FETAL DEVELOPMENT AND FETAL CIRCULATION

● 7-8 days from fertilization to

REVIEW: COITUS TO IMPLANTATION implantation

Coitus TROPHOBLAST
| ● outer layer of a blastocyst
Sperms travel to the Ampulla of fallopian tube ● develop into a large part of the placenta
| ● The trophoblast proliferates and
Capacitation differentiates into 2 cell layers at
sperm approach the egg, the sperm release approximately 6 days after fertilization:
hyaluronidase which dissolve the protective ● Cytotrophoblast: inner layer, single
layer of the egg, allowing penetration of one celled
sperm for fertilization ● Syncytiotrophoblast: outer layer, thick
| and multinucleated. It secretes hCG to
Fertilization maintain progesterone secretion and
Joining of the sperm & the egg sustain pregnancy.
|
Zygote PRIMARY GERM LAYERS
-Product of fertilization
-Zygote travels towards the uterus ● Cepalo -caudal growth & development
approximately 3 days (Zygote: 1-8 cells & ● Stem cell- 4 days of zygote pluripotent
Morulla: 16-50 cells) stem cell use for for reproductive
| cloning
Blastocysts ● Multipotent - after few more days
Fluid-filled cell mass - secretory phase specific parts develop.
attached to endometrial lining
FETAL DEVELOPMENT
Trophoblast - cells on the blastocysts outer
ring that develop into placenta and membranes OVUM OR PREEMBRYONIC- last from
conception until day 14. This period covers
Embryoblast - inner cell mass that will form cellular replication, blastocyst formation, initial
the embryo development of the embryonic membranes and
| establishment of primary germ layers.
Implantation
Contact between the growing fertilized cell & PRIMARY GERM LAYERS
uterine lining
| 1. Ectoderm - the upper layer of the
Apposition embryonic disk. Forms the epidermis, the
Process by which the fertilized egg brushes the glands (anterior pituitary, cutaneous and
endometrial lining mammary), the nails and hair, the CNS and
| PNS, the lens of the eyes, enamel and floor of
Embryo the amniotic cavity tooth
Fertilized egg that has implanted
2. Mesoderm middle layers, forms the bones,
FERTILIZATION teeth and connective tissue, the CVS and
spleen, the muscles (skeletal, smooth and
● Begins with 46 pair of chromosomes, cardiac) and the urogenital system
splits off to 23 then combine for a
unique new 46 pair. 3. Endoderm - lower layer, rise to epithelium
● Decidua - results from the preservation lining the respiratory and digestive tract,
and further thickening of the glandular cells of associated organs, including
endometrial lining. The corpus luteum the oropharynx, liver and pancreas, urethra,
by HCG cause elevation of bladder and vagina. Also forms the roof of the
progesterone level that cause yolk sac.
development of decidua.
FETAL MEMBRANES
Early Human Development
1. Zygote 1. CHORION -
2. Blastomeres - Develops from thropoblast and contains
3. Morula chorionic villi on its surface. This
4. Blastocyst becomes the covering of the fetal side
5. Embryo of the placenta. Contains the major
6. Fetus umbilical blood vessels.
7. Conceptus - Chorionic villi have progesterone
central core. Produce placental
Stages and Time Frames hormones such as hcg, hpl, estrogen
● Ovum and progesterone
● Zygote (3-4 days, 16-50 cell) -
● Morula (3-4 days)
● Blastocyst 2. AMNION -
● Embryo - inner cell membranes, develops from
● Fetus the interior cells of the blastocyst. The
1
FETAL DEVELOPMENT AND FETAL CIRCULATION
cavity that develops between this inner about 5 mm (about 0 .2 in) from crown
cell mass and outer layer of cells to rump.
(trophoblast) is the amniotic cavity
- Support the amniotic fluid & produced Week Six
fluids, it is also seem as fetal surface of ● Beginning of formation of the lungs and
the placenta. It also produces further development of the brain. Arms
phospholipid that forms prostaglandins and legs have lengthened with foot and
that cause contraction hand areas distinguishable. Hands and
feet have digits, but may still be
webbed

