IV.

WONDERS OF FERTILIZATION

A. Fertilization

1. Stages of Fetal Growth & Development

*Pre-embryonic Stage
a. Zygote ------fertilization up to 14th day.
------Lifespan of zygote – from fertilization to 2 months
b. Morula ----- mulberry-like ball with 16 – 50 cells/ 4 days free floating &
multiplication

c. Blastocyst – enlarging cells that forms a cavity & later becomes the embryo.

*Trophoblast ---- covering of blastocys that later becomes placenta & trophoblast
*Cornix- where sperm is deposited after entering the vagina
*Sperm- small head, long tail, pearly white
*Phonones-vibration of head of sperm to determine location of ovum
*Sperm should penetrate corona radiata and zona pellocida.
*Corona Radiata – outer layer of ovum
*Zona Pellucida – inner layer of ovum
*Capacitation- ability of sperm to release proteolytic enzyme to penetrate corona radiata &
zona pellocida.
d. Implantation/ Nidation - occurs after fertilization 7 – 10 days.

Normal implantation------ upper portion

-------lower portion -----placenta previa
Signs of implantation:
 Slight pain
 Slight vaginal bleeding

3 processes of Implantation
1. Apposition
2. Adhesion
3. Invasion
*If with fertilization – corpus luteum continues to function & become source of estrogen &
progesterone
while placenta is not developed.

Physiology: Zygote -------sperm + ovum

Travels 3-4 days (mitotic cell division begins)

Uterus Names
Zygote: Fertilization
to 14th day
Morula Embryo: 15th day to 2
months/8 wks.
Floats in the uterus 3-4 days Fetus : 2 months to
birth

Blastocysts

*Embroyonic Stage

e. Dicidua – thickened endometrium ( Latin – falling off)

* Basalis: (base) part of endometrium located under fetus where placenta is

developed,
 this is located where implantation occurs
* Capsularies – encapsulate the fetus/ located on the backside
* Vera – remaining portion of endometrium.

f. Chorionic Villi- finger life projections that develops 10 – 11th day of pregnancy

*Chorionic Villi Sampling (CVS) ----- removal of tissue sample from the fetal portion of the
developing placenta for
genetic screening.
>Done early in pregnancy around 9-12 wks.
>Common complications: Fetal limb defect. Ex. missing
digits/toes.

g. Cytotrophoblast –outer layer or “Langhans layer” – protects fetus against syphilis up to

24 wks/6 months
then degenerates at 16 wks.

h. Synsitiotrophoblast –inner layer or “Synsitial layer” – responsible production of hormone

1. Amnion – innermost layer

a. Umbilical Cord or “FUNIS”

 Whitish grey
 15 – 55cm or 20 – 21”
 Protected by Wharton’s Jelly.
 3 vessels: A – unoxygenated blood
V – O2 blood
A – unoxygenated blood
 Short cord----- abruptio placenta or invertion of uterus.
 Long cord------cord coil or cord prolapse

b. Amniotic Fluid – or “Bag of Water”

 Clear, odor mousy/musty w/ crystallized forming pattern, slightly

alkaline.
 Normal amount of amniotic fluid : full term----500 -1,000 cc
 > 1,000 is Polyhydramnios----- GIT malformation (TEF/TEA)
 <500 is Oligohydramnios------ kidney disease ,malformation
*Function of Amniotic Fluid:

1. Cushions fetus against sudden blows or trauma

2. Facilitates musculo-skeletal development
3. Maintains temperature
4. Prevent cord compression
5. Help in delivery process

Diagnostic Tests for Amniotic Fluid

a. Amniocentesis
N.I : Empty bladder before performing the procedure.
Purpose : Obtain a sample of amniotic fluid by inserting a needle through
the abdomen
into the amniotic sac; fluid is tested for:

1. Genetic Screening- Maternal Serum Alpha Feto-Protein Test

(MSAFP)
-Early Screening ----1st trimester
- Decrease MSAFP------Down Syndrome
 - Increase MSAFP-------Spina Bifida or Open
Tube Neural Defect
2. Determination of fetal maturity primarily by evaluating factors
indicative
of lung maturity
- Late Screening------ 3rd trimester
a. Testing time ------- 36 weeks
b. Definitive Test for lung maturity--
Phosphatiglycerol or PG+

Surfactant---- to prevent lung collapse

-Lecithin Sphingomyelin L/S
- Uses the L:S ratio of 2:1 ( shake or foam test) Shake test – amniotic +
saline & shake
- If decrease L:S ratio ----indicative of RDS
*Common complication Amniocentesis : Infection
*Dangerous complications : Spontaneous Abortion
*Important factor to consider for amniocentesis: needle insertion site
* Primary Indication for early screening: Advanced Maternal Age
*Primary Indication for late screening: DM Mother

AMNIOTIC FLUID EVALUATION

1. Yellowish – Jaundice/ Hyperbilibirubinemia

2. Greenish – Meconium stained
3. Cloudy - infection

b. Amnioscopy – direct visualization or exam to an intact fetal membrane.

c. Fern Test- determine if bag of water has ruptured or not. Done for laboring
mother

d. Nitrazine Paper Test –use to differentiate amniotic fluid & urine.

Paper turns yellow- urine.
Paper turns blue green/gray-(+) rupture of amniotic fluid.

2. Chorion – outermost membrane, where placenta is developed

a. Placenta or “Secundines” combination of chorionic villi + deciduas basalis.

- Size: 500g or ½ kg
-8 inches long & 1 inch thick
-Cotylydon = 15-28 pcs.

