1ST WEEK: OVULATION TO IMPLANTATION

FERTILIZATION
Process by which male and female gametes fuse in the ampullary region of oviduct (widest part and
close to ovary)
Spermatozoa viable in female reproductive tract for several days ascent to uterine tubes
o Flagellar activity in cervical mucus
o Contractions of muscles of uterus and oviduct
o Isthmus = sperm reservoir movement to ampulla is SYNCHRONIZED
o Not able to fertilize oocyte require capacitation and acrosome reaction
CAPACITATION:
o Period of conditioning in female reproductive
tract
o Approx 7 hours
o Much occurs in uterine tube epithelial
interactions between sperm and mucosal
surface
o Glycoprotein coat and seminal plasma proteins
removed from cm that overlies acrosomal
region of spermatozoa
o Only capacitated sperm pass through corona
for acrosome rxn

Phases:
Penetration of Corona radiata
300-500 reach site of fertilization
Only one fertilizes egg
Others aid fertilizing sperm in
penetrating barriers of female
gamete
Only capacitated sperm pass through
corona cells

ACROSOME REACTION
o Occurs after binding to ZP induced by zona
proteins
o Release of enzymes to penetrate ZP including
acrosin and trypsin like substances
o Cm of sperm covering acrosomal head cap
disappears

Penetration of ZP
ZP glycoprotein shell surrounding
egg that facilitates and maintains
sperm binding
-induces acrosome reaction
-binding mediated by ZP4 and
receptors on sperm cm
-acrosin allows sperm to penetrate
zona
Zona reaction
-permeability changes when head of
sperm contacts oocyte surface
release of lysosomal enzymes from
cortical granules lining cm of oocyte
alteration of properties of ZP
prevent sperm penetration and
inactivate species specific receptor
prevent polyspermy

Fusion of oocyte and sperm cell

membranes
-interaction of integrins on oocyte
and disintegrins on sperm
-actual fusion of oocyte membrane
and membrane at POSTERIOR region
of sperm head
-head and tail of sperm enters
cytoplasm of oocyte cm left behind
on oocyte surface
-response of oocyte:
1. cortical and zona reactions
-impenetrable oocyte membrane
-altered structure and composition of
ZP
2. resumption of 2nd meiotic division
-immediately after entry of sperm
-2nd polar body (little cytoplasm) +
definitive oocyte
-vesicular nucleus: FEMALE
PRONUCLEUS
3. metabolic activation of the egg
-activating factor carried by sperm

Sperm nucleus swollen MALE PRONUCLUES tail detaches and degenerates

contact of male and female pronucleus lose nuclear envelopes replicate its own DNA normal
mitotic division split longitudinally at centromere

biochemistry:
ZP3 O linked glycoprotein
receptor for sperm on oocyte surface
galactosyltransferase on sperm surface attach to oligosaccharide chains of ZP3 transmembrane signalling
induction of acrosomal reaction liberation of acrosomal enzymes

PH30 (hamsters) binding of cm and subsequent fusion

Significance: drugs/ antibodies interfere with ZP3 and PH30 CONTRACEPTIVE AGENTS
Main results of fertilization:
1. restoration of diploid number of chromosomes
2. determination of sex
3. initiation of cleavage
Factors affecting fertilization:
1. abnormal zygotes lost within 2 3 weeks of fertilization
o 50% of pregnancies end in spontaneous abortion
o Half due to chromosomal abnormalities screening embryos for defects
2. Contraception
o Barrier methods
o Inhibit ovulation (COC) and permit menses
o IUD
o RU-486 abortion within 8 weeks of previous menses antiprogesterone agent initiate
menses
o Vasectomy/ tubal ligation
o Infertility: 15 30% of couples
3. IVF: GIFT/ ZIFT
4. Intracytoplasmic sperm injection for oligozoospermia/ azoospermia
CLEAVAGE
30 hours: 2 cell stage
o Series of mitotic divisions
o BLASTOMERES: cells become csmaller with each cleavage division
40 hours: 4 cell stage
o 8 cells: loosely arranged clump
o COMPACTION: blastomeres maximize contact with each other compact ball of cells held by
tight junctions

