Post basic B.

Sc DEGREE COURSE IN NURSING

MATERNAL NURSING

UNIT- II

3. REVIEW OF FETAL DEVELOPMENT

Dr.K.Latha
Vice - Principal
Objectives

At the end of the class the students will be able to

• Describe the fetal growth and devopment from
embryonic period to fetal period in week by week
 INTRODUCTION

Prenatal or antenatal development is the

process in which embryo or fetus gestates
during pregnancy from fertilization until birth. It is
also known as fetal development or embryology.
Development biology is the study of the
sequences of events from the fertilization of a
secondary oocyte by a sperm cell to the
formation of an adult organism
 CONCEPTION

Conception occurs when an egg from the mother is

fertilized by a sperm from the father. In humans, the
conception process begins with ovulation, when an
ovum, or egg (the largest cell in the human body),
which has been stored in one of the mother’s two
ovaries, matures and is released into the fallopian
tube.
Ovulation occurs about halfway through the woman’s
menstrual cycle and is aided by the release of a
complex combination of hormones.
FERTILIZATION

• The fusion of the sperm cell nucleus with the egg

cell nucleus to produce a zygote (fertilized egg)

• Brings male and females gametes together –

produces diploid zygote

• It also activates the egg, triggering the beginning

of embryonic development
 MECHANISM OF FERTILIZATION

1.Encounter of sper m at ozoa and ova

1. 2.Capacitation and contact

2. 3.Acrosome r e a c t i o n a n d p e n e t r a t i o n

3. 4.Fusion o f t h e s p e r m w i t h t h e e g g

4. 5 . A c t i v a t i o n o f ovum
ENCOUNTER OF SPERMATOZOA AND OVA

• During the fertile phase, millions of sperm travel from the

vagina to the uterus and into the fallopian tubes.
• Chemotaxis – A chemical substance is found in the cortex
of eggs.
• In general interaction is through special devices or particular
forms of behaviour.
• The primary need is a fluid medium for the act of
fertilization and delivery of spermto the eggs at the right
time.
•
Capacitation

-Sperm undergo capacitation (further maturation)

within the female reproductive tract.

-It occurs in the female’s vagina.

-Vaginal secretions cause a molecular change in the

sperm plasmalemma (removal of decapacitating
factor - semen proteins, results in increased
membrane fluidity,).

-Takes 4-5 hr in humans

Acrosome reaction and penetration

• When the acrosome reaction occurs, a number of

proteolytic enzymes are exposed or released.

• One or more of these enzymes is responsible for

digesting the hole through the zona pellucida
through which the sperm enters the perivitelline
space.
 Fusion of the sperm with the egg
• The male nucleus enters the egg cytoplasm and
becomes the male pronucleus.
• As a result of the sperm fusing with the egg
plasmalemma, the oocyte nucleus, which is at
metaphase of the second meiotic division,
completes that division giving rise to another polar
body.
• Following the second meiotic division, what is now
the nucleus of the ovum becomes the female
pronucleus.
• The haploid male and female pronuclei move
toward one and other, meet, and fuse to form the
diploid nucleus of the zygote.
• The zygote will now proceed to undergo cleavage
• A series of morphological, physiological and
molecular changes that occur in the egg in
response to fusion of the sperm with the egg.
Activation of ovum

1. Release of Ca++ (calcium) stored in the egg

endoplasmic reticulum - appears to be the critical step
in the process.
2.Cortical reaction - rupture of cortical granules that
occurs concurrently with the Ca++ release. Contents of
granules are released into perivitelline space and
cause “hardening” of the vitelline membrane or zona
pellucida. Causes vitelline/fertilization membrane to
rise away from surface of egg in some species.
CONT...
3. In many species, an influx of Na+ (sodium) into the egg
cytoplasm that causes a change in membrane potential - fast block
to polyspermy.
4. In many species a reorganization of the egg cytoplasm.
5. In most cases, completion of meiosis by the egg.
6. An efflux of H+ (hydrogen) ions causing an increase in
cytoplasmic pH - this activates previously inhibited synthetic
pathways.
7. Increase in metabolism - zygote gears up for development.
Fertilization
 DEVELOPMENT OF EMBRYO

