4TH WEEK OF DEVELOPMENT

ORGANOGENETIC PERIOD
HIGHLIGHTS OF THE 4TH TO 8TH WEEKS

Ass.Prof.Dr. Saleh Nasser S. A. Alkardae

Lecturer of Human Anatomy & Embryology
Chairman of Anatomy Department,
TUFOM_GUSTFOM
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 LEARNING OBJECTIVES

• By the end of the lecture, the student will be able

to:
• List the highlights of the period that give rise to all
the major organs and systems
• List the methods of estimation of embryonic age
• Define different terminologies used for the age
determination (crown-rump length and crown-
heel length)
• Determine gestational age with help of history
and calculate expected date of delivery.
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Ass.Prof.Dr. Saleh Nasser S. A. Alkardae
Why the embryonic period of pregnancy (i.e., from
3rd to 8th week) very important for the normal
development of the baby and the most sensitive
period for teratogens?

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 Folding of Embryo

• Folding of an embryo is a significant

event in the establishment of the primitive
form of the human body. As a result of
folding, the flat embryonic disc becomes
somewhat cylindrical embryo.
• The folding occurs in both median and
horizontal planes due to rapid growth of
the embryo

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 Folding of Embryo in the Median Plane

The folding of embryo in the median plane occurs as

follows:
• There is a progressive increase in the length of embryo
(embryonic disc), but its head and tail ends remain
relatively close together. Consequently, the embryonic
disc bends producing a convexity dorsally and bulges
upward into the amniotic cavity.
• With further increase in the length of embryonic disc,
the head and tail ends also get folded on itself to form
head fold and tail fold, respectively. As a result of the
formation of head and tail folds, the head and tail ends
of embryo move ventrally. 5
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Because of the formation of head and tail folds, the part
of yolk sac becomes enclosed within the embryo to form
a long tubular structure called primitive gut. The
primitive gut forms most of the gastrointestinal tract
(GIT).
• The primitive gut is divisible into three parts: foregut,
midgut, and hindgut. The midgut is in wide
communication with the yolk sac through a wide
channel – the primordium of vitellointestinal duct (yolk
stalk).
• A small diverticulum arises from the caudal part of the
yolk sac and grows into the connecting stalk attached to
the caudal end of the embryo called allantois (allantoic
diverticulum). 10
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 Folding of Embryo in the Horizontal Plane
• The folding of sides of the embryo forms right and left lateral folds.
The lateral folds move medially and fuse to each other to form the
anterior abdominal wall. However, in the center of the anterior
abdominal wall a somewhat circular aperture remains, which
represents the future umbilicus.
• With the formation of lateral folds in embryo, communication
between midgut and yolk sac narrows to form the vitellointestinal
duct (omphaloenteric duct).
• As the embryo folds on itself, the amniotic cavity expands
enormously and completely surrounds the embryo. Now the embryo
floats freely in the amniotic fluid within amniotic cavity, which serves
as a swimming pool for the embryo.
Because of enormous expansion of amniotic cavity, the
extraembryonic celom gets almost completely obliterated and the
amnion forms the covering of the 13 umbilical cord.
 Effects of Folding of Embryo
1. Because of the formation of folds on all sides, the flat
embryonic disc becomes cylindrical leaving an opening on the
ventral aspect called umbilical ring.
2. The ectoderm forms the outer covering of the embryo.
3. The embryo becomes completely surrounded by the
amniotic cavity. 4.The part of yolk sac gets incorporated in the
embryo to form the primitive gut.
5. The cranial end of primitive gut is now separated from
stomodeum by buccopharyngeal membrane, and the caudal
end of primitive gut is separated from proctodeum by the
cloacal membrane.
6. The connecting stalk (future umbilical cord) now becomes
attached to the ventral aspect of embryo around the
umbilical opening. 14
7. The allantois now gets connected to the terminal part of the
hindgut.
8. The head containing brain now forms the cranial most part of the
embryo.
9. The septum transversum and pericardial cavity now lie on the
ventral aspect of the cranial end of
the embryo, with heart tube lying dorsal to the
pericardial cavity.
10. The septum transversum now lies caudal to the
primitive heart tube and pericardial cavity.
11. A depression is formed between head bulge and
pericardial bulge . This depression is called stomodeum and is
separated from the cranial end of foregut by the buccopharyngeal
membrane.
12. Two halves of the peritoneal cavity now fuse to form a single
peritoneal cavity.
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 Fourth Week

