FETAL DEVELOPMENT AND FETAL CIRCULATION

● 7-8 days from fertilization to

REVIEW: COITUS TO IMPLANTATION implantation

Coitus TROPHOBLAST
| ● outer layer of a blastocyst
Sperms travel to the Ampulla of fallopian tube ● develop into a large part of the placenta
| ● The trophoblast proliferates and
Capacitation differentiates into 2 cell layers at
sperm approach the egg, the sperm release approximately 6 days after fertilization:
hyaluronidase which dissolve the protective ● Cytotrophoblast: inner layer, single
layer of the egg, allowing penetration of one celled
sperm for fertilization ● Syncytiotrophoblast: outer layer, thick
| and multinucleated. It secretes hCG to
Fertilization maintain progesterone secretion and
Joining of the sperm & the egg sustain pregnancy.
|
Zygote PRIMARY GERM LAYERS
-Product of fertilization
-Zygote travels towards the uterus ● Cepalo -caudal growth & development
approximately 3 days (Zygote: 1-8 cells & ● Stem cell- 4 days of zygote pluripotent
Morulla: 16-50 cells) stem cell use for for reproductive
| cloning
Blastocysts ● Multipotent - after few more days
Fluid-filled cell mass - secretory phase specific parts develop.
attached to endometrial lining
FETAL DEVELOPMENT
Trophoblast - cells on the blastocysts outer
ring that develop into placenta and membranes OVUM OR PREEMBRYONIC- last from
conception until day 14. This period covers
Embryoblast - inner cell mass that will form cellular replication, blastocyst formation, initial
the embryo development of the embryonic membranes and
| establishment of primary germ layers.
Implantation
Contact between the growing fertilized cell & PRIMARY GERM LAYERS
uterine lining
| 1. Ectoderm - the upper layer of the
Apposition embryonic disk. Forms the epidermis, the
Process by which the fertilized egg brushes the glands (anterior pituitary, cutaneous and
endometrial lining mammary), the nails and hair, the CNS and
| PNS, the lens of the eyes, enamel and floor of
Embryo the amniotic cavity tooth
Fertilized egg that has implanted
2. Mesoderm middle layers, forms the bones,
FERTILIZATION teeth and connective tissue, the CVS and
spleen, the muscles (skeletal, smooth and
● Begins with 46 pair of chromosomes, cardiac) and the urogenital system
splits off to 23 then combine for a
unique new 46 pair. 3. Endoderm - lower layer, rise to epithelium
● Decidua - results from the preservation lining the respiratory and digestive tract,
and further thickening of the glandular cells of associated organs, including
endometrial lining. The corpus luteum the oropharynx, liver and pancreas, urethra,
by HCG cause elevation of bladder and vagina. Also forms the roof of the
progesterone level that cause yolk sac.
development of decidua.
FETAL MEMBRANES
Early Human Development
1. Zygote 1. CHORION -
2. Blastomeres - Develops from thropoblast and contains
3. Morula chorionic villi on its surface. This
4. Blastocyst becomes the covering of the fetal side
5. Embryo of the placenta. Contains the major
6. Fetus umbilical blood vessels.
7. Conceptus - Chorionic villi have progesterone
central core. Produce placental
Stages and Time Frames hormones such as hcg, hpl, estrogen
● Ovum and progesterone
● Zygote (3-4 days, 16-50 cell) -
● Morula (3-4 days)
● Blastocyst 2. AMNION -
● Embryo - inner cell membranes, develops from
● Fetus the interior cells of the blastocyst. The
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FETAL DEVELOPMENT AND FETAL CIRCULATION
cavity that develops between this inner
cell mass and outer layer of cells
(trophoblast) is the amniotic cavity
- Support the amniotic fluid & produced
fluids, it is also seem as fetal surface of
the placenta. It also produces
phospholipid that forms prostaglandins
that cause contraction
• As it grows larger, the a mnion forms on the
opposite side of the developing blastocyst. The
developing embryo draws the amnion around
itself, forming a fluid filled sac. The amnion
becomes the covering of the umbilical cord and
covers the chorion on the fetal surface of the
placenta
TRIMESTER
● 1st = week's 1-13
● 2nd = week's 14-26
● 3rd = week's 27 and on (38-42
WEEKS)
Day One
● The first cell of a new human being,
called a zygote, is formed when a
sperm fertilizes an egg. In the egg cell
shown here, the nuclei of the sperm
and egg appear as two yellow-brown,
irregular shapes. When these two
nuclei fuse, fertilization is
accomplished.
