CARE OF THE FETUS & FETAL TERMS USED TO DENOTE FETAL GROWTH

DEVELOPMENT
Ovum from ovulation to
“Life is present at the beginning of conception” fertilization
Zygote fertilization to
implantation
ASSESSMENT OF THE FETAL GROWTH Embryo implantation to 5-8
AND DEVELOPMENT weeks
Fetus 5-8 weeks until term
Purpose Conceptus developing embryo
or fetus and placental
1. Predict the outcome of the pregnancy structures throughout
2. Manage the remaining weeks of pregnancy
3. Plan possible complication at birth
4. Plan for problems that may occur in the FETUS DEVELOPMENT
newborn infant Pre-embryonic 1st 2 weeks, begin at
5. Decide whether to continue the pregnancy fertilization
6. Find conditions that may affect future Embryonic weeks 3-8
pregnancies Fetal 8th week -birth
 Full-term- 38 to 40 weeks
Includes:  Pre-term- < 38 weeks
 Post-term- > 42 weeks
 Health history
 Physical examination
 Examining fetal health
THE FERTILIZATION PROCESS
 Fetal growth
 Assessing the fetal well being Each month inside your ovaries, a group of
eggs starts to grow in small, fluid-filled sacs
called follicles. Eventually one of the eggs
HEALTH HISTORY erupts from the follicle (ovulation). It usually
happens about two weeks before your next
Assess the mother: period
 pre pregnancy illness Fertilization: also referred to conception and
 drugs impregnation
 nutritional intake
- The fusion of the sperm cell nucleus
 personal habits that may affect the fetus
with the egg cell nucleus to produce a
 exposure to teratogens (drugs, bacteria,
zygote
viruses)
- Union of ovum and spermatozoon
PHYSICAL EXAMINATION - Usually occurs in the outer third of the
fallopian tube (ampullar portion)
Assess the mother:
OVA
 weight
 general appearance
 bruises (may indicate partner violence;
greatly stressed ang mother, affecting
the fetus)
 - Released from the Graffian Follicle
- Will be surrounded by a ring of
In a fertilized egg or zygote, this mitotic division
mucopolysaccharide fluid (Zona is called cleavage.
pellucida) and a circle of cell (Corona
Radiata)
- Moves from the ovary to the fallopian
tube through the cilia and peristaltic
movement of fallopian tube
SPERM
- Per ejaculation, 2.5 semen containing
50-200M spermatozoa is release (AVG
40M per ejaculation)
- Moves through the cervix, uterus,
fallopian tube because of their flagella
and uterine contractions
- Undergoes capacitation changes in the
plasma membrane of the sperm head to
Cleavage Divisions
reveal sperm binding receptor sites
before penetrating into Corona Radiata As the zygote moves through the fallopian tube
- Clusters around coronal cells it continues to divide and grow into a ball of
- Will release hyaluronidase (proteolytic cells called morula made up of approx. 50 cells
enzyme) to dissolve the corona radiata
As the morula moves into the uterus from the
(or the first layer of the cell)
fallopian tube it becomes a hollow structure
- Sperm penetrates the cell; cell
known as blastocyst
membrane of ova changes composition;
nucleus is released The blastocyst secretes an enzyme and breaks
through the uterus wall in a process known as
Zygote- the new cell created by fertilization is
implantation
called
Bakit zygote tawag sa pinagsamang sperm pati egg?
Bakit di na lang spermsilog? Hehe :P
IMPLANTATION
FERTILIZATION is joining of two sex cells - 5 days or 7 days
(haploid) to create a new individual which is a
genetic combination of both parents (diploid). - after fertilization, the trophoblast burrows into
Once the zygote is formed it begins to grow in the endometrium (upper part of the uterus),
cell number through MITOSIS. embedding the fertilized egg into the uterine
lining
Steps of Fertilization:
Decidua- what the endometrium is called after
1.) Sperm to penetrates egg using implantation
enzymes to break through egg’s
protective layer The cluster of cells (blastocyst) divides into 3
2.) Once inside the egg, the nuclear layers in a process of GRASTRULATION
membrane of both the sperm and egg These layers will become all of the organs and
rupture and the genetic material of the tissues of the embryo.
egg and sperm are combined
Germ Layers 3. Amniotic sac- formed by 2 fetal
membranes (chorion, amnion)
1. Ectoderm (outer layer)
Contains fluid (amniotic fluid) that
a. Nervous system including brain,
protects fetus by giving it a stable and
spinal cord and nerves
environment and absorbing shock
b. Lining of the mouth, nostrils, and
anus 2 presentations of placenta:
c. Epidermis of skin, sweat glands,
1. Maternal
hair, nails
2. Fetal
2. Mesoderm (middle layer)
a. Bones and muscles
4. Amniotic Fluid- formed by the secretion
b. Blood and blood vessels
of:
c. Reproductive and excretory cells
1. Amniotic cells
d. Inner layer (dermis) of skin
2. Lungs and skin of fetus
3. Endoderm (inner layer)
3. Fetal urine
a. Lining of digestive tract
o 98% water, but also contains
b. Lining of trachea, bronchi, and
lungs glucose, protein, sodium, urea,
c. Liver, pancreas creatinine, lanugo, vernix
d. Thyroid, parathyroid, thymus, caseosa
urinary bladder o Slightly alkaline, replaced approx.
every 3 hours
The outer layer of the blastocyst forms a o Amniotic cells and the fetus
membrane that protects and nourishes the urinating and swallowing regulate
developing embryo knowns as the amniotic the secretion and reabsorption of
sac. the fluid
Note: Inner to outer ang growth of fetus Functions of amniotic fluid:
a. Never stagnant
b. Serves to protect fetus
o Shields against pressure;
equalizes the pressure around
the fetus; cushions the fetus from
external compression
o Protects from temperature
changes; provides constant
temperature and fluid for the fetus
to swallow
o Protects umbilical cord
o Allows freedom of movement for
the fetus
1. Chorion- outer fetal membrane, formed o Lubricates the membrane and the
from the trophoblast (maternal side of
fetus
placenta)
2. Amnion- originates in the blastocyst
during early stages of development,
expands as the fetus grows until it
slightly adheres to the chorion (fetal side
of placenta)
PLACENTA AND UMBILICAL CORD
Placenta- formed by the:

