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Chapter 10
Mary L. Dunlap MSN,
Fall 2015
Fetal Development

• Measured in the number of weeks

after fertilization
• Average pregnancy lasts 280 days
or 40 weeks from the date of the las
t menstrual period (LMP)
• Fertilization usually occurs 14 days
after the LMP
Three Stages of
Fetal Development

• Preembryonic stage: fertilization thr

ough the second week
• Embryonic stage: end of second w
eek through the eighth week
• Fetal stage: ninth week until birth
Preembryonic Stage
(Stage 1)

• Fertilization - union of the ovum and spe

rm in the outer 3rd of the fallopian tube cr
eating a zygote
• The union restores the diploid number of
46 chromosomes
Fetal Development

• Fertilization
Preembryonic Stage
(Stage 1)
• Zygote undergoes cleavages (mitosi
s) as it is transported to the uterine c
avity in 72⁰
• Cleavages create a ball of 16 cells c
alled a morula, which divides into cel
ls that form fetal structures
Preembryonic Stage
(Stage 1)
• Blastocysts - inner cells form the em
bryo and the amnion
• Trophoblasts - outer cells form the e
mbryonic membranes, Chorion and
• Implantation in the endometrium occ
urs between the 7th to 10th day.
Embryonic Stage
(Stage 2)
Fetal membranes start forming
around the time of implantation
• Decidua- endometrial linning
• Chorion-placenta
• Embryonic germ layers- ectoderm, m
esoderm, endoderm
• Amnion- lines the amniotic sac & for
ms the umbilical cord
Embryonic Stage
(Stage 2)
Amniotic Fluid
• Surrounds embryo,
• Helps maintain a constant body tem
perature for the fetus
• Permits symmetric growth and deve
• Cushions the fetus from trauma
Embryonic Stage
(Stage 2)
Amniotic Fluid Function
• Allows the umbilical cord to be relatively
free of compression
• Promotes fetal movement to enhance m
usculoskeletal development
Embryonic Stage
(Stage 2)
Umbilical cord
•Life line between mother and embryo
•1 large vein & 2 small arteries (AVA)
•Wharton’s jelly surrounds the blood vess
els preventing compression
•Term length 22 in. / 1 in. wide
•Central insertion site on the placenta
Embryonic Stage
(Stage 2)
•Functioning by end of the 3rd wk.
•Produces hormones that control the basi
c physiology of the mother and near term
mature fetal organs for life outside of the u
•Protects the fetus from immune attack by
the mother
•Removes waste produced by the fetus
Embryonic Stage
(Stage 2)
• Placental barrier prevents the mix of ma
ternal blood with fetal blood
Placental Hormones
• Human chorionic gonadotropin (hCG)
• Human placental lactogen (hPL)
• Estrogen, progesterone
• Relaxin
Embryonic Stage

• Maternal Fetal circulation via the pla


• Embryonic and Fetal Development

• Table 10-1 p 286-287

• Fetal Development

Embryonic stage 3rd to 8th wk.

•Neural tube forms
•Brain waves detectable
•Heart development completed and beats
•Arms and legs move
•Resembles a human being
•Weight 1gram
Fetal Stage
(Stage 3)
9Th week to Birth
•12 wks.- heart beat heard with Doppler, s
ex is distinguishable, placenta formation c
•13-16 wks.- fetal movement (quickening)
felt by mother
•17-20 wks.- heart beat can be heard with
a stethoscope
Fetal Stage
(Stage 3)
• 21-24 wks.- lungs produce surfactant
• 24-32 wks.- alveoli begin to mature, eyeli
ds can open and close, increase in subcut
aneous fat
• 32-40 wks.- fetus kicks actively, lanugo d
ecrease, weight 7-8 lb’s
Length 17.3-19.2 in
Fetal Circulation
• Needed to sustain the fetus
• Must develop quickly and accurately sin
ce the fetal nutrient needs Increase as t
he embryo advances to a fetus
• Oxygen received from the placenta
• Placenta functions for the fetal lungs an
d liver
Fetal Circulation

