OUTLINE

I. Definition III. Fetus

II. Stages of Intrauterine Life IV. Placenta
A. Germinal Period V. Barker’s Hypothesis
B. Embryonic Period VI. References
C. Fetal Period
LEGENDS
-books
-mentioned by the lecturer but was not in the ppt/lecture notes
- from old transes
-take note for exam
I. DEFINITION
● In Utero: ​Latin for ​“in the womb”​ or ​“in the uterus”
Figure 1.​ Germinal Period​ [Dr. Cruz PPT]
● Life in Utero = Intrauterine Life
● Intrauterine Life
→ The interval of life between conception and birth Fertilization
→ Very dynamic, a continuum, there is always something that is ● Occurs in the fallopian tube
happening in the embryo even if we are not aware of it ● Chemotaxis
→ Chemical process in which chemical signals from egg direct
movement of sperm toward the egg
II. STAGES OF INTRAUTERINE LIFE
● Adhesion
Timeline → Out of the millions of sperm cells released in ejaculation, only
● Zygote – Day 0 to Day 5 1 sperm will be able to fertilize the egg
→ Once the sperm reaches the egg, the sperm will adhere to
→ Day 0 refers to the day of fertilization
the egg in courtesy of sperm-receptor proteins
● Blastocyst – Day 5 to Day 10
● Acrosome and Zona Pellucida
● Embryo – Week 2 to Week 7
→ An organelle found at the head of the sperm
● Fetus – Week 8 to Week 40
→ Releases digestive enzymes to break down the zona
pellucida of the ovum
Stages
● Germinal Period
→ From zygote to blastocyst Cleavage
→ First 2 weeks ● Zygote​ – a fertilized egg that undergoes series of mitosis for
● Embryonic Period about 3 days
→ Week 3 to Week 8 ● Mitosis takes place every 12 to 24 hours
→ Period of organogenesis ● End result is called a ​morula
● Fetal Period ● Occurs while still in the fallopian tube
→ After 8 weeks onwards
→ Period of growth

A. GERMINAL PERIOD
● First and shortest stage of intrauterine life
● 4 processes:
→ Fertilization
→ Cleavage
→ Blastulation
→ Implantation

Figure 2.​ Early stages of embryonic development​ [Dr. Cruz PPT]

Blastulation
● From a morula to a blastocyst
● Blastocyst differentiates into
→ Embyroblast​ – inner cell mass (forms the embryo)
→ Trophoblast​ – outer cell mass (forms the placenta)

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 ● Throughout the embryonic stage, the head of the embryo is
comparatively larger than its trunk

● The embryonic period is the period of ​maximum sensitivity to

developmental abnormalities because it is the time where the
organs are formed
→ Problems in this period can cause physical abnormalities

C. FETAL PERIOD
● Transition from embryo to a fetus is designated by most
Figure 3.​ Blastocyst​ [Dr. Cruz PPT] embryologists to begin 8 weeks after fertilization
→ For clinicians - 10 weeks age of gestation (AOG) or 10
weeks after the last menstrual period (LMP)
Implantation ● Fetus is about 4 cm. long
● Process wherein blastocyst embeds in the uterine endometrium ● Time for the growth and maturation of organs
● Usually occurs on the upper posterior uterine wall
● Occurs 6 or 7 days after fertilization

B. EMBRYONIC PERIOD

● Two descriptions of gestational age:

→ Embryologists describe embryo as fetal development in
terms of ovulation age
▪ Fertilization should occur to have an embryo
→ For clinicians, it is 2 weeks longer (based on the last
menstrual period of the pregnant woman)
● Gestational age is synonymous with menstrual age (because of
LMP) – usually 40 weeks or 280 days
● Termed “embryo” at the beginning of the third week
● Usually lasts for 8 weeks III. FETUS
● Period of organogenesis
→ Week 3: formation of the central nervous system; fetal blood A. 12 WEEKS AGE OF GESTATION
vessels in chorionic villi appear
→ Week 4: the cardiovascular system has been formed; a true
circulation is established between the embryo and chorionic
villi
→ Week 5: limb buds start to appear; differentiates into
extremities
→ Week 6: embryo is 22-24 mm; heart is completely formed;
fingers and toes are present