Segregates inner cells: gap junctions

Outer cells
3 days: 16 cell stage (morula/ mulberry)
o Inner cells: inner cell mass = embryo proper
o Outer cells: outer cell mass = trophoblast = placenta
4 days: late morula disappearance of ZP
BLASTOCYST FORMATION
Morula enters uterine cavity fluid begins to penetrate through ZP into intercellular spaces of inner
cell mass confluence of intercellular spaces BLASTOCELE
Morula blastocyst
o Inner cell mass = embryoblast
o Outer cell mass = trophoblast flatten and form epithelial wall of blastocyst
6th day:
o trophoblast over embryoblast pole: penetrate between epithelial cells of uterine mucosa
o integrins by trophoblast
o laminin on ECM promote attachment
o firbronectin on ECM stimulate migration
o interact along signal transduction pathways regulate trophoblast differentiation
implantation a result of mutual trophoblastic and endometrial action
Uterus at time of implantation
secretory phase:
o uterine glands and arteries coiled
o succulent tissues
3 distinct layers in endometrium:
o Superficial compact layer
o Intermediate spongy layer
o Thin basal layer
Implantation along anterior/ posterior wall of body of uterus embedded between openings of glands

If not fertilized: venules and sinusoidal spaces packed with blood cells extensive diapedesis of blood
into the tissue MENSTRUAL PHASE
o Escape of blood from superficial arteries
o Stroma and glands break away
o Expulsion of compact and spongy layers
o Basal layer retained supplied by BASAL ARTERIES regenerative layer in rebuilding glands
and arteries in PROLIFERATIVE PHASE

Main result of 1st week:

1. morula and blastocyst stages
2. implantation in uterine mucosa
Factors affecting implantation:
1. abnormal implantation sites
a. close to internal os: PLACENTA PREVIA during 2nd part of pregnancy and during delivery
BLEEDING!!!
b. Outside uterus: EXTRAUTERINE/ ECTOPIC PREGNANCY

95% in ampulla of oviduct (tubal)

Primary ovarian, abdominal cavity, rectouterine cavity, peritoneal covering of intestinal

tract/ omentum

Embryo dies about 2nd month severe hemorrhage and abdominal pain
2. Abnormal blastocyst 34.6%
o Corpus luteum does not persist
o Blastocyst aborted by menstrual flow
o H MOLE: Trophoblast develops and forms placental membranes with little or no embryonic
tissue

High HCG secreted: benign/ malignant choriocarcinoma

Cells diploid but entire genome is PATERNAL

3. Genetic diseases
o Deletion on chromosome 15: PRADER WILLII SYNDROME (father)
o Deletion on chromosome 15: ANGELMAN SYNDROME (father)
2nd WEEK: BILAMINAR GERM DISC
Day 8
-

partial embed in endometrial stroma

trophoblast differentiation
cytotrophoblast
syncytiotrophoblast
inner layer of
outer multinucleated zone
mononucleated cells
without distinct cell
boundaries
mitotic figures found
no mitotic figures
migrate to
syncytiotrophoblast fuse
and lose individual cell
membranes

embryoblast differentiation
hypoblast
epiblast
Small cuboidal cells
High columnar cells
adjacent to blastocyst
adjacent to amniotic cavity
cavity
Form a flat disc BILAMINAR GERM DISC
AMNIOTIC CAVITY:small cavity within apiblast
Amnioblast: epiblast cells adjacent to cytotrophoblast
and line amniotic cavity
Endometrial stroma: edematous and highly vascular;
large tortuous glands secrete abundant GLYCOGEN AND
MUCUS

Day 9
-

more deeply embedded

penetration defect in surface epithelium closed by fibrin coagulum
lacunar stage of trophoblast
embryoblast
- embryonic pole: vacuoles appear in syncytium
Hypoblast
-fusion of vacuoles large lacunae
-abembryonic pole: form
thin membrane
EXOCOELOMIC
(HEUSERS MEMBRANE):
lines inner surface of

cytotrophoblast
Exocoelomic cavity/
primitive yolk sac:
Lined by hypoblast +
Heusers membrane
Day 11
-

and 12
complete embedded blastocyst
surface epithelium entirely covers original defect in uterine wall
slight protrusion into lumen of uterus
DECIDUA REACTION:
o endometrial cells become polyhedral and loaded with glycogen and lipids
o intercellular spaces filled with extravasate and tissue edematous