Day Three
● The zygote begins its journey down the
Fallopian tube. About 36 hours after
fertilization, cell division begins in the
Fallopian tube, and continues to occur
about twice a day. In three to four days,
the cluster of dividing cells completes
the 10 cm (4 in) journey through the
Fallopian tube to the uterus.
Day Six
● About the fifth day after fertilization, a
cluster of about a hundred cells floats in
the uterus. It soon takes the form of a
fluid-filled ball of cells called a
blastocyst. After one or two days in the
uterus, the blastocyst burrows into the
uterine lining, which grows over the
blastocyst and provides it with nutrients
First Trimester
1 Month
At the end of four weeks:
● Baby is 1/4 inch in length
● Heart, digestive system, backbone and
spinal cord begin to form
● Placenta (sometimes called "afterbirth")
begins to develop
● The single fertilized egg is now 10,000
times larger than size at conception
● form primitive organ
● the head (bottom, left) can be
distinguished.
● The four-week-old embryo measures
about 5 mm (about 0 .2 in) from crown
to rump.
Week Six
● Beginning of formation of the lungs and
further development of the brain. Arms
and legs have lengthened with foot and
hand areas distinguishable. Hands and
feet have digits, but may still be
webbed
Month 2
At the end of 8 weeks:
● 1-1/8 inches long or the eight-week- old
fetus measures about 30 mm
(abou1in)from crown to rump.
● Heart is functioning
● Eyes, nose, lips, tongue, ears and teeth
are forming
● Penis begins to appear in boys
● Baby is moving, although the mother
can not yet feel movemen
● Embryo passes into the fetal stage of
development. The fetus shown here
floats in the watery amniotic fluid, which
is contained by the transparent, tough,
amniotic membrane. The amniotic fluid
acts as a shock absorber, preventing
damage to the developing fetus.
Month 3
At the end of 12 weeks:
● Baby is 2 1/2 to 3 inches long
● Weight is about 1/2 to 1 ounce
● Baby develops recognizable form. Nails
start to develop and earlobes are
formed
● Arms, hands, fingers, legs, feet and
toes are fully formed
● Eyes are almost fully developed
● Baby has developed most of his/her
organs and tissues
● Baby's heart rate can be heard at 10
weeks with a special instrument called
a Doppler
Second Trimester
Month 4
At the end of 4 months:
● Baby is 6 1/2 to 7 inches long
● Weight is about 6 to 7 ounces
● Baby is developing reflexes, such as
sucking and swallowing and may begin
sucking his/her thumb
● Tooth buds are developing
● Sweat glands are forming on palms and
soles
● Fingers and toes are well defined
● Sex is identifiable
● Skin is bright pink, transparent and
covered with soft, downy hair
● Although recognizably human in
appearance, the baby would not be
able to survive outside the mother's
body
● Meconium is produce in the intestinal
tract. Liver and pancreas produce their
appropriate fluid secretions
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FETAL DEVELOPMENT AND FETAL CIRCULATION
Month 5
At the end of 5 months:
● Baby is 8 to 10 inches long
● Weight is about 1 pound
● Hair begins to grow on baby's head
● Soft woolly hair called lanugo will cover
its body. Some may remain until a week
after birth, when it is shed.
● Mother begins to feel fetal movement
● Internal organs are maturing
● Eyebrows, eyelids and eyelashes
appear
● Toes the fetus is more active with
increased muscle development
Month 6
At the end of 6 months:
● Baby is 11 to 14 inches long
● Weight is about 1 3/4 to 2 pounds and
Eyelids begin to parta eyes open
sometimes for short periods of time
● Skin is covered with protective coating
called vernix
● Baby is able to hiccup
● Eyebrows and eyelashes are well
formed.
● The fetus has a hand and startle reflex
foot prints and fingerprints
● Forming alveoli (air sacs) forming in
lungs
Month 7
At the end of 7 months:
● Baby is 14 to 16 inches long
● Weight is about 2 1/2 to 3 1/2 pounds
● Taste buds have developed
● Fat layers are forming
● Organs are maturing
● Skin is still wrinkled and red
● If born at this time, baby will be
considered a premature baby and
require special care
● Rapid increase in the amount of body
at rhythmic breathing movements
occur, but lungs are not fully mature
bones are fully developed, but still soft
and pliable fetus begins storing iron,
calcium, and phosphorus
Month 8
At the end of 8 months:
● Baby is 16 1/2 to 18 inches long
● Weight is about 4 to 6 pounds
● Overall growth is rapid this month
● Tremendous brain growth occurs at this
time
● Most body organs are now developed
with the exception of the lungs
● Movements or "kicks" are strong
enough to be visible from the outside
● Kidneys are mature
● Skin is less wrinkled
● Fingernails now extend beyond
fingertips
Month 9
At the end of 9 months:
● Baby is 19 to 20 inches long
● Weight is about 7 to 7 1/2 pound
● The lungs are mature
● Baby is now fully developed and can
survive outside the mother's body
● Skin is pink and smooth
● Baby settles down lower in the
abdomen in preparation for birth and
may seem less active
AMNIOTIC FLUID
● Clear, yellowish fluid surrounding the
developing fetus.
