Embryo Second Week

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Estimation of Fetal age
• Ultrasound measurements of the CRL

determine fetal size, probable age and helps
predict expected date of confinement .
• Fetal head measurements and femur length
can be used to evaluate the age of the fetus.
• Gestational age/menstrual age: The length
calculated from the last day of the LNMP.
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Trimesters of Pregnancy
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• At the end of the first trimester, all major

systems are developed
• At the second, fetal size increases
sufficiently so that good anatomical detail
can be visualized using ultrasonography
• During this period most fetal anomalies can
be detected using high resolution, real time
ultrasound
• At 35 weeks of gestation, the fetus weighs
about 2500 gr, which is used to define the
level of fetal maturity.
External Characteristics of
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Fetuses
• CRL is preferred for • Basic measurements

estimating fetal age are:
until the end of the – Biparietal diameter
first trimester (BPD)
• In the 2nd and 3rd – Head circumference
– Abdominal
trimesters, several
circumference
structures can be – Femur length
identified and – Foot length
measured • Fetal weight is often
ultrasonographically.
useful in estimating
age.
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Fetal period – 9 to 12 weeks
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• 9 week fetus • 12 week fetus

– The head is very big and – CRL has more than
half the CRL. doubled.
– The face is broad, eyes – Primary ossification
are widely separated, centers appear in the
the ears are low set and skeleton, especially in
the eyelids are fused. the skull and long bone.
– Male and Female – The upper limbs have
genitalia appear similar. reached their final
– Erithropoiesis is taking relative length.
place in the liver. – Erythropoyesis begins to
occur in the spleen.
– The genitals can be
distinguished.
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10 weeks
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Fetal Period – 13 to 16 weeks
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• Rapid growth and active ossification

• Limb movements become coordinated by
the 14th week,
• Slow eye movement occur at 14 weeks,
• The external genitalia can be recognized by
14 weeks,
• Scalp hair patterning is determined.
• In the female, the ovaries are differentiated
and contain primordial follicles that have
oogonia.
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Fetus 13 to 16 weeks
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• Growth slows down in • Eyebrows and head hair

this period, are completely visible
• Quickening is felt by at 20 weeks, and the
the mother, body is completely
• The skin of the fetus is covered with fine
covered with a greasy downy hair called
cheese like material – “Lanugo”.
“Vernix Caseosa” • By the 18th week the
• Brown fat is formed uterus is formed and
during this period. canalization of the
vagina has begun.
• By 20 weeks the testis
have started to
descend
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• There is substantial weight gain.

• The skin is wrinkled and more translucent.
• At 21 weeks rapid eye movements begin.
• By 24 weeks the epithelial cells (type II
pneumocytes) of the interalveolar walls of
the lungs have begun secreting
surfactants.
• Fingernails are also present at this time .
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24 weeks
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• Fetal lungs can breath air.

• The CNS has matured to the stage where
it can direct rhythmic breathing
movements and control body
temperature.
• At 26 weeks, the eyes re-open and
Lanugo and head hair are well developed.
• Toenails become visible and subcutaneous
fat is present under the skin.
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Por: Nombre profesor(a) Fetal Period – 26 to 29 weeks
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cont…
• The fetal spleen, which was an important site

of hematopoyesis,finish in this function.
• Between week 28 and 32, the male testes are
totally descended.
• During the 29th week the bone marrow becomes
the major site of erythrocyte formation.
• The fetal spleen is an important site of
hematopoesis.
• During the 29th week the bone marrow becomes
the major site of erythrocyte formation.
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28 weeks
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• Pupillary light reflexes of the eyes,

• The skin becomes pink and smooth,
• The upper and lower limbs have a
chubby appearance.
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Por: Nombre profesor(a) Fetal Period – 35 to 38 weeks
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• Has firm grasp,

• Has a spontaneous • Fetal growth slows
orientation to light, down,
• The nervous system can • By full term the skin
carryout some integrated
functions, is usually bluish pink,
• The circumference of • The chest is
the head and abdomen prominent and the
are equal,
• After 36 weeks the
breast protrude
circumference of the slightly in both
abdomen may be greater sexes.
than that of the head.
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35 to 38 weeks
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• The male testes at this stage are now

in the scrotum.
• Although the head is now significantly
smaller than it was earlier in fetal life,
it is still one of the largest regions in
the body.
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Expected Date of Delivery
• EDD is 266 days or 38 weeks after fertilization. i.e 280 days or 40

weeks after LNMP.
• Common Delivery Date Rule
• Ultrasound is more reliable
What is Post Maturity Syndrome?
• It’s cause by the prolongation of pregnancy for 3 or more

weeks beyond EDD.
• It results in the absence of Lanugo hair, decreased or absent
Vernix Caseosa, long nails, increase alertness.
• Causes increase in mortality so many times delivery is
induced .
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Factors influencing fetal growth
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• The fetus requires substances for growth and

energy.
• Gases and nutrients pass freely to the fetus from
the mother through the placental membrane
• Glucose is a primary source of energy for fetal
metabolism and growth. Amino acids are also
required
• Insulin is required for metabolism of glucose and
is secreted by fetal pancreas.
• The factors influencing the fetal growth are
divided in three categories:
• MATERNAL, FETAL AND PLACENTAL.
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Factors influencing fetal growth
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• Nutritional state, diabetes

