Prenatal

development
Prenatal development is often divided into three
major phases.
The first phase, called the period of the zygote,
lasts from conception through implantation,
when the developing zygote becomes firmly
attached to the wall of the uterus. The period of
the zygote normally lasts about 10 to 14 days
(Leese, 1994).
 • As the fertilized ovum, or zygote, moves down the
fallopian tube toward the uterus, it divides by
mitosis into two cells.
• These two cells and all the resulting cells continue to
divide, forming a ball-like structure, or blastocyst,
that will contain 60 to 80 cells within 4 days of
conception (see Figure 4.1).
• Cell differentiation has already begun.
• The inner layer of the blastocyst will become the
embryo, and the outer layer of cells will develop into
tissues that protect and nourish the embryo.

The Period of the Zygote

• Once implanted, the blastocyst’s outer layer rapidly forms four major support
structures that protect and nourish the developing organism (Sadler, 1996).
• One membrane, the amnion, is a watertight sac that fills with fluid from the
pregnant woman’s tissues. The purposes of this sac and its amniotic fluid are to
cushion the developing organism against blows, regulate its temperature, and
provide a weightless environment that will make it easier for the embryo to
move. Floating in this watery environment is a balloon-shaped yolk sac that
produces blood cells until the embryo is capable of producing its own.
• This yolk sac is attached to a third membrane, the chorion, which surrounds the
amnion and eventually becomes the lining of the placenta—a multipurpose
organ (see Figure 4.2).
• A fourth membrane, the allantois, forms the embryo’s umbilical cord

Development of Support
Systems
The second phase of prenatal development, the
period of the embryo, lasts from the beginning
of the third week through the end of the eighth.
This is the time when virtually all the major
organs are formed, and the heart begins to beat
(Corsini, 1994).
 • The period of the embryo lasts from
implantation (roughly the third
week) through the eighth week of
pregnancy (see Figure 4.3).
• By the third week, the embryonic
disk is rapidly differentiating into
three cell layers. The outer layer, or
ectoderm, will become the nervous
system, skin, and hair. The middle
layer, or mesoderm, will become the
muscles, bones, and circulatory
system. The inner layer, or
endoderm, will become the
digestive system, lungs, urinary tract,
and other vital organs such as the
pancreas and liver.

The Period of the Embryo

• In the third week after conception, a portion of the
ectoderm folds into a neural tube that soon becomes the
brain and spinal cord.
• By the end of the fourth week, the heart has not only
formed but has already begun to beat.
• The eyes, ears, nose, and mouth are also beginning to form,
and buds that will become arms and legs suddenly appear.
• At this point, the embryo is only about 1/4th of an inch
long, but already 10,000 times the size of the zygote from
which it developed.
• During the second month, the embryo becomes much more human in
appearance as it grows about 1/30th of an inch per day.
• By the middle of the fifth week, the eyes have corneas and lenses.
• By the seventh week, the ears are well formed, and the embryo has a
rudimentary skeleton.
• Limbs are now developing from the body outward; that is, the upper
arms appear first, followed by the forearms, hands, and then fingers.
• The legs follow a similar pattern a few days later.
• The brain develops rapidly during the second month, and it directs the
organism’s first muscular contractions by the end of the embryonic
period.

The Second Month

• During the seventh and eighth prenatal weeks, the embryo’s
sexual development begins with the appearance of a genital
ridge called the indifferent gonad.
• If the embryo is a male, a gene on its Y chromosome triggers a
biochemical reaction that instructs the indifferent gonad to
produce testes.
• If the embryo is a female, the indifferent gonad receives no such
instructions and will produce ovaries.
• The embryo’s circulatory system now functions on its own, for
the liver and spleen have assumed the task of producing blood
cells
• By the end of the second month, the embryo is
slightly more than an inch long and weighs less
than 1/4th of an ounce. At this point, all the
major structures of the human are formed, and
the organism is beginning to be recognizable as
a human (Apgar & Beck, 1974).
The third phase, the period of the fetus, lasts
from the ninth week of pregnancy until the baby
is born. During this phase, all the major organ
systems begin to function, and the developing
organism grows rapidly (Malas et al., 2004).
• The last seven months of pregnancy, or period of the fetus, is a period
of rapid growth (see Figure 4.4) and refinement of all organ systems.
• This is the time during which all major organ systems begin to function
and the fetus begins to move, sense, and behave (although not
intentionally).
• This is also a time when individuality emerges as different fetuses
develop unique characteristics, such as different patterns of movement
and different facial expressions.

