CONCEPTION

FETAL DEVELOPMENT &

GENETICS
Chapter 10
Mary L. Dunlap MSN,
Fall 2015
 Fetal Development

• Measured in the number of weeks

after fertilization
• Average pregnancy lasts 280 days
or 40 weeks from the date of the
last menstrual period (LMP)
• Fertilization usually occurs 14 days
after the LMP
 Three Stages of
Fetal Development

• Preembryonic stage: fertilization

through the second week
• Embryonic stage: end of second
week through the eighth week
• Fetal stage: ninth week until birth
 Preembryonic Stage
(Stage 1)

• Fertilization - union of the ovum and

sperm in the outer 3rd of the fallopian
tube creating a zygote
• The union restores the diploid number of
46 chromosomes
 Fetal Development

• Fertilization
 Preembryonic Stage
(Stage 1)
• Zygote undergoes cleavages
(mitosis) as it is transported to the
uterine cavity in 72⁰
• Cleavages create a ball of 16 cells
called a morula, which divides into
cells that form fetal structures
 Preembryonic Stage
(Stage 1)
• Blastocysts - inner cells form the
embryo and the amnion
• Trophoblasts - outer cells form the
embryonic membranes, Chorion and
placenta
• Implantation in the endometrium
occurs between the 7th to 10th day.
 Embryonic Stage
(Stage 2)
Fetal membranes start forming
around the time of implantation
• Decidua- endometrial linning
• Chorion-placenta
• Embryonic germ layers- ectoderm,
mesoderm, endoderm
• Amnion- lines the amniotic sac &
forms the umbilical cord
 Embryonic Stage
(Stage 2)
Amniotic Fluid
• Surrounds embryo,
• Helps maintain a constant body
temperature for the fetus
• Permits symmetric growth and
development
• Cushions the fetus from trauma
 Embryonic Stage
(Stage 2)
Amniotic Fluid Function
• Allows the umbilical cord to be relatively
free of compression
• Promotes fetal movement to enhance
musculoskeletal development
 Embryonic Stage
(Stage 2)
Umbilical cord
•Life line between mother and embryo
•1 large vein & 2 small arteries (AVA)
•Wharton’s jelly surrounds the blood
vessels preventing compression
•Term length 22 in. / 1 in. wide
•Central insertion site on the placenta
 Embryonic Stage
(Stage 2)
Placenta
•Functioning by end of the 3rd wk.
•Produces hormones that control the
basic physiology of the mother and near
term mature fetal organs for life outside of
the uterus
•Protects the fetus from immune attack by
the mother
•Removes waste produced by the fetus
 Embryonic Stage
(Stage 2)
• Placental barrier prevents the mix of
maternal blood with fetal blood
Placental Hormones
• Human chorionic gonadotropin (hCG)
• Human placental lactogen (hPL)
• Estrogen, progesterone
• Relaxin
 Embryonic Stage

• Maternal Fetal circulation via the

placenta
 Development

• Embryonic and Fetal Development

• Table 10-1 p 286-287
 Development

• Fetal Development
 Development

Embryonic stage 3rd to 8th wk.

•Neural tube forms
•Brain waves detectable
•Heart development completed and beats
•Arms and legs move
•Resembles a human being
•Weight 1gram
 Fetal Stage
(Stage 3)
9Th week to Birth
•12 wks.- heart beat heard with Doppler,
sex is distinguishable, placenta formation
completed
•13-16 wks.- fetal movement (quickening)
felt by mother
•17-20 wks.- heart beat can be heard with
a stethoscope
 Fetal Stage
(Stage 3)
• 21-24 wks.- lungs produce surfactant
• 24-32 wks.- alveoli begin to mature,
eyelids can open and close, increase in
subcutaneous fat
• 32-40 wks.- fetus kicks actively, lanugo
decrease, weight 7-8 lb’s
Length 17.3-19.2 in
 Fetal Circulation
• Needed to sustain the fetus
• Must develop quickly and accurately
since the fetal nutrient needs Increase
as the embryo advances to a fetus
• Oxygen received from the placenta
• Placenta functions for the fetal lungs
and liver
 Fetal Circulation
Three unique shunts
• Ductus Venosus
• Foramen Ovale
• Ductus Arteriosus
• Fetal Circulation Prior to Birth
• Foramen Ovale & Ductus Arteriosus
 Genetics