Figure 7.​ 12 weeks AOG​ [Dr. Cruz’s PPT]

● Fetal C-R length is 6-7 cm

● Centers of ossification present in most fetal bones
→ Differentiation up to fingers and toes
● External genitalia
→ Begins to show differentiation whether male or female
● Spontaneous movements
● Uterus is palpable just above the symphysis pubis
● After 12-13 weeks, 2​nd trimester of pregnancy, chances of
miscarriage or spontaneous abortion reduced to 1.5-3%

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 B. 16 WEEKS AGE OF GESTATION ▪ depends on the institution
→ there is a 50% chance of survival of the fetus with or without
medical care if born at 24 weeks
→ with improved neonatal care, there is an increase in survival
rates of preterm babies, even those who are considered
extremely preemies​ (below 27 weeks)
▪ threshold of viability
− 23+0 weeks to 24+6 weeks gestation
→ Parents are informed about the chances of the premie’s
survival they are given the choice to either give intensive
medical care or to just “let the fetus be comfortable”
● Respiratory problems at birth
Figure 8.​ 16 weeks AOG​ [Dr. Cruz’s PPT]
→ Canalicular period of lung development (Alveolar ducts
● C-R length is 12 cm nearly completed​)
● Weight is 110 gms → Lung development is nearly complete.
● Genitalia ▪ A fetus born at 24 weeks will attempt to breathe but many
→ To an experienced observer, gender can be determined by will die because terminal sacs (needed for gas exchange)
14 weeks because of the external genitalia are still not yet fully formed.
● Eye movements
→ Begin at 16-18 weeks coinciding with midbrain maturation E. 28 WEEKS AGE OF GESTATION
● Weight: >1000g
C. 20 WEEKS AGE OF GESTATION ● Thin skin is red but may be covered with ​vernix caseosa
● An otherwise normal neonate born at 28 weeks​ ​has​ 90%
chance of survival ​without physical or neurological impairment
→ Babies born less than 28 weeks AOG are still considered
extremely premature

F. 32-36 WEEKS AGE OF GESTATION

● Weight at 32 weeks: ~1800g
● Weight at 36 weeks: ~2500g
Figure 9.​ 20 weeks AOG​ [Dr. Cruz’s PPT] ● Growth and maturation continues
● Weight: > 300 gms → Increase in fat deposits
● Movement every minute; activity noted 10-30% of the time → Body is more rotund, i.e. fatty
→ Fetal movement perceived as “quickening” by the mother → Skin is less wrinkled
● Fetal skin is less transparent ● Descent of testes​ for males begins at 32 weeks
● 20 weeks midpoint of pregnancy ● Fingernails and toenails are visible and continue to grow
→ usually, if expulsion or extraction from a mother of a fetus is G. 37-42 WEEKS AGE OF GESTATION
before 20 weeks, it is an abortus. If after 20 weeks it as a
​ ​term baby.
● Baby is called​ a
birth
● Average birth weight of a term infant: 3500g with a crown-rump
● Downy lanugo covers the body, scalp hair develops
length of 36 cm
→ Birth weight of a term Filipino infant: 2800-3000g
D. 24 WEEKS AGE OF GESTATION
▪ Both mother and father have Filipino ethnicities.
● Weight: >600g ● Body is usually plump
→ Fat deposits begin to appear ● Chest is prominent
▪ Not enough; when born at 24 weeks, the premature infant ● Lanugo hair is almost absent;
is put into a plastic bag in order to raise the heat at the ● Toenails reach the toe tips
time of birth ● Males – testes in the scrotum or palpable at the inguinal canal.

IV. PLACENTA
● An organ in the uterus that must be considered when talking
about intrauterine life.
● Has a limited life span
● Has 2 sides:
→ Fetal side
▪ Covered by the membranes
▪ Where the umbilical cord is attached

Figure 10.​ Preterm infant born at 24 weeks AOG​ [Dr. Cruz PPT]