Trophoblast
-lacunar spaces form intercommunicating network evident
at embryonic pole
-abembryonic pole: still mainly cytotrophoblast
Cytotrophoblast
Syncytiotrophoblast
-penetrate deeper into
stroma and erode
endothelial lining of
maternal capillaries
(SINUSOIDS)
-maternal blood enters
lacunar system
-establish UTEROPLACENTAL
CIRCULATION

Embryoblast
-growth slow compared to trophoblast: disc remains
samll

Hypoblast
Epiblast
EEM
-between inner surface of
cytotrophoblast and outer
surface of exocoelomic
cavity
-derived from yolk sac
cells
-forms fine loose
connective tissue which
eventually fills all of the
space between
(hypoblast cont.) trophoblast externally and amnion and exocoelomic membrane internally
-large cavities develop and become confluent CHORIONIC CAVITY/ EXTRAEMBRYONIC COELOM
>surrounds primitive yolk sac and amniotic cavity except at connecting stalk
1. extraembryonic somatopleuric mesoderm lining cytotrophoblast and amnion
2. extraembryonic splanchnopleuric mesoderm covering yolk sac
Day 13
healed surface defect in endometrium
occasional bleeding at implantation site because of increased blood flow into lacunar spaces usually
at 28th day of menstrual cycle
Trophoblast
Embryoblast
-villous structures
Cytotrophoblast
Syncytiotrophoblast
Hypoblast
Epiblast
-proliferate locally and
-additional cells that
*EEM = extraembroynic
penetrate
migrate along inside of
mesoderm
syncytiotrophoblast form
exocoelomic membrane
cellular columns
formation of SECONDARY
surrounded by syncytium =
YOLK SAC/ DEFINITIVE
PRIMARY VILLI
YOLK SAC
>new cavity within
exocoelomic cavity
>much smaller than
original primitive yolk sac
>large portions of
exocoelomic cavity pinched
off EXOCOELOMIC CYSTS

found at chorionic cavity

Extraembryonic coelom
-expands and forms large
cavity (chorionic cavity)
Chorionic plate:
EEM lining inside of
cytotrophoblast
Connecting stalk: only
place where EEM traverses
chorionic cavity
Main result of 2nd week: (week of twos)
2 apposed cell discs:
o Epiblast: floor of amniotic cavity
o Hypoblast: roof of secondary yoilk sac
Buccopharyngeal membrane: slight thickening in cephalic region of hypoblastic disc, firmly attached to
overlying epiblastic disc
2 cavities: Amniotic cavity, Primitive yolk sac
2 trophoblast: Cytotrophoblast, Syncytiotrophoblast
2 EEM: Somatopleuric (chorionic plate), Splanchnopleuric
3RD WEEK: TRILAMINAR GERM DISC
Gastrulation: formation of embryonic mesoderm and endoderm
Establishment of all 3 germ layers
Formation of PRIMITIVE STREAK on surface of epiblast
o 15 16 day: narrow groove with slightly bulging regions on either side
o PRIMITIVE NODE cephalic end of streak slightly elevated area surrounding PRIMITIVE PIT
Epiblast migrate toward primitive streak become flask shaped detach from epiblast slip
beneath it (INVAGINATION) displace hypoblast(ENDODERM); lie between epiblast and endoderm
(MESODERM); cells remaining (ECTODERM)
Epiblast = source of all germ layers
o Spread laterally and cephalad migrate beyond margin of disk contact with EEM
o Pass on each side of prechordal plate

Lies between tip of notochord and buccopharyngeal membrane (caudal to it)

