THE GROWING

FETUS
 STAGES OF FETAL DEVELOPMENT

• Terms use to denote fetal growth

Name Time period
Ovum From ovulation to fertilization
Zygote From fertilization to implantation
Embryo From implantation to 5-8 wks
Fetus From 5-8 wks until term
Conceptus Developing embryo or fetus and
placental structures throughout
pregnancy
Ovum
Zygote
Embryo
Fetus – 9 weeks Newborn
FERTILIZATION: The
Beginning of Pregnancy
I. Fertilization : The Beginning of Pregnancy

• Fertilization
(conception ,impregnation,or fecundation )
-the union of an ovum and a
spermatozoon in the outer third
of a fallopian tube, the
ampullar portion.

• General consideration:
❖ only one ovum reaches maturity each
month.
❖ once released, fertilization must occur
fairly quickly
❖ ovum is only capable of fertilization for
only 24 hours (48 hours at the most)
❖ after that, it atrophies and becomes
nonfunctional.
❖The total critical time span then, for
fertilization to be successful is about 72
hours
• ( 48 hrs before ovulation plus 24 hrs
afterward).
Ovum

• Zona Pellucida – ring of

mucupolysaccharide fluid
surrounding an ovum.
• Corona radiata
- circle of cells

Zona Pellucida and Corona

radiata
- increase the bulk of the
ovum and serve as protective
buffers against injury.
• Ovum is propelled into a
nearyby fallopian tube by
currents initiated by the
fimbriae-the fine hairlike
structures that line the
openings of the fallopian
tube.
• A combination of
peristaltic action of the
tube and movements of
the tube cilia help propel
the ovum along the length
of the tube.
 Sperm
❖normal amount of
semen per ejaculation
– 2.5 ml of fluid
❖Number of
sperms/cc/ml – 50-200
million or average of
400 million sperm per
ejaculation.
⮚Sperms are capable of fertilizing
even for 3-4 days after ejaculation.
⮚ Normal life span of sperms – 7 days
⮚ Sperms, once deposited in the
vagina, will generally reach the
cervix within 90 seconds.
⮚reaches outer fallopian tube within 5
minutes
( this is why douching is not an
effective contraceptive)
• Spermatozoa move
by means of their
flagella (tails) and
uterine
contractions
through the cervix
and the body of the
uterus and into the
fallopian tubes,
toward the waiting
ovum.
• Capacitation – the final
process that sperm must
undergo to be ready for
fertilization.
- consists of changes in the
plasma membrane of the
sperm head , which reveal
the sperm-binding receptor
site.
- all of the spermatozoa that
achieve capacitation reach
the ovum and cluster around
the protective layer of
corona cells.
• Hyaluronidase( a proteolytic
enzyme) – released by the
spermatozoa and acts to
dissolve the layer of cells
protecting the ovum.
•Zygote- the resulting
structure when
chromosomal material of the
of the ovum and
spermatozoon fuse
immediately after the
penetration of the ovum.
* ZYGOTE
Zygote – 46 chromosomes
chromosomes – DNA-containing structure
of cellular organism
autosomes – chromosomes that do not
determine the sex
* Sperm ( 22 autosomes and 1 X or 1 Y sex
chromosomes )
* Ova ( 22 autosomes and 1 X sex
chromosome)
• Only fathers determine the sex of their
children.
• Ex. The union of Y-carrying sperm and
a mature ovum results in a baby boy
(XY).
• If xx – results in a baby girl
• Fertilization is never a certain occurrence
because it depends on at least three separate
factors:

1. equal maturation of both sperm and ovum,

2. the ability of the sperm to reach the ovum,

3. The ability of the sperm to penetrate the

zona pellucida and cell membrane and
achieve fertilization.
Implantation
Fertilization is complete – over 3-4 days – zygote migrates
toward the body of uterus --- mitotic cell division or cleavage
begins (blastomere) --- 1st cleavage occurs at about 24 hrs ---
cleavage divisions continue to occur at a rate of one about every
22 hrs --- consists of 16 to 50 cells by the time the zygote reaches
the body of the uterus --- now known as morula.
• Morula continues to multiply as it floats freely in the uterine
cavity for 3 or 4 more days --- large cells tend to collect at the
the periphery of the ball, leaving a fluid space sorrounding the
inner cell mass---now known as blastocyst ( the structure that
attaches to the uterine endometrium).
• The cells in the outer ring are trophoblast cells. They are 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 form the embryo.
• Trophoblast – are cells in the outer ring. Part of the
structure that will later form the placenta and membranes.
• They produce proteolytic enzymes that dissolve any tissue
they touch.
• The action allows the blastocyst to burrow deeply into the
endometrium and receive basic nourishment of glycogen
and mucoprotein from the endometrial gland.
• THE INNER CELL MASS

- while trophoblast is developing into the

placenta, which will nourish the fetus, the
inner cell mass is forming the fetus itself.
Three layers of the inner cell mass:
1. The ectoderm – forms the skin and
nervous system.
2. The mesoderm – forms bones and
muscles and also the heart and blood
vessels, including those in the placenta.
3. The endoderm – forms mucous
membranes and glands.
* the three layers together are known as
the embryonic plate.
Implantation, or contact between the growing structure and the uterine
endometrium, occurs approximately 8 to 10 days after fertilization.