• Major changes in body form occur during the fourth

week.
• At the beginning, the embryo is almost straight and
has four to 12 somites that produce conspicuous
surface elevations.
• The neural tube is formed opposite the somites, but it
is widely open at the rostral and caudal neuropores.
• By 24 days, the first two pharyngeal arches are
visible. The first (mandibular arch) and the second
(hyoid arch) are distinct.

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• The embryo is now slightly curved because of
the head and tail folds.
• The heart produces a large ventral
prominence and pumps blood.
• Three pairs of pharyngeal arches are visible
by 26 days, and the rostral neuropore is
closed.
• The forebrain produces a prominent elevation
of the head, and folding of the embryo has
given the embryo a C-shaped curvature.
• Upper limb buds are recognizable by day 26
or 27 as small swellings on the ventrolateral
body walls. 22
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• The otic pits, the primordia of the internal ears, are
also visible.
• Ectodermal thickenings (lens placodes) indicating
the future lenses of the eyes are visible on the sides of
the head.
• The fourth pair of pharyngeal arches and the lower
limb buds are visible by the end of the fourth week.
• Toward the end of the fourth week, a long tail-like
caudal eminence is a characteristic feature.
• Rudiments of many of the organ systems,
especially the cardiovascular system, are established.
• By the end of the fourth week, the caudal
neuropore is usually closed.

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 Fifth Week
o Enlargement of the head is caused mainly by the
rapid development of the brain and facial
prominences.
o The face soon contacts the heart prominence.

o The rapidly growing second pharyngeal arch

overgrows the third and fourth arches, forming a
lateral ectodermal depression on each side-the
cervical sinus
o Mesonephric ridges indicate the site of the
mesonephric kidneys, which are interim excretory
organs in humans.
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32 days (Carnegie stage 14, 6.8 mm)
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 Sixth Week

o By the sixth week, embryos show reflex response

to touch. The upper limbs begin to show regional
differentiation as the elbows and large hand plates
develop.
o The primordia of the digits (fingers), called digital
rays, begin to develop in the hand plates, which
indicate the formation of digits.
o Embryos in the sixth week show spontaneous
movements, such as twitching of the trunk and
limbs.

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The diaphragm is a dome-shaped,
musculotendinous partition that
separates the thoracic and abdominal
cavities. It is a composite structure that
develops from four embryonic
components:
■ The septum transversum, which forms
the central tendon o f the diaphragm
■ The two pleuroperitoneal membranes
■ Muscular components from somites at
cervical segments three to five
■ The mesentery of the esophagus, in
which the crura of the diaphragm develop
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 Sixth Week
o Development of the lower limbs occurs 4 to 5 days later than
that of the upper limbs.
o Several small swellings-auricular hillocks-develop around the
pharyngeal groove or cleft between the first two pharyngeal
arches.
o This groove becomes the external acoustic meatus (external
auditory canal).
o The auricular hillocks contribute to the formation of the
auricle, the shell-shaped part of the external ear.
o Largely because retinal pigment has formed, the eye is now
obvious.
o The head is now much larger relative to the trunk and is bent
over the heart prominence.
o The trunk and neck have begun to straighten.
o The intestines enter the extraembryonic coelom in the
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proximal part of the umbilical cord.
 Sixth Week
o This umbilical herniation is a normal event in the
embryo.
o The herniation occurs because the abdominal cavity is
too small at this age to accommodate the rapidly
growing intestine.

