Third Month to Birth ((An 11wk fetus.

The umbilical cord still shows a swelling at

The Fetus and The Placenta its base, caused by herniated intestinal loops. The skull of
this fetus lacks the normal smooth contours. Fingers and
DEVELOPMENT OF THE FETUS toes are well developed.))

• fetal period - the period from the beginning of the
9th week to birth.
• characterized by maturation of tissues and
organs and rapid growth of the body.
• LENGTH of the fetus is usually indicated as
o the crown- rump length (CRL) (sitting
height)
o the crown-heel length (CHL) (standing
height)
CHANGES DURING THE 4TH, 5TH MONTHS
• The fetus lengthens rapidly vs the weight
• The fetus is covered with fine hair, called lanugo
hair; eyebrows and head hair are also visible.
• During the fifth month, movements of the fetus
can be felt by the mother.
• Weight increases considerably, particularly
during the last 2.5 months, when 50% of the full-
term weight (approximately 3,200 g) is added.
• the skin of the fetus is reddish and has a wrinkled
appearance because of the lack of underlying
connective tissue (6th month).
• By 6.5 to7months, the fetus has a CRL of about
25cm and weighs approximately 1,100 g.

• In general, the length of pregnancy is considered

to be 280 days, or 40 weeks after the onset of
the last normal menstrual period (LNMP) or,
• more accurately, 266 days or 38 weeks after
fertilization.