● most doctors consider 24 weeks AOG as the ​age of viability

→ Age of viability
▪ age in weeks of a fetus wherein survival outside the
uterus is possible
Figure 11.​ Fetal side of the placenta​ [Dr. Cruz PPT]
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 − This is transferred to the placenta and is further
→ Maternal side metabolized in the placenta to produce estrogens that
▪ Implants in the uterus are then given to the mother and the fetus.
V. BARKER’S HYPOTHESIS
● Proposed in 1990 by ​David Barker​, a British epidemiologist
→ Studied maps in the UK and plotted areas where
cardiovascular diseases (CVDs) are prevalent
→ It was previously believed that CVDs were primarily
associated with urban/high-income community dwellers
→ However, he discovered that it was actually more common in
rural and poor communities
→ Studied birth registries and observed that women in the rural
Figure 12.​ Maternal side of the placenta​ [Dr. Cruz PPT]
communities give birth to low-birth-weight infants, signifying
undernutrition in the intrauterine life (IUL)
● The placenta can affect the health of the mother and the health ● Holds that events during IUL have a profound impact on one’s
of the fetus not only during the intrauterine life or during risk in the development of adult disease
pregnancy, but also even after pregnancy. ● The concept of fetal origins of adult disease
▪ How it affects the mother: → Published a study in 1986 in the Lancet relating
− Insulin resistance low-birth-weight (LBW) to developing coronary heart disease
− Toxemia of pregnancy (e.g. eclampsia, gestational and related conditions (hypertension, stroke, insulin
hypertension) resistance) in adulthood
▪ How it affects the fetus: ● Barker’s hypothesis paved the way for further epidemiological
− Fetal renal, respiratory, hepatic, gastrointestinal, studies concerning fetal programming
endocrine, and immune system ● “In utero programming of chronic diseases”
− Any insult to the placenta can affect intrauterine life → A review published in 1998
and growth of the fetus → Stated that a limited supply of nutrients in human fetuses can
● The Three-Compartment Model of the Nourishment and permanently change their structure and metabolism
Nutrition of the Fetus A. FETAL PROGRAMMING
● “A lifetime health is under the control of in utero health” (EJ
Kwon, et al 2017)
● Any stress to the fetus (nutrition, the introduction of nicotine,
introduction to alcohol, anxiety disorders) can reprogram the
organs of a fetus and can lead to structural, physiological or
metabolic changes
● Can predispose individuals to obesity, diabetes, heart diseases,
osteoporosis, etc.

Table 1.​ Undernourishment ​(Dr. Cruz’s ppt)

When a mother lacks Disease
Folic Acid Spina bifida, preterm birth
Iodine Brain damage (mental retardation),
Figure 13.​ 3-Compartment Model​ [Dr. Cruz PPT] hypothyroidism
Vitamin D Osteoporosis
→ The mother, the placenta, and the fetus each have their own Vitamin E Asthma
metabolic processes, but at the same time, they interact with
each other. Table 2. ​Stressors ​(Dr. Cruz’s ppt)
→ The mother will have her own metabolic processes Form of stress Disease
▪ Pregnancy becomes a hyperestrogenic state so there is Excess stress and Attention Deficit Hyperactivity Disorder
an increase in the production of estrogen anxiety (ADHD), anxiety
▪ Pregnant women become emotional because they are Nicotine Stillbirth, preterm birth, Sudden Infant
hormonal and there is an increase in the production of Death Syndrome (SIDS), ADHD, conduct
hormones disorder, obesity, diabetes, heart disease
▪ At the end of pregnancy, the basal metabolic rate of the Alcohol Fetal Alcohol Syndrome, preterm birth,
mother increases to 10-20% conduct disorder, ADHD, alcohol abuse
→ The placenta metabolizes on its own
▪ Human chorionic gonadotropin Conduct Disorder
− Hormones produced during pregnancy ● range of antisocial behavior exhibited in children and teens –
− Made by cells formed in the placenta may exhibit a pattern of disruptive and violent behavior or have
− nourishes the egg after it has been fertilized and problems following rules
becomes attached to the uterine wall Fetal Alcohol Syndrome
− hormone needed to maintain pregnancy ● small eye opening, thin upper lip, smooth philtrum; small head,
− quantitative measure used in pregnancy tests poor growth, brain damage; non-reversible changes
→ The ​fetal adrenal glands, ​particularly the ​adrenal cortex​, are
the organ of metabolism of the fetus
▪ The adrenal cortex produces ​DHEA-S V. REFERENCES
(​Dehydroepiandrosterone sulfate) ● Lecture’s PPT

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