FETAL DEVELOPMENT

Mrs.Juliet Baclig Aguilar Hipolito Rn, MAN

"Life is present from the moment of conception.

"A person's a person, no matter how small!"

 The sperm produced from male and the eggs produced by females are very important to the reproduction of children. During puberty males start to produce sperm in the testes, sperm has three distinct parts; a head, middle piece, and tail. The head is covered in enzymes needed to penetrate the egg while the middle provides energy for the tail made of flagellum to propel its self threw the cervix to an egg. The only function of sperm is too carry the 23 chromosomes to the egg.

 The ovaries of women produce eggs along with hormones. A women usually ovulates once a month which is when the ovary releases an egg to be fertilized. If the egg is not fertilized then menstruation takes place. If the egg is fertilized the it will attach its self to the lining of the uterus.

FERTILIZATION
When sperm is deposited in the vagina, it travels through the cervix and into the Fallopian tubes. Fertilization usually takes place in the Fallopian tube. A single sperm penetrates the mother's egg cell, and the resulting cell is called a zygote. The zygote contains all of the genetic information (DNA) necessary to become a child. Half of the genetic information comes from the mothers egg, and half from the fathers sperm.

 The zygote spends the next few days traveling down the Fallopian tube and divides to form a ball of cells. Further cell division creates an inner group of cells with an outer shell. This stage is called a "blastocyst". The inner group of cells will become the embryo, while the outer group of cells will become the membranes that nourish and protect it.

 The blastocyst reaches the uterus at roughly the fifth day, and implants into the uterine wall on about day six. At this point in the mother's menstrual cycle, the endometrium (lining of the uterus) has grown and is ready to support a fetus. The blastocyst adheres tightly to the endometrium, where it receives nourishment via the mother's bloodstream. The cells of the embryo now multiply and begin to take on specific functions. This process is called differentiation, which produces the varied cell types that make up a human being (such as blood cells, kidney cells, and nerve cells).

 There is rapid growth, and the baby's main external features begin to take form. It is during this critical period of differentiation (most of the first trimester) that the growing baby is most susceptible to damage from: Alcohol, certain prescription and recreational drugs, and other substances that cause birth defects Infection (such as rubella or cytomegalovirus) Radiation from x-rays or radiation therapy Nutritional deficiencies

3.5 weeks
will have formed the heart begins development of the brain and spinal cord starts forming the gastrointestinal tract

 Once in the uterus, the developing embryo, called a blastocyst, searches for a nice place to implant, where it actually burrows beneath the surface of the uterus. The yolk sac, shown on the left, produces blood cells during the early weeks of life. The unborn child is only one-sixth of an inch long, but is rapidly developing. The backbone, spinal column, and nervous system are forming. The kidneys, liver, and intestines are taking shape.

7.5 weeks
the eyes move forward on the face and eyelids begin to form the palate is nearing completion and the tongue begins to form gastrointestinal tract separates from the genitourinary tract all essential organs have begun to form

 Facial features are visible, including a mouth and tongue. The eyes have a retina and lens. The major muscle system is developed, and the unborn child practices moving. The child has its own blood type, distinct from the mother's. These blood cells are produced by the liver now instead of the yolk sac.

8.5 weeks
the embryo now resembles a human facial features continue to develop beginnings of external genitalia form anal passage opens, but the rectal membrane is intact circulation through the umbilical cord is well developed long bones begin to form

 The unborn child, called a fetus at this stage, is about half an inch long. The tiny person is protected by the amnionic sac, filled with fluid. Inside, the child swims and moves gracefully. The arms and legs have lengthened, and fingers can be seen. The toes will develop in the next few days. Brain waves can be measured.

10 weeks
A fetus at 10 weeks of development has fully formed eyelids and well-formed digits and ears.

 The heart is almost completely developed and very much resembles that of a newborn baby. An opening the atrium of the heart and the presence of a bypass valve divert much of the blood away from the lungs, as the child's blood is oxygenated through the placenta. Twenty tiny baby teeth are forming in the gums.

12 weeks
A fetus at 12 weeks can make a fist and suck its thumb.

 Vocal chords are complete, and the child can and does sometimes cry (silently). The brain is fully formed, and the child can feel pain. The fetus may even suck his thumb. The eyelids now cover the eyes, and will remain shut until the seventh month to protect the delicate optical nerve fibers.

16 weeks
At week 16, the fetus: reaches a length of about 6 inches makes active movements makes sucking motions with the mouth

 Five and a half inches tall and only six ounces in weight, eyebrows, eyelashes and fine hair appear. The child can grasp with his hands, kick, or even somersault.

24 weeks
At 24 weeks the fetus: has fully developed eyes has a hand and startle reflex is forming footprints and fingerprints is forming alveoli in lungs

 Seen here at six months, the unborn child is covered with a fine, downy hair called lanugo. Its tender skin is protected by a waxy substance called vernix. Some of this substance may still be on the child's skin at birth at which time it will be quickly absorbed. The child practices breathing by inhaling amnionic fluid into developing lungs.

26-28 weeks
At 26 to 28 weeks a fetus: is rapidly developing its brain controls some body functions has eyelids which open and close has a rapidly developing respiratory system

32 weeks
At 30 to 32 weeks a fetus: has increased central nervous system control over body functions has rhythmic breathing movements is still developing lungs is partially in control of body temperature

 For several months, the umbilical cord has been the baby's lifeline to the mother. Nourishment is transferred from the mother's blood, through the placenta, and into the umbilical cord to the fetus. If the mother ingests any toxic substances, such as drugs or alcohol, the baby receives these as well.