Changes during the 3rd month

• the face becomes more human looking
 The eyes, initially directed laterally,
move to the ventral aspect of the face,
 the ears come to lie close to their
definitive position at the side of the
head
 The limbs reach their relative length in
comparison with the rest of the body,
although the lower limbs are still a little
shorter and less well developed than
the upper extremities.
• During the sixth week, intestinal loops cause a
large herniation in the umbilical cord, but by the
12th week, the loops have withdrawn into the
abdominal cavity.
• At the end of the third month, reflex activity can
be evoked in aborted fetuses, indicating
muscular activity.
• Primary ossification centers are present in the
long bones and skull by the 12th week.
• External genitalia develop that the sex of the
fetus can be determined by ultrasound
 • During the last 2 months, the fetus obtains well-
rounded contours as the result of deposition of
subQ fat
• By the end of intrauterine life, the skin is covered
by a whitish, fatty substance (vernix caseosa).
• At the end of the ninth month, the skull has the
largest circumference of all parts of the body.
• At the time of birth, the weight of a normal fetus
is 3,000 to 3,400 g, its CRL is about 36 cm, and
its CHL is about 50 cm. Sexual characteristics
are pronounced, and the testes should be in the
scrotum.
• (( A 7-month fetus would be able to survive. It has
well rounded contours as a result of deposition of
subcutaneous fat. Note the twisting of the
umbilical cord.))
Date of Conception
• 280 days or 40 weeks from the first day of the
LNMP
• 7th to 14th weeks - CRL
• 16th to 30th weeks - biparietal diameter (BPD),
head and abdominal circumference, and femur
length
Clinical Correlations
• Low birth weight (LBW) refers to a weight <2,500
g, regardless of gestational age.
• Small for gestational age (SGA) have a birth
weight that is below the 10th percentile for their
gestational age
• Intra-Uterine Growth Restriction (IUGR)
Incidence: 1 in 10 babies higher in blacks than in
whites.
Factors:
– chromosomal abnormalities;
– teratogens;
– congenital infections (TORCH);
– poor maternal health (hypertension and
renal and cardiac disease)
– maternal nutritional & socioeconomics-
use of cigarettes, alcohol & drugs;
– placental insufficiency
– multiple births (e.g., twins, triplets).
– increased risk of neurological
problems, congenital malformations,
meconium aspiration, hypoglycemia,
hypocalcemia, and respiratory distress
syndrome [RDS).
– long-term effects on IUGR infants - the
Barker hypothesis
PLACENTA
• Exchange of gases
• Exchange of nutrients & electrolytes
• Transmission of maternal antibodies
• Hormone production
Clinical Correlations
• Preeclampsia is a condition characterized by
maternal hypertension and proteinuria due to
reduced organ perfusion and occurs in
approximately 5% of pregnancies.
 The condition may progress to
eclampsia, which is characterized by
seizures.
 Preeclampsia begins suddenly anytime
from approximately 20 weeks’
gestation to term.
• HDN - Erythroblastosis Fetalis and Fetal Hydrops
 Because some fetal blood cells escape
across the placental barrier, there is a
potential for these cells to elicit an
antibody response by the mother’s
immune system. This process is
isoimmunization,
 The antibodies then will attack and
hemolyze fetal RBCs, resulting in
hemolytic disease of the fetus and
newborn. Previously, the disease was
called erythroblastosis fetalis.
 In rare cases, the anemia becomes so
severe that fetal hydrops [edema and
effusions into the body cavities) occurs,
leading to fetal death
• Umbilical Cord Abnormalities
 At birth, the umbilical cord is
approximately 1-2cm in diameter and
50-60cm long.
 Normally, there are two arteries and
one vein (A-V-A).
 In 1:200 newborns, however, only a
single umbilical artery is present, and
these babies have approximately 20%
chance of having cardiac and other
vascular defects.
 Amniotic Bands
 Tears in the amnion result in amniotic
bands that may encircle part/s of the
fetus, particularly the limbs and digits.
• Amniotic Fluid
 Polyhydramnios is an excess of
amniotic fluid (1,500 to 2,000 mL)
 Causes:
– idiopathic causes (35%)
– maternal diabetes (25%], and
congenital malformations, including central
nervous system disorders (e.g., anencephaly]
and gastrointestinal defects (atresias, e.g.,
esophageal) that prevent the infant from
swallowing the fluid.
• Oligohydramnios refers to a decreased amount and each embryo has its own placenta
(<400 mL]. Both conditions are associated with and chorionic sac
an increase in the incidence of birth defects.
 a rare occurrence that may result from renal
agenesis. The lack of fluid in the amniotic
cavity may constrict the fetus or there may
be too little fluid for the fetus to “breathe”
into its lungs resulting in lung hypoplasia.
• Prematura rupture of the membranes (PROM)
refers to rupture of the membranes before uterine
contractions begin and occurs in 10% of
pregnancies. Preterm PROM occurs before 37
completed weeks of pregnancy, occurs in 3% of
pregnancies, and is a common cause of preterm
labor.
• Dizygotic Twins
 90% of twins are dizygotic, or fraternal
 their incidence increases with maternal age  Splitting of the zygote usually occurs at
(doubling at age 35) and with fertility the early blastocyst stage. The inner
procedures, including ART. cell mass splits into two separate
 results from simultaneous shedding of two groups o f cells within the same
oocytes and fertilization by different blastocyst cavity. The two embryos
spermatozoa. Because the two zygotes have a common placenta and a
have totally different genetic constitutions, common chorionic cavity but separate
the twins have no more resemblance than amniotic cavities.
any other brothers or sisters. They may or  In rare cases, the separation occurs at
may not be of different sex. The zygotes the bilaminar germ disc stage, just
implant individually in the uterus, and before the appearance of the primitive
usually each develops its own placenta, streak. This method of splitting results
amnion, and chorionic sac. in formation of two partners with a
single placenta and a common
chorionic and amniotic sac. Although
the twins have a common placenta,
blood supply is usually well balanced.
 Although triplets are rare (about 1 per
7,600 pregnancies), birth of
quadruplets, quintuplets, and so forth is
rarer. In recent years, multiple births
have occurred more frequently in
mothers given gonadotropins (fertility
drugs) for ovulatory failure.
• Fetus Papyraceus. One twin is larger and the
other has been compressed and mummified.
Hence, the term papyraceus.

• Monozygotic Twins
 10% of twins are monozygotic, or
identical, twins.
 incidence 3-4: 1,000.
 results from splitting of the zygote at
various stages of development.
 The earliest separation is believed to
occur at the two-cell stage, in which
case two separate zygotes develop.
The blastocysts implant separately,