● Average amount 1000 ml.
● Having < 300ml – Oligohydramnios,
associated with fetal renal
abnormalities.
● Having > 2 L- Hydramnios, associated
with GI and other malformations
FUNCTIONS:
➢ Protects Fetus (cushion)
➢ Allows Movement
➢ Source of oral fluid
➢ Acts as a excretion-collection
repository
➢ Maintain constant body temperature
➢ Shields against pressure or a blow to
the mother's abdomen
➢ Probably aids in muscular development
because it allows the fetus freedom to
move
➢ Protects umbilical cord from pressure,
protecting fetal oxygenation
AMNIOTIC MEMBRANE
● Provide support and produces the
amniotic fluid
● Produces precursors to prostaglandins,
which initiates the contractions during
labor
● No nerve supply which is evident
during the painless rapture of
membrane
UMBILICAL CORD
● Connecting link between fetus and
placenta.
● Transports oxygen and nutrients to the
fetus from the placenta and returns
waste products from the fetus to the
placenta.
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FETAL DEVELOPMENT AND FETAL CIRCULATION
● Contains: 2 arteries and 1 vein
supported by mucoid material
(wharton's jelly) to prevent kinking and 3. Progesterone
knotting.
● Contains NO pain receptors.
● Composed of smooth muscles which
constrict upon fetal delivery, naturally
clamping the blood vessels and
preventing bleeding.
● The average length of umbilical cord or
funis in humans is 55 cm and its
diameter is 2 cm.
PLACENTA
● Arises out of trophoblast tissue
● Serves as a fetal lungs, kidney and GIT
and as a separate endocrine organ
throughout pregnancy
● 15 to 20 cm in - diameter, 2 to 3 cm
depth at term
● Structure that involves mediating
between maternal and fetal circulation
and producing essential hormones
during pregnancy.
● Sieve/filter- allows smaller particles
through and holds back larger
molecules. Passage of materials in
either direction is effected by:
>Diffusion: gasses, water, electrolytes
>Facilitated transfer: glucose, amino
acids, minerals.
>Pinocytosis: movement of minute
particle
● Mother transmits immunoglobulin G
(IgG) to the fetus providing limited
passive immunity.
● Leakage: caused by membrane defect:
may allow maternal and fetal blood
mixing.
FUNCTIONS
● Source of oxygen
● Source of nutrient
● Source of an important hormone
producing system
● Act as a barrier against microorganisms
and some drugs
PRODUCE PROTEIN HORMONES:
● Human chorionic gonadotropin (HCG)-
8-10 days past conception, is basis for
pregnancy test
● Progesterone
● Estrogen
● Human Placental Lactogen
HORMONES PRODUCED BY PLACENTA
1.HCG (Human Chorionic Gonadotropin)
● First hormone that produce the
placenta present circulation during the
first 100 days of pregnancy
● Ensures that corpus luteum of the
ovary continue to produce
progesterone and estrogen
● Exert an effect on male fetal testes to
begin testosterone production
2. Estrogen (Primarily Estradiol)
● Mother's mammary gland development
in preparation of lactation
● Stimulates the uterus to grow to
accommodate the developing fetus
● Also referred as "hormone of mothers"
● Maintain endometrial lining of the
uterus during pregnancy
● Induction of quiescence of the uterine
musculature during pregnancy which
prevents premature labor
4. Human Placental Lactogen (HPL)
● It helps prepare your body for
breastfeeding. It also regulates
metabolism and insulin sensitivity to
make sure the fetus gets enough
nutrients.
● increases maternal insulin resistance
and reduces maternal glucose
utilization, elevating maternal blood
glucose levels (supporting
transplacental glucose transfer)
VIABILITY
● Capability of fetus to survive outside
uterus at the earliest gestational age ( 4
weeks)
SURVIVAL DEPENDS ON:
● Maturity of fetal central nervous system
● Maturity of lungs
RESPIRATORY SYSTEM
● Terminal SAC period - 24 Weeks to
birth
● Growth of primitive alveoli
● Pulmonary surfactants produced which
act as wetting agents that prevent
alveolar walls from sticking
● Insufficient surfactant - RDS
● Lecithin/Sphingomyelin-Phospholipids
L/S Ratio
30-32 Weeks 1.2:1
35 Weeks 2:1 (MATURITY)
CARDIOVASCULAR SYSTEM
● 1st System to function
● FHR 120-160/Min
● Can hear FHR with doppler at 10-12
Weeks
● Non stress test
● Stress test
FETAL CIRCULATION
● It is a circulatory system of the human
fetus, often encompassing the entire
fetoceptal circulation that also
includes the umbilical cord and the
blood vessels within the placenta that
carry fetal blood.