Functions of Placenta:
1. Respiratory System- exchange of O2 & CO2 via simple diffusion
-use it as the breathing system not the lungs
- beginning of lung function after 1st cry of baby.

2. GIT –as a transport center like glucose transport thru facilitated

diffusion (rapid)
If mom hypoglycemic then fetus hypoglycemic too
3. Excretory System- waste products carried by arteries. Liver of mom
detoxifies waste.

4. Circulating system – Fetoplacental circulation achieved by selective

osmosis
5. Endocrine System – produces hormones
 Human Chorionic Gonadrophin (HCG)
Primary Purpose: Maintains corpus luteum alive
Secondary Purpose: Basis of Pregnancy
  Human Placental Lactogen (HPL) or sommamommamotropin Hormone
 Responsible for mammary gland development
 Has a diabetogenic effect – serves as insulin
antagonist
 Relaxin Hormone- for softening of maternal joints &
bones
 Estrogen
 Progestin
*Mother needs increase insulin support as pregnancy progresses
6. It serves as a protective barrier against some microorganisms –
HIV,HBV,CMV,Rubella

*Fetal Stage “ Fetal Growth & Development”

*Entire pregnancy days : 266 – 280 days or 37 – 42 weeks *280/28 days = 10

lunar months
*280/30 days = 9.7
calendar month
First trimester: Period of Organogenesis/ Development of Organs
*Most Critical Period

1st month : Brain & Heart development

1. FHT begins – heart is the oldest part of the body
2. CNS develops – gives dizziness to mom d/t hypoglycemic effect
 GIT& URT – remains as single tube
Glucose -Food of brain ----gives as complex CHO ex. potato, tuna

 Differentiation of Primary Germ layers---by end of 2nd week

* Endoderm - Thyroid – for basal metabolism
- Parathyroid - for calcium
- Thymus – development of immunity
- Liver & lining of upper RT & GIT

* Mesoderm - Heart, musculoskeletal system, Kidneys, Reproductive organs

* Ectoderm -Brain, CNS, skin, 5 senses, mucus membrane of hair, nails,

anus & mouth

2nd Month : All vital organs are formed

 Placenta developed
 Sex organ formed
 Meconium is formed
 Corpus luteum – source of estrogen & progesterone of infant – life span
& functions till end of 2nd month

3rd Month : Placenta is Complete

 Kidneys functional
 Buds of milk teeth appear
 Fetal heart tone heard by Doppler at 10 – 12 weeks
 Sex is distinguishable

Second Trimester: Period of Continuous Growth & Development

*Focus ----length of fetus

4th Month :
 Lanugo begins to appear
 FHT audible by fetoscope (18 – 20 wks.)
 Buds of permanent teeth appear
 Meconium is present
 5th Month :
 Quickening : 1st fetal movement used for EDC (Primi: 18- 20 wks.)
(Multi: 16- 18 wks)
 Lanugo covers body
 Actively swallows amniotic fluid
 FHT audible by stet w/ or w/o instrument
 19-25 cm fetus
 Actively swallow amniotic fluid
6th Month :
 Eyelids open
 Skin red & wrinkled
 Vernix caseosa covers the skin
 Exhibits startle reflex
 Sucking

Third trimester: Period of Most Rapid Growth

*Focus : Weight of fetus

7th Month:
 Development of surfactant – lecithin
 Male : testes begin to descend into scrotal sac
 Female : clitoris is prominent & labia majora are small & do not cover labia
minora

8th Month:
 Lanugo begin to disappear
 Sub Q fats deposits, steady weight gain occurs
 Nails extend to fingers
 Active Moro reflex is present
 Nails longer to fingers

9th Month:
 Lanugo & vernix caseosa begins to thin
 Amniotic fluid decreases
 Birth position is assumed
 Sole of foot has few creases

10th Month:
 Bone ossification of fetal skull
 Vernix caseosa is evident in body folds

*Moulding – no longer occurs for post-term babies

TO CONSIDER:

Terratogens- any drug, virus or irradiation, the exposure to such may cause damage to the fetus

A. Drugs:
Streptomycin – anti TB & or Quinine (anti malaria) – damage to 8th cranial nerve :
Ototoxicity & deafness
Tetracycline – staining of tooth enamel, inhibits growth of long bone
Vitamin K – Hemolysis, hyperbilirubenimia or jaundice
Iodides – enlargement of thyroid or goiter
Thalidomides – Amelia (absence of extremities) or pocomelia (Absence of distal parts of
extremeties)
Steroids – cleft lip or palate or abortion
Lithium – anti-manic may cause congenital malformation
B. Alcohol – LBW (vasoconstriction –monther/ FAS or fetal alcohol syndrome ---characterized
by microcephaly
C. Smoking – LBW
D. Caffeine – LBW
E. Cocaine – LBW w/c causes vasoconstriction leads to abruptio placenta

TORCH (Terratogenic) Infections – viruses

CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or
ascend through birth canal and adversely affect fetal growth and development. These infections are
often characterized by vague, influenza like findings, rashes and lesions, enlarged lymph nodes,
and jaundice (hepatic involvement). In some chases the infection may go unnoticed in the pregnant
woman yet have devastating effects on the fetus.

T – toxoplasmosis – handling of cat litter or raw vegetables or meat

O – others. Hep. A or Hep. B, HIV – blood & body fluids, Syphilis
R – rubella – German measles – congenital heart disease (1st month) normal rubella titer 1:10
<1:10 – less immunity to rubella, after delivery, mom will be given rubella vaccine. Don’t get
pregnant for 3 months. Vaccine is terratogenic
C – cytomegalo virus
H – herpes simplex virus