• As it grows larger, the a mnion forms on the Month 2

opposite side of the developing blastocyst. The At the end of 8 weeks:
developing embryo draws the amnion around ● 1-1/8 inches long or the eight-week- old
itself, forming a fluid filled sac. The amnion fetus measures about 30 mm
becomes the covering of the umbilical cord and (abou1in)from crown to rump.
covers the chorion on the fetal surface of the ● Heart is functioning
placenta ● Eyes, nose, lips, tongue, ears and teeth
are forming
TRIMESTER ● Penis begins to appear in boys
● 1st = week's 1-13 ● Baby is moving, although the mother
● 2nd = week's 14-26 can not yet feel movemen
● 3rd = week's 27 and on (38-42 ● Embryo passes into the fetal stage of
WEEKS) development. The fetus shown here
floats in the watery amniotic fluid, which
Day One is contained by the transparent, tough,
amniotic membrane. The amniotic fluid
● The first cell of a new human being, acts as a shock absorber, preventing
called a zygote, is formed when a damage to the developing fetus.
sperm fertilizes an egg. In the egg cell
shown here, the nuclei of the sperm Month 3
and egg appear as two yellow-brown, At the end of 12 weeks:
irregular shapes. When these two ● Baby is 2 1/2 to 3 inches long
nuclei fuse, fertilization is ● Weight is about 1/2 to 1 ounce
accomplished. ● Baby develops recognizable form. Nails
start to develop and earlobes are
Day Three formed
● Arms, hands, fingers, legs, feet and
● The zygote begins its journey down the toes are fully formed
Fallopian tube. About 36 hours after ● Eyes are almost fully developed
fertilization, cell division begins in the ● Baby has developed most of his/her
Fallopian tube, and continues to occur organs and tissues
about twice a day. In three to four days, ● Baby's heart rate can be heard at 10
the cluster of dividing cells completes weeks with a special instrument called
the 10 cm (4 in) journey through the a Doppler
Fallopian tube to the uterus.
Day Six Second Trimester
● About the fifth day after fertilization, a
cluster of about a hundred cells floats in Month 4
the uterus. It soon takes the form of a At the end of 4 months:
fluid-filled ball of cells called a ● Baby is 6 1/2 to 7 inches long
blastocyst. After one or two days in the ● Weight is about 6 to 7 ounces
uterus, the blastocyst burrows into the
uterine lining, which grows over the ● Baby is developing reflexes, such as
blastocyst and provides it with nutrients sucking and swallowing and may begin
sucking his/her thumb
First Trimester ● Tooth buds are developing
● Sweat glands are forming on palms and
1 Month soles
At the end of four weeks: ● Fingers and toes are well defined
● Baby is 1/4 inch in length ● Sex is identifiable
● Heart, digestive system, backbone and ● Skin is bright pink, transparent and
spinal cord begin to form covered with soft, downy hair
● Placenta (sometimes called "afterbirth") ● Although recognizably human in
begins to develop appearance, the baby would not be
● The single fertilized egg is now 10,000 able to survive outside the mother's
times larger than size at conception body
● form primitive organ ● Meconium is produce in the intestinal
● the head (bottom, left) can be tract. Liver and pancreas produce their
distinguished. appropriate fluid secretions
● The four-week-old embryo measures
2
FETAL DEVELOPMENT AND FETAL CIRCULATION
Month 5 Month 9
At the end of 5 months:
● Baby is 8 to 10 inches long At the end of 9 months:
● Weight is about 1 pound
● Hair begins to grow on baby's head ● Baby is 19 to 20 inches long
● Soft woolly hair called lanugo will cover ● Weight is about 7 to 7 1/2 pound
its body. Some may remain until a week ● The lungs are mature
after birth, when it is shed. ● Baby is now fully developed and can
● Mother begins to feel fetal movement survive outside the mother's body
● Internal organs are maturing ● Skin is pink and smooth
● Eyebrows, eyelids and eyelashes ● Baby settles down lower in the
appear abdomen in preparation for birth and
● Toes the fetus is more active with may seem less active
increased muscle development

Month 6
At the end of 6 months:
● Baby is 11 to 14 inches long
● Weight is about 1 3/4 to 2 pounds and
Eyelids begin to parta eyes open
sometimes for short periods of time AMNIOTIC FLUID
● Skin is covered with protective coating
called vernix ● Clear, yellowish fluid surrounding the
● Baby is able to hiccup developing fetus.
● Eyebrows and eyelashes are well ● Average amount 1000 ml.
formed. ● Having < 300ml – Oligohydramnios,
● The fetus has a hand and startle reflex associated with fetal renal
foot prints and fingerprints abnormalities.
● Forming alveoli (air sacs) forming in ● Having > 2 L- Hydramnios, associated
lungs with GI and other malformations