Maternal • Smoking, alcohol, drugs
• Chromosomal abnormalities
Fetal • Infection
• Chromosomal placental abnormality

Placental • Placental insuffieciency, calcification.
Procedures for assessing fetal
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status
• Diagnostic Amniocentesis
– Trans abdominal Amniocentesis
• Alpha-Fetoprotein (AFP) Assay

– AFP and Fetal Anomalies
• Spectrophotometric Studies
• Chorionic Villus Sampling (CVS)
– Diagnostic Value of CVS
• Sex Chromatin Patterns

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• Intrauterine Fetal Transfusion

• Fetoscopy
• Percutaneous Umbilical Cord Blood Sampling
(PUBS)
• Ultrasonography
• Computed Tomography (CT) and Magnetic
Resonance Imaging (MRI)
• Amniography and Fetography
• Fetal Monitoring
– Fetal Distress
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Status
• Intrauterine Fetal Transfusion

• Fetoscopy
• Percutaneous Umbilical Cord Blood Sampling
(PUBS)
• Ultrasonography
• Computed Tomography (CT) and Magnetic
Resonance Imaging (MRI)
• Amniography and Fetography
• Fetal Monitoring
– Fetal Distress
PLACENTA AND FETAL
MEMBRANES
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PLACENTA
Two Components:
• FETAL PORTION:
developed from the
chorionic membrane.
• MATERNAL PORTION:
formed by the
Endometrium.
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Placenta
cont…
Functions of the fetal membranes and
placenta:
• Protection
• Nutrition
• Respiration - Expiration
• Hormone production
Nombre asignatura Development of the Placenta
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• By the end of the 3rd week

(approx 15 days)
mesenchyme grows into the
primary chorionic villi,
forming a core of loose
connective tissue. Called
secondary chorionic villi at
this point.
- The mesenchymal cells
differentiate to form
capillaries.
- By about 20 days gestation
the blood vessels form
arteriovenous networks.
Nombre asignatura Development of the Placenta cont…
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• Once the blood vessels

appear the villi are
called tertiary chorionic
villi.
• These blood vessels

become connected with
the embryonic heart
vessels that
differentiate in the
mesenchyme of the
chorion and the body
stalk.
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• By the end of the 3rd week blood begins to

circulate through the capillaries of the
chorionic villi.
- Oxygen and nutrients from the maternal
blood in the intervillous spaces diffuse
through the walls of the villi and enter the
fetal capillaries.
- Carbon dioxide and waste products
diffuse from the fetal vessels through the
wall of the villi into the maternal blood.
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• Formation of the cytotrophoblastic shell.

Occurs concurrently with the development of
the chorionic villi.
• The cytotrophoblastic cells extend through
the syncytial trophoblastic layer to form a
shell.
• The cytotrophoblastic shell attaches the
chorionic sac to the endometrial tissues.
• Villi that attach to the maternal tissues are
called anchoring villi.
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• Maternal component formed from

endometrial tissues.
• The functional layer of the
endometrium that is involved in the
formation of the placenta is referred
to as the decidua.
• It is shed at parturition.
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Cells of the decidua:

• Large, pale-staining endometrial stromal cells
Contain large amounts of glycogen and lipids.
• They degenerate in the area of the syncytial
trophoblast at implantation and in this way serve
as a source of nutrition for the early embryo.
• May also protect the maternal tissues from
uncontrolled invasion of the syncytial
trophoblast.
• Some of the cells are involved in hormone
production.
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Three regions of the

decidua:
• Decidua basalis — deep to
the conceptus; forms the
maternal component of the
placenta.
• Decidua capsularis —
superficial portion overlying
the conceptus.
• Decidua parietalis — the
remaining mucosal lining of
the uterus.
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• The smooth chorion or chorion laeve

forms as the chorionic sac and the
surrounding decidua capsularis become
compressed.
- Results as the villi degenerate
producing a smooth nearly avascular
area.
• The placenta is formed from the fetal

villous chorion and the maternal decidua
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• Wedge-shaped areas of decidual tissue

form as the chorionic villi invade the
decidua basalis. These are called
placental septa.
• The placental septa divide the fetal
part of the placenta into cotyledons.
• Each cotyledon consists of two or
more stem villi and their branches.
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Intervillous spaces form from the

lacunae.
• These are large blood sinuses.
• Maternal blood enters the intervillous
space via the spiral arteries in the
decidua basalis.
• Blood drains into the endometrial
veins. Circulates nutrients and oxygen
and takes away waste products.
Nombre asignatura Circulation in the Placenta
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• Maternal and fetal circulation

separated by the placental membrane.
• Small amounts of fetal blood may
enter the maternal circulation through
tears or gaps in the placental
membrane.
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Circulation in the Placenta cont…
• Maternal blood entering the intervillous space

is temporarily outside of the maternal
circulation.
- Spurts in via spiral arteries.
- High pressure entry to force blood toward
the chorionic plate.
- Between spurts the blood flows slowly
over the chorionic villi.
- Allows for exchange of gaseous and
metabolic products to be exchanged.
• Maternal blood drains into the endometrial
veins.
Nombre asignatura Placental Membrane
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• By 20 weeks: the connective tissue of the villus and

endothelium of the capillaries create the placental
membrane.
• Not really a barrier. Microscopic breaks allow fetal RBCs

into the maternal circulation.
• Some cells cross on their own (e.g., maternal leukocytes

and various microorganisms)
• Microorganisms can also cause lesions that will allow

mixing of maternal and fetal blood.
• The placental membrane becomes thinner during pregnancy.

