Fetal Cardiopulmonary Development

Basic Terminology
Introduction
Development of the Pulmonary System
Development of the Cardiovascular System
Fetal Circulation
Development of Other Intrauterine Structures

1) BASIC TERMINOLOGY
a. GESTATIONAL AGE
i. Time frame from conception to birth. Usually given in weeks.
b. FULL TERM
i. Birth between the gestation age of 37 to 42 weeks
c. PRETERM (PREMIE)
i. Born before week 37 (approx 12% births in US)
2) GENERAL STAGES OF DEVELOPMENT
THREE stages: 1) CONCEPTION 2) EMBRYONIC 3) FETAL DEVELOPMENT
a. CONCEPTION
i. Weeks 0-2
ii. When ovum and sperm unit
b. EMBRYONIC STAGE
i. Weeks 3-12
ii. When the heart, brain, and spinal cord begin to develop
c. FETAL DEVELOPMENT STAGE
i. Weeks 13-40
ii. When most lung development occurs
3) DETERMINING GESTATIONAL AGE
a. Accuracy is important for estimating fetal development
i. ESPECIALLY for lung maturity
b. Gestational age is determined from the start of the last menstrual period to birth
i. 280-287 days, or approximately 40 weeks
c. When the first day of the last menstrual period is not known, other methods may be used:
i. Crown-to-Rump
1. Commonly used in first trimester up to 8 weeks, b/c size variability is minimal.
2. Measurement is taken from tip of head to bottom of buttocks

4) FETAL PULMONARY DEVELOPMENT — Lung development is divided into FIVE PHASES

- EMBRYONIC — WEEKS 3-6
- PSEUDOGLANDULAR — WEEKS 5-17
- CANALICULAR — WEEKS 16-25
- SACCULAR — WEEKS 24-BIRTH
- ALVEOLAR PHASE — WEEKS 36 – 8YO

a. EMBRYONIC — WEEKS 3-6

First stage
i. Right and left lung buds arise from the esophagus
ii. Development of the trachea and major bronchi begin to form
iii. Diaphragm starts to develop
1. Fully developed at the end of week 7 in the pseudoglandular phase
iv. Respiratory epithelium forms
v. Lungs begin to emerge as a bud from the pharynx
 1. Elongates and forms two bronchial buds and the trachea
a. The trachea at this time is separated from the esophagus by an esophageotracheal
septum
b. If there is an incomplete separation at this stage, it will result in esophageal atresia
2. Distal end of the lung bud bifurcates into right & left primary bronchial buds
3. Proximal end forms the trachea and larynx
4. By 5th week, primary bronchial buds form three on the right, and two and the left
vi. Embryonic connective tissue from the mesoderm & middle germ layer begin to develop into:
1. Pulmonary interstitium
2. Smooth muscle
3. Blood vessels
4. Cartilage
vii. Diaphragm is fully formed w/in the mesoderm at the end of 7 weeks
1. Congenital Diaphragmatic Hernia (CDH) — Failure of the diaphragm to completely close
during the embryonic stage

b. PSEUDOGLANDULAR — WEEKS 5-17

i. Name is due to gland-like appearance of lungs during this stage
ii. Cartilage, smooth muscle cells, and mucus glands develop
iii. Week 7
1. Respiratory tree undergoes 12-14 generations of branching, forming terminal bronchioles
2. Epiglottis is forming
3. Thin membrane that divides the nasopharynx form the oropharynx disintegrates, creating a
passageway between the pro & nasopharynx
a. Choanal atresia — when the membrane between the naso & oropharynx does not
disintegrate
iv. Weeks 7-12 — hard and soft palate that does separate the naso & oropharynx develops
v. Week 8 — vocal cords begin to appear
vi. Week 12 — major lobes of the lung are identifiable
vii. Week 10 — cilia appears in the trachea
viii. Weeks 10-13– inter-segmental airways form the fastest
ix. Week 13 — Presence of mucus can be found in the fetal lungs & peripheral airways

c. CANALICULAR — WEEKS 16-25

i. Bronchioles continue to multiply
1. Terminal bronchioles further divide into respiratory bronchioles
a. Becomes surrounded w/an increase vasculaturization
ii. Week 20 — capillary network begins to grow around the airways, awaiting the full formation of the
airways
1. Gas exchange is not possible until approximately weeks 20-24
a. This is when the capillary network and the alveoli have sufficient surface area & are
close enough to each other
2. Acinar units are formed:
a. Respiratory bronchioles
b. Alveolar ducts
c. Alveolar sacs
iii. 250-300mL of fetal lung fluid is secreted per day
1. This fluid maintains latency and avoids collapse of the airways until birth
2. Differs from amniotic fluid. Fetal Lung Fluid has:
a. Lower pH, HCO2, and protein
b. Higher sodium and chloride
iv. Type I & II Alveolar cells start to appear
1. Type I Alveolar Cells — help create the structures. This is where gas exchange occurs
 2. Type II Alveolar Cells — synthesize, store, and release surfactant
v. Surfactant is made up of lipids and glycoproteins
1. Main phospholipids that make up surfactant are:
a. PC — phosphatidylcholine
b. PG — phosphatidylglycerol
i. Immature surfactant lacks PG
ii. Appears around week 35, during the saccular phase
2. Prior to week 35, surfactant deficiency can lead to atelectasis and several problems leading
to respiratory distress
vi. End of canalicular stage marks the beginning of the survivability of premature infants
d. SACCULAR — WEEKS 24-BIRTH
i. Named b/c true alveoli begin to appear at about week 30
ii. Saccules, which are short, shallow sacs, group close together to form septal walls
iii. Towards the end of week 35, the mature surfactant (PG) appears, and minimal risks of pulmonary
complications occur
e. ALVEOLAR — WEEK 36- 8YRS
i. Alveoli quickly proliferate into approximately 50 million alveoli at birth
ii. Alveoli continue to proliferate through infancy and early childhood
iii. Alveoli continue to grow in size and shape during the first few years of life
iv. Mature lungs form around 8 years of age
BASIC TERMINOLOGY:
What is gestational age

What is considered full-term

What is considered pre-term

What % of births in the US are pre-term

GENERAL STAGES OF DEVELOPMENT

Pregnancy is divided into how many stages?