Function: induction of forebrain

Formation of notochord
PRENOTOCHORDAL CELLS: invaginate in primitive pit move forward and cephalad reach
PRECHORDAL PLATE
o Intercalated in hypoblast midline of embryo: 2 cell layers of NOTOCHORDAL PLATE
(HYPOBLAST + PRENOTOCHORDAL CELLS)
o Hypoblast replaced by endoderm cells proliferation of cells of notochordal plate
detachment from endoderm cells DEFINITIVE NOTOCHORD
DEFINITIVE NOTOCHORD: underlies neural tube and serve as basis for axial skeleton
o Cranial end forms first
o Caudal regions added as primitive streak assumes more caudal position
o Notochord and prenotochordal cells extend cranially to prechordal plate and caudally to
primitive pit
NEURENTERIC CANAL: point where primitive pit forms indentation in epiblast
o Temporary connection of amniotic and yolk sac cavities
CLOACAL MEMBRANE
o Caudal end of embryonic disc
o Similar in structure to prechordal plate
o Tightly adherent ectoderm and endoderm; NO MESODERM
o Formation of diverticulum that extends into connecting stalk at posterior wall of yolk sac
allantoenteric diverticulum/ ALLANTOIS (16th day)

Rudimentary in humans

Involved in abnormalities of bladder

Fate map established during gastrulation

Notochord: cells that ingress through cranial region of node
Paraxial mesoderm: cells migrating at lateral edges of node and from cranial end of streak
Intermediate mesoderm: cells migrating through mistreak
Lateral plate of mesoderm: cells migrating through caudal part of streak
Difference between mesenchyme and mesoderm
Mesenchyme: loosely organized embryonic connective tissue regardless of origin
Mesoderm: cells derived from epiblast and extraembryonic tissues
Growth of embryonic disc
Initially flat elongated with broad cephalic and narrow caudal end
Expansion mainly in cephalic region with primitive streak region remain same size continuous
migration of cells from primitive streak in cephalic direction continues until 4th week regressive
changes, shrinking, disappearance of primitive streak
Cephalocaudal development of embryo:
o Middle of third week: differentiation of cephalic part
o End of fourth week: differentiation of caudal part
Further development of trophoblast
3rd week: PRIMARY VILLI
o Cytotrophoblastic core covered by syncytial layer
SECONDARY VILLI
o Mesoderm cells penetrate core of primary villi and grow toward deciduas
End of 3rd week: TERTIARY VILLI/ DEFINITIVE PLACENTAL VILLI
o Differentiation of mesodermal cells into blood cells and small blood vessels villous capillary
system contact capillaries in connecting stalk and chorionic plate contact with
intraembryonic circulatory system
o 4th week: HEART begins to beat villous system ready to supply embryo
OUTER CYTOTROPHOBLAST SHELL: cytotrophoblastic cells penetrate into overlying syncytium reaching
maternal endometrium contact with similar extensions of neighboring villous stems
o Surrounds trophoblast entirely and attaches chorionic sac firmly to maternal endometrial tissue
STEM/ ANCHORING VILLI: villi that extend from chorionic plate to deciduas basalis
FREE/ TERMINAL VILLI: villi that branch from sides of stem villi (exchange of nutrients occur)
19 20th day: enlargement of chorionic cavity and attachment of embryo to trophoblastic shell by ONLY
connecting stalk UMBILICAL CORD
3rd to 8th WEEK (2nd month): EMBRYONIC PERIOD/ PERIOD OF ORGANOGENESIS
-

Germ layers give rise to specific tissues and organs

Main organ system establishment

Derivatives of ectodermal germ layer

Organs and structures that maintain contact with outside world
Shape of a disc broader in cephalic than caudal
Notochord and prechordal mesoderm induces ectoderm thickening NEURAL PLATE
NEUROECTODERM: cells making up neural plate
o Induction represents initial event of NEURULATION
NEURULATION
o Neural plate extends to primitive streak
o End of 3rd week: lateral edges of neural plate more elevated NEURAL FOLDS
o Depressed midregion NEURAL GROOVE
o Neural folds approach each other in midline and fuse at 5th somite (future neck) and proceeds
cephalad and caudad NEURAL TUBE
o CRANIAL & CAUDAL NEUROPORES: cephalic and caudal ends of neural tube which
communicate with amniotic cavity

