NORMAL PREGNANCY &

CARE OF THE DEVELOPING FETUS

Jet Fernandez, RN
LEARNING OUTCOMES:

1. Describe the physiology of normal pregnancy.

2. Describe the different stages of embryological
development.
3. Differentiate between pre-embryonic and embryonic
development.
4. Identify the developmental origin of the different
organ systems and fetal structures.
5. List stages and milestones of fetal growth and
development with key landmarks and critical time
frames.
 PREGNANCY
• Latin word origin:
“PRAEGNANTEM” (meaning-
“before birth”)

• It is the period of carrying a

developing embryo or fetus inside the
womb.

• Occurs when a sperm fertilizes an egg

after it’s released from the ovary
during ovulation. The fertilized egg
then travels down into the uterus,
where implantation occurs. A
successful implantation results in
pregnancy.
• Pregnancy lasts about 40 weeks from
the first day of the woman’s last
period to the completion of the
pregnancy, labor, and birth.

• Divided into 3 Trimesters:

 First Trimester (Weeks 1 to 13)

 Second Trimester (Weeks 14 to 27)
 Third Trimester (Weeks 28+)
 FERTILIZATION is the process
wherein the ovum and the spermatozoa
unite at the ampullary portion of the
fallopian tube, the usual site of
fertilization.
 WHAT HAPPENS IN
• FERTILIZATION?
A mature ovum can only be fertilized within 24 to 48 hours after
being released.
• The functional life of the spermatozoa is only 48 to 72 hours.
• The best time that fertilization would occur is 72 hours after
sexual intercourse.
• The fertilized ovum is propelled along the tube through the help
of the peristaltic movements of the fallopian tube and the tube’s
cilia.
• The average time that the sperm can reach the cervix is within
90 seconds, and it can reach the outer fallopian tube within 5
minutes.
• If the ovum has already been penetrated by a spermatozoon, it
changes its composition so that it becomes impermeable to other
spermatozoa.
• After penetration, the chromosomal materials of both the ovum
and the spermatozoon combine to form a zygote.
• Three factors determine the certainty of fertilization:
 the maturation of both the sperm and the ovum;
 the ability of the sperm to reach the ovum; and

 IMPLANTATION is the migration of the zygote
towards the uterus reaches 3 to 4 days, and it is
propelled by the muscular contractions in the fallopian
tube.
 WHAT HAPPENS IN
• IMPLANTATION?
Mitotic cell division or cleaving starts after 24 hours. The rate of
cleaving is an average of one every 22 hours.
• As the zygote reaches the uterus, it already has 16 to 50 cell
divisions, and it is now called a morula because of its bumpy
appearance.
• The morula floats freely along the body of the uterus within 3 to 4
days, and it becomes a blastocyst.
• The blastocyst attaches into the endometrium, and this process is
called implantation, which occurs 8 to 10 days after fertilization.
• Apposition, or the brushing of the blastocyst against the
endometrium, is the first part of implantation.
• Adhesion occurs afterwards as the blastocyst attaches to the surface
of the endometrium, then invasion, as it settles into the folds of the
endometrium.
• On the day of implantation, the woman may experience a small
amount of vaginal spotting as the capillaries by the implanting
blastocyst.
STAGES OF FETAL DEVELOPMENT
I. The Germinal Stage (Weeks 2 to 4)
II. The Embryonic Stage (Weeks 5 to 9)
III. The Fetal Stage (Weeks 10+)
 THE GERMINAL STAGE (PRE-
• EMBRYONIC)
The period from
Conception
(sperm and egg
cell unite in one
of the two
fallopian tubes)
to implantation,
usually lasts
about 14 days.
• Zygote (fertilized
egg) formation.
• Blastocyst forms,
differentiation
• Ends with
Implantation.
Through the process of mitosis, the zygote first divides
into two cells, then into four, eight, sixteen, and so on.
A cluster of cells formed is known as the morula.
• The cells develop into what is known as a blastocyst.
The blastocyst is made up of three layers, each of
which develops into different structures in the body.
 Ectoderm: Skin and nervous system
 Endoderm: Digestive and respiratory systems
 Mesoderm: Muscle and skeletal systems
 EMBRYONIC STAGE
• From 3rd to 8th week
• Formation of the Embryo- the initial product of conception from implantation at about
two weeks after fertilization through the eighth week of development.
• The placenta begins forming.
• Cephalocaudal Development
• Proximodistal Development

• Organogenesis- the series of organized

integrated processes that transforms an
amorphous mass of cells into a
complete organ in the developing
embryo.