Month 7 FUNCTIONS:
At the end of 7 months:
● Baby is 14 to 16 inches long ➢ Protects Fetus (cushion)
● Weight is about 2 1/2 to 3 1/2 pounds ➢ Allows Movement
● Taste buds have developed ➢ Source of oral fluid
● Fat layers are forming ➢ Acts as a excretion-collection
● Organs are maturing repository
● Skin is still wrinkled and red ➢ Maintain constant body temperature
● If born at this time, baby will be ➢ Shields against pressure or a blow to
considered a premature baby and the mother's abdomen
require special care ➢ Probably aids in muscular development
● Rapid increase in the amount of body because it allows the fetus freedom to
at rhythmic breathing movements move
occur, but lungs are not fully mature ➢ Protects umbilical cord from pressure,
bones are fully developed, but still soft protecting fetal oxygenation
and pliable fetus begins storing iron,
calcium, and phosphorus AMNIOTIC MEMBRANE

Month 8 ● Provide support and produces the

At the end of 8 months: amniotic fluid
● Produces precursors to prostaglandins,
● Baby is 16 1/2 to 18 inches long which initiates the contractions during
● Weight is about 4 to 6 pounds labor
● Overall growth is rapid this month ● No nerve supply which is evident
● Tremendous brain growth occurs at this during the painless rapture of
time membrane
● Most body organs are now developed
with the exception of the lungs UMBILICAL CORD
● Movements or "kicks" are strong
enough to be visible from the outside ● Connecting link between fetus and
● Kidneys are mature placenta.
● Skin is less wrinkled ● Transports oxygen and nutrients to the
● Fingernails now extend beyond fetus from the placenta and returns
fingertips waste products from the fetus to the
placenta.
3
FETAL DEVELOPMENT AND FETAL CIRCULATION
● Contains: 2 arteries and 1 vein accommodate the developing fetus
supported by mucoid material
(wharton's jelly) to prevent kinking and 3. Progesterone
knotting. ● Also referred as "hormone of mothers"
● Contains NO pain receptors. ● Maintain endometrial lining of the
● Composed of smooth muscles which uterus during pregnancy
constrict upon fetal delivery, naturally ● Induction of quiescence of the uterine
clamping the blood vessels and musculature during pregnancy which
preventing bleeding. prevents premature labor
● The average length of umbilical cord or
funis in humans is 55 cm and its 4. Human Placental Lactogen (HPL)
diameter is 2 cm. ● It helps prepare your body for
breastfeeding. It also regulates
PLACENTA metabolism and insulin sensitivity to
● Arises out of trophoblast tissue make sure the fetus gets enough
● Serves as a fetal lungs, kidney and GIT nutrients.
and as a separate endocrine organ ● increases maternal insulin resistance
throughout pregnancy and reduces maternal glucose
● 15 to 20 cm in - diameter, 2 to 3 cm utilization, elevating maternal blood
depth at term glucose levels (supporting
● Structure that involves mediating transplacental glucose transfer)
between maternal and fetal circulation
and producing essential hormones VIABILITY
during pregnancy. ● Capability of fetus to survive outside
● Sieve/filter- allows smaller particles uterus at the earliest gestational age ( 4
through and holds back larger weeks)
molecules. Passage of materials in SURVIVAL DEPENDS ON:
either direction is effected by: ● Maturity of fetal central nervous system
>Diffusion: gasses, water, electrolytes ● Maturity of lungs
>Facilitated transfer: glucose, amino
acids, minerals. RESPIRATORY SYSTEM
>Pinocytosis: movement of minute ● Terminal SAC period - 24 Weeks to
particle birth
● Mother transmits immunoglobulin G ● Growth of primitive alveoli
(IgG) to the fetus providing limited ● Pulmonary surfactants produced which
passive immunity. act as wetting agents that prevent
● Leakage: caused by membrane defect: alveolar walls from sticking
may allow maternal and fetal blood ● Insufficient surfactant - RDS
mixing. ● Lecithin/Sphingomyelin-Phospholipids
L/S Ratio
FUNCTIONS 30-32 Weeks 1.2:1
● Source of oxygen 35 Weeks 2:1 (MATURITY)
● Source of nutrient
● Source of an important hormone CARDIOVASCULAR SYSTEM
producing system ● 1st System to function
● Act as a barrier against microorganisms ● FHR 120-160/Min
and some drugs ● Can hear FHR with doppler at 10-12
Weeks
PRODUCE PROTEIN HORMONES: ● Non stress test
● Human chorionic gonadotropin (HCG)- ● Stress test
8-10 days past conception, is basis for FETAL CIRCULATION
pregnancy test ● It is a circulatory system of the human