Three unique shunts

• Ductus Venosus
• Foramen Ovale
• Ductus Arteriosus
• Fetal Circulation Prior to Birth
• Foramen Ovale & Ductus Arteriosus

• Human Genome Project 1990

• International 13 year study
• Goal map the human genome
• Better understanding how genetic chang
es contribute to disease
• Helped develop new strategies for preve
ntion, diagnosing and treating diseases
and disorders
• Genetic services are becoming an integr
al part of medical care.
• Diagnostic procedures have provide the
opportunity to increase survival rates.
• Nursing needs basic knowledge to be ab
le to help their patients.
Genetic Disorders

• Result from abnormalities in patterns of

inheritance or chromosomal abnormaliti
Chromosomal Abnormalities
• 1 in 33 infants born in the U.S. have birth
defects and genetic disorders
• Numeric abnormalities
• Structural abnormalities
Numeric Abnormalities

• Often result due to failure of the chromo

some pair to separate
• Few of these abnormalities are compati
ble with normal development and end in
spontaneous abortion
• Two common abnormalities Monosomie
s and Trisomies
Numeric Abnormalities

• Monosomies-missing a chromosome onl

y one instead of a pair
• Trisomies - three of a particular chromos
• Trisomy 21(Down syndrome)
Structural Abnormalities

• Breakage and loss of a portion of one or

more chromosomes and the broken end
s rejoin incorrectly
• Altered structure can be a deletion, dupli
cation, inversion or translocation
• Mutation
Structural Abnormalities

• Cystic fibrosis
• Phenylketonuria
• Sickle cell
• Tay-Sacks
Structural Abnormalities
• Huntington's disease
• Polycystic kidney disease
• Cri du Chat syndrome
• Fragile X syndrome
Threats to Development
The following are capable of inducing abn
ormal fetal structure or function by interferi
ng with normal fetal development
•TORCH infections
Genetic Evaluation and Counse
• Genetic counseling is an evaluation of a
n individual to confirm, diagnose or rule
out a genetic condition.
Genetic Evaluation and Counseli
• Ideal time: before conception
“ preconception counseling provides
the opportunity to identify, reduce,
and plan for potential risks.
Genetic Evaluation and Counselin

• Reasons an individual should be referre

d to genetic counseling (see Box 10-2 P
Genetic Evaluation and Counseli
• Genetic Testing
• Genetic Counseling
• Discussion about Genetic Counseling
Nurse’s Role
• Discussing costs, benefits, and risks of u
sing health insurance, and potential risk
s of discrimination
• Recognizing ethical, legal, and social iss
• Safeguarding privacy and confidentiality
• Monitoring emotional reactions after rec
eiving information
Nursing Role

• Providing emotional support

• Referring to appropriate support groups
• Beginning the preconception counselin
g process and referring for further gene
tic information
• Taking a family history (Box 10-4 Pg. 2
Nursing Role

• Scheduling genetic testing

• Explaining the purposes, risks/benefits
of all screening and diagnostic tests (se
e Laboratory and Diagnostic Tests 10-1
Pg. 258)
• Answering questions and addressing co
Prenatal Testing and Hard Choi
Antepartum Testing

• Understanding Prenatal testing

Antepartum Testing
• Alpha-fetoprotein
• Amniocentesis • Fetal nuchal tran
• Chorionic villus sa slucency
mpling • Level II ultrasoun
• Percutaneous umb d
ilical blood sampli • Triple marker tes
ng t
Antepartum Testing

• Alpha-fetoprotien
• Diagnostic Amniocentesis
• Chorionic Villus Sampling CVS
• Percutaneous umbilical blood sampling
• Fetal nuchal translucency
• Types of Ultrasounds 7 min
• Quad screen