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Primary Activities of the Placenta
• Metabolism (placenta synthesizes glycogen,

cholesterol, and fatty acids particularly early in
pregnancy.
• Transfer Via simple diffusion, facilitated

diffusion, active transport, pinocytosis.
Substances transferred: gases, nutrients,
hormones, electrolytes, antibodies, waste
products, drugs, viruses (some can cause fetal
infection).
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Primary Activities of the Placenta cont…
• Endocrine secretion
- Protein hormones, e.g., human
chorionic gonadotropin (hCG) to
maintain the corpus luteum and
lactogen to stimulate lacatation.
- Steroid hormones, e.g., progesterone
and estrogens.
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Por: Nombre profesor(a) AMNIOTIC FLUID
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• This fluid is a clear, slightly yellowish liquid that

surrounds the unborn baby (fetus) during pregnancy
- it is contained in the amniotic sac.
• The fetus floats in the amniotic fluid. During
pregnancy the amniotic fluid increases in volume as
the fetus grows. Amniotic fluid volume is greatest at
approximately 34 weeks of gestation, when it
averages 800 ml. Approximately 600 ml of amniotic
fluid surrounds the baby at full term (40 weeks
gestation). This fluid is constantly circulated by the
baby swallowing and "inhaling" existing fluid and
replacing it through "exhalation" and urination.
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Amniotic fluid accomplishes numerous

functions for the fetus, including:
• Protects from outside injury by cushioning
sudden blows or movements
• Allows for freedom of fetal movement and
permits symmetrical musculoskeletal
development
• Maintains a relatively constant temperature
for the environment surrounding the fetus,
thus protecting the fetus from heat loss
• Permits proper lung development.
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• An excessive amount of amniotic fluid is called

polyhydramnios. This condition may accompany
multiple pregnancy (twins or triplets), congenital
anomalies, or gestational diabetes.
• An abnormally small amount of amniotic fluid is

known as oligohydramnios. This condition may
accompany postdates pregnancies, ruptured
membranes, placental dysfunction, or fetal anomalies.
• The fluid provides a great deal of knowledge
concerning the sex, state of health, and maturity of
the fetus. Removal of a sample of the fluid is called
amniocentesis.
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Twins, Multiple Births and the Fetal
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Membranes and Placenta

• Two types of twins may develop - dizygotic (fraternal) from
two zygotes; monozygotic (identical) from a single zygote.
Dizygotic twins are derived from two zygotes which happened
to form simultaneously. The two blastocysts may implant into
the uterus independently or side by side. In any case there will
be a separate chorion and amnion for each embryo. If the
implantation is close then adjacent parts of the two chorions
may fuse and a single large placenta may form. The two fetal
circulations will be separate. Monozygotic twins develop from
the same zygote. Splitting may occur in one of two ways: The
blastocyst may form two inner cell masses. Each inner cell
mass will form an embryonic plate. Each embryonic plate will
form an amnion. The blastocyst will form a chorion resulting in
the presence of two amnions and a shared chorion. A single
placenta will form and the two fetal circulations may be either
separate or joined
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Twins, Multiple Births and the Fetal
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Membranes and Placenta Cont…

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• On the other hand division may occur at the morula stage

with the splitting of the morula to form two identical
blastocysts. Each blastocyst then forms an embryonic plate
resulting in two amnions and two chorions. There may be
one or two placentas but the circulations will not be joined.
Conjoined twins develop from the duplication but
incomplete separation of the embryonic plate. The eventual
twins will be joined where the two copies of the plate did
not separate. Splitting of the plate may occur in only a short
segment leading to either a fetus with two heads, or a
parasitic twin in which one fetus is fully formed and has
attached to it a partially formed twin. Since the embryonic
plate does not separate into two, there is only one amniotic
cavity. Since there is only one blastocyst there is only one
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Development of dizygotic twins.

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Normally, each embryo has its

own amnion, chorion, and
placenta.
A, but sometimes the placentas
are fused.
B. Each embryo usually receives
the appropriate amount of blood,
but on occasion, large
anastomoses shunt
more blood to one of the partners
than to the other.
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Possible relations of fetal

membranes in monozygotic twins.
A. Splitting occurs at the two-cell
stage, and each embryo has its own
placenta, amniotic cavity, and
chorionic cavity.
B. Splitting of the inner cell
separated groups.
The two embryomass into two
completely s have a common
placenta and a common chorionic
sac but separate amniotic cavities.
C. Splitting of the inner cell mass at
a late stage of development. The
embryos have a common placenta,
a common amniotic cavity, and a
common chorionic cavity.
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Conjoined twins
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 Conjoined twins is other type of MZ twins. In this