The Period of the Fetus

• During the third prenatal month, organ systems that were formed
earlier continue their rapid growth and become interconnected.
• For example, coordination between the nervous and muscular
systems allows the fetus to perform many interesting maneuvers
in its watery environment—kicking its legs, making fists, twisting
its body—although these activities are far too subtle to be felt by
the pregnant woman.
• The digestive and excretory systems are also working together,
allowing the fetus to swallow, digest nutrients, and urinate (El-
Haddad et al., 2004; Ross & Nijland, 1998).

The Third Month

• Sexual differentiation is progressing rapidly.
• The male testes secrete testosterone—the male sex
hormone responsible for the development of a penis and
scrotum.
• In the absence of testosterone, female genitalia form.
• By the end of the third month, the sex of a fetus can be
detected by ultrasound and its reproductive system already
contains immature ova or sperm cells.
• All these detailed developments are present after 12 weeks
even though the fetus is a mere 3 inches long and still
weighs less than an ounce
• Development continues at a rapid pace during the 13th
through 24th weeks of pregnancy.
• At age 16 weeks, the fetus is 8 to 10 inches long and weighs
about 6 ounces.
• From 15 or 16 weeks through about 24 or 25 weeks, simple
movements of the tongue, lips, pharynx, and larynx increase
in complexity and coordination, so that the fetus begins to
suck, swallow, munch, hiccup, breathe, cough, and snort,
thus preparing itself for extrauterine life (Miller, Sonies, &
Macedonia, 2003).

The Fourth through Sixth

Months
• In fact, infants born prematurely may have difficulty
breathing and sucking because they exit the womb at an
early stage in the development of these skills—simply put,
they haven’t had enough time to practice (Miller, Sonies,
& Macedonia, 2003).
• During this period the fetus also begins kicking that may
be strong enough to be felt by the pregnant woman.
• The fetal heartbeat can easily be heard with a stethoscope,
and as the amount of bone and cartilage increases as the
skeleton hardens (Salle et al., 2002) the skeleton can be
detected by ultrasound.
• By the end of the 16th week, the fetus has assumed a
distinctly human appearance, although it stands virtually
no chance of surviving outside the womb.
• During the fifth and sixth months, the nails harden, the skin
thickens, and eyebrows, eyelashes, and scalp hair suddenly
appear.
• At 20 weeks, the sweat glands are functioning, and the fetal
heartbeat is often strong enough to be heard by placing an ear
on the pregnant woman’s abdomen.
• The fetus is now covered by a white, cheesy substance called
vernix and a fine layer of body hair called lanugo.
• Vernix protects fetal skin against chapping during its long
exposure to amniotic fluid and lanugo helps vernix stick to
the skin.
• By the end of the sixth month, the fetus’s visual and auditory
senses are clearly functional.
• the human fetus has some ability to discriminate between
sounds.
• The last 3 months of
pregnancy comprise a
“finishing phase” during
which all organ systems
mature rapidly,
preparing the fetus for
birth.
• Indeed, somewhere
between 22 and 28 weeks
after conception ---
• the point at which survival
outside the uterus is
possible (Moore &
Persund, 1993).

The Seventh through Ninth Months

• Research using fetal monitoring techniques reveals that
28- to 32-week-old fetuses suddenly begin to show better
organized and more predictable cycles of heart rate
activity, gross motor activity, and sleepiness/waking
activity, findings that indicate that their developing
nervous systems are now sufficiently well organized to
allow them to survive should their birth be premature
(DiPietro et al., 1996; Groome et al., 1997).
• Nevertheless, many fetuses born this young will still
require oxygen assistance because the tiny pulmonary
alveoli (air sacs) in their lungs are too immature to
inflate and exchange oxygen for carbon dioxide on
their own (Moore & Persaud, 1993).
• By the end of the seventh month, the
fetus weighs nearly 4 pounds and is
about 16 to 17 inches long.
• One month later, it has grown to 18
inches and put on another 1 to 2
pounds. Much of this weight comes
from a padding of fat deposited just
beneath the skin that later helps to
insulate the newborn infant from
changes in temperature.
• By the middle of the ninth month,
fetal activity slows and sleep
increases (DiPietro et al., 1996; Sahni
et al., 1995).
• The fetus is now so large that the most comfortable position
within a restricted, pear-shaped uterus is likely to be a
head-down posture at the base of the uterus, with the
limbs curled up in the so-called fetal position.
• At irregular intervals over the last month of pregnancy, the
pregnant woman’s uterus contracts and then relaxes—a
process that tones the uterine muscles, dilates the cervix,
and helps to position the head of the fetus into the gap
between the pelvic bones through which it will soon be
pushed.
• As the uterine contractions become stronger, more
frequent, and regular, the prenatal period draws to a
close. The pregnant woman is now in the first stage of
labor, and within a matter of hours she will give birth.
 You may interview your parents or sibling.
1.What kind of birth did you have?
2.How big was your baby when he or she was
born?
3.What were the first few things you did to take
care of your infant during the first month?
4.How would you describe the infants' vision,
hearing, smell, taste and skin sensitivities?
5.Cultural Beliefs and Practices about Pregnancy
and Childbirth (10 During Pregnancy and 10 After
birth)
ASSIGNMENT
• Identical or monozygotic twins- when one egg cell/ovum
further divides into two after being fertilized by one
sperm. They have exactly the same genetic constitutions,
thus, they always have the same sex and very similar
looks
• Non-identical or fraternal or dizygotic twins- arise from
two eggs/ova which are fertilized by two different sperm
cells.

