintaining pressure in the intervillous spaces by closing off the uterine veins momentarily c each
contraction
Uterine perfusion and thus placental circulation is most efficient when woman lies on her left side in w/c it lifts
the uterus away from inferior vena cava , preventing blood from being trapped in womans lower extremities
If woman lies on her back and weight of uterus compresses vena cava , placental circulation can be so sharply
reduced that supine hypotension occurs
At term, placenta weighs 400 to 600 g (1lb)
If placenta is smaller than normal , it suggests that circulation to fetus may have been inadequate
If placenta is larger than normal, it may indicate that circulation to fetus was threatened because it suggests that
placenta was forced to spread out in an unusual manner to maintain a sufficient blood supply
Fetus of woman c DM may develop a larger than usual placenta from excess fluid collected bet. cells

Endocrine Function

Human Chorionic Gonadotropin

o Can be found in maternal blood and urine as early as the first missed menstrual period through about 100 th
day of pregnancy
o Hormone analyzed by pregnancy tests
o Womans blood serum will be completely negative for hCG within 1 to 2 weeks after birth
o Testing for hCG after birth can be used as proof that placental tissue is no longer present
o Act as a fail-safe measure to ensure that corpus luteum of ovary continues to produce progesterone and
estrogen
o Suppresses maternal immunologic response so that placental tissue is not detected and rejected as a
foreign substance.
o Structure is similar to that of luteinizing hormone : If fetus is male , it exerts an effect on fetal testes to
begin testosterone production . Presence of testosterone causes maturation of male reproductive tract
o At 8th week of pregnancy, the outer layer of cells of developing placenta begins to produce progesterone
making the corpus luteum no longer necessary so hCG at this point begins to decrease
Estrogen (estriol)
o Often referred to as hormone of women
o Contributes to womans mammary gland development in preparation for lactation
o Stimulates uterine growth to accommodate developing fetus
Progesterone
o Often referred to as hormone of mothers
o Maintain endometrial lining during pregnancy
o Present in serum as early as 4th week of pregnancy as a result of continuation of corpus luteum
o Reduce contractility of uterus during pregnancy , preventing premature laboro

Amniotic membranes

Human
o
o
o

There are chorionic villi on medial surface of trophoblast that are not involved in implantation because they do not
touch the endometrium and thus gradually thin, leaving the medial surface of structure smooth (Smooth Chorion)
Smooth Chorion eventually becomes the Chorionic membrane

Placental Lactogen (Human Chorionic Somatomammotropin)

Produced by placenta beginning as early as 6th week of pregnancy
Has both growth-promoting and lactogenic properties
Regulate maternal glucose, CHON , and fat levels so that adequate amt of these nutrients are always
available to fetus

Chorionic membrane
Outermost fetal membrane
Form the sac that contains the amniotic fluid
Amniotic membrane
Amnion , forms beneath the chorion
Not only supports the amniotic fluid but also actually produces the fluid
Produces phospholipids that initiates formation of prostaglandins w/c can cause uterine contractions and may be the
trigger that initiates labor

Amniotic fluid

Umbilical cord

Fetus continually swallows the fluid

Shield the fetus against pressure to the mothers abdomen
Protects fetus from changes in temperature
Aids in muscular development because it allows the fetus move freely
Protects umbilical cord from pressure
Even if amniotic membranes rupture before birth and bulk of amniotic fluid is lost , some will always surround the
fetus in utero , because new fluid is constantly formed
Slightly alkaline, Has a pH of about 7.2 ; Checking pH differentiates it from urine w/c is acidic (pH of 5.0-5.5)
In Fetal Intestine :
o It is absorbed into the fetal bloodstream
o From bloodstream, it goes to the umbilical arteries and to the placenta
o And it is exchanged across the placenta
At term, amount of this fluid is 800 to 1200 mL
If fetus cant swallow , reasons may be :
o Esophageal atresia
o Anencephaly
Hydramnios
o Excessive amniotic fluid w/c is more than 2000 mL in total will result
o Tends to occur in women w/ diabetes because hyperglycemia causes excessive fluid shifts into the amniotic
space
o As soon as fetal kidneys become active, fetal urine adds to the quantity of amniotic fluid
Oligohydramnios
o Due to the disturbance of kidney function
o Reduction in the amount of amniotic fluid w/c is less than 300 mL in total

Formed from the fetal membranes

Provides circulatory pathway that connects embryo to the chorionic villi of placenta
Transport oxygen and nutrients to fetus from placenta and return waste products from fetus to placenta
53 cm in length at term, 2 cm thick
Contain no nerve supply and can be cut at birth w/o discomfort to either child or woman
Whartons jelly
o Gelatinous mucopolysaccharide gives the cord body
o Prevents pressure on the vein and arteries that pass through it
Contains only 1 vein , 2 arteries :
o Vein : carrying blood from placental villi to the fetus
o Arteries : carrying blood from fetus back to placental villi
Number of vein and arteries in cord is always assessed
If not the normal number, infants may have chromosomal disorders or congenital anomalies
Rate of blood flow at term is 350 mL/min
Contains no nerve supply so it can be cut at birth without discomfort to either child or woman
Percutaneous umbilical blood sampling (PUBS)
o Blood can be w/drawn from umbilical vein or transfused into the vein during intrauterine life for fetal
assessment

Mechanisms by which Nutrients cross the placenta

Diffusion

Substances cross the membrane from area of higher concentration to area of lower concentration
Ex: Oxygen, Carbon dioxide, sodium and chloride

Facilitated
diffusion

Some substances cross the placenta guided by a carrier so move more rapidly than would occur if only
simple diffusion were operating.
Ex: Glucose

Active transport

Requires action of an enzyme to facilitate transport

Ex: Essential amino acids and water-soluble vitamins

Pinocytosis

Absorption by cellular membrane of microdroplets of plasma and dissolved substances.

Ex: Gamma globulin, lipoproteins, and phospholipids, Viruses

Origin and Development of Organ Systems

Stem cells
Zygote growth
Primary germ layers
Cardiovascular System
Respiratory System
Nervous System
Endocrine System
Digestive System
Musculoskeletal System
Reproductive System
Urinary System
Integumentary System
Immune system
Milestones of fetal Growth and Development
Determination of Estimated Birth Date
Assessment of Fetal Growth and Development
Health History
Estimated Fetal Growth
Assessing Fetal Well-being