ZYGOTE
ZYGOTE
1. The sperm and egg join to form a zygote: the first
cell of a new individual.
2. Zygote results of the fusion of DNA from sperm and
egg
3. Fertilization occurs in the Fallopian Tubes
4. The zygote begins rapid mitotic cell division
5. Beginning of human development
CLEAVAGE OF ZYGOTE
MORULA

▪About 96 hours after fertilization.

▪This picture shows a MORULA,
a solid ball of 32 cells that
resembles a raspberry
BLASTULA

Five days after

fertilization
1. A ball of more
that 64 cells
surrounding a fluid-
filled cavity (the
blastocele)
2. Blastula is produced
by the repeated
mitotic division of a
zygote
BLASTOCYST

1. The fastening of the

embryo to the wall of the
uterus is called
implantation
2. Implantation occurs
seven days after
fertilization
3. Implantation takes
places in the uterus
DIVISION OF BLASTOCYST
Trophoblast

Trophoblasts (from Greek trephein: to feed; and

blastos: germinator) are cells forming the outer
layer of a blastocyst, which provide nutrients to
the embryo and develop into a large part of the
placenta. They are formed during the first stage
of pregnancy and are the first cells to
differentiate from the fertilized egg.
LAYERS OF
TROPHOBLAST

Differentiate into two layers

1.SYNCYTIO TROPHOBLAST
2.CYTO TROPHOBLAST
INNER CELL MASS
GASTRULATION
Gastrulation involves a series of cell migrations to positions
where they will form the three primary cell layers.
•Ectoderm forms the outer layer. Ectoderm forms skin, hair,
sweat glands, epithelium, brain and nervous system.
•Endoderm forms the inner layer. The endoderm forms
digestive, respiratory systems, liver, pancreas, all bladder, and
endocrine glands such as thyroid and parathyroid glands.
•Mesoderm forms the middle layer. The mesoderm forms
body muscles, cartilage, bone, blood, reproductive system
organs and kidneys
 IMPLANTATION
Definition :
It is the process by which an embryo attaches to the
uterine wall and penetrates first the epithelium and then
the circulatory system of the mother to form the placenta.
It is a process that is limited in both time and space.
Timing:
2-3 days after the fertilized egg enters the uterus; entry is
on day 18 or 19 of the cycle.
5-7 days after fertilization.
PREPARATION OF IMPLANTATION

The change from proliferative to secretory

endometrium
At the time of implantation , The endometrium is 10-14
mm thick
Secretory activity has reached a peak
This change is the histologic expression of many
biochemical and molecular events.
{The primary endocrine requirement is the presence of
progesterone
II. Endometrial receptivity
• heralded by the progesterone- induced formation
of pinopodes
• pinopodes absorb fluid from the uterine cavity
forcing the blastocyst to be in contact with the
endometrial epithelium.
• The window of endometrial receptivity: 20-24 of a
28-day normal cycle
III. A dialogue between endometrium and the early
embryo.
1.Early pregnancy factor (EPF)
detected in the maternal circulation within 1-2 days after
fertilization.
prior to implantation is produced by the ovary in response to a
signal from the embryo.
After implantation is derived from the embryo.
has immunosuppressive properties
2. HCG
Secreted by blastocysts
beginning days 7-8 after fertilization
enhancing steroid secretion from corpus luteum
 Stages of implantation