case the embryonic disc do not divide completely or
embryonic disc fuse producing various types of
conjoined twins. They are classified depending
where they are joined.
 Classification
– Thoracopagus: anterior union of thoracic region
– Pigopagus: attached by back, pelvis
– Isquiopagus: conection at inferior pelvis
– Craneopagus: attached at the head
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Parasitic twin
 One twin is bigger
than the other
 One could be normal
or almost normal
and the other one
incomplete being a
parasite of the first
one
Nombre asignatura PARTURITION
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LABOR.- is the sequence of involuntary uterine

contractions that result in dilation of the cervix and
delivery of the fetus and placenta from uterus.
Fetal hypothalamus……corticotropin-releasing
hormone… hypophisis
ACTH…corticol…synthesis of estrogens…..uterine
contraction
Maternal posterior cerebral hypophisis……
Oxitocin… prostaglandin
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Nombre asignatura THE STAGES OF LABOR
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The first stage of labor (dilation stage). Begins when regular painful
contraction of the uterus occur less than 10 minutes apart.
Duration…..12 or 7 hours
Expulsion:
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 Second stage.
 Begins when the cervix is
fully dilated.
 During this time the fetus
descends through the cervix
and vagina.
 Usually it last 20 to 50
minutes depending on the
patient.
 Once the baby is out it’s
called a newborn infant.
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Placenta Stage:
 Third stage
 Begins at the moment the baby
is born, ends when the placenta
and membranes are out.
 Last around 15 minutes
 Contractions and manual
compressions are made to
detached the complete placenta.
 All of the material is expelled
through the vagina and pudental
cleft.
 The placenta separates through
the spongy layer.
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FETAL FACE
MATERNAL FACE
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Recovery:
 Fourth stage
 Begins when the placenta and the
fetal membranes are expelled.
 Last around 2 hours
 During this time the myometrial
constricts the arteries and begin to
supply blood to the intervillous
space.
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General Information
Mesoderm differentiates into mesenchyme

The mesoderm of the somite further differentiates
into the dermatome (which becomes the dermis)
and the Myotome (which becomes skeletal muscle)
and the Sclerotome (which becomes bone)
The bones of the axial skeleton (excluding the
skull) are derived from the Sclerotome; an
exception is that the sternum is derived from
somatic mesoderm of the lateral plate
D. Neural crest cells migrate away from the neural
tube to form some of the bones of the face
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ARISE FROM: 1.- Mesoderm 2.- Neural crest cell
Paraxial mesoderm Somites, which differentiates into two parts:
Vertebra
Ventromedial Sclerotome
Ribs
Myotome muscle
Dorsolateral Dermomyotome
Dermatome Dermis
Neural crest cells migrate to pharyngeal arches and form the bones and
connective tissue of Craniofacial structures.
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PHASES IN THE MORPHOGENESIS OF BONE
• Epithelial-mesenchymal interactions
Precondensation • Expresion of HOX genes, growth factors
and Syndecan 1 and 2
• Growth factors, syndecan 3

Condensation • Glycoproteins
• Glycoproteins
Differentiation • Collagen
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Osteogenesis: Bone Formation
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Histogénesis of Cartilage
Cartilage develops from mesenchyme and first appear in the embryo during
the fifth week.
Chondrification centers. Areas of mesenchyme condensation. The cells
proliferate and become rounded Chondroblast
Which secrete collagenous fibrils and the ground substance of the matrix.
Depending of the matrix three types of cartilage are described.
• Hyaline cartilage
• Fibrocartilage
•Elastic cartilage
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Histogénesis of Bone
Mesenchyme
Bones develops from two sources
Cartilage
Cells
BONE
Matrix (Collagen fibrils embedded in an amorphous component)
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Intramembranous Ossification
In intramembranous ossification, some of the

mesenchymal cells differentiate into osteoblasts.
1. Osteoblasts undergo cell division and begin to secrete
the bony matrix (osteoid tissue).
2. Osteoblasts become trapped in the hard, calcified
matrix and develop into osteocytes
3. Most of the bone is composed of osteocytes trapped in
matrix; a few osteoblasts remain for repair
a.Osteoclasts reabsorb bone
b. There is a dynamic interactions between osteoblasts
and osteoclasts that is responsible for bone remodeling.
In the interstices, mesenchyme Bone Marrow
Endochondral Ossification Cont…
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osteoclasts make tunnels

osteoblasts invade and build new bone against the walls of the
tunnels
tunnel is filled with concentric rings of bone
central canal (Haversian canal) contains blood vessels and
nerves
osteon = canal + rings of bone
bones grow in length as long as cartilage is present at epiphysial
plate
osteoblasts in periosteum increase diameter
osteoclasts in endosteum reabsorb bone to enlarge medullary
cavity
remodeling continues throughout adult life
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RICKETS
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Is a disease that occurs in children who

have a vitamin D deficiency. Calcium
absorption by the intestine is impaired,
causing disturbances of ossification of the
epiphyseal cartilage plate and there is
disorientation of cells at the metaphysis.
The limbs are shortened and deformed,
with severe bowing of the limbs bones.
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DEVELOPMENT OF JOINTS
Is an area in which two or more bones meet each other.