● Progesterone fetus, often encompassing the entire
● Estrogen fetoceptal circulation that also
● Human Placental Lactogen includes the umbilical cord and the
blood vessels within the placenta that
HORMONES PRODUCED BY PLACENTA carry fetal blood.
1.HCG (Human Chorionic Gonadotropin) ● Arteries in the umbilical cord and fetal
● First hormone that produce the body carry deoxygenated blood.
placenta present circulation during the ● Veins in cord and those in the fetal
first 100 days of pregnancy body carry oxygenated blood.
● Ensures that corpus luteum of the ● Ductus venosus connects umbilical
ovary continue to produce vein and inferior vena cava; bypassing
progesterone and estrogen portal circulation
● Exert an effect on male fetal testes to ● In the fully developed human, the heart
begin testosterone production serves two main purposes.
● The right heart pumps blood to the
2. Estrogen (Primarily Estradiol) lungs for oxygenation and the left heart
● Mother's mammary gland development pumps oxygenated blood to the rest of
in preparation of lactation the body.
● Stimulates the uterus to grow to ● In the embryo and fetus, the lungs do
4
FETAL DEVELOPMENT AND FETAL CIRCULATION
not oxygenate the blood. The core concept behind fetal
● Fetal circulation is consequently quite circulation is that fetal hemoglobin has a
different than that of a breathing baby higher affinity for oxygen than does adult
or adult. hemoglobin, which allows a diffusion of
● When a baby is born and takes its first oxygen from the mother's circulatory
breath, the ducts close and blood is system to the fetus.
rerouted to the lungs. The circulatory system of the mother
● Fetal circulation consequently differs is not directly connected to that of the
from the adult one predominantly due fetus, so the placenta functions as the
to the presence of 3 major vascular respiratory center for the fetus as well as a
shunts: site of filtration for plasma nutrients and
○ Ductus venosus: between the wastes.
umbilical vein and IVC
○ Foramen ovale: between the FETAL CIRCULATION SEQUENCE
right and left atrium ● Exchange of gasses occurs in the
○ Ductus arteriosus: between placenta. Oxygenated blood is carried
the pulmonary artery and by the umbilical vein towards the fetal
descending aorta heart.
● By the third month of development, all ● The ductus venosus directs part of the
major blood vessels are present and blood flow from the umbilical vein away
functioning. from the fetal liver (filtration of the blood
● Fetus must have blood flow to the by the liver is unnecessary during the
placenta. fetal life) and directly to the inferior
● Resistance to blood flow is high in vena cava.
lungs. ● Blood from the ductus venosus enters
the inferior vena cava. Increased levels
of oxygenated blood flows into the right
LOCATION FUNCTIONS
atrium.
PLACENTA attached to gas ● In adults, the increased pressure of the
uterus exchange right atrium causes the tricuspid valve
during fetal to open thus, draining the blood into the
life right ventricle. However, in fetal
circulation most of the blood in the right
UMBILICAL ONE VEIN in Oxygenated atrium is directed by the foramen ovale
VEIN one cord Blood to (opening between the two atria) to the
fetus carry left atrium.
● The portion of the blood that drains into
UMBILICAL TWO Carries the right ventricle passes to the
ARTERIES ARTERIES Unoxygenate pulmonary artery.
in one cord d blood from ● As blood enters the pulmonary artery
(TAOV) fetus (carries blood to the lungs), an opening
called ductus arteriosus connects the
FORAMEN opening in shunts blood pulmonary artery and the descending
OVALE atrial septum from the right aorta. Hence, most of the blood will
(between R atrium to the bypass the non- functioning fetal lungs
& L Atrium) left atrium so and will be distributed to the different
that blood parts of the body. A small portion of the
can be oxygenated blood that enters the lungs
supplied to remains there for fetal lung maturity.
brain, heart ● The umbilical arteries then carry the
and kidney non- oxygenated blood away from the
heart to the placenta for oxygenation.
DUCTUS accessory supplies
VENOSUS vein blood to liver,
connecting Bypass to
umbilical the fetal liver
vein into the
fetal liver &
inferior vena
cava

DUCTUS connection shunts of the

ARTERIOSU between larger portion
S fetal lungs & of the blood
aorta away from
the lungs
and directly
into the aorta