• Apposition,
• Adhesion,
• Invasion
Apposition:
The human blastocyst remains in the uterine secretions
for approximately 1 to 3 days and then hatches from its
zona pellucida in preparation for attachment.
The implantation site:
usually in the upper, posterior wall in the mid sagittal
plane.
Apposition of the blastocyst to the uterine epithelium,
usually about 2-4 days after the morula enters the uterine
cavity
II. Adhesion:
• {integrin binding}
• Peak integrin expression at the time of
implantation
• Abnormal level of integrin expression may be a
cause of infertility .
• Formation of junctional complexes prevents
dislodging the embryo by flushing
 III. Invasion
• {invasion of the trophoblast via degradation of the
extracellular matrix}.
• Three subsequent interactions occur:
• Trophoblasts intrude between the uterine epithelial cells.
• Epithelial cells are lifted off the basement membrane;
trophoblasts can interdigitate underneath.

• Fusion of trophoblast with the uterine epithelial

cells
Age of the fetus –
•Gestational age is the duration of pregnancy
calculated from the first day of last menstrual
period (LMP).
•It is greater than the post conception
(fertilization) age by 2 weeks
 Pre embryonic period

Embryogenesis start with the fertilization of the

egg cell (ovum) by a sperm cell (spermatozoon).
Once fertilized, the ovum is referred to as zygote,
a single diploid cell It is greater than the post
conception (fertilization) age by 2 weeks.
 CHANGES OF DEVELOPMENT BY WEEKS
OF GESTATION
Pre embryonic period-
Week 1-2 – no developments occurs since
fertilization hasn’t actually occurred.
Week 3- from 15-21 days, embryonic 5-7 days.
Fertilization occur and form zygote.
The embryo hatches from its protein shell and
perform implantation (5-6 days).
Week 4th – days 22-28 from LMP
embryonic age 2 weeks-
Events-
•Trophoblast cells surrounding the embryonic cells
proliferate and invade deeper into uterine lining.
•Eventually form placenta and embryonic
membrane.
•Formation of yolk sac.
•Primitive streak develop at 13 days.
•Primary stem villi appears at 13 day
Week 5
•Gestational age: 4 weeks Embryonic age: Week no. 3
•A notochord forms in the center of the embryonic
disk. (day 16 of fert) gastrulation commences.
•A neural groove (future spinal cord)forms over the
notochord with a brain bulge at one end. Neuromeres
appear. (day 18 of fert.) Somites, the divisions of the
future vertebra, form. (day 20 of fert.)
•Primitive heart tube is forming. Vasculature begins to
develop in embryonic disc. (day 20 of fert.
•Week 6- embryonic age 4 weeks
•Events –
•Embryo measures 4 mm
•The heart bulge, and begins to beat in a regular
rhythem. The neural tube closes. Arm buds and tail are
visible. Pulmonary primordium appear .Hepatic plate
appear .Buccopharyngeal membrane ruptures. This
form the future mouth. Anterior and posterior horns
differentiate in the spinal cord.
▪ Week 7- embryonic age 5 week
Events
Length is 9 mm
Lens pits and optic cups develops.Nasal pits form.
Brain divides into 5 vessicles including the early
telencephalon.Leg buds form.
The metanephros, precursor of kidney start to
develop.Stomach differentiation begins.
Week 8-
•The embryo measures 13 mm (1/2 inch) in length.
Lungs begin to form. The brain continues to develop.
•Arms and legs have lengthened ,with foot and hand
areas distinguishable.
•The hands and feet have digits, but may still be
webbed. The gonadal ridge begins to be perceptible.
•The lymphatic system begins to develop. Main
development of external genitalia starts.
Week 9-
•The embryo measures 18 mm (3/4 inch) in
length.
•Fetal heart tone (the sound of the heart beat)
can be heard using doppler
•Nipples and hair follicles begin to form.
•Location of the elbows and toes are visible.
•Spontaneous limb movements may be detected
by ultrasound. All essential organs have at least
begun. The vitelline duct normally closes
 Fetal development

From the 10 weeks of gestation (8th week of

embryogenic) the developing organism is called
fetus.
All the major structures are already formed in
the fetus but they continue to grow.
Week 10 -12