- Chorionic villi at the base of the

implanted fertilized ovum and the
decidua basalis
- Endometrium at the site of implantation

Between days 6 and 14, implantation (the

adhering of blastocyst to the wall of uterus)
occurs.
The placenta also begins to form.
At this stage, there is no more embryonic stem
cells.
By the 3rd week of pregnancy, the placenta
begins to form in the uterus.
The placenta is the connection between the
mother and the embryo which provides a
supply of oxygen and nutrients, while keeping
the mother and embryo’s blood supplies
separate.
Nutrients and oxygen are exchanged through
diffusion. The placenta is the embryo’s organ
of respiration, nourishment, and excretion.
PLACENTA
- Fully functional by the 12th week
2 sides:
1. Maternal side (Duncan): irregular and
divided into subdivisions called
cotyledons
2. Fetal side (Schultz): covered by amnion,
smooth and shiny
UMBILICAL CORD - Carry unoxygenated blood from the
fetus to the placenta
- structure that connects fetus to placenta
- Become umbilical ligaments after birth
- has 2 arteries and 1 vein (AVA)
o 2 arteries carry deoxygenated Ductus Venosus
blood from the fetus to the
- Carry oxygenated blood from umbilical
placenta
vein to IVC
o 1 vein carries oxygenated blood
- Bypassing fetal liver
to the fetus, along with nutrients, - Becomes ligamentum venosum after
hormones, etc. birth
FETAL DEVELOPMENT
FETAL CIRCULATION Ductus Arteriosus
- Carry oxygenated blood from pulmonary
artery to aorta
- Bypassing fetal lungs
Note: Failure mag close ang ducts will lead to
illness