Multiple births
1. Natural or spontaneous birth- results when the fetus’
head emerges first through the birth canal followed by
one shoulder then the other, next by the arms one at a
time and finally the legs.
2. Instrument birth- is employed with the aid of surgical
instruments if the fetus is too large or its position does
not allow normal birth process.

Types of birth
3. Breech birth- takes place if the fetal buttocks appear first,
followed by the legs, arms and eventually the head.
Instruments can sometimes be used to aid delivery here.
4. Transverse presentation birth- occurs when the fetus lies
crosswise on the mother’s uterus. Again, instruments can be
used to aid delivery
5. Cesarean-section birth- is employed when the fetus is
delivered surgically by means of a slit created in the
maternal abdominal wall.
1st stage is the longest labor and can last up to 20 hours.
It begins when your cervix starts to open (dilate) and ends
when it is completely open (fully dilated) at 10 centimeters.
When the cervix dilates from 0 to 3 -4 cm, contractions get
stronger as time progresses.
Mild contractions begin at 15 to 20 minutes apart and last
60 to 90 seconds.
The contractions become more regular until they are less
than 5 minutes.
This part of labor (called the Latent Phase) is best
experienced in the comfort of your home.

Stages of Labor
• When the cervix dilates from 4 to 8 cm (called Active
phase), contractions are getting stronger and are about 3
minutes apart, lasting about 45 seconds.
• You may have a backache and increased bleeding from
your vagina (called the “bloody show”).
• Your mood may become more serious as you focus on the
hard work of dealing with the contractions.
• You will also depend more on your support person.
• If your amniotic membrane ruptures or your “water
breaks”- the contractions may get much stronger.
• When the cervix dilates from 8 to 10 centimeters (called
Transition Phase), contractions are 2 to 3 minutes apart
and last about 1 minute
• You may feel pressure on your rectum and your backache
may feel worse.
• Bleeding from your vagina will be heavier
• The second stage of labor when your cervix is fully
dilated at 10 minutes. This stage continues until your
baby passes through the birth canal, vagina and is born.
• This stage may last 2 hours or longer.
• The third stage of labor begins after the baby is born and
ends when the placenta separates from the wall of the
uterus and is passed through the vagina. (Afterbirth)
• If you have episiotomy or small tear, it will be stitched
during this stage of labor
• Birth and the Perinatal Environment
• ■ Childbirth is a three-step process:
• ■ It begins with contractions that dilate the cervix (first
stage of labor).
• ■ These are followed by the baby’s delivery (second
stage of labor).
• ■ And finally the afterbirth is expelled (third stage of
labor).
• ■ The Apgar test is used to assess the newborn’s
condition immediately after birth
■ The Neonatal Behavioral Assessment Scale (NBAS),
administered a few days later, is a more extensive measure of the
baby’s health and well-being.
■ Labor and delivery medication given to mothers to ease pain
can, in large doses, interfere with the baby’s development.
■ Many mothers feel exhilarated shortly after birth if they have
close contact with their babies and begin the process of emotional
bonding with them.
■ Fathers are often engrossed with their newborns.
■ The support of fathers during pregnancy and childbirth can
make the birth experience easier for mothers.
• Potential Problems at Birth
■ Anoxia is a potentially serious birth complication that can
cause brain damage and other defects. Mild anoxia usually has no
long-term effects.
■ Women who abuse alcohol and drugs, who smoke, or who
receive poor prenatal care risk delivering preterm or low-birth-
weight babies.
■ Small-for-date babies usually have more severe and longer-
lasting problems than do preterm infants.
■ Interventions to stimulate these infants and to teach their
parents how to respond appropriately to their sluggish or irritable
demeanor can help to normalize their developmental progress.
■ The problems stemming from both prenatal and birth
complications are often overcome in time, provided that the child
is not permanently brain damaged and has a stable and
supportive postnatal environment in which to grow.
Teratogens
The term teratogen refers to any disease, drug, or other
environmental agent that can harm a developing embryo or
fetus by causing physical deformities, severely retarded
growth, blindness, brain damage, or even death.