• Human Genome Project 1990

• International 13 year study
• Goal map the human genome
• Better understanding how genetic
changes contribute to disease
• Helped develop new strategies for
prevention, diagnosing and treating
diseases and disorders
 Genetics
• Genetic services are becoming an
integral part of medical care.
• Diagnostic procedures have provide the
opportunity to increase survival rates.
• Nursing needs basic knowledge to be
able to help their patients.
 Genetic Disorders

• Result from abnormalities in patterns of

inheritance or chromosomal
abnormalities
 Chromosomal Abnormalities
• 1 in 33 infants born in the U.S. have birth
defects and genetic disorders
• Numeric abnormalities
• Structural abnormalities
 Numeric Abnormalities

• Often result due to failure of the

chromosome pair to separate
• Few of these abnormalities are
compatible with normal development
and end in spontaneous abortion
• Two common abnormalities
Monosomies and Trisomies
 Numeric Abnormalities

• Monosomies-missing a chromosome
only one instead of a pair
• Trisomies - three of a particular
chromosome
• Trisomy 21(Down syndrome)
 Structural Abnormalities

• Breakage and loss of a portion of one or

more chromosomes and the broken
ends rejoin incorrectly
• Altered structure can be a deletion,
duplication, inversion or translocation
• Mutation
 Structural Abnormalities

• Cystic fibrosis
• Phenylketonuria
• Sickle cell
• Tay-Sacks
 Structural Abnormalities
• Huntington's disease
• Polycystic kidney disease
• Cri du Chat syndrome
• Fragile X syndrome
 Threats to Development
The following are capable of inducing
abnormal fetal structure or function by
interfering with normal fetal development
•Teratogens
•Medications
•TORCH infections
 Genetic Evaluation and
Counseling
• Genetic counseling is an evaluation of
an individual to confirm, diagnose or rule
out a genetic condition.
 Genetic Evaluation and
Counseling
• Ideal time: before conception
“ preconception counseling provides
the opportunity to identify, reduce,
and plan for potential risks.
 Genetic Evaluation and
Counseling

• Reasons an individual should be

referred to genetic counseling (see Box
10-2 Pg.302)
 Genetic Evaluation and
Counseling
• Genetic Testing
• Genetic Counseling
• Discussion about Genetic Counseling
 Nurse’s Role
• Discussing costs, benefits, and risks of
using health insurance, and potential
risks of discrimination
• Recognizing ethical, legal, and social
issues
• Safeguarding privacy and confidentiality
• Monitoring emotional reactions after
receiving information
 Nursing Role

• Providing emotional support

• Referring to appropriate support groups
• Beginning the preconception
counseling process and referring for
further genetic information
• Taking a family history (Box 10-4 Pg.
257)
 Nursing Role

• Scheduling genetic testing

• Explaining the purposes, risks/benefits
of all screening and diagnostic tests
(see Laboratory and Diagnostic Tests
10-1 Pg. 258)
• Answering questions and addressing
concerns
 Prenatal Testing and Hard
Choices
• http://www.youtube.com/watch?v=7rrA4F_
NY3w
 Antepartum Testing

• Understanding Prenatal testing

 Antepartum Testing
• Alpha-fetoprotein
• Amniocentesis • Fetal nuchal
• Chorionic villus translucency
sampling • Level II
• Percutaneous ultrasound
umbilical blood • Triple marker
sampling test
 Antepartum Testing

• Alpha-fetoprotien
• Diagnostic Amniocentesis
• Chorionic Villus Sampling CVS
• Percutaneous umbilical blood sampling
PUBS
• Fetal nuchal translucency
• Types of Ultrasounds 7 min
• Quad screen