OLABISI ONABANJO UNIVERSITY

FACULTY OF BASIC MEDICAL SCIENCES

DEPARTMENT OF NURSING SCIENCE
HAMATAN SEMESTER 2020/2021 SESSION

COURSE TITLE: MATERNAL AND CHILD HEALTH II

COURSE CODE: NSG 314
NO OF UNITS : 3 UNITS
LECTURER’S NAME: MRS OGUNDARE
COURSE OBJECTIVES
At the end of the course, the students should be able to:
1. Discuss the development process giving due considerations to physiological changes in
the baby from conception through the perinatal period.
2. Identify the cultural and socio-economic factors that affect child bearing process
3. Displays skills in the management of normal pregnancy, labour, puerperium and care of t
he new born
4. Discuss the need for family and community involvement in the child bearing process

Stages of Fetal Development

In just 38 weeks, a fertilized egg matures from a single cell carrying all the necessary genetic mat
erial to a fully developed foetus ready to be born.
Foetal growth and development is typically divided into three periods: pre-embryonic (first 2 we
eks, beginning with fertilization), embryonic (weeks 3 through 8), and fetal (from week 8 throug
h birth).
Fertilization: The Beginning of Pregnancy
Fertilization is the union of the ovum and a spermatozoon. Other terms used to describe this phen
omenon as conception, impregnation, or fecundation. Fertilization usually occurs in the outer thir
d of a fallopian tube, the ampular portion. Because the functional life of a spermatozoon is about
48 hours, possibly as long as 72hours, the total critical time span during which fertilization may
occur is about 72 hours(48 hours before ovulation plus 24 hours afterwards).
After ovulation, as the ovum is extrude from the grafian follicle, it is surrounded by a ring of mu
copolysaccharide fluid (the zona pellucida) and a circle of cells (the corona radiata). These struct
ures increase the bulk of the ovum, facilitating its migration to the uterus. They probably also ser
ve as protection from injury. The ovum and surrounding cells are propelled into the near fallopia
n tube by currents initiated by the fimbriae, the fine, hair like structures that line the openings of t
he fallopian tubes. Peristaltic action of the tube and movement of the tube cilia help propel the ov
um along the length of the tube. Usually only one ovum reaches maturity each month. Once relea
sed, fertilization must occur fairly quickly because an ovum is capable of fertilization for only 24
hours (48 hours at the most). After that time, it atrophies and becomes non-functional.
Normally, an ejaculation of semen averages 2.5 mL of fluid containing 50 to 200 million spermat
ozoon per millilitre, or an average of 400 million per ejaculation. At the time of ovulation, there i
n a reduction in the viscosity (thickness) of the cervical mucus, making it easier for spermatozoa
to penetrate it. Sperm transport is so efficient close to ovulation that spermatozoa deposited in th
e vagina during intercourse generally reach the cervix within 80 seconds and the outer end of a fa
llopian tube within 5 minutes after deposition. This is one reason why douching is not an effectiv
e contraceptive measure.Spermatozoa move by means of their flagella (tails) and uterine contract
ions through the cervix and the body of the uterus and into the fallopian tubes toward the waiting
ovum. The mechanism whereby spermatozoa are drawn toward an ovum is probably a species-sp
ecific reaction, similar to an antibody-antigen reaction. Capacitation is a final process, which hap
pens as the sperm move toward the ovum, consists of changes in the plasm membrane of the sper
m head, which reveals the sperm-binding receptor sites.
All the spermatozoa that achieve capacitation reach the ovum and cluster around the protective la
yer of corona cells. Hyaluronidase (a proteolytic enzyme) is apparently released by the spermato
zoa and acts to dissolve the layer numbers of sperm contained in an ejaculation provide enough e
nzymes to dissolve the corona cells. Under ordinary circumstances, only one spermatozoon is abl
e to penetrate the cell membrane of the ovum. Once it penetrate the zona pellucida, the membran
e becomes impervious to other spermatozoa. An exception to this is the formation of hydatidifor
m mole, in which multiple sperm enter; this leads to abnormal growth. Immediately after penetra
tion of the ovum, the chromosomal material of the ovum and spermatozoon fuse. The resulting st
ructure is called a zygote. Because the spermatozoon and ovum each carried 23 chromosomes (2
2 autosomes and 1 sex chromosome), a fertilized ovum has 46 chromosomes. If an X-carrying sp
ermatozoon enters the ovum, the resulting child will have two X chromosomes and will be femal
e (XX). If Y-carrying spermatozoon fertilizes the ovum, the resulting child will have an X and a
Y chromosome and will be male (XY).
Fertilization is never a certain occurrence because it depends on at least three separate factors: m