Begin to develop during the sixth week.
Joints are classified as:
• Fibrous joints
• Cartilaginous joints
• Synovial joints
Keys: Bones/interzonal mesenchyme

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AXIAL SKELETON
VERTEBRAL RIBS AND

SKULL
COLUM STERNUN
Nombre asignatura The Vertebral Column Cont….
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Sclerotome cells migrate around the neural tube and the

notochord during the 4th week of development; the notochord
and the spinal cord become surrounded by these mesenchymal
cells.
1. Around the neural tube they form the neural arch
(vertebral arch)
2. Around the notochord, they form the body and the
intervertebral disc
3. The caudal half of each Sclerotome fuses with the cranial
half of the Sclerotome immediately below it to form a
condensation of mesenchyme that will become the vertebral
body; thus, each vertebral body is an intersegmental structure
derived from Sclerotome of two adjacent somites
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The Vertebral Column Cont….
4. The anulus fibrosus of the intervertebral disc is derived from

the Sclerotome. The nucleus pulposus is the remnant of the
notochord
5. Three primary ossification centers appear in each
cartilaginous vertebra during the 7th week of development;
vertebral ossification is not completed until the mid-twenties
6. There are sacral intervertebral discs until late teenage years;
the discs are replaced by bone and the sacral vertebrae are fused
by about age 30
7. The body of the atlas fuses with the body of the axis to form
the odontoid process (dens). Thus, the atlas is actually only the
two fused neural (vertebral) arches
8. Mesenchyme migrates into the body wall to form ribs
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The Vertebral Column Cont….
Vertebral curves
1. At birth, there is one ventral curve
2. The cervical curvature develops when the baby begins to
raise his head
3. The lumbar curvature develops when the baby begins to
stand
Congenital malformations of the vertebral column
1. Hemi vertebra = failure of one side of the vertebral body to
ossify; this leads to scoliosis
2. Kyphosis = failure of both sides of the vertebral body to
ossify
3.Spina bifida oculta = failure of the vertebral arch of one or
more vertebrae to develop and to fuse in the midline
The Ribs Develop As Projections of the
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Developing Vertebrae
A.Eventually the initial connection between the rib and the vertebra
degenerates and the vertebrocostal joints are established in its place.
B. The ribs undergo Endochondral ossification; the anterior portion

of the rib remains cartilaginous and forms the costal cartilages.
C. Accessory ribs

1. Accessory ribs in the cervical region, usually at the seventh
cervical vertebra, range from a complete, ossified rib to a fibrous
band of tissue; the accessory rib may compress the brachial plexus
and/or the subclavian artery leading to pain in the arm; the accessory
rib can be removed surgically
2. Accessory ribs in the lumbar region, usually at the first lumbar
vertebra, tend to be asymptomatic
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Sternum
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Is Formed From Somatic Mesoderm
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(Lateral Plate) in the Ventral Body Wall
An Sternal bars are mesenchymal bands that develop

ventrolaterally in the body wall; they form the Sternal bars
B.Initially, these bars are not connected to the ribs; the bars
will chondrified and fuse to the extending rib cartilages
C.When the anterior body wall fuses in the midline, the bars
of cartilage come together and fuse in a cranial to caudal
direction
D. Congenital malformations of the sternum are usually not
serious; a Sternal foramen may be present at the junction of the
3rd and 4th Sternal bars and is due to an incomplete fusion of
the cartilaginous Sternal bars
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Development of the skull
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The skull develops from mesenchyme around the developing brain.

The skull consists of:
The Neurocranium, a protective case for brain.
The Viscerocranium, the skeleton of the face.
NEUROCRANIUM:
The bones of the cranium (Neurocranium) are formed from two
sources:
1. Paired cartilages at the base of the brain undergo Endochondral
ossification to form the cartilaginous neurocranium
2.The sides and top of skull develop by intramembranous ossification to
form the membranous neurocranium
NEUROCRANIUM Cont..
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The bones of the cranial cavity, the neurocranium

Include:
1..The cartilaginous neurocranium (also known as the chondrocranium) forms
the base of the skull. It is derived from 9 paired cartilages that fuse in the
midline and undergo endochondral ossification; ossification begins during the
third month
2.. The membranous neurocranium forms the top and the sides of the skull;
the membranous neurocranium undergoes intramembranous ossification.
a. Bones included = most of frontal, parietals, squamous part of the
occipital, squamous part of the temporal
b. The fontanellas, large areas of fibrous tissue, (soft spots in the baby's
head) are in the membranous neurocranium
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UNIBE Viscerocranium
The bones of the face (Viscerocranium) are formed from the first
two pharyngeal arches by intramembranous ossification; the
bones of the face are derived from cells of neural crest origin that
migrate into these two arches.
The bones of the face, the Viscerocranium, include:
1. The cartilagenous viscerocranium:
a. First arch: incus, and malleus
b. Second arch: stapes, styloid process, and part of the hyoid
c. Third arch: rest of the hyoid bone
d. Local mesenchyme: nasal, lacrimal, and part of the frontal
2. The membranous viscerocranium includes the squamous
temporal bone, maxilla and zygomatic.
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Congenital malformations
UNIBE
1. Acrania = calvaria absent