• After 3rd or 4th day of free floating ( about 8 days since ovulation) –the
blastocyst sheds the last residues of the corona and zona pellucida.
• The structure brushes against the rich uterine endometrium, a process
termed apposition.
• It attaches to the surface of the endometrium (adhesion) and settles down
into its soft folds ( invasion ).
• …and
settles
down into
its soft folds
( Invasion ).
6 day-old human embryo implanting
• Implantation
point is usually
high in the
uterus, on the
posterior
surface.
Abnormal Implantation
This drawing illustrates a
phenomenon known as implantation
bleeding. Maternal blood fills the
cavities in the trophoblast.
The trophoblast surrounds the whole
embryo and just before it is
completely covered some of blood in
the superficial cavities might leak
into the uterine cavity and escape via
the vagina.
This implantation bleeding occurs
exactly at the time of the expected
menstruation. It therefore can cause
uncertainty about the duration of
pregnancy. Implantation bleeding
seldom occurs.
Once implanted, the zygote
becomes an embryo
EMBRYONIC AND
FETAL
STRUCTURES
• The placenta, which will serve as the
fetal lungs, kidneys, and digestive
tract in utero, begins growth in early
pregnancy in coordination with
embryo growth.
The decidua
- after fertilization, the corpus
luteum continues to function
because of the influence of
hCG.
Uterine endometrium
continues to grow in
thickness and vascularity.
Endometrium is now termed
decidua and will be discarded
only after birth.
 A. The Decidua ( latin: falling off )

- the name given to the

endometrium during pregnancy.
Three separate areas:
1. Decidua Basalis – lies directly
under the embryo.
2. Decidua capsularis – the portion
of the endometrium that
stretches or encapsulates the
surface the surface of the
trophoblast.
3. Decidua vera – the remaining
portion of the uterine lining.
-
The Decidua

- as embryo continues to grow, it

pushes the decidua capsularis
before it like a blanket.

- Eventually, enlargement brings the

structure into contact with the
opposite uterine wall.
- At birth, the entire inner surface of
the uterus is stripped away, leaving the
organ highly susceptible to
hemorrhage and infection.
B. Chorionic Villi
- initially the ovum appears to be covered
with fine, downy hair surrounding the
ovum.
- these proliferate and branch from about 3
weeks after fertilisation , forming the
chorionic villi.
- - at term, almost 200 villi will have formed.
- - it is most profuse in the area where the
blood supply is the richest – that is, the
basal decidua.
- - the villi erode the walls of maternal blood
vessels as they penetrate the decidua,
opening them up to form a lake of
maternal blood in which they float. A few
villi are more deeply attached to the
decidua and are called anchoring villi.
TWO OUTER COVERING :
1. The syncytiotrophoblast- capable of breaking down tissue as in the
process of embedding. It erodes the walls of the blood vessels of the
decidua, making nutrients in the maternal blood accesible to the
developing organism.
- produces hCG, somatomammotropin, estrogen and progesterone
TWO OUTER COVERING :
2. The cytotrophoblast – The hormone is responsible for informing
the corpus luteum that a pregnancy has begun. The corpus
luteum continues to produce estrogen and progesterone.
Menstruation then is supressed.
- protect the growing embryo and fetus from certain infectious
organisms such as spirochete of syphilis.
• Cytotrophoblast or Langhans layer –is
present as early as 12 days gestation.
• - disappears between the 20th and 24th
week.
• - the reason why syphillis is considered
to have a high potential for fetal damage
late in pregnancy.
C. THE PLACENTA ( latin for
pancake )

❖ arises out of trophoblast tissue

❖ it serves as the fetal lungs,
kidneys, and gastrointestinal
tract and as a separate
endocrine organ throughout
pregnancy.
❖ its growth parallels that of the
fetus, growing from a few
identifiable cells at the
beginning of pregnancy to an
organ 15 to 20 cm in diameter
and 2 to 3 cm in depth at term.
 Placental
Circulation
• 12th day of pregnancy – maternal
blood begins to collect in the
intervillous spaces of the uterine
endometrium sorrounding the
chorionic villi.
• 3rd week : oxygen and other
nutrients, such as glucose, amino
acids, fatty acids, minerals, vitamins,
and water diffuse from the maternal
blood through the cell layers of the
chorionic villi to the villi capillaries.
• From there: nutrients are
transported back to the developing
embryo.
Note:

⮚There is no direct exchange of blood between the embryo and

the mother during the pregnancy.
⮚The exchange is carried out only by selective osmosis through
the chorionic villi.
⮚Minute break allow occasional fetal cells to cross as chorionic
villi is only one cell thick.
⮚Placental osmosis is so effective that all but a few substances
are able to cross from the mother into the fetus.
⮚It is important that a woman take no nonessential drugs
( including alcohol and nicotine) during pregnancy.
 Mechanisms by Which Nutrients Cross the Placenta
Mechanism Description

Diffusion When there is a greater concentration of a substance on one side of a

semipermeable membrane than on the other, substances of correct molecular
weight cross the membrane from the area of higher concentration to the area of
lower concentration.
Oxygen, carbon dioxide, sodium, and chloride cross the placenta by this method.
Facilitated diffusion To ensure that the fetus receives enough concentrations of necessary growth
substances, some substances cross the placenta more rapidly or more easily
without the expenditure of energy.
A carrier moves the substance into and through the membrane.
Glucose is an example of a substance that crosses by this process.