aturation of both sperm and ovum, the ability of sperm to reach the ovum, and the ability of the s
perm to penetrate the zona pellucid and cell membrane and achieve fertilization.
From the fertilization ovum (the zygote), the future child and also the accessory structure needed
for support during intrauterine life, such as the placenta, foetal membranes, amniotic fluid, and u
mbilical cord, are formed.
Implantation
Once fertilization is complete, the zygote migrates toward the body of the uterus, aided by the cu
rrent initiated by the muscular contractions of the fallopian tubes. It takes three or four days for t
he zygote to reach the body of the uterus. During this time, mitotic cell division, or cleavage, beg
ins. The first cleavage occurs at about 24 hours produces daughter cells called blastomeres; cleav
age divisions continue to occur at a rate of one about every 22 hours. By the time the zygote reac
hes the body of the uterus, it consists of 16 to 50 cells. At this stage, because of its bumpy outwar
d appearance, it is termed a morula (from the Latin word morus, meaning mulberry).
Morula stages
The morula continues to multiply as it floats free in the uterine cavity for 3 or 4 more days. Large
cells tend to collect at the periphery of the ball, leaving a fluid space surrounding an inner cell m
ass. At this stage, the structure is termed a blastocyst. It is this structure that attaches to the uteri
ne endometrium. The cells in the outer ring are known as trophoblast cells. They are the part of
the structure that will later form the placenta and membranes. The inner cell mass (embryoblast
cells) is the portion of the structure that will later form the embryo.
Implantation, or contact between the growing structure and the uterine endometrium, occurs appr
oximately 8 to 10 days after fertilization. After the third or fourth day of free floating (about 8 da
ys from ovulation), the last residues of the corona and zona pellucid are shed by the growing stru
cture. The blastocyst brushes against the rich uterine endometrium (in the second [secretory] pha
se of the menstrual cycle), a process termed apposition. It attaches to the surface of the endometri
um (adhesion) and settles down into its soft folds (invasion).
The blastocyst is able to invade the endometrium because as the trophoblast cells on the outside
of the structure touch the endometrium, they produce proteolytic enzymes that dissolve the tissue
they touch. This action allows the blastocyst to burrow deeply into the endometrium and receive
some basic nourishment of glycogen and mucoprotein from the endometrial glands. As invasion
continues, the structure establishes an effective communication network with the blood system of
the endometrium. The touching or implantation point is usually high in the uterus, on the posteri
or surface. If the point of implantation is low in the uterus, the growing placenta may occlude the
cervix and make birth of the child difficult (placenta previa).
Implantation is an important step in pregnancy because as many as 50% of zygote never achieve
it. In these instances, a pregnancy ends as early as 8 to 10 days after conception, often before the
woman is even aware it had begun. Occasionally, a small amount vaginal spotting appears with i
mplantation because capillaries are ruptured by the implanting trophoblast cells. A woman who n
ormally has a particularly scant menstrual flow may mistake implantation bleeding for her menst
rual period. If this happens, the predicted date of birth of her baby (based on the time of her last
menstrual period) will then be calculated 4 weeks later. Once implanted, the zygote is called an e
mbryo.
Embryonic and Fetal Structure
The Decidua
After fertilization, the corpus luteum in the ovary continues to function rather than to atrophy bec
ause of the influence of human chorionic gonadotropin (HCG) hormone secreted by the trophobl
ast cells. Thus, the uterine endometrium, instead of sloughing off as in a normal menstrual cycle,
continues to grow in thickness and vascularity. The endometrium is now termed decidua (the Lat
in word for falling off) because it will be discarded after the birth of the child. The decidua has th
ree separate areas:
1. Decidua basalis, the part of the endometrium lying directly under the embryo (or the portion
where the trophoblast cells are establishing communication with maternal blood vessels)
2. Decidua capsularis, the portion of the endometrium that stretches or encapsulates the surface
of the trophoblast.
3. Deciduas Vera, the remaining portion of the uterine lining.
As the embryo continues to grow, it pushes the decidua capsularis before it like a blanket. Eventu
ally, enlargement brings the structure into contact with the opposite uterine wall. Here, the decid
ua capsularis fuses with the endometrium of the opposite wall. This is why at birth, the entire inn
er surface of the uterus is stripped away, leaving the organ highly susceptible to haemorrhage an
d infection.