40 weeks
The baby, now approximately seven and a half pounds, is ready for life outside its mother's womb. At birth the placenta will detach from the side of the uterus and the umbilical cord will cease working as the child takes his first breaths of air. The child's breathing will trigger changes in the structure of the heart and bypass arteries which will force all blood to now travel through the lungs.

LABOR
Labor is a physiologic process during which the products of conception (ie, the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration.

 Labor is a clinical diagnosis. The onset of labor is defined as regular, painful uterine contractions resulting in progressive cervical effacement and dilatation. Cervical dilatation in the absence of uterine contraction suggests cervical incompetence, whereas uterine contraction without cervical change does not meet the definition of labor.

True vs. False

True labor -Contractions occur at regular intervals -Intervals gradually shorten -Intensity gradually increases -Discomfort is in back and abdomen -Cervix dilates -Discomfort is not stopped by sedation -Bloody show may be present False labor -Contractions occur at irregular interval -Intervals remain long -Intensity remains unchanged -Discomfort is mainly in lower abdomen -Cervix does not dilate -Discomfort is usually relieved by sedation -Usually no bloody show (unless pt has had vaginal exam)

Admission History
1. Identifying information, e.g., name, age, race, etc 2. Labor history - contractions, bloody show, status of membranes, vaginal bleeding, last meal, headache, visual disturbances, dysuria 3. Pregnancy history - LMP, EDC, gestation, where received antepartal care, AP complications and treatment, drugs and medications during pregnancy, any special tests during pregnancy (eg, ultrasound, amniocentesis.) 4. Past obstetric history - gravida, parity, complications' during previous pregnancies, length of last labor, type of delivery (SVD, forcep, CS) size of largest and smallest babies, any fetal or neonatal deaths. 5. Past medical and surgical history (include gyn history) 6. Family history 7. Social history - not just alcohol, tobacco, drugs and STDS. Ask about work outside home, marital status, is partner/father of the baby supportive, who has accompanied her to labor suite, etc. Also need to ask about birth plans, anesthesia, will partner participate, breastfeeding, plans for postpartum sterilization. 8. Prenatal records (if available) may provide much of this information, which will only need to be confirmed.

Stages of Labor
First stage of labor The first stage begins with regular uterine contractions and ends with complete cervical dilatation at approximately 10 cm. In his landmark studies of 500 nulliparas, Friedman (1955) subdivided the first stage into an early latent phase and an ensuing active phase. The latent phase describes the period between the onset of labor and when the rate of cervical dilatation changes most rapidly, usually at about 3-4 cm of cervical dilatation. The active phase heralds a period of increased rapidity of cervical dilation and ends with complete cervical dilation of 10 cm. According to Friedman, the active phase is further divided into an acceleration phase, a phase of maximum slope, and a deceleration phase.

Cervical Effacement and Dilation

Second stage of labor The second stage begins with complete cervical dilatation and ends with the delivery of the fetus. Third stage of labor The third stage of labor lasts from the delivery of the fetus until the delivery of the placenta and fetal membranes. Although delivery of the placenta requires less than 10 minutes, the duration of the third stage of labor may last as long as 30 minutes before active intervention is commonly considered Fourth Stage of Labor Begins with delivery of the placenta and ends one-to-two hours after delivery.

Mechanism of Labor

A.

Descent - occurs throughout labor, most dramatic during 2-nd stage. In primigravidas, considerable descent occurs before onset of labor. In multiparas, descent may not occur until labor is advanced. Brought about by downward pressure of uterine contractions, bearing down efforts of the mother, and gravity. B. Flexion - partial flexion is the natural attitude of the fetus in utero. Resistance to descent leads to increased flexion. Flexion is usually complete by he time the presenting part reaches the pelvic floor. Effectively changes the presenting diameter from the occipito-frontal of 11.0 cm to the smaller and rounder suboccipitobregmatic of 9.5 cm.

C.

Internal rotation- In the majority of pelvises the inlet is a transverse oval. The AP diameter of the midpelvis is a little longer than the transverse diameter. The outlet is an anteroposterior oval. So in order for the fetal head to accommodate to the maternal pelvis, it must rotate while it descends. When the occiput contacts the pelvic floor (the levator ani muscles and fascia), it rotates to an anteroposterior diameter of the pelvis - usually the occiput comes to lie near the pubic symphysis and the sinciput near the sacrum. The shoulders remain in the oblique diameter, with the neck twisted 45 degrees while the Head is in the pelvis.

D.

Extension - results from downward pressure of uterine contractions and resistance of the pelvic floor. The anterior wall of the pelvis (the pubis) is 4-5 cm long, while the posterior wall (the sacrum) is 10-15 cm. Hence the sinciput has a longer distance to travel than the occiput. As the occiput passes through the outlet, the nape of the neck pivots in the subpubic angle. The bregma, forehead, nose, mouth, and chin are born in succession as the sinciput sweeps along the sacrum. E. Restitution (some authors do not differentiate between restitution and external rotation) -- Once the head is born and is free of the pelvis, the neck untwists and the head restitutes back 45 degrees to resume the normal relationship with the shoulders and its original position in the pelvis.

External rotation - As the shoulders rotate to the AP diameter of the pelvis, the head further rotates until the sagittal suture is transverse again. Thus the shoulders accommodate to the widest diameter of the outlet for birth, just as the fetal head did. G. Expulsion - Usually the anterior shoulder is born first, followed by the posterior shoulder; the rest of the body is quickly extruded. H. Labor in occiput posterior positions - usually the same as OT or OA, but occiput has to rotate 135 degrees instead of 90 or 45. In 510 % of cases, for several reasons (inadequate contractions, pelvic architecture, epidural anesthesia, etc), the occiput may arrest in the transverse position or rotate posteriorly.

F.