● Arteries in the umbilical cord and fetal
body carry deoxygenated blood.
● Veins in cord and those in the fetal
body carry oxygenated blood.
● Ductus venosus connects umbilical
vein and inferior vena cava; bypassing
portal circulation
● In the fully developed human, the heart
serves two main purposes.
● The right heart pumps blood to the
lungs for oxygenation and the left heart
pumps oxygenated blood to the rest of
the body.
● In the embryo and fetus, the lungs do
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FETAL DEVELOPMENT AND FETAL CIRCULATION
not oxygenate the blood. The core concept behind fetal
● Fetal circulation is consequently quite circulation is that fetal hemoglobin has a
different than that of a breathing baby higher affinity for oxygen than does adult
or adult. hemoglobin, which allows a diffusion of
● When a baby is born and takes its first oxygen from the mother's circulatory
breath, the ducts close and blood is system to the fetus.
rerouted to the lungs. The circulatory system of the mother
● Fetal circulation consequently differs is not directly connected to that of the
from the adult one predominantly due fetus, so the placenta functions as the
to the presence of 3 major vascular respiratory center for the fetus as well as a
shunts: site of filtration for plasma nutrients and
○ Ductus venosus: between the wastes.
umbilical vein and IVC
○ Foramen ovale: between the FETAL CIRCULATION SEQUENCE
right and left atrium ● Exchange of gasses occurs in the
○ Ductus arteriosus: between placenta. Oxygenated blood is carried
the pulmonary artery and by the umbilical vein towards the fetal
descending aorta heart.
● By the third month of development, all ● The ductus venosus directs part of the
major blood vessels are present and blood flow from the umbilical vein away
functioning. from the fetal liver (filtration of the blood
● Fetus must have blood flow to the by the liver is unnecessary during the
placenta. fetal life) and directly to the inferior
● Resistance to blood flow is high in vena cava.
lungs. ● Blood from the ductus venosus enters
the inferior vena cava. Increased levels
of oxygenated blood flows into the right
LOCATION FUNCTIONS
atrium.
PLACENTA attached to gas ● In adults, the increased pressure of the
uterus exchange right atrium causes the tricuspid valve
during fetal to open thus, draining the blood into the
life right ventricle. However, in fetal
circulation most of the blood in the right
UMBILICAL ONE VEIN in Oxygenated atrium is directed by the foramen ovale
VEIN one cord Blood to (opening between the two atria) to the
fetus carry left atrium.
● The portion of the blood that drains into
UMBILICAL TWO Carries the right ventricle passes to the
ARTERIES ARTERIES Unoxygenate pulmonary artery.
in one cord d blood from ● As blood enters the pulmonary artery
(TAOV) fetus (carries blood to the lungs), an opening
called ductus arteriosus connects the
FORAMEN opening in shunts blood pulmonary artery and the descending
OVALE atrial septum from the right aorta. Hence, most of the blood will
(between R atrium to the bypass the non- functioning fetal lungs
& L Atrium) left atrium so and will be distributed to the different
that blood parts of the body. A small portion of the
can be oxygenated blood that enters the lungs
supplied to remains there for fetal lung maturity.
brain, heart ● The umbilical arteries then carry the
and kidney non- oxygenated blood away from the
heart to the placenta for oxygenation.
DUCTUS accessory supplies
VENOSUS vein blood to liver,
connecting Bypass to
umbilical the fetal liver
vein into the
fetal liver &
inferior vena
cava

DUCTUS connection shunts of the

ARTERIOSU between larger portion
S fetal lungs & of the blood
aorta away from
the lungs
and directly
into the aorta

PLACENTAL ROLE
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FETAL DEVELOPMENT AND FETAL CIRCULATION
● Foramen Ovale allows blood to flow
from right to left atrium, bypassing
lungs.
● Ductus Arteriosus allows blood flow
from pulmonary artery to aorta,
bypassing fetal lungs
Foramen Ovale Closes shortly after
birth
Ductus arteriosus Closes soon after
birth becomes
ligamentum
arteriosum in about 3
mos.