2. Craniostenosis = premature closure of the sutures; more
common in males
a. Scaphocephaly = wedge shaped skull due to the premature
closure of the sagittal suture; it accounts for 50% of all
Craniostenosis
b. Oxycephaly = tower-like skull due to the premature
closure of the coronal suture bilaterally; 30%
c. Plagiocephaly = twisted skull due to premature closure of
either the coronal or the lambdoidal suture ipsilaterally
3. Microcephaly = normal sized face, but small calvaria; the
fontanellas and the sutures close early due to a failure of the
brain to grow; these individuals are mentally retarded
4. Hypertelorism = widely spaced eyes
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Craniosynostosis. A and B, An
Nombre asignatura infant with scaphocephaly.
UNIBE This condition results from
premature closure (synostosis)
of the sagittal suture. Note the
elongated, wedge-shaped
cranium seen from above (A)
and the side (B).
C, An infant with bilateral
premature closure of the coronal
suture (brachycephaly). Note
the high, markedly elevated
forehead.
D, An infant with premature
closure of the frontal suture
(trigonocephaly). Note the
hypertelorism and prominent
midline ridging of the forehead.
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SCAPHOCEPHALY
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HYPERTELORISM
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OXYCEPHALY
PLAGIOCEPHALY
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Congenital malformations
Spina bifida
Accessory Ribs
Fused Ribs
Hemi vertebra
Rachischisis
Cleft sternum
Klippel-Feil syndrome (brevicolis)….. Short neck,low hairline and restricted

neck movements.
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THE APPENDICULAR SKELETON
UNIBE
Critical period = days 24-42
A. The pectoral girdle and the upper limb begin forming prior to the
pelvic girdle and the lower limb; the lag is about 2 days
B. Within a limb, bone models appear first proximally and proceed distally
C.Limb buds have a mesenchymal core derived from the somatic

mesoderm of the lateral plate
Patterning in the developing limbs is regulated by homeobox

containing (Hox) genes.
Dermatomes and Cutaneous Innervations
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Por: Nombre profesor(a) of Limbs
UNIBE
• Motor branches of the spinal nerve occur in the

5th week.
• Sensory branches arrive later.
• Neural crest cells provide schwann cells which
myelinate fibers.
• Dermatome is the area of the skin supplied by a
single spinal nerve and it is spinal ganglion.
• A cutaneous nerve area is the area of the skin
supplied by a peripheral nerve.
Nombre asignatura Blood Supply to the Limbs
UNIBE
• The limb buds are supplied by branches of the

intersegmental arteries from the aorta.
• The primitive vascular patterns consist of a
primary axial artery and it’s branches.
• The vascular pattern changes as the limbs
develop.
• The primary axial artery becomes the brachial
artery in the arm and the common interosseous
artery in the forearm.
• In the thigh, the primary axial artery is
represented by the deep artery of the thigh.
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The appendicular skeleton
UNIBE
Cartilage models begin to

form by condensation of
cartilage mesenchyme in
week 5. Cartilage models
begin to form in week 6, and
by the week 8, all cartilage
models are completed.
Ossification begins in the
third month in many bones,
but others do not begin to
ossify until well after birth.
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D. Hand and foot development

1. At 6 weeks, there are hand and foot
plates separated from the rest of the
developing limb by a circular constriction
marking the wrist and ankle; inside are the
developing cartilagenous models.
2. Later, a second constriction appears;
this marks the elbow and knee.
3. The fingers and toes are formed by
selective cell death between the digits.
E. The appendicular skeleton is formed by

endochondral ossification: the exception is
the clavicle which is formed by
intramembranous ossification; the bones of
the limbs are not completely ossified until
the late teenage years.
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The Appendicular Skeleton Cont ..
Congenital Malformations
1. The limb itself:
a. Amelia = one or two limbs absent
b. Meromelia = hands/feet attached to the trunk
c. Micromelia = all segments are present, but are
abnormally short
d. These types of limb malformations are associated
maternal ingestion of thalidomide
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The Appendicular Skeleton
UNIBE Cont..
Congenital Malformations
2. The digits:
a. Polydactyly = extra digits; this is an autosomal dominant trait
b. Syndactyly = fused digits
Lobster claw = a form of syndactyly in which there is a cleft between the 2nd and 4th
metacarpals or metatarsals plus a cleft of the soft tissue; the 3rd metacarpal/metatarsal is
absent
c. Bradydactyly = the absence of phalanges makes the digits short; this is an autosomal
dominant trait
3. Club foot (talipes) = foot is turned inward, adducted, and plantar flexed; higher incidence
in males; 1: 1000
4. Congenital hip dislocation: underdevelopment of acetabulum and head of femur; higher
incidence in female
5. Achondroplastic dwarfism is the most common form of dwarfism and is an autosomal
dominant trait present in 1: 10,00; the defect is in the endochondral ossification of the
epiphysial plates of the long bones so that the individual has short limbs but an almost normal
trunk
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UNIBE
• Is used as a sedative and

antinauseant, was withdrawn in
1961
• Causes :
– Amelia - complete absence
of a limb or limbs
– Meromelia - partial absence
of a limb or limbs
Polydactyly
Extra fingers in periphery

Is inherited as a dominant trait
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UNIBE Syndactyly
• One of the most common anomalies.