Active transport This process requires energy and action of an enzyme to facilitate transport.
Essential amino acids and water-soluble vitamins cross the placenta against the
pressure gradient or from an area of lower molecular concentration to an area of
greater molecular concentration.

Pinocytosis Absorption by the cellular membrane of microdroplets of plasma and dissolved

substances.
Gamma globulin, lipoproteins, phospholipids, and other molecular structures that
are too large for diffusion and that cannot participate in active transport cross in
this manner.
Viruses that infect the fetus can also cross in this manner.
❖Cotyledons

- as the number of chorionic villi

increases with pregnancy, the villi
form an increasingly complex
communication network with the
maternal blood.
- intervillous spaces grow larger and
larger, becoming separated by a
series of partitions or septa.
- in a mature placenta, there as
many as 30 separate segments,
called cotyledons.
- these compartments are what
make the maternal side of the
placenta at term look rough and
uneven.
Cotyledons
Duncan/Shultz presentation
❖Blood supply
- about 100 maternal uterine arteries supply the mature placenta.
- to provide enough blood for exchange, the rate of uteroplacental blood
flow in pregnancy increases from 50ml/min at 10 weeks to 500 to 600
ml/min at term.
- no additional maternal arteries appear after the first 3 months of
pregnancy; instead, to accommodate the increased blood flow, the
arteries increase in size.
_ Systematically, the mother’s heart rate, total cardiac output, and blood
volume increase to supply the placenta.
• Uterine perfusion and
placental circulation is most
efficient when the mother
lies on her left side.
• This position lifts the uterus
away from the inferior vena
cava, preventing blood
from being trapped in her
lower extremities.
• If the mother lies on her
back and the weight of the
uterus compresses the
vena cava, placental
circulation can be so
sharply reduced that supine
hypotension occurs.
• At term, placental circulatory network has grown so
extensively that a placenta weighs 400 to 600 g( 1 lb ).
• Smaller placenta : suggests that circulation to the fetus
may have been inadequate.
• Bigger placenta : may indicate that circulation to the
fetus was threatened, because the placenta was forced
to spread out in an unusual manner to maintain a
sufficient blood supply. E.g., mother with diabetes
( probably from excess fluid collected between the cells)
 Endocrine Function in
pregnancy
1. Human Chorionic Gonadotropin
- first hormone produced
- can be found in maternal blood and urine as early as the
first missed menstrual period ( shortly after implantation
has occurred)
- a false-negative result from a pregnancy test may be
reported before or after this period.
- mother’s serum will be completely negative for hCG
within 1 to 2 weeks after birth.
- testing for hCG after birth can be used as proof that all of
the placental tissue has been delivered.
Role of hCG

a. act as a fail-safe measure to ensure that the corpus luteum of

the ovary continues to produce progesterone and estrogen.
- if corpus luteum should fail and the level of progesterone
fall, this would cause endometrial sloughing, with loss of
pregnancy followed by a rise of pituitary gonadotropins to
induce menstrual cycle.

b. Supressess the maternal immunologic response so that

placental tissue is not rejected
c. If fetus is male, it exerts an effect on the fetal testes to begin
testosterone production, because hCG structure is similar to
that of LH.
2. Estrogen
- produced as a second product of the syncytial cells of the
placenta.
- contributes to the mother’s mammary gland in preparation
for lactation and stimulates uterine growth to accommodate the
developing fetus.
- “ hormone of women”
3. Progesterone
- “ hormone of mothers”
- necessary in pregnancy to maintain the endometrial lining of
the uterus.
- present in serum as early as the 4th week of pregnancy.
- rises progressively during the remainder of pregnancy
- helps prevent premature labor as it reduces the contractility
of the uterine musculature during pregnancy.
4. Human Placental lactogen ( Human Chorionic
Somatomammotropin)
- a hormone with both growth-promoting and lactogenic
(milk-producing) properties.
- produced by the placenta as early as the 6th week of
pregnancy.
- be assayed in both maternal serum and urine.
- promotes mammary gland growth in preparation for
lactation in the mother.
- also serves the important role of regulating maternal
glucose, protein, and fat levels so that adequate amount of
these nutrients are always available to the fetus.
 THE AMNIOTIC MEMBRANES
Formation of Chorion
- the chorionic villi on the
medial surface of the
trophoblast gradually thin,
leaving the medial surface of
the structure smooth
(smooth chorion )
- smooth chorion eventually
becomes the chorionic
membrane, the outermost
fetal membrane.
- once it becomes smooth, it
offers support to the sac that
contains the amniotic fluid.
Formation of Amnion