PLACENTAL ROLE
5
FETAL DEVELOPMENT AND FETAL CIRCULATION
RENAL SYSTEM
● Foramen Ovale allows blood to flow ● Kidneys form in 5th week and begin to
from right to left atrium, bypassing function 4 weeks later.
lungs. ● Voiding into amniotic fluid
● Ductus Arteriosus allows blood flow ● Low volume can show renal
from pulmonary artery to aorta, dysfunction
bypassing fetal lungs ● Renal malformation can be diagnosed
in utero.
● GFR is low at birth
Foramen Ovale Closes shortly after
birth
NEUROLOGICAL SYSTEM
Ductus arteriosus Closes soon after ● Formed from the ectoderm during the
birth becomes 3rd week
ligamentum ● Respiratory effort 18 1/2 WKS
arteriosum in about 3 ● Swallowing 12 1/2 WKS
mos. ● Sucking 29 WKS
● Fetal movement felt 16-20 WKS
Ductus venosus Ligamentum (Quickening)
venosum
ENDOCRINE SYSTEM
Umbilical arteries Medial umbilical ● Thyroid gland 1st to develop
ligaments ● Insulin produced at 20 weeks

Umbilical Vein ligamentum teres INTEGUMENTARY SYSTEM

● 7th week -Two layers of cells
1. First breath ● Vernix caseosa -Protects skin
2. Lungs expand (Pressure in the left ● Lanugo - Fine hair
atrium increases as increased blood ● 10th week - Fingernails, toenails
returns via pulmonary veins.)
3. Stimulates closure of foramen ovale IMMUNE SYSTEM
4. Increased oxygen saturation causes ● Passive immunity - FROM MOM
ductus arteriosus to constrict. ● Active immunity - FROM FETUS
5. DA closes 10-15 hrs after birth
Permanent closure 10-21 days after ASSESSMENT FOR FETAL GROWTH AND
birth (Unless O2 remains low) DEVELOPMENT
● Heath History mother: nutrition,
PROBLEM WITH PERSISTENCE OF FETAL personal habits, accidents and intimate
CIRCULATION partner abuse
● Patent (open) ductus arteriosus and ● Fetal Growth estimation: Fetal
patent foramen ovale each characterize Movement at least 10 times a day
about 8% of congenital heart defects. ○ Sandovsky method - a woman
● Both cause a mixing of oxygen-rich and counts fetal movements three
oxygen-poor blood; blood reaching times a day after meals (F). In
tissues not fully oxygenated. Can cause the fixed-period method, fetal
cyanosis movement counting may be
● Surgical correction now available, done over a period of one hour,
ideally completed around age two. daily or, if a rapidly changing
● Many of these defects go undetected condition is anticipated,
until the child is at least in school. six-hourly.
○ Cardiff method - A way to
HEPATIC SYSTEM assess intrauterine well-being in
● Liver functions 4-6 weeks which the expectant woman
● Full liver function after delivery records fetal movement during
her usual activities. There
MUSCULO-SKELETAL SYSTEM should be at least 10
● Bones and muscles develop by 4th movements within a 12-hour
week period; if fewer than 10
● Fontanels areas where >2 bones meet movements are perceived,
● 7-8 Weeks arms & leg movements further medical evaluation is
needed.
GASTROINTESTINAL SYSTEM ● Fetal Heart Rate (FHR)
● Forms during 4th week ○ Normal: 120-160 beats per
● Middle portion of the intestine projects minute
out into the cord during the 5th week. ○ Rhythm Strip Testing - FHT for
● Returns during the 10th week. If this 20 mins. (mother left recumbent
does not occur- Omphalocele present position)
at birth ○ Non-stress test - fetal
● Meconium - Dark black tarry waste movement (2 acceleration of
green accumulated in the fetal to FHR for 15 sec =reactive)
intestine near term ○ Vibroacoustic stimulation
○ Contraction stress test
6
FETAL DEVELOPMENT AND FETAL CIRCULATION
○ Ultrasonography
○ Maternal Serum
Alpha-fetoprotein
○ Amniocentesis
○ Percutaneous umbilical cord
sampling
○ Biophysical profile - fetal activity,
breathing movement, fetal body
movement, fetal tone and
amniotic fluid volume (highest
score is 10 and more accurate).
○ Fetoscopy
○ Chorionic villi sampling
○ Amnioscopy - performed to
assess for meconium staining
TERATOGENS
● Environmental exposures that can
adversely affect the developing fetus
● Maternal Conditions
● Alcoholism, Diabetes,
Endocrinopathies, Phenylketonuria
(PKU), Smoking, Nutritional problems,
cocaine,
● Infections Agents
● Rubella, Toxoplasmosis, Syphilis,
Herpes Simplex, Cytomegalic Inclusion
Disease, Varicella, Venezuelan Equine
Encephalitis
● Mechanical Problems (deformations)
● Amniotic band constrictions, Umbilical
Cord constraint, Disparity in uterine
size and uterine contents
● Chemicals, drugs, radiation,
hyperthermia