• Occurs in 1 : 2,200 birth.
• Two types.
– Cutaneous type – webbed fingers, is a failure in
webs to degenerates. Is more common in the foot.
– Osseous type – occurs when the notches between
the digital rays fail to develop in the 7 th week.
Separation of the digits do not occur.
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Cleft Hand and Cleft Foot
• Is absence of the
middle digits.
• Are related to
abnormal
organization of the
digital rays or
failure to develop.
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Por: Nombre profesor(a) Congenital Absence of Radius
UNIBE
• Radius partially or
completely absence.
• The hand deviates
laterally and the
ulna bows with the
concavity on the
lateral side of the
forearm.
• Usually caused by
genetic factors.
Nombre asignatura Congenital Club Foot
UNIBE
• Any deformity of the foot

involving the talus
• Is a common anomaly
• Occurs in 1 : 1,000 births
• Is an abnormal position of
the foot that prevents
normal weight bearing
• The most common type is
Talipes Equinovarus
– Twice frequent in
males
– The sole of the foot is
turned medially and
inverted
Nombre asignatura Congenital Dislocation of the Hip
UNIBE
• Occurs in 1 : 1,500 babies

• Is more common in females
• Abnormal acetabulum or joint laxity
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Amputation by amniotic
band syndrome
THE MUSCULAR
SYSTEM
THE MUSCULAR SYSTEM
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UNIBE
• The muscular system develops from

MESODERM, NEURAL CREST AND
NEUROECTODERM.
• Muscle tissue develops MYOBLASTS,
embryonic muscle cells that are derived from
mesenchyme.
• Myoblast cells appear to be induced to form
muscle by the presence of a transcription
factor, MyoD.
Nombre asignatura SKELETAL MUSCLE
UNIBE
• The myoblasts that form the skeletal

muscles of the trunk are derived from
mesoderm in the myotome regions of the
somites.
• The limb muscles develop from myogenic
precursor cells in the limb buds.
• Skeletal muscle originates from one of
five sources:
(1) the somites (also called the paraxial
mesoderm or somatic mesoderm) of the
body
(2) the preotic somites
(3) the occipital somites
(4) the branchial apparatus
(5) the somatic mesoderm of the lateral
plate
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LIMB MUSCLE DEVELOPMENT
A model for molecular interactions

during myogenesis. Shh and Wnts,
produced by the neural tube (NT) and
notochord (NC), induce Pax-3 and
Myf-5 in the somites. Either of them
can activate the initiation of MyoD
transcription and myogenesis. Surface
ectoderm (E) is also capable of
inducing Myf-5 and MyoD. In
addition, Pax-3 regulates the
expression of c-met, necessary for the
migratory ability of myogenic
precursor cells, that also express: En-
1, Sim-1, Ibx-1 and 26M15. DM,
dermamyotome; S, sclerotome.
Nombre asignatura SKELETAL MUSCLE Cont..
UNIBE
• The middle portion of the somite is called

the myotome; it is the mesoderm in this
region of the somite that forms skeletal
muscle.
• Each typical myotome part of a somite

divides into:
• A)Dorsal or Epaxial Division
• B)Ventral or Hypaxial division
UNIBE
• Derivates Of The Epaxial DivisionsOf

Myotomes:
- The extensor muscles of the neck and vertebral
column
- The embryonic extensor muscles derived form
the sacral and coccygeal myotomes. They
degenerate and their adult derivatives are the
dorsal sacro-coccygeal ligaments.
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SKELETAL MUSCLE Cont..
• The Preotic Somites:

There are three pairs of preotic somites that
differentiate into the extrinsic muscles of the
eye and are innervated by the oculomotor (III),
trochlear (IV), and abducens (VI) nerves.
• The Occipital Somites:
Three pairs of occipital somites which migrate to
form the muscles of the tongue; they bring with
them segmental nerves that form the
hypoglossal nerve (XII).
UNIBE
• The Branchial Apparatus:

Pharyngeal arch mesenchyme produces
myoblasts that develop into the muscles of
the head and neck.
• The Somatic Mesoderm of the Lateral
Plate:
Somatic mesoderm produces the skeletal
muscles of the lateral and anterior body
wall.
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Smooth muscle is derived from:
UNIBE
• 1. Splanchnic mesoderm for the gut and its

derivatives.
• 2. Somatic mesoderm for blood vessels.
• 3. Ectoderm for the myoepithelial cells of
the mammary and sweat glands and the
muscles of the iris.
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Cardiac muscle develops from the lateral splanchnic mesoderm, which

gives rise to the mesenchyme surrounding the developing heart tube .
Cardiac myoblasts differentiate from the primordial myocardium.
Heart muscle is recognizable in the fourth week and likely develops
through expression of cardiac-specific genes.
Cardiac muscle fibers arise by differentiation and growth of single
cells. Growth of cardiac muscle fibers results from the formation of new
myofilaments. The myoblasts adhere to each other as in developing
skeletal muscle, but the intervening cell membranes do not disintegrate;
these areas of adhesion give rise to intercalated discs.
Late in the embryonic period, special bundles of muscle cells develop
with relatively few myofibrils and relatively larger diameters than typical
cardiac muscle fibers. These atypical cardiac muscle cells-Purkinje
fibers-form the conducting system of the heart
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EMBRYONIC Nombre asignatura ADULT DERIVATIVE
STRUCTURE Por: Nombre profesor(a)
UNIBE
Preotic somites (3 pairs) extrinsic muscles of the eye
Occipital somites (3 pairs) muscles of the tongue