- second membrane lining the

chorionic membrane
- forms beneath the chorion
- at birth, they can be seen covering
the fetal surface of the placenta,
giving that surface its typically
shiny appearance.
- no nerve supply
- spontaneously rupture at term or
artificially ruptured
- produces the amniotic fluid
- also produces a phospholipid that
initiates the formation of
prostaglandins, which can cause
uterine contractions and may be
the trigger that initiates labor.
Amnion/Chorion
The Amniotic Fluid

- is constantly being newly formed by

the amniotic membrane, so it never
becomes stagnant.
- slightly alkaline, with a pH of about
7.2
- absorption :
a. direct contact with the fetal
surface of the placenta
b. fetus continually swallows the
fluid, the major method of absorption
c. in the fetal intestine, it is
absorbed into the fetal bloodstream –
umbilical arteries – to placenta –
exchanged across the placenta.
Amount at term – 800-1,200 mL

Hydramnios – excessive amniotic fluid

- more than 2,000 mL
- commonly due to : esophageal
atresia or anencephaly
- also tends to occur in women
with diabetes
Oligohydramnios – reduction in the
amount of amniotic fluid
- due to the disturbance in the
fetal kidney function
- less than 300 mL
Function of amniotic fluid:
-serves as important protective
mechanism for fetus.
- shield against pressure or a
blow to the mother’s abdomen.
- protects fetus from changes of
temperature
- probably aids in muscular
development, because it allows
the fetus the freedom to move.
- protects the umbilical cord
from pressure, protecting the
fetal oxygen supply.
D. The umbilical Cord
UMBILICAL CORD/FUNIS

i. Description
- is formed from the fetal
membranes ( amnion and
chorion )
- provides a circulatory pathway
that connects the embryo to the
chorionic villi of the placenta.

ii. Function
- transport oxygen and nutrients
to the fetus from the placenta
and to return waste products
from the fetus to the placenta.
iii. Characteristics
- about 53 cm (21 in) in
length at term
- about 2 cm ( ¾ in ) thick
- bulk of the cord is gelatinous
mucopolysaccharide called “
Wharton’s jelly “, it gives the cord
body and prevents pressure on
the vein and arteries that pass
through it.
- outer surface is covered
with amniotic membrane.
 - umbilical cord contains : 1 vein ( carrying
blood from the placental villi to the fetus),
and 2 arteries ( carrying blood from the
fetus back to the placental villi ).
- the number of veins and arteries in the
cord is always assessed and recorded at
birth.
- blood can be withdrawn from the
umbilical vein or transfused into the vein
during intrauterine life for fetal
assessment or treatment.
- rate of blood flow: 350 mL/min at term
and rapid
- cord is unlikely to twist or knot due to its
rapidity
• - in about 20% of all births, a loose loop of cord is
found around the fetal neck ( nuchal cord).
• - wall of umbilical cord arteries are lined with
smooth muscle. Constriction of these muscles after
birth contributes to hemostasis and helps prevent
hemorrhage.
• - it does not contain nerve supply, thus it can be
cut at birth without discomfort to either the child
or mother.
Umbilical cord
Dry umbilical cord
 ORIGIN AND DEVELOPMENT OF
ORGAN SYSTEMS

A. Stem Cells
B. Zygote Growth
C. Primary Germ Layers
D. Cardiovascular System
E. Fetal Circulation
F. Fetal Hemoglobin
G. Respiratory System
H. Nervous System
I. Endocrine System
J. Digestive System
K. Musculoskeletal System
L. Reproductive System
M. Urinary System
N. Integumentary system
O. Immune system
 A. Stem Cells

1. Totipotent stem cells ( zygote cells )

- occurs during the first 4 days of life
- so undifferentiated that they have the
potential to form a complete human being.
2. Pluripotent stem cells
- in another 4 days, the structure implants and
becomes an embryo- begin to show
diferentiation and are no longer capable of
becoming any body cell – slated now to
become specific body cells, such as nerve,
brain, or skin cells.
3. Multipotent stem cells
- specific that they have set a sure course toward
what body organ they will create.
2 types of Cloning:

1. Reproductive cloning
- the nucleus is removed from an
oocyte and the nucleus of an adult
cell is transferred into the oocyte,
the embryo has the potential to
grow into an infant that is
identical to the adult donor.
2. Therapeutic cloning
- pluripotent stem cells are removed
and allowed to grow in the
laboratory, these have the
potential to be able to supply any
type of body cell needed by the
adult donor.
 B. Zygote Growth