What are the THREE stages of pregnancy

What are the time frames and what occurs during the THREE stages of pregnancy

What is conception
What weeks is the conception stage
What is the embryonic stage
What weeks the embryonic stage
What is the fetal development stage
What weeks are the fetal development stage
What stage of pregnancy does most lung development occur?

How is gestational age determined:

- From the star of last menstrual period to birth
Approx 280-287 days, or 40 weeks

How is gestation age determined when the last menstrual period is unknown?

Explain crown-to-rump

Whey is gestational age accuracy important?

- Estimating fetal development, ESPECIALLY lung maturity

FETAL PULMONARY DEVELOPMENT

Lung development is divided into how many stages?

What are the FIVE stages of fetal pulmonary/lung development

What are the weeks for each of the FIVE stages of fetal pulmonary/lung development

The Embryonic Phase are what weeks?

What occurs during the embryonic phase?

The pseudoglandular phase are what weeks?

What occurs during the pseudoglandular phase?

The Canalicular phase are what weeks?

What occurs during the Canalicular phase?

The saccular phase are what weeks?

What occurs during the saccular phase?

The alveolar phase are what weeks?

What occurs during the alveolar phase?

The right & left lung buds arise from what anatomical feature?

The right & left lung buds arise during what stage?

When does the diaphragm begin to develop? When is the diaphragm fully developed?

Respiratory epithelium forms in what stage?

The lungs begin to emerge as a bud from what anatomical feature? (Ask Dee about the conflicting bullet points)

At what stage does the trachea separate from the esophagus?

The trachea separates from what during the embryonic stage?

What separates the trachea from the esophagus?

What is the purpose of the esophageotracheal septum?

What is esophageal atresia?

What is it called when there is an incomplete separation of the trachea from the esophagus?

What do the distal end of the lung buds bifurcates into?

The proximal end of the lung buds form what two anatomical features?

What week do the primary bronchial buds form?

How many primary bronchial buds form on the right? How many on the left?

Embryonic connective tissue from the mesoderm & middle germ lay develop into what FOUR things?
— Pulmonary interstitium, smooth muscle, blood vessels, & cartilage

Pulmonary interstitium, smooth muscle, blood vessels, & cartilage developed from what?
— Embryonic connective tissue from the mesoderm & middle germ layer

What is the pseudoglandular phase named after?

- The gland-like appearance of lungs during this stage?

What occurs during week 7 of the pseudoglandular phase? (5 distinct things)

— Respiratory tree undergoes 12-14 generations of branching, forming the terminal bronchioles
— Epiglottis begins forming
— Thin membrane that divides the naso & oropharynx disintegrate, creating a passageway between the two
 — Hard & soft palate the separates the naso & oropharynx begins to develop in week 7, fully developed by
week 12
— Diaphragm is full formed by the end of week 7

What occurs during week 8 of the pseudoglandular phase?

— Vocal cords begin to appear

What is it called when the diaphragm does not completely close during the embryonic phase?

What is Congenital Diaphragmatic Hernia (CDH)?

How many generations of branching does the respiratory tree undergo during week 7 of the pseudoglandular phase?
What will it eventually form?
- 12-4 generations of branches. Eventually forming the terminal bronchioles

What stage and week does the epiglottis begin to form?

What stage & week does the thin membrane that divides the naso & oropharynx disintegrate?

What forms to separate the naso & oropharynx? What stage & weeks does it form?

When do the vocal cords begin to appear? What stage and what week?

What is Choanal Atresia?

What occurs during week 12?

In what stage & what week are the major lobes of the lung identifiable?

What occurs during weeks 10-13?

When do the inter-segmental airways form the fastest? What stage & what weeks?

When does cilia appear in the trachea? When does it appear in the peripheral airway? What stage and what weeks?

Are alveoli present during the pseudoglandular stage? If not, when is it present?

What stage & what week is the presence of mucus found in fetal lungs?

What is present in the fetal lungs around week 13 of the pseudoglandular stage?

What stage & weeks does the hard & soft palates begins to form? What two structures does it separate?

What weeks are the canalicular phase?

What does the end of the canalicular phase maker?

What do the terminal bronchiole further divide into? What is it surrounded by?

What occurs at approximately week 20?

What stage and week does the capillary network begin to grow around the airways
When is gas exchange possible? What two things need to occur? What stage & weeks does this occur in?

What do the acinar units comprise of?

What stage does the fetal lung fluid begin to appear?

How much fetal lung fluid is secreted per day?

What is the purpose of the fetal lung fluid?

How is the fetal lung fluid different from amniotic fluid?

What is the purpose of Type I alveolar cells?

What is the purpose of Type II alveolar cells?

What two things is surfactant made up of?

What are the two main phospholipids that make up mature surfactant?

What does immature surfactant lack? What stage and week does it appear & become mature?

What can surfactant deficiency lead to prior to week 35?

What weeks are the saccular phase?

What is the saccular phase named for?

What are saccules?

What week and stage does mature surfactant appear? What is significant about it?

What weeks are the alveolar phase?

How many alveoli are present at birth?

What stage are alveoli quickly proliferating into the millions?

How long do alveoli continue to proliferate?

How long doe alveoli continue to grow in size and shape?

What stage & age are mature lungs fully formed?