DEVELOPMENT OCCURS IN SYSTEMATIC

MANNER
1. From head to toe
2. From proximal to distal
3. From generic to specific
4. Described in general term of trimester
a. 1st trimester – 12 weeks
b. 2nd trimester – 13 to 27 weeks
c. 3rd trimester – 28 to 40 weeks
EMBRYONIC STAGE
Week 4
Special structures:
- (wt 0.4g, length 4-6 mm), half the size of
Foramen Ovale a pea, brain differentiates, G.I. tract
- Connects the left and right atria begins to form, limbs buds appear
- Bypassing fetal lungs - May indicators if normal size, weight, etc
- Obliterated after birth to become fossa Week 5
ovalis
- cranial nerves present, muscles have
Umbilical Vein innervation (L 6-8mm)
- Brings oxygenated blood coming from Week 6
the placenta to the heart and liver
- Becomes ligamentum teres - fetal circulation established; liver
produces red blood cells; CNS forms;
Umbilical Arteries primitive kidney forms; lung buds
 present; cartilage forms; primitive Week 16
skeleton forms; muscles differentiate
- meconium forms in bowels, scalp hair
Week 7 appears, frequent fatal movement, skin
thin and pink, sensitive to light, 200 ml of
- eyelids form, palate and tongue form
amniotic fluid
stomach forms, diaphragm formed, arms
and legs move (L 22-28mm) Meconium is the earliest stool of a
mammalian infant. Unlike later
Week 8
feces, meconium is composed of materials
- resembles human being, eyes move to ingested during the time the infant spends in
face front, heart development complete, the uterus: intestinal epithelial cells, lanugo,
hands and feet well forms, bone and mucus, amniotic fluid, bile and water.
cells begin to replace cartilage, all body
Week 20
organs have begun forming (wt- 2g, l-
3cm) - myelination of spinal cord begins,
peristalsis begins, lanugo covers body;
Note: Pyka – unusual cravings
vernix caseosa covers body, brown fat
By the end of the 8th week of pregnancy, the deposit begins, swallos and sucks
embryo is called a fetus and all of major amniotic fluid, heart beat heard by
structures are present. fetoscope, hands can grasp, regular
schedule of sucking, kicking and
sleeping (wt 435g, l 19cm)
FETAL STAGE Note: for measurement- 5 fingers (5 months)
Week 9 pinky and thumb on fundus – dapat at level of
umbilicus na
- fingers and toenails form; eyelids fuse
shut Week 24

Week 10 - alveoli present in lungs/ begin producing

surfactant, eyes completely formed,
- head growth slows; islets of Langerhans eyelashes and eyebrows appear, many
differentiated, bone marrow forms, rbc reflexes appear, (+) chance of survival if
produced; bladder sac forms; kidneys born
make urine (wt – 14g, l – 5-6cm C-H)
Surfactant- aids in the expansion of the lungs
Week 11 of the baby; keeps the alveoli from collapsing
- tooth buds appear, live secretes bile; Week 28
urinary system functions, insulin forms in
pancreas - subcutaneous fat deposits begin; lanugo
begins to disappears; nails appear;
Week 12 eyelids open and close; testes begin to
- lungs take shape, palate fuses, heart descend
beat heard with Doppler, ossification Week 32
established, swallowing reflex present;
external genitalia, male or female - more reflexes present, CNS direct
distinguished rhythmic breathing movement/partially
controls body temp, begins storing iron,
Note: Normal fetal heart rate: 120-160 bpm calcium phosphorus; ratio of lungs
 surfactant lecithin and sphingomyelin is How to do Kick Counts
1.2:2
1. Choose a time when baby is active
Week 36 - This is usually in the evening,
baby may need a little prompting
- a few creases on soles of feet, skin less
2. Assume the position
wrinkled, fingernails reach fingertips,
- Either sitting or lying down—
sleep-wake cycle fairly definite, transfer
preferably on your left side
of maternal antibodies
3. See how long it takes baby to move 10
Week 38 times
- Usually happens within 30 mins,
- Last trimester; L/S ratio 2:1, the baby could take up to 2 hours
has mature lungs and is ready for life
outside the uterus
Week 40 Gender

- Lanugo only on shoulders and upper - Refers to the attitudes, feelings, and
back; creases over sole, vernix mainly in behaviors that a given culture
folds of skin, ear cartilage firm, less associates with a person’s biological sex
active, limited space, ready to be born
Biologic Gender
Vernix caseosa, also known as vernix, is the
- denotes chromosomal development
waxy or cheese-like white substance found
(XX-female; XY-male)
coating the skin of newborn human babies. It is
produced by dedicated cells and is thought to Gender Role
have some protective roles during fetal
- is the male or female behavior a person
development and for a few hours after birth.
exhibits, which again, may or may not
Eclampsia be the same as biologic gender or
gender identity
Rhythm Strip Testing Record
ASSESSING FETAL WELL-BEING
- assessing FHR for whether a good
1. Fetal heart rate
baseline rate and both long- and short-
2. Fetoscope
term variability are present
3. Doppler
- record FHR for 20 min
- In 10 mins, 3-5 movements: Normal
Daily fetal movements count (kicks count) - Stimulated para mag move si baby