• Development proceeds in a cephalocaudal

direction.
 C. Primary Germ layer
1. Ectoderm : a distinctive layer of cells, arises from amniotic
cavity which is the largest.
2. Entoderm : arises from the yolk sac , a smaller cavity
- yolk sac appears to supply nourishment only
after implantation.
- after that, its main purpose is to provide a
source of red blood cells until the embryo’s
hematopoetic system is mature enough to perform this
function.
- it then atrophies and remains only as white
streak discernible in the cord at birth.
3. Mesoderm – 3rd layer
Implications of the Primary Germ layers:
- each of these germ layers, primary tissue develops into specific
body systems ( see table)
- coexisting congenital defects found in newborns usually arise
from the same layer.
ex. Esophageal and tracheal fistula ( entoderm )
Heart and kidney defects ( mesoderm)
Bladder and urethral defects ( entoderm )
Note:
- Rubella infection is serious in pregnancy as it can infect all
three germ layers, thereby causing congenital anomalies
- Screening procedures are ordered for newborns with
congenital malformations.
e.g radiographic exam of the kidney with a child born with
heart defects.
Germ Layer Body Portions Formed
Ectoderm Central nervous system (brain and spinal cord)
Peripheral nervous system
Skin, hair, and nails
Sebaceous glands
Sense organs
Mucous membranes of the anus, mouth, and nose
Tooth enamel
Mammary glands
Mesoderm Supporting structures of the body ( connective tissue, bones, cartilage,
muscle, ligaments and tendons )
Dentin of teeth
Upper portion of the urinary system ( kidneys and ureters )
Reproductive system
Heart
Circulatory system
Blood cells
Lymph vessels

Entoderm Lining of pericardial, pleura, and peritoneal cavities

Lining of the gastrointestinal tract, respiratory tract, tonsils, parathyroid,
thyroid, thymus glands
Lower urinary system
( bladder and urethra )
• At 8 week’s gestation ( the end of embryonic period), all
organ system are complete.

• Organogenesis – the growing structure is most

vulnerable to invasion by teratogens
( see fig 8.5 Critical periods of fetal growth.p 191,
Pillitteri)
D. Cardiovascular System
• One of the first system to become functional in intrauterine life.
• Forms as early as the 16th day of life and beats as early as the
24th day.
• 6th or 7th week: septum that divides the heart into chambers is
developed.
• 10th to 12th week : heartbeat maybe heard thru a Doppler
instrument
• 11th week : ECG
• After 28th wk : 5 beats/min thru a fetal heart rate rhythm strip.
 d1. Fetal Circulation
▪ 3rd week of intrauterine life, fetal blood begins to
exchange nutrients with maternal circulation across the
chorionic villi.
▪ Fetus derives oxygen and excretes carbon dioxide from
the placenta.
▪ The blood flow is to supply the cells of the lungs.
▪ Specialized structures present in the fetus shunt blood
flow to supply the most important organs of the body:
the brain, the heart, and kidneys.
▪ Blood from the placenta is highly oxygenated.
▪ Blood enters the fetus through the umbilical vein (called a
vein even though it carries oxygenated blood, bec the
direction of the blood is toward the fetal heart).
Fetal
circulation
▪ This vein carries the blood to the inferior vena cava through an
accessory structure, the ductus venosus, which allows
oxygenated blood to be supplied directly to the fetal liver.
▪ Oxygenated blood then empties into the inferior vena cava
and is carried to the right side of the heart.
▪ The blood then enters the right atrium, into the left atrium
through an opening in the atrial septum, called foramen ovale.
▪ From the left atrium, it follows the course of normal circulation
into the left ventricle and into the aorta.
▪ Ductus arteriosus- shunts away from the lungs small amount
of blood that returns to the heart directly into the descending
aorta.
▪ Most of the blood flow from the descending aorta is
transported by the umbilical arteries ( called arteries, even
though they are now transporting deoxygenated blood, bec
they are carrying blood away from the fetal heart) back
through the umbilical cord to the placental villi, where new
oxygen exchange takes place.
• 80% - blood oxygen saturation level of the fetus
• Rapid fetal heart rate ( 120 to 160/min ) is necessary
to supply oxygen to cells.
d2. Fetal hemoglobin
• Compose of two alpha and two gamma chains ( adult: two
alpha and two beta chains)
• More concentrated
• Has greater oxygen affinity
• 17.1g/100mL hg level (adult : 11g/100 mL)
• 53% hct level ( adult : 45% )
 E. Respiratory
System
• 3rd week: respiratory and digestive tracts exist as single tube.
• Initially it is a solid structure, canalizes then by end of 4th
week, a septum begins to divide the esophagus and trachea-
at the same time, lung buds appear on the trachea.
Note:
Diaphragmatic hernia or intestine still present in the chest
occurs if the diaphragm fails to close completely by end of 7th
week.
Important respiratory developmental milestones :

• Alveoli and capillaries begin to form between the 24th and 28th
weeks.
• 3 mos : spontaneous respiratory practice movts begin
• Specific lung fluid with a low surface tension and low viscosity
forms in alveoli to aid in expansion of the alveoli at birth; it is
rapidly absorbed after birth.
• Surfactant , formed at about the 24th week.
 F. Nervous
System
• Begins to develop extremely early in pregnancy, during the 3 rd
and 4th
weeks of life.
Milestones :
❖3rd week : neural plate ( thickened portion of the ectoderm) is apparent.
- top portion differentiates into the neural tube, which form into brain and
spinal cord.
❖8th week : brain waves can be detected by EEG
❖All parts of the brain form in utero.
❖The eye and inner ear develop as projections of the original neural tube.
❖24 weeks : ear is capable of responding to sound; eyes exhibit a pupillary
reaction, indicating that sight is present.