25th day (18 20 somite): closure of cranial neuropore

27th day (25 somite): closure of posterior neuropore

Completion of neurulation
o CNS representation:

Closed tubular structure (neural tube)

Narrow caudal portion: spinal cord

Broad cephalic portion: brain vesicles

Neural crest cells: dissociate as neural folds elevate and fuse

Epithelial to mesenchymal transition as it leaves neuroectoderm by active migration

and displacement of underlying mesoderm
2 bilateral ectodermal thickenings in cephalic region:

Otic placodes invaginate OTIC VESICLES hearing/ maintenance of equilibrium

Lens placodes invaginate LENSES OF EYE (5th week)

Derivatives of mesodermal germ layer

Thin sheet of loosely woven tissue on each side of the midline
17th day: proliferation of cells close to midline thickened plate of tissue PARAXIAL MESODERM
LATERAL PLATE: mesoderm layer more laterally that remains thin coalescence of intercellular
cavities:
o Somatic/ parietal mesoderm layer = continuous with mesoderm covering amnion
o Splanchnic/ visceral mesoderm layer = continuous with mesoderm covering yolk sac
o Intraembryonic cavity = formed by the two layers continuous with extraembryonic cavity
(chorionic cavity) on each side of the embryo
o Intermediate mesoderm = connects paraxial and lateral plate mesoderm
PARAXIAL MESODERM
3rd week: organized into segments SOMITOMERES
o Formation proceeds cephalocaudally
o Mesodermal cells arranged in concentric whorls around the center of the unit
o Head region: form in association with segmentation of neural plate into NEUROMERES
majority of head mesenchyme
o Occipital region caudally: somitomeres somites
-

SOMITES
o 20th day: 1st pair in cervical region
o 3 pairs per day
o End of 5th week: 42-44 pairs present:

Occipital = 4

Cervical = 8

Thoracic = 12

Lumbar = 5

Sacral = 5

Coccygeal = 8-10

1st occipital and last 5-7 coccygeal somites later disappear

o Formation of AXIAL SKELETON
o Age of embryo expressed in number of somites
o 4th week: ventral and medial walls of somite lose compact organization polymorphous
shift position to surround notochord SCLEROTOME form loosely woven tissue
MESENCHYME
o Dorsolateral portions migrate precursors of limb and body wall musculature
o Dorsomedial portion proliferate and migrate down to ventral side of remaining dorsal
epithelium of somite MYOTOME
o Remaining dorsal epithelium DERMATOME lose epithelial configuration after ventral
extension of myotome spread out under overlying ectoderm to form dermis
o Myotome + dermatome = dermomyotome

INTERMEDIATE MESODERM
Temporarily connects paraxial and lateral plate mesoderm
Cervical and upper thoracic regions: segmental cell clustures (NEPHROTOMES)
CAUDALLY: unsegmented mass of tissue (NEPHROGENIC CORD)
LATERAL PLATE MESODERM
Splits into 2 layers which line intraembryonic cavity and surround the organs (see table)
BLOOD AND BLOOD VESSELS
3RD week: visceral mesoderm of wall of yolk sac blood cells and blood vessels
Angioblasts isolated cell clusters and cords angiogenic cell clusters canalized by confluence of
intercellular clefts

Central cells: primitive blood cells programmed cell death as embryo develops and replaced by fetal
cells
o May arise from dorsal mesentery/ yolk sac
o Colonize liver (major hematopoietic organ of fetus)
o Migration again to bone marrow (source of adult blood cells)
Peripheral cells: flatten endothelial cells lining BLOOD ISLANDS approach each other rapidly
small vessels
Development of blood cells and capillaries in EEM of villous stems and connecting stalk establish
contact with inside embryo
Establish intraembryonic blood cells and blood vessels (heart tube) in the same way