Ductus venosus Ligamentum
venosum
Umbilical arteries Medial umbilical
ligaments
Umbilical Vein ligamentum teres
1. First breath
2. Lungs expand (Pressure in the left
atrium increases as increased blood
returns via pulmonary veins.)
3. Stimulates closure of foramen ovale
4. Increased oxygen saturation causes
ductus arteriosus to constrict.
5. DA closes 10-15 hrs after birth
Permanent closure 10-21 days after
birth (Unless O2 remains low)
PROBLEM WITH PERSISTENCE OF FETAL
CIRCULATION
● Patent (open) ductus arteriosus and
patent foramen ovale each characterize
about 8% of congenital heart defects.
● Both cause a mixing of oxygen-rich and
oxygen-poor blood; blood reaching
tissues not fully oxygenated. Can cause
cyanosis
● Surgical correction now available,
ideally completed around age two.
● Many of these defects go undetected
until the child is at least in school.
HEPATIC SYSTEM
● Liver functions 4-6 weeks
● Full liver function after delivery
MUSCULO-SKELETAL SYSTEM
● Bones and muscles develop by 4th
week
● Fontanels areas where >2 bones meet
● 7-8 Weeks arms & leg movements
GASTROINTESTINAL SYSTEM
● Forms during 4th week
● Middle portion of the intestine projects
out into the cord during the 5th week.
● Returns during the 10th week. If this
does not occur- Omphalocele present
at birth
● Meconium - Dark black tarry waste
green accumulated in the fetal to
intestine near term
RENAL SYSTEM
● Kidneys form in 5th week and begin to
function 4 weeks later.
● Voiding into amniotic fluid
● Low volume can show renal
dysfunction
● Renal malformation can be diagnosed
in utero.
● GFR is low at birth
NEUROLOGICAL SYSTEM
● Formed from the ectoderm during the
3rd week
● Respiratory effort 18 1/2 WKS
● Swallowing 12 1/2 WKS
● Sucking 29 WKS
● Fetal movement felt 16-20 WKS
(Quickening)
ENDOCRINE SYSTEM
● Thyroid gland 1st to develop
● Insulin produced at 20 weeks
INTEGUMENTARY SYSTEM
● 7th week -Two layers of cells
● Vernix caseosa -Protects skin
● Lanugo - Fine hair
● 10th week - Fingernails, toenails
IMMUNE SYSTEM
● Passive immunity - FROM MOM
● Active immunity - FROM FETUS
ASSESSMENT FOR FETAL GROWTH AND
DEVELOPMENT
● Heath History mother: nutrition,
personal habits, accidents and intimate
partner abuse
● Fetal Growth estimation: Fetal
Movement at least 10 times a day
○ Sandovsky method - a woman
counts fetal movements three
times a day after meals (F). In
the fixed-period method, fetal
movement counting may be
done over a period of one hour,
daily or, if a rapidly changing
condition is anticipated,
six-hourly.
○ Cardiff method - A way to
assess intrauterine well-being in
which the expectant woman
records fetal movement during
her usual activities. There
should be at least 10
movements within a 12-hour
period; if fewer than 10
movements are perceived,
further medical evaluation is
needed.
● Fetal Heart Rate (FHR)
○ Normal: 120-160 beats per
minute
○ Rhythm Strip Testing - FHT for
20 mins. (mother left recumbent
position)
○ Non-stress test - fetal
movement (2 acceleration of
FHR for 15 sec =reactive)
○ Vibroacoustic stimulation
○ Contraction stress test
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FETAL DEVELOPMENT AND FETAL CIRCULATION
○ Ultrasonography
○ Maternal Serum
Alpha-fetoprotein
○ Amniocentesis
○ Percutaneous umbilical cord
sampling
○ Biophysical profile - fetal activity,
breathing movement, fetal body
movement, fetal tone and
amniotic fluid volume (highest
score is 10 and more accurate).
○ Fetoscopy
○ Chorionic villi sampling
○ Amnioscopy - performed to
assess for meconium staining
TERATOGENS
● Environmental exposures that can
adversely affect the developing fetus
● Maternal Conditions
● Alcoholism, Diabetes,
Endocrinopathies, Phenylketonuria
(PKU), Smoking, Nutritional problems,
cocaine,
● Infections Agents
● Rubella, Toxoplasmosis, Syphilis,
Herpes Simplex, Cytomegalic Inclusion
Disease, Varicella, Venezuelan Equine
Encephalitis
● Mechanical Problems (deformations)
● Amniotic band constrictions, Umbilical
Cord constraint, Disparity in uterine
size and uterine contents
● Chemicals, drugs, radiation,
hyperthermia