❖Note:
- Meningocele ( spinal cord disorder ) – may occur because of lack of folic
acid.
 G. Endocrine
System
• Fetal adrenal glands supply a precursor for estrogen
synthesis by the placenta.
• The fetal pancreas produces the insulin needed by
the fetus ( insulin does not cross the placenta from
the mother to the fetus )
• The thyroid and parathyroid glands play vital roles in
metabolic function and calcium balance.
H. Digestive System
• 4th week ; separates from the respiratory tract
• 16th week : meconium forms
• GIT tract is sterile before birth, vitamin K level is low
• 32 weeks or 1,500 g : sucking and swallowing reflexes matures
• 36 weeks: ability of the GIT to secrete enzymes essential to
carbohydrate and protein digestion is mature.
• Liver is active throughout gestation
- functions as filter between the incoming blood and fetal
circulation
- and a deposit site for fetal store such as iron and glycogen
 I. Musculoskeletal
System
• 11th week : fetus can be seen moving through
ultrasound
• 20 weeks : quickening can be felt by the
mother
 J. Reproductive
System
• Child’s sex is determined at the moment of conception
• 8th week : can be ascertained through chromosomal
analysis
• 6th week: gonads ( testes and ovaries ) form
• Testes first form in the abdominal cavity
• 34th to 38th week : testes descend into the scrotal sac

Note:
* If testes is formed : testosterone is secreted influencing
the sexually neutral genital duct to form other male
organs ( maturity of the wolffian, or mesonephric, duct ).
• * if no testosterone : female organs will form ( maturation
of the müllerian, or paramesonephric, duct).
• Importance :
• * if mother should take an androgen-like substance
during this stage of pregnancy, a child who is
chromosomally female would appear more male than
female at birth.
• * if deficient testosterone is secreted by the testes, both
the müllerian duct and the wollfian duct could develop
(pseudo-hermaphroditism, or intersex ).
 K. Urinary
System
• End of 4th week : kidneys are present but is not
essential as the placenta clears the fetus of waste
products.
• 12th week : urine is formed
• 16th week: urine is excreted into the amniotic fluid
• At term : fetal urine is being excreted at the rate of
500 mL/day.
• Oligohydramnios ( amount of amniotic fluid that is
less than normal ) suggests that fetal kidneys are not
secreting adequate urine.
 L.
Integumentary
• The skin of aSystem
fetus appears thin and almost
translucent until subcutaneous fat begins to be
deposited at about 36 weeks.
Skin is covered by :
• lanugo - soft downy hairs)
• vernix caseosa - a cream cheese-like substance,
important for lubrication and for keeping the skin
from macerating in utero.
 M. Immune System
Third trimester :
IgG maternal antibodies cross the placenta into the fetus
- give the fetus temporary passive immunity against diseases for
which the mother has antibodies.
- includes poliomyelitis, rubella, rubeola, diptheria, tetanus,
infectious parotitis, hep B, and pertussis.
- fetus is susceptible to herpes virus as there is little or no
immunity at all
- level of immunity peaks at birth and then decreases over the
next 8months while the infant begins to build up his or her own
stores of IgG, IgA and IgM.
2 months : immunization is started as passive immunity declines
MILESTONES of FETAL GROWTH

and DEVELOPMENT
MILESTONES of FETAL GROWTH and DEVELOPMENT

Day 1: fertilization: all human

chromosomes are present; unique
human life begins.
• Day 6: embryo begins implantation in the uterus.
• Day 22: heart begins to beat with the child's own blood, often
a different type than the mothers'.
• Week 3: By the end of third week the child's backbone spinal
column and nervous system are forming. The liver, kidneys
and intestines begin to take shape.
• Week 4: Length: 0.75 to 1 cm
Weight : 400 mg
• Week 5: Eyes, legs, and hands begin to develop.
Week 6: Brain waves are detectable; mouth and lips are
present; fingernails are forming.

Week 7: Eyelids, and toes form, nose distinct. The baby is

kicking and swimming.

Week 8: Every organ is in place, bones begin to replace

cartilage, and fingerprints begin to form. By the 8th week the
baby can begin to hear.
▪Length : 2.5 cm ( 1 in )
▪ Weight : 20 g
▪ Organogenesis is complete.
▪ The heart, with septum and valves, is beating rythmically.
▪ Facial features are definitely discernible.
▪ Arms and legs are developed.
▪ External genitalia are present, but sex is not distinguishable
by simple observation.
▪ The primitive tail is regressing.
▪ Abdomen appears large because the fetal intestine is growing
rapidly.
▪ Sonogram shows a gestational sac, diagnostic of pregnancy.
• Weeks 9 and 10: Teeth begin to form,
fingernails develop. The baby can turn his
head, and frown. The baby can hiccup.