Potential Problems
■ The effects of a teratogen on a body part or organ system are worst
during the period when that structure is forming and growing most
rapidly.
■ Not all embryos or fetuses are equally affected by a teratogen;
susceptibility to harm is influenced by the embryo’s or fetus’s and the
pregnant woman’s genetic makeup and the quality of the prenatal
environment.
■ The same defect can be caused by different teratogens.
■ A variety of defects can result from a single teratogen.
■ The longer the exposure to or higher the “dose” of a teratogen, the
more likely it is that serious harm will be done.
■ Embryos and fetuses can be affected by fathers’ as well as by
mothers’ exposure to some teratogens.
■ The long-term effects of a teratogen often depend on the quality of
the postnatal environment.
■ Some teratogens cause “sleeper effects” that may not be apparent
until later in the child’s life.
RUBELLA
rubella (German measles) a disease that has little
effect on a pregnant woman but may cause a number of
serious birth defects in developing organisms who are
exposed in the first 3 to 4 months of pregnancy.

Diseases suffered by
pregnant women
• toxoplasmosis
disease caused by a parasite found in raw meat and cat
feces; can cause birth defects if transmitted to an embryo in
the first trimester and miscarriage later in pregnancy.
• syphilis a common sexually transmitted disease that may
cross the placental barrier in the middle and later stages
of pregnancy, causing miscarriage or serious birth
defects.
• genital herpes a sexually transmitted disease that can
infect infants at birth, causing blindness, brain damage, or
even death

Sexually Transmitted
Diseases
• acquired immunodeficiency syndrome (AIDS) a viral
disease that can be transmitted from a mother to her fetus
or neonate and that results in a weakening of the body’s
immune system and, ultimately, death.
• thalidomide a mild tranquilizer that, taken early in
pregnancy, can produce a variety of malformations of the
limbs, eyes, ears, and heart.
• diethylstilbestrol (DES) a synthetic hormone, formerly
prescribed to prevent miscarriage, that can produce
cervical cancer in female offspring and genital-tract
abnormalities in males.

Drugs
• fetal alcohol syndrome (FAS) a group of serious
congenital problems commonly observed in the offspring
of mothers who abuse alcohol during pregnancy
• The most noticeable characteristics of fetal alcohol
syndrome are defects such as microcephaly (small head)
and malformations of the heart, limbs, joints, and face
(Abel, 1998). FAS babies are likely to display excessive
irritability, hyperactivity, seizures, and tremors. They are
also smaller and lighter than normal, and their physical
growth lags behind that of normal age-mates.

Alcohol
• fetal alcohol effects (FAE) a group of mild congenital
problems that are sometimes observed in children of
mothers who drink sparingly to moderately during
pregnancy
• These effects include retarded physical growth and minor
physical abnormalities as well as such problems as poor
motor skills, difficulty paying attention, subnormal
intellectual performance, and verbal learning defi cits

Social Drinking
• cleft lip a congenital disorder in which the upper lip has a
vertical (or pair of vertical) openings or grooves.
• cleft palate a congenital disorder in which the roof of the
mouth does not close properly during embryonic
development, resulting in an opening or groove in the
roof of the mouth.

Cigarette Smoking
Illicit Drugs
• Radiation.
• Soon after the atomic blasts of 1945 in Japan, scientists became painfully
aware of the teratogenic effects of radiation. Not one pregnant woman
who was within one-half mile of these explosions gave birth to a live
child. In addition, 75 percent of the pregnant women who were within a
mile and a quarter of the blasts had seriously handicapped children who
soon died, and the infants who did survive were often mentally retarded
(Apgar & Beck, 1974; Vorhees & Mollnow, 1987).

• We don’t know exactly how much radiation it takes to harm an embryo

or fetus. Even if an exposed child appears normal at birth, the possibility
of developing complications later in life cannot be dismissed. For these
reasons, pregnant women are routinely advised to avoid X-rays,
particularly of the pelvis and abdomen, unless they are crucial for
their own survival.

Environmental Hazards
• Chemicals and Pollutants. Pregnant women routinely
come in contact with potentially toxic substances in their
everyday environments, including organic dyes and
coloring agents, food additives, artificial sweeteners,
pesticides, and cosmetic products, some of which are
known to have teratogenic effects in animals (Verp,
1993). Unfortunately, the risks associated with a large
number of these common chemical additives and
treatments remain to be determined
• Diet
• Age
• Emotional well being