- Fetal kick count Nonstress Testing

- Quickening- movement felt by the
- measure the response of the FHR to
momma
fetal movement
- Occurs approx. 18-20 weeks of
pregnancy Ultrasonography
- Peaks- 28 to 38 weeks
- measure the response of the sound
o the pregnant woman reports at
waves against solid object
least 10 movements in 12 hours
o absence of fetal movement Assessing Fetal Well Being cont.
precedes intrauterine fetal death
a. Doppler Umbilical Velocity
by 48 hours
 - Measure the velocity at which red blood - Birth defects
cells in the uterine and fatal vessel travel o 3-5%
o Will increase if expose to
b. Placental Grading for matury
teratogens
- placenta can be graded by ultrasound - Miscarriage
based on the particular amount of o 25%
calcium deposited its presentin the base o Decreases 20 10% on the eighth
o 0: between 12 and 24 weeks week (2 mos: all organs are
o 1: 30 to 32 weeks formed)
o 2: 36 weeks o Will increase upon teratogenic
o 3: 38 weeks (because fetal lungs are exposure
apt to be measured by) a grade 3
placenta suggests that fetus is
mature
c. Electronic Fetal Monitoring Chemical Teratogens
- measured when laboring AGENT EFFECT ON
- 38-40 weeks ang term HUMAN
DEVELOPMENT
d. Amniotic Fluid Volume Alcohol Growth & mental
- measure the amount of amniotic fluid to retardation,
estimate fetal health microcephaly,
- between 28-40 weeks, the total pockets various
malformation of
of amniotic revealed by sonogram
the face and
average 12-15 cm trunk, septal
e. Hydramnios defects
Diethylstilbestrol (DES) Cervical & uterine
- normal 12-15 cm abnormalities
- amount greater than 20-24 cm
(excessive fluid, perhaps caused by Lithium Heart anomalies,
inability of the fetus to swallow) ebstein’s
anomaly, tricuspid
f. Polyhydramnios atresia, atrial
septal defect
- amount greater than 20 to 24 cm Mercury Mental
(excessive fluid, perhaps caused by retardation,
inability of the fetus to swallow cerebral atrophy,
spasticity,
g. Oligohydramnios
blindness
- amount of amniotic fluid less than to 5- Streptomycin Hearing loss,
6cm (caused by poor perfusion and auditory nerve
kidney failure of mother) damage
Tetracycline Hypoplasia &
h. Teratogens staining of tooth
enamel, staining
- Any exposure that can cause harm to an of bones
unborn or breastfeeding baby Thalidomide Limb defects, ear
Risk: defects,
cardiovascular
 anomalies, calcification,
teralogy of fallot mental
septal defects. retardation
Truncus
arteriosus OTHER COMMON TERATOGEN
CIGARETTE SMOKING
Teratogenic Commonest type
- Miscarriage influence
- Stillbirth Maternal diabetes Ventricular septal
- Low birth weight defect, transposition
- Premature birth of the great arteries,
tetralogy of fallot,
- Sudden infant death syndrome (SIDS)
coarctation
- Possible increase in developmental
Maternal Tetralogy of fallot
delays phenylketonuria
- 1% risk for cleft palate Systemic lupus Complete heart block
- And failure to thrive erythematosus
Hydantoin Pulmonary & aortic
VIRUSES, BACTERIA & PROTOZOA stenosis, coarctation,
persistent ductus
ORGANISM DISEASE CONGENITAL
arteriosus
DEFECT
Trimethadione Tetralogy of fallot,
Rubella virus German Cataracts,
transposition of the
measles deafness,
great arteries,
cardiovascular
hypoplastic left heart
defects, slow
Retinoic acid Conotruncal heart
growth of fetus,
defects
persistent
Ductus
arteriosus,
peripheral
pulmonary
artery stenosis,
septal defects
Cytomegalo- Cytomegalic Microcephaly,
virus inclusion microphthalmia
disease , cerebral
calcification,
slowing of
intrauterine
growth
Trepanoma Syphilis Dental
pallidum abnormalities,
(Spirochete deatness,
bacterium) mental
retardation,
skin & bone
lesions,
meningitis
Toxoplasma Toxoplasmosi Microcephaly,
gondii s hydrocephaly,
(protozoan) cerebral