• Weeks 10 and 11: The baby can "breathe"

amniotic fluid and urinate.
• Week 11: the baby can grasp objects placed in
its hand; all organ systems are functioning. The
baby has a skeletal structure, nerves, and
circulation.
Week 12( First trimester ):
❖The baby has all of the parts necessary to
experience pain, including nerves, spinal
cord, and thalamus. Vocal cords are
complete. The baby can suck its thumb.
❖Length : 7 to 8 cm
❖Weight :45 g
❖Sex is distinguishable by outward
appearance
❖Kidney secretion has begin
❖Heartbeat is audible through Doppler
Week 14:
At this age, the heart pumps several quarts
of blood through the body every day.
• Week 15:
The baby has an adult's taste buds.

• Month 4:
Bone Marrow is now beginning to form. The heart is pumping
25 quarts of blood a day. By the end of month 4 the baby will
be 8-10 inches in length and will weigh up to half a pound.
Week 17:
The baby can have dream (REM)
sleep.

Week 19:
Babies can routinely be saved at
21 to 22 weeks after
fertilization, and sometimes
they can be saved even younger.
❖Week 20:
❖The earliest stage at which Partial birth abortions are
performed. At 20 weeks the baby recognizes its'
mothers voice.
❖Length : 25 cm
❖Weight : 223 g
❖Spontaneous fetal movements can be felt by the
mother
❖Antibody production is possible.
❖Hair forms extending to include eyebrows and hair in
the head.
❖Meconium is present in the upper intestine.
❖Brown fat starts to develop
❖Vernix caseosa begins to form.
End of 24th Gestational week ( Second
Trimester )
❖The baby practices breathing by
inhaling amniotic fluid into its developing
lungs. The baby will grasp at the
umbilical cord when it feels it.
❖Most mothers feel an increase in
movement, kicking, and hiccups from the
baby.
❖Oil and sweat glands are now
functioning.
❖ Length: 28 to 36 cm
❖Weight: 550g
❖Pupils are capable of reacting to light.
❖Achieved a practical low-end age of
viability if they are cared in a modern
intensive care facility and has a weight of
601 g.
❖Hearing can be demonstrated by
response to sudden sound.
• Months 7 through 9:
❖Eyeteeth are present.
❖The baby opens and closes his eyes.
❖baby is using four of the five senses (vision, hearing, taste, and
touch.)
❖He knows the difference between waking and sleeping, and can
relate to the moods of the mother.
❖The baby's skin begins to thicken, and a layer of fat is produced
and stored beneath the skin.
❖Antibodies are built up, and the baby's heart begins to pump
300 gallons of blood per day.
❖Approximately one week before the birth the baby stops
growing, and "drops" usually head down into the pelvic cavity.
• End of 40th Gestational week
❖Length: 48 to 52 cm
❖Weight: 1,800 to 2,700g ( 5 to 6 lb)
❖Fetus kick actively
❖Fetal hemoglobin begins its conversion to adult hemoglobin
❖Vernix caseosa is fully formed.
❖Creases of the soles of the feet cover at least two thirds of
the surface.
MEASUREMENT of
the LIFE of FETUS
MEASUREMENT of the LIFE of FETUS

• Ovulation age
• Gestational age – measured from the first day of the last
menstrual cycle

Lunar mos – 4 weeks period

Trimesters – 3 mos period
Lunar mos – 10 mos ( 40 wks or 280 days )
Determination of Estimated Birth Date

• Traditionally, this date has been referred to as the estimated

date of confinement ( EDC).
• Changed to EDB as women are no longer “confined’ after
childbirth.
• If fertilization occurred early in a menstrual cycle, the
pregnancy will probably end “early”
• If ovulation and fertilization occurred later in the cycle, the
pregnancy will end “late”.
• Because of these, a pregnancy ending 2 weeks before or 2
weeks after the calculated EDB is considered.
Nagele’s Rule : standard method to predict the length of
pregnancy.

1. Determine the last normal menstrual period (LMP).

2. Consider the FIRST DAY of the LMP.
3. Consider the month in numerical term.
for example : Jan = 1 April = 4
Feb = 2 May = 5
and so forth.
For the first 3 months of the year, add 12 to the
numerical value.

for example : January : 1 + 12 = 13

February : 2 + 12 = 14
March : 3 + 12 = 15
 4. Now use the Nagele’s Formula : subtract 3 months
and add 7 days to the first day of LMP.
example A : Given LMP is January 5 – 10.
Numerical value of January is 13:
13 5
- 3
10 5
+ 7
- 10 12

EDD is October 12.

Example B : Given LMP is September 12 – 17.
Numerical value of September is 9.
9 12
-3
6 12
+ 7
6 19

Note: The Nagele’s Rule is just an estimate.