Derivatives of endodermal germ layer

GIT as main organ system derivative
CEPHALOCAUDAL FOLDING: rapid longitudinal growth of CNS
LATERAL/ TRANSVERSE FOLDING: produced by formation of rapidly growing somites
VITELLINE DUCT: narrow constricting long duct communication between embryo and yolk sac as a
result of folding movements from initial wide communication
Covers ventral surface of embryo and forms roof of yolk sac
-

Development of brain vesicles embryonic disc bulges to amniotic cavity cephalocaudal folding:
o Head fold
o Tail fold

Result: larger portion of endoderm lined cavity incorporated into body of embryo
proper
FOREGUT: anterior part of endoderm temporarily bounded by ectodermal-endodermal membrane
BUCCOPHARYNGEAL MEMBRANE
o 4TH week: rupture of membrane open communication between amniotic cavity and primitive
gut
HINDGUT: tail region temporarily terminates by ectodermal-endodermal membrane CLOACAL
MEMBRANE
o 7th week: rupture of membrane opening for anus
MIDGUT: between foregut and hindgut temporarily communicates with yolk sac by vitelline duct
Rapid growth of somites rounded appearance of embryo
Ventral body wall established except for a small part in ventral abdominal region where yolk sac duct
and connecting stalk attached
Body folding communication of midgut and yolk sac long and narrow vitelline duct obliterated
later lose connection with endoderm lined cavity
Partial incorporation of allantois into body of embryo CLOACA
o 5TH week: yolk sac duct, allantois, umbilical vessels and umbilical ring
Yolk sac = only nutritive role in early stages 2nd month: lies in chorionic cavity

External appearance during 2nd month

4th week 28 somite stage: somites and pharyngeal arches
Age of embryo expressed as somites
Difficult to count somites crown rump length in mm vertex of skull to midpoint between apices of
buttocks
Greatly changed by enormous size of head and formation of limbs, face, ears, nose, eyes
5th week: forelimbs and hindlimbs appear as paddle shaped buds
o Forelimbs dorsal to pericardial swelling at 4th cervical to 1st thoracic somites innervations by
brachial plexus
o Hindlimbs appear slightly later caudal to attachment of umbilical stalk at lumbar and upper
sacral somites
o Flattening of terminal portions of buds FIRST circular constriction separates them from
proximal cylindrical segment
o 4 radial grooves (RAYS) separating 5 slightly thicker areas on distal portion of buds
formation of digits

Appear in hand region first foot (upper limb more advanced in development)

SECOND constriction divides proximal portion of buds into 2 segments

Ectoderm

Neural crest
derivatives

Mesoderm
Supporting tissues = connective tissue, cartilage, bone
Striated and smooth musculature

Endoderm

CNS
PNS
Sensory
epithelium of
ear, nose, eye
Epidermis (hair
and nails)
SQ glands,
mammary
glands,
pituitary gland
Enamel of
teeth

Connective
tissue and
bones of face
and skull
Cranial nerve
ganglia
C cells of thyroid
gland
Conotruncal
septum in heart
Odontoblasts
Dermis in face
and neck
Spinal root
ganglia
Sympathetic
chain and
preaortic
ganglia
Parasympathetic
ganglia of GIT
Adrenal medulla
Schwann cells
Glial cells
Arachnoid and
pia mater
Melanocytes

Blood and lymph cells and walls of heart, blood, lymph

vessels
Kidneys, gonads and corresponding ducts
Cortical portion of suprarenal gland
spleen
Paraxial
Intermediate
Lateral plate
mesoderm
mesoderm
of mesoderm
Sclerotome Surround the spinal
cord and notochord
Forms vertebral
column
Myotome - Muscles
of the back (epiaxial
musculature)

Urogenital
structures
Nephrotomes
and
nephrogenic
cord: excretory
units of urinary
system and the
gonads

Dermatomes Disperse to form

dermis and SQ
tissue of skin
*Each myotome and
dermatome retains
its innervations
from segment of
origin no matter
where cells migrate
*each somite forms
its own sclerotome
(cartilage and
bone), myotome
(segmental muscle
component),
dermatome
(segmental skin
component)