Branchial arch mesoderm muscles of the head, pharynx and larynx
Myotome of the somite (somatic mesoderm) skeletal muscles
Epimeres of myotomes extensors of the neck, vertebral column and
lumbar region
Hypomeres of myotomes scalenes, quadratus lumborum, psoas

muscles, perineal muscles
somatic mesoderm (lateral plate mesoderm) - infrahyoid muscles, intercostals muscles,

sternalis, rectus abdominis, pyramidalis,
obliques and transversus muscles of the
abdomen
- muscles of the limb
Hypomere and somatic mesoderm muscles of the limb girdle
Splanchnic mesoderm cardiac and smooth muscle

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SKELETAL MUSCLE Cont..
UNIBE
• Derivates Of The Hypaxial Divisions Of Myotomes:

- Cervical Myotomes form: The scalene, prevertebral,
geniohyoid and infrahyoid muscles.
- Thoracic Myotome form: The lateral and ventral
flexor muscles of the vertebral column.
- The Lumbar Myotome form: the Quadratus
Lumborum Muscle.
- The Sacrococcygeal Myotomes form: The muscles of
the pelvic diaphragm and probably the striated muscles
of the anus and sex organs.
Embryonic structures and
myogenesis. TheNombre
current view
asignatura
suggests that thePor:dorsal neural
Nombre profesor(a)
UNIBE
tube (NT) and the overlying non-
neural ectoderm (E) are sources of
signaling molecules
belonging to the family of Wnt
secreted proteins and bone
morphogenetic protein (BMP)-4,
whereas the notochord (NC) and
the ventral neural tube (green)
are sources of the Shh. They
positively regulate the onset of
myogenesis and the induction of
the myotome. By contrast,
thelateral plate mesoderm (LPM)
produces BMP-4 and FGF5
(fibroblast growth factor 5),
negatively regulating muscle
terminal differentiation in the
lateral part of the myotome
lineage.
Response to the BMP-4 signal may
be mediated by its binding
proteins noggin and follistatin.
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Embryo Second Week

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Embryo Second Week

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Nombre asignatura

Por: Nombre profesor(a)

• Ultrasound measurements of the CRL

• At the end of the first trimester, all major

• CRL is preferred for • Basic measurements

• 9 week fetus • 12 week fetus

• Rapid growth and active ossification

• Growth slows down in • Eyebrows and head hair

• There is substantial weight gain.

• Fetal lungs can breath air.

• The fetal spleen, which was an important site

• Pupillary light reflexes of the eyes,

• Has firm grasp,

• The male testes at this stage are now

• EDD is 266 days or 38 weeks after fertilization. i.e 280 days or 40

What is Post Maturity Syndrome?

• It’s cause by the prolongation of pregnancy for 3 or more

• The fetus requires substances for growth and

• Nutritional state, diabetes

• Chromosomal placental abnormality

• Alpha-Fetoprotein (AFP) Assay

• Sex Chromatin Patterns

• Intrauterine Fetal Transfusion

• Intrauterine Fetal Transfusion

• By the end of the 3rd week

• Once the blood vessels

• These blood vessels

• By the end of the 3rd week blood begins to

• Formation of the cytotrophoblastic shell.

• Maternal component formed from

Cells of the decidua:

Three regions of the

• The smooth chorion or chorion laeve

• The placenta is formed from the fetal

• Wedge-shaped areas of decidual tissue

Intervillous spaces form from the

• Maternal and fetal circulation

• Maternal blood entering the intervillous space

• By 20 weeks: the connective tissue of the villus and

• Not really a barrier. Microscopic breaks allow fetal RBCs

• Some cells cross on their own (e.g., maternal leukocytes

• Microorganisms can also cause lesions that will allow

• The placental membrane becomes thinner during pregnancy.

• Metabolism (placenta synthesizes glycogen,

• Transfer Via simple diffusion, facilitated

Primary Activities of the Placenta cont…

• This fluid is a clear, slightly yellowish liquid that

Amniotic fluid accomplishes numerous

• An excessive amount of amniotic fluid is called

• An abnormally small amount of amniotic fluid is

Membranes and Placenta

Membranes and Placenta Cont…

• On the other hand division may occur at the morula stage

Development of dizygotic twins.

Normally, each embryo has its

Possible relations of fetal

 Conjoined twins is other type of MZ twins. In this

LABOR.- is the sequence of involuntary uterine

Mesoderm differentiates into mesenchyme

ARISE FROM: 1.- Mesoderm 2.- Neural crest cell

Paraxial mesoderm Somites, which differentiates into two parts:

• Growth factors, syndecan 3

In intramembranous ossification, some of the

osteoclasts make tunnels