It is said that 4% of all babies arrive “on time” using this rule,
whereas 60% appear 1 to 7 days early or late.
Estimating Age of Gestation
LMP : Jan. 2, 2016
Clinic Visit : July 29, 2016
Computation:
Jan 31 – Jan 2 = 29
Feb = 28
March = 31
April = 30
May = 31
June = 30
July = 29
_______
208 / 7 = 29.7
or : 29 x 7 = 203 – 208 = 5
29 weeks and 5 days

in months : 29/ 4 weeks = 7.2 months

or 7 x 4 = 28 – 29 = 1 week
therefore AOG is : 7 months , 1 week and 5 days
ASSESSMENT OF
GROWTH AND
DEVELOPMENT
ASSESSMENT OF FETAL GROWTH AND DEVELOPMENT

IMPORTANCE:
* Fetal growth and development can be compromised if :
- a fetus has a metabolic or chromosomal disorder that
interferes with normal growth,
- if the supporting structures such as the placenta or cord do
not form normally
- or if environmental influences, such as cigarette smoking or
alcohol consumption interfere with fetal growth.
Nursing responsibilities:

1. Seeing that a signed consent form has been obtained as

needed.
2. Scheduling the procedure
3. Explaining the procedure to the woman and her support
person
4. Preparing the woman physically and psychologically
5. Providing support during the procedure
6. Assessing both fetal and maternal responses to the
procedure
7. Providing any necessary follow-up care
8. Managing equipment and specimens
A. Health History
1. nutritional intake
2. personal habit
3. any accidents or experienced intimate
partner abuse

B. Estimating Fetal Growth

a. Estimating Fundic Height by McDonald’s
Method ( indicator of uterine size in early pregnancy)
• EQUIPMENT : A centimeter tape measure
PROCEDURE :
• 1. Explain the procedure to the mother.
• 2. Ask the mother to empty her bladder.
• A full bladder displaces the uterus causing an
• inaccurate measurement.
• 3. Position mother on dorsal recumbent.
• 4. Drape.
• 5. Measure the distance abdominally from the top
of the symphysis pubis over the curve of the abdomen to
the top of the uterine fundus.
• Fundic height ( FH ) in cm correlates well with weeks of
gestation between 20-31 weeks.
LIMITATION:
- inaccurate in women with obesity, polyhydramnios and
uterine fibroids.
ESTIMATING GESTATIONAL AGE BY MCDONALD’S RULE

- This knowledge is exceedingly vital in the event of a high-risk

pregnancy.

• PROCEDURE:

• 1. Explaining the procedure to the client.

• 2. Have the woman void.
• 3. Measure the fundal height (FH) using
• McDonald’s Method ( from the symphysis pubis to the top
of the fundus ).
• 4. Compute using the McDonald’s Rule :
• a. Duration of pregnancy in lunar months :
• FH in cm x 2 divided by 7

• b. Duration of pregnancy in weeks :

• FH in cm x 8 divided by 7
• example : FH : 34 cm
•
• 34 x 8 = 272

• 272 / 7 = 38 – 39 weeks
ASSESSING
Fetal well-
being
C. Assessing Fetal Well-Being
1. Fetal movement –

a. Sandovsky method : felt by the mother ( quickening ) begins approximately 18

to 20 weeks of pregnancy and peaks at 28 to 38 weeks.
- a healthy fetus moves at least 10x/day.
how to assess fetal movement:
* let the mother lie in recumbent position after a meal
* record how many fetal movements she feels over the next
hour. ( min. twice every 10 min or an average of 10-12 x/hour)
* if less than 10 movements let the mother
repeat the test for the next half hour.
* if still less within two hours – call hlth care provider
another protocol ….
b. Cardiff method ( count-to-Ten)
* the mother records the time interval it takes for her to
feel 10 fetal movements. Usually, this occurs within 60
minutes.
2. Fetal Heart Rate ( FHR )

FHR beat
- 120 to 160 per minute
whole pregnancy
- can be heard and counted
as early as 10th to 11th
week of pregnancy by
doppler tech.
- fetal heart rate of less than
90 bpm is high risk for
miscarriage at 5 to 8
weeks of pregnancy
• Variability is categorized as:

a. Absent ( none apparent)

b. Minimal ( extremely small fluctuations)
c. Moderate ( amplitude range of 6-25 beats per
minute )
d. Marked ( amplitude range over 25 beats)
•
• If a 20-minute period passes without any fetal
movement, it may mean only that the fetus is sleeping.

• If the mother is given an oral carbohydrate snack, such

as orange juice, her blood glucose level may increase
enough to cause fetal movement.
11. Triple Screening
- or analysis of three indicators ( MSAFP,
unconjugated estriol, and hCG)
- done to yield even more reliable results.
12. Chorionic Villi Sampling
- a biopsy and chromosomal analysis of
chorionic villi that is done at 10 to 12 weeks of
pregnancy.
14. Percutaneous
Umbilical Blood
Sampling
- the aspiration of
blood from the umbilical
vein for anaylsis.
- if fetus is found to be
anemic, blood may be
transfused using the
same procedure.
15. Amnioscopy
- the visual inspection of the
amniotic fluid through the
cervix and membranes with an
amnioscope ( a small
fetoscope ).
- use to detect meconium
staining.
• 16. Fetoscopy
• - fetus is visualized by
inspection through a fetoscope ( an
extremely narrow, hollow tube
inserted by amniocentesis
technique).
• -used for the following
purposes:
• * to confirm the intactness of
the spinal column.
• * to obtain biopsy samples of
the fetal tissue and fetal blood
samples
• * to perform elemental surgery
• 17. Biophysical Profile
• - combines five parameters ( fetal reactivity, fetal
breathing movements, fetal body movement, fetal tone,
and amniotic fluid volume) into one assessment.