Parietal
mesoderm +
ectoderm =
lateral and
ventral body
wall
Visceral
mesoderm +
endoderm =
wall of the gut
Mesoderm cells
of parietal layer
= mesothelial
membranes/
serous
membranes
(peritoneal,
pericardial,
pleural
cavities)
Mesoderm cells
of visceral
layer = thin
serous
membrane
around each
organ

Epithelial
lining of
primitive gut
and
intraembryoni
c portions of
allantois and
vitelline duct
Epithelial
lining of
respiratory
tract
Parenchyma of
thyroid,
parathyroids,
liver, pancreas
Reticular
stroma of
tonsils and
thymus
Epithelial
lining of
urinary
bladder and
urethra
Epithelial
lining of
tympanic
cavity and
auditory tube

3RD MONTH TO BIRTH: FETAL PERIOD

Development of fetus
Maturation of tissues and organs and rapid growth of the body
Few structural birth defects although deformations and disruptions may occur
Time for prenatal screening to detect birth defects
CNS vulnerable postnatal behavioural distrubnces, learning disabilities, lowered intelligence
Length of fetus = CRL (sitting height) / CHL(standing height) expressed in cm
Crown heel length vertex of skull to heel
Growth in length = 3 5months
Growth in weight = last 2 months
280 days/ 40 weeks after onset of LNMP/ 266 days or 38 weeks after fertilization
Monthly changes

Time
-

Relative slowdown in growth of head compared with rest of body

3rd month: head approx. half of CRL
5th month: head 1/3 of CHL
Birth: of CHL
3rd month
o face more human looking
o eyes initially directed laterally ventral aspect of face
o ears lie close to definitive position on side of head
o limbs relative length with rest; lower limbs still shorter
o primary ossification centers
o external genitalia intestinal loops withdraw into abdominal cavity (large swelling in umbilical
cord during 6th week)
o reflex activity unnoticeable
4th 5th month
o Lengthens rapidly
o CRL 15cm half of newborn
o <500g
o Lanugo hair
o Eyebrows and head hair
o Clear movements of the fetus
2nd half of intrauterine life Increase in weight last 2.5 months 50% of full term weight added
6th month
o Reddish skin with wrinkled appearance
o Lack of underlying connective tissue
o Great difficulty surviving if born
o Respiratory system and CNS not differentiated and coordination not established
Last 2 months
o Deposition of SQ fat well rounded contours
o Vernix vaseosa (secretory products from sebaceous glands)
o 28 weeks: able to survive with great difficulty
9th month:
o Skull largest circumference
o 3000-3400g/ 36cm CRL/ 50cm CHL
o Pronounced sexual characteristics
o Testes in scrotum
of birth
Most pregnancies occur when intercourse within 6 day period that ends on day of ovulation
40 weeks/ 280 days from FIRST DAY of LNMP

Additional notes on development of embryonic membranes:

Amnion = 8th day
Secondary yolk sac =
Primary yolk sac = 9th
13th day
day
Chorion = 13th day

Allantois = 16th day

Umbilical cord = 5th
week

10

AMNION AND UMBILICAL CORD

Primitive umbilical ring oval line of reflection between amnion and embryonic ectoderm (AMNIOECTODERMAL JUNCTION)
5TH week: (structures that pass through ring)
o Connecting stalk: allantois + umbilical vessels (AVA)
o Yolk sac (vitelline duct) with vitelline vessels occupies space in chorionic cavity (space
between amnion chorionic plate)
o Canal connecting intraembryonic and extraembryonic cavities
Enlargement of amniotic cavity at the expense of chorionic cavity amnion evelops the connecting
stalk and yolk sac stalks crowding them together UMBILICAL CORD
o Distal: yolk sac stalk and umbilical vessels
o Proximal: intestinal loops and remnant of allantois
o End of 3rd month: expansion of amnion comes in contact with chorion obliterate chorionic
cavity and yolk sac and intestinal loops are withdrawn; allantois and vitelline duct and its
vessels also obliterated