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52 days
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A 9-week fetus
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 Seventh Week

o Notches appear between the digital rays in

the hand plates, clearly indicating the future
digits.
o Communication between the primordial gut
and umbilical vesicle is now reduced to a
relatively slender duct, the omphaloenteric
duct.
o By the end of the seventh week, ossification
of the bones of the upper limbs has begun.

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about 48 days
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 Eighth Week
o At the beginning of this final week of the embryonic period, the
digits of the hand are separated but noticeably webbed.
o The scalp vascular plexus has appeared and forms a
characteristic band around the head.
o By the end of the eighth week, all regions of the limbs are
apparent, the digits have lengthened and are completely
separated.
o Purposeful limb movements first occur during this week.
o Ossification begins in the femur.
o All evidence of the caudal eminence has disappeared by the
end of the eighth week
o Both hands and feet approach each other ventrally.
o At the end of the eighth week, the embryo has distinct human
characteristics.

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56 days

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8 wks

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❑ The head is still disproportionately large, constituting
almost half of the embryo.
❑ The neck region is established, and the eyelids are
more obvious.
❑ The eyelids are closing, and by the end of the eighth
week, they begin to unite by epithelial fusion.
❑ The intestines are still in the proximal portion of the
umbilical cord.
❑ The auricles of the external ears begin to assume
their final shape.
❑ Although there are sex differences in the
appearance of the external genitalia, they are not
distinctive enough to permit accurate sexual
identification. 44
 CRL 13 mm

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 Estimation of Gestational and Embryonic Age

* By convention, obstetricians date

pregnancy from the first day of the LNMP.
* This is the gestational age.
* Embryonic age begins at fertilization,
approximately 2 weeks after the LNMP.
* Fertilization age is used in patients who
have undergone in vitro fertilization or
artificial insemination.

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 10 mm
7 wks

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4.2 cm
9 wks

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 ESTIMATION OF EMBRYONIC AGE

* It is determined from their external characteristics and

measurements of their length
* The appearance of the developing limbs is a helpful
criterion for estimating embryonic age.
* The crown-rump length is most frequently used for
older embryos
* longest crown-rump length is the most accurate.
* The length of an embryo is only one criterion for
establishing age
* The Carnegie Embryonic Staging System is used
internationally.
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 CROWN-RUMP LENGTH

▪ It is the measurement from the vertex of the skull to

the midpoint between the apices of the buttocks.
▪ Crown-rump (CR) length correlated to approximate
age in weeks.
▪ Estimation of gestational age from the menstrual
history alone may be unreliable.

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 . Gastroschisis

Ectopla cordls.

Bladder exstrophy.
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Congenital diaphragmatic hernia. A. Abdominal surface of the diaphragm showing a
large defect of the pleuroperitoneal membrane. B. Hernia of the intestinal loops and
part of the stomach into the left pleural cavity. The heart and mediastinum are
frequently pushed to the right, and the left lung is compressed. C. Radiograph of a
newborn with a large defect in the left side of the diaphragm. Abdominal viscera have
entered the thorax through the defect. 54
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CLINICAL PROBLEMS
2. What do you understand by the term teratomas? Give
the embryological basis.
3. The teratomas are located either in the midline
structures or in the paramedian structures of the body.
Why? Give the embryological basis.

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 THE FETAL MEMBRANES AND
PLACENTA

Ass.Prof.Dr. Saleh Nasser S. A. Alkardae

Lecturer of Human Anatomy & Embryology
Chairman of Anatomy Department,
TUFOM_GUSTFOM
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 LEARNINGOBJECTIVES
After completion of this lecture, the student should be able
to:
• Understand the development and function of fetal
membranes including chorion, amnion, yolk sac , umbilical
cord and allantois.
• Discuss the birth injuries related to amniotic fluid.
• Give the development of placenta.
• understand how the placenta functions to maintain the
fetus.

