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CONCEPTION

FETAL DEVELOPMENT &


GENETICS
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
placenta
• 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
lopment
• 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)
Placenta
•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
terus
•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


centa
Development

• Embryonic and Fetal Development


• Table 10-1 p 286-287
Development

• Fetal Development
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
ompleted
•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
Genetics

• 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
Genetics
• 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
es
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
ome
• 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
•Teratogens
•Medications
•TORCH infections
Genetic Evaluation and Counse
ling
• Genetic counseling is an evaluation of a
n individual to confirm, diagnose or rule
out a genetic condition.
Genetic Evaluation and Counseli
ng
• Ideal time: before conception
“ preconception counseling provides
the opportunity to identify, reduce,
and plan for potential risks.
Genetic Evaluation and Counselin
g

• Reasons an individual should be referre


d to genetic counseling (see Box 10-2 P
g.302)
Genetic Evaluation and Counseli
ng
• 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
ues
• 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
57)
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
ncerns
Prenatal Testing and Hard Choi
ces
• http://www.youtube.com/watch?v=7rrA4F_
NY3w
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
PUBS
• Fetal nuchal translucency
• Types of Ultrasounds 7 min
• Quad screen