Whartons jelly + umbilical vessels all that remains in umbilical cord

Whartons jelly rich in proteoglycans protective layer for blood vessels

Walls of artiereis muscular rapid constriction and contraction of umbilical vessels

after cord is tied off
Physiological umbilical hernia:
o Abdominal cavity too small for rapidly developing intestinal loops pushed into
extraembryonic space
PLACENTAL CHANGES AT END OF PREGNANCY
Reduced exchange between 2 circulations
o Increase fibrous tissue in core of villus
o Thickening of basement membranes of fetal capillaries
o Obliterative changes in small capillaries of villi
o Deposition of fibrinoid on surface of villi in the junctional zone and in the chorionic plate

Excessive fibrinoid formation infarction of an intervillous lake and sometimes entire

cotyledon cotyledon assumes whitish appearance
AMNIOTIC FLUID
Clear, watery fluid by amniotic cells
Derived primarily from MATERNAL BLOOD
10weeks: 30ml
20 weeks: 450 ml
37 weeks: 800-1000ml
Suspension of umbilical cord in this fluid protective cushion
o Absorbs jolts
o Prevents adherence of embryo to amnion
o Allows fetal movements
Fluid replaced every 3 hours
Beginning of 5th month: swallowing of amniotic fluid 400ml/day and fetal urine
Amnio-chorionic membrane forms hydrostatic wedge that helps dilate cervical canal
Parturition (birth)
34 38 weeks: myometrium does not respond to signals for parturition (birth)
Last 2 4 weeks: transitional phase in preparation for onset of LABOR
o Thickening of myometrium in upper region of uterus
o Softening and thinning of lower region and cervix
3 STAGES OF LABOR:
1. Effacement thinning and shortening and dilatation of cervix
o Produced by uterine contractions that force amniotic sac against cervical canal like a wedge
o If ruptured amniotic membranes presenting part of fetus (head usually)
2. Delivery of fetus
o Assisted by uterine contractions

o Most important force: contraction of abdominal muscles increased intra-abdominal pressure

Delivery of placenta and fetal membranes
o Requires uterine contractions and aided by increase intra-abdominal pressure
Uterine contractions: upper part retracts (smaller lumen) lower part expands
3.

TWINNING
Dizygotic twins
(fraternal)
2/3 of twins; incidence:
7-11/ 1000 births and
increases with maternal
age
Simultaneous shedding
of 2 oocytes and
fertilization of different
spermatozoa
Zygotes totally different
genetic constitutions
-no more resemblance
than any other brothers/
sisters
-may not be of different
sex

Monozygotic twins (identical)

3-4/1000 births

Develops from single fertilized ovum

Partners of monozygotic pair

-strong resemblance in blood groups, fingerprints, sex, external appearance
(eye, hair color)

Splitting at 2 cell stage

(earliest)

2 separate zygotes
develop separate
implantation
Own amnion
Own placenta but 2
placentas close together
may fuse
Own chorionic sac but
Chorionic sacs may also
fuse
Erythrocyte mosaicism
each twin possesses RBC
of 2 different types
fusion of 2 placentas so
intimate that RBCs were
exchanged

2 separate zygotes
develop separate
implantation
Own amnion
Own placenta

Own chorionic sac

Splitting at early
blastocyst stage (usual)
2 separate groups of
cells within same
blastocyst cavity
Same implantation site

Splitting at bilaminar
germ disc stage just
before appearance of
primitive streak

Own amnion
Common placenta

Common amnion
Common placenta

Common chorionic sac

Common chorionic sac

Same implantation site

Blood supply at placenta

usually well balanced

Twin defects
Twin pregnancies high incidence of mortality and morbidity tendency toward preterm delivery
12% of premature infants are twins usually small at birth
Twins are conceived more often than they are born
o Vanishing twin death of one fetus during first trimester or early 2 nd trimester; may result from
resorption or formation of a fetus papyraceus
o Twin transfusion syndrome 5-15% of monochorionic monozygotic pregnancies

One twin receives most of blood flow and flow to the other compromised one twin
larger

Placental vascular anastomosis occur in a balanced arrangement in most

monochorionic placentas

Conjoined (Siamese) twins: partial splitting of the primitive node and streak
o Thoracopagus (thorax)
o Pygopagus (buttocks)
o Craniopagus (head)