•Embryo measures 30–80 mm (1.2–3.2 inches) in

length.
•Intestines rotate.
•Facial features continue to develop.
•The eyelids are more developed.
•The external features of the ear begin to take their
final shape.
•The head comprises nearly half of the fetus' size.
Cont…
The face is well formed
•The eyelids close and will not reopen until about
the 28th week.
•Tooth buds appear.
•The fetus can make a fist with its fingers.
•Genitals appear well differentiated.
•Red blood cells are produced in the liver
Week 13-16
•The fetus reaches a length of about 15 cm (6
inches).
•A fine hair called lanugo develops on the
head.
•Fetal skin is almost transparent.
•More muscle tissue and bones have
developed, and the bones become harder.
•Sucking motions are made with the mouth.
•CONT…
•Meconium is made in the intestinal tract.
•The liver and pancreas produce fluid
secretions.
•From week 13, sex prediction
At week 15, main development of external
genitalia is finished
•Abdominal wall closes
Abdominal wall defects
Week 17-21
•The fetus reaches a length of 20 cm (8 inches).
Lanugo covers the entire body.
•Eyebrows and eyelashes appear.
•Nails appear on fingers and toes.
•The fetus is more active with increased muscle
development.
•"Quickening" usually occurs (the mother and others
can feel the fetus moving).
•The fetal heartbeat can be heard with a
stethoscope.
Week 23-26

•The fetus reaches a length of 28 cm (11.2 inches).

•The fetus weighs about 925g.
•Eyebrows and eyelashes are well formed.
•All of the eye components are developed.
•The fetus has a hand and startle reflex.
•Footprints and fingerprints continue forming.
•Alveoli (air sacs) are forming in lungs.
Week 27-30

•The fetus reaches a length of 38 cm (15

inches). The fetus weighs about 1.2 kg.
•The brain develops rapidly.
•The nervous system develops enough to
control some body functions.
•The eyelids open and close.
•The respiratory system, while immature, has
developed to the point where gas exchange is
possible.
Week 31-34

•The fetus reaches a length of about 38–43 cm

(15– 17 inches).
•The fetus weighs about 1.5 kg (3 lb 0 oz).
•The amount of body fat rapidly increases.
•Rhythmic breathing movements occur, but
lungs are not fully mature.
•CONT..
•Thalamic brain connections, which mediate
sensory input, form.
•Bones are fully developed, but are still soft and
pliable.
•The fetus begins storing a lot
of iron, calcium and phosphorus
Week 35
•The fetus reaches a length of about 40–48 cm
(16– 19 inches).
•The fetus weighs about 2.5 to 3 kg (5 lb 12 oz to
6 lb 12 oz).
•Lanugo begins to disappear.
Body fat increases.
•Fingernails reach the end of the fingertips.
•A baby born at 36 weeks has a high chance of
survival, but may require medical interventions
Week 36-40

•The fetus is considered full-term at the end of the

39th week of gestational age.
It may be 48 to 53 cm (19 to 21 inches) in length.
•The lanugo is gone except on the upper arms and
shoulders.
•Fingernails extend beyond fingertips.
•Small breast buds are present on both sexes.
•Head hair is now coarse and thickest
REFERENCES

1. Myle’s Textbook for Midwives, 2008, Elsevier

2. Reeder & Martin – Maternity Nursing,
Lippincott
3. Fraser DM, Cooper MA. Myles Textbook of
Midwives. Fourteenth edition. Edinburgh;
Churchill Livingstone: 2003.
4. Orshan – Maternity Nursing ,2009,LWW
5. Ricci – Essentials of maternity nursing, 2009,
Lippincott’s
6. William’s Obstetrics,2009,Mcgrahill
7. Mudaliar – Clinical Obstetrics, Orient Black
swan.
8. Berek - Novak’s Gynecology,2008,LWW