• Morphogenesis- a biological process

that causes a tissue or organ to develop
its shape by controlling the spatial
distribution of cells during embryonic
development.
Crucial phase: Risk of Teratogenesis
the process by which congenital malformations are
produced in an embryo or fetus.
• At this point, the mass of cells is now known as an
embryo.
• The beginning of the third week after conception
marks the start of the embryonic period.
• The embryonic stage plays an important role in the
development of the brain.
• Neural tube formation (approx. 4 weeks after
conception) that will later develop into the CNS
including the spinal cord and brain. The basic
structure of the peripheral nervous system is also
defined towards the end of this stage.
• The tube begins to close and brain vesicles form,
eventually becoming the forebrain, midbrain, and
hindbrain.
• 4th week: the head begins to form; eyes; nose; ears;
and mouth, the blood vessel that will become the
heart start to pulse.
• 5th week: buds that will form the arms and legs
appear.
• 8th week: the embryo has all of the basic organs and
parts except those of the sex organs. The embryo
weighs just one gram and is about one inch in length.
 FETAL STAGE

• From 9th to 40th

week.
• At week 9, the
embryo is referred
to as a fetus.
• Fetus matures to
viability.
• Major structures
start to develop.
• Refinement of
organ structure
and perfection of
function continue.
• Once cell differentiation is mostly complete, the embryo enters
the next stage and becomes known as a fetus.
• This stage is marked by amazing change and growth.
• The early body systems and structures established in the
embryonic stage continue to develop like neural tubes-brain and
spinal cord, neurons; synapses
• Between the 9th and 12th week of gestation (at the earliest),
reflexes begin to emerge.
• During the 3rd month of gestation, the sex organs begin to
differentiate. By the end of the month, all parts of the body will
be formed.
• At this point, the fetus weighs around three ounces.
• During the 2nd trimester, the heartbeat grows stronger and other
body systems become further developed. Fingernails, hair,
eyelashes, and toenails form. Perhaps most noticeably, the fetus
increases about six times in size.
• During the period from 7 months until birth, the fetus continues
to develop, put on weight, and prepare for life outside the
womb. The lungs begin to expand and contract, preparing the
muscles for breathing.
 EMBRYONIC AND FETAL
DECIDUAS STRUCTURES
• The uterine endometrium continues to thicken
because of the corpus luteum that is influenced
by hCG, and instead of sloughing off in a usual
menstrual cycle, it becomes the deciduas.
• The deciduas are divided into three parts:
basalis, capsularis, and vera.
• The decidua basalis is the innermost portion of
the layer which rests directly under the embryo.
• The decidua capsularis encapsulates the
trophoblast’s surface.
• The decidua vera becomes the remaining
portion of the uterine lining, and sheds as the
lochias.
• Eventually, the deciduas vera and capsularis
fuse because of the enlarging embryo.
CHORIONIC VILLI
• On the 11th or 12th day, the chorionic villi start
to form from the miniature villi that protrude
from a single layer of cells to start the
formation of placenta.
• The chorionic villi have a central core & fetal
capillary, and a double layer of trophoblast
cells.
• The syncytial layer or the outer portion of the
two layers produces placental hormones such
as hPL (human placental lactogen), hCG,
estrogen, and progesterone.
• The Langhans’ layer is the middle layer and it
protects the embryo and fetus from infectious
diseases. This layer appears to function as early
as 12 days’ gestation.
• The layer disappears on the 20th to 24th week
of gestation, however, leaving the fetus more
susceptible to infections.
 THE PLACENTA
• A Latin term for “pancake” for its appearance
came from the trophoblast tissues and has a lot
of functions that benefit the fetus.

• Nutrients such as glucose, amino acids,

vitamins, minerals, fatty acids, and water as
well as oxygen are transported through the
placenta from the maternal blood supply to the
fetus.

• Placental osmosis also plays an essential part in

maintaining the health of the fetus. it is
impermeable to a few harmful substances,
thereby it does not allow the crossing of these
substances towards the fetal blood circulation.

• The syncytial layer produces various hormones

that benefit both the mother and the fetus.
AMNIOTIC MEMBRANES

• The smooth portion of the chorionic

villi eventually becomes the chorionic
membrane which forms the sac that
contains the amniotic fluid.

• The amniotic membrane forms under the chorion, giving

an appearance that seem like they are only one
membrane.
• The amniotic membrane is also responsible for producing
the amniotic fluid and the phospholipids that triggers the
formation of prostaglandins, the hormone that initiates
uterine contractions.
AMNIOTIC FLUID
• The normal amount of amniotic fluid is 800 to
1000 mL.
• The role of the amniotic fluid in the safety of the
fetus is it protects the fetus from trauma or
pressure to the mother’s abdomen. It also
regulates the temperature for the fetus and aids in
muscular development allowing the fetus to
move freely
• The amniotic fluid also protects the umbilical
cord from trauma and pressure, thereby
protecting the fetal oxygen supply.
UMBILICAL CORD
• The amnion and chorion compose the umbilical cord which connects the embryo to the chorionic
villi of the placenta.
• The main function of the umbilical cord is the transport of oxygen and nutrients from the placenta
to the fetus and the return of waste products from the fetus to the placenta.

• The cord is made up of a

gelatinous mucopolysaccharide
called Wharton’s jelly that
protects the vein and arteries
from trauma.
• The umbilical cord contains only
one vein, which carries blood
from the placenta to the fetus,
and two arteries, which carries
blood from the fetus to the
placenta.