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ASS.PROF.DR. SALEH NASSER S. A. ALKARDAE
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Objectives
Describe the structure and function of the placenta,
umbilical cord and membranes

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 Decidual plate

Chorionic plate

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 Cotyledon (15-20)

Chorionic villi

Lacunar/intervillous spaces
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Macroscopic appearance of placenta

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Placenta – fetal surface

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Placenta – maternal surface

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Placenta and membranes

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What is placental barrier?

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 Placental barrier

1
2

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Functions of the placenta

Exchange of gases

Removal of metabolic products

Nutrition

Transmission of maternal Ab

Production of hormones

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Placental hormones

Human chorionic gonadotropin-hCG

Progesterone

Oestrogens

Human chorionic somatomammotropin-hCS

Relaxin

These are secreted into the maternal circulation.

Most maternal hormones do not cross the placenta.
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 Progesterone
hCG
Maintains the corpus luteum during the initial
period of pregnancy hCS
Maintains the pregnancy

Relaxin
Oestriol function
Lactogenic
Growth stimulation

Inhibits myometrial contractions

10 20 30 40 Weeks
6 12
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 Progesterone
hCG

hCS

Relaxin
Oestriol

10 20 30 40 Weeks
6 12
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Congenital Anomalies of the Placenta
The congenital anomalies of the placenta are
grouped
into three types:
(a) Anomalies due to abnormal adherence of
chorionic
villi to uterus.
(b) Anomalies due to abnormal shape.
(c) Anomalies due to abnormal site of
attachment of
umbilical cord.
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A. Anomalies Due to Abnormal Adherence
of Chorionic Villi to Uterus
(a) Placenta accreta, if the chorionic villi
are attached to myometrium.
(b) Placenta increta, when chorionic villi
penetratethe full thickness of
myometrium.
(c) Placenta percreta, if chorionic villi
penetrate full thickness of myometrium
and perimetrium (uterine serosa).
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B. Anomalies Due to Abnormal Shape
Normally, the placenta is circular and discoid/discoidal (circular disc
shaped). The various anomalies of the shape of placenta are
discussed as follows.
1. Bilobed (bidiscoidal) placenta: The placenta consists of two lobes.
2. Multilobular placenta: The placenta consists of more than two
lobes.
3. Diffuse placenta: The placenta is thin and notdisc shaped. It occurs
when chorionic villi persist all around the blastocyst.
4. Placenta succenturiata: In this type, a small part of the placenta is
separated from the main (rest) part of the placenta, but remains
connected through blood vessels and placental membranes.
5. Placenta fenestrata: In this type, a hole is present in the placental
disc.
6. Circumvallate placenta: In this type, the peripheral edge of the
placenta is covered by a circular fold of the decidua.
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C. Anomalies Due to Abnormal Site of Attachment of Umbilical Cord
Normally, the umbilical cord is attached to the center of
placenta on its fetal side. The various anomalies of placenta
due to abnormal attachment of umbilical cord are mentioned
as follows.
1. Marginal (Battledore) placenta : When the cord is attached
to the margin of the placenta.
2. Furcate placenta: When blood vessels of umbilical cord
divide before reaching the
placenta.
3. Velamentous placenta: When the umbilical blood vessels
are attached to amnion and
ramify there before reaching the placenta.
N.B. Anomalies due to abnormal implantation of placenta in
the uterine cavity, e.g., placenta
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Unwanted functions of placenta

Transfer of infectious agents

Transfer of drugs

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Functions of the fetal membranes

Protection/shock absorption

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Umbilical cord

umbilical arteries umbilical vein

Wharton’s jelly
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Chorion
•One of the membranes that exist during pregnancy
between the developing fetus and mother.
•Formed by :
•Extraembryonic mesoderm and
•Two layers of trophoblast.
•Surrounds the embryo and other membranes.

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 Significance of Amniotic Fluid

* Permits symmetric external growth of the

embryo and fetus.
* Acts as a barrier to infection.
* Permits normal fetal lung development.
* Helps control the embryo’s body
temperature by maintaining a relatively
constant temperature.
* Cushions the embryo and fetus against
injuries by distributing impacts the mother
receives.
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