DEVELOPMENT OF FETUS

DEFINITION

Conception: It is defined as the union of a single egg and sperm,

marks the beginning of a pregnancy.

The act of becoming pregnant, by the fertilization of an ovum.

Foetal development

After the embryonic period (8 weeks) and birth the developing human
is called a foetus.

FERTILIZATION :Following ovulation, the ovum passes into the

uterine tube and is moved along towards the uterus. At this time
cervix, under the influence of oestrogen, secretes a flow of alkaline
mucus that attracts the spermatozoa. At intercourse about 300
million sperm are deposited in the posterior fornix of the
vagina.Those that reach the loose cervical mucus survive to propel
themselves towards the uterine tubes while the remainder are
destroyed by the acid medium of the vagina. Only thousands reach
the uterine tube where they meet the ovum, usually in the ampulla.
During this journey, the sperm matures and is capable of releasing
the enzyme hyaluronidase, which allows penetration of the zona
pellucida and the cell membrane is sealed to prevent entry of any
further sperm and the nuclei of the two cells fuse. The sperm and the
ovum are known as the male and female gametes, and the fertilised
ovum as the zygote.

AMNIOTIC FLUID :

Amniotic Fluidity is secreted by the amnion, especially the part

covering the placenta and umbilical cord. Some fluid is exuded from
maternal vessels in the decidua and also from fetal vessels in the
placenta. It increases in amount weekly until there is approximately
800-1200 ml at term. It is a clear, pale straw colored fluid 99% water
and 1% is dissolved solid matter.

FUNCTIONS OF AMNIOTIC FLUID :

1. It distends the amniotic sac and allows for the growth and free
movement of the foetus.
2. It maintenance of constant body temperature for the fetus and
provides small amounts of nutrients.
3. It equalizes pressure and protects the fetus from jarring and
injury.
 4. It protects the placenta and umbilical cord from the pressure of
uterine contractions during labour.

PLACENTA: Placental development begins at third week of

embryonic

development and develops at site where embryo attaches to

uterine wall

FUNCTIONS OF PLACENTA:

➢ Produces 4 hormones necessary to maintain pregnancy

➢ Support fetus for respiration, nutrition, excretion

➢ Storage of glucose in the form of glycogen and reconverts to

glucose and also store proteins, calcium and iron

Fetal sac: It consists of a double membrane, outer membrane is the

chorion, which lies under the capsular deciduas and becomes closely
adherent to the uterine wall. The inner membrane is the amion which
contains the amniotic fluid.

Choroin: It is a thick opaque, friable membrane derived from the

trophoblast.It is continuous with the chorionic plate, which forms the
base of the placenta.

Amion: It is a smooth, tough, translucent membrane derived from

the inner cell mass. It is thought to have a role in the formation of the
amniotic fluid.

UMBILICAL CORD:

➢ Develops from amnion Body stalk attaches embryo to yolk sac,

fuses with embryonic portion of placenta

➢ Provides pathway from chorionic villi to embryo

➢ Contains two arteries and one vein

➢ Surrounded by Wharton’s jelly to protect vessels

➢ Wharton’s jelly: Specialized connective tissue protects blood

vessels

Function of umbilical cord: Provides circulatory pathway to

Embryo
Pre-embryonic stage

The first two weeks following conception is called the preembryonic

period.

Embryonic development

From the fourteenth day after conception through the eighth week of
pregnancy the products of conception are referred to as the embryo.

Third week:

The embryonic disc becomes elongated and pear-shaped, with a

broad cephalic and a narrow caudal end.The ectoderm formed a long
cylindrical tube for brain and spinal cord development.The
gastrointestinal tract developed from the endoderm appears as
another tube like structure communicating with the yolk sac. The
most advanced organ is the heart. At 3 weeks, a single tubular heart
forms outside the body cavity of the embryo and by the end of 28
days, it starts beating at regular rhythm and push its own primitive
blood cells through the main blood vessels.

Fourth week:

The interval between date 21 and 32 is characterized by somite

formation.Somites are a series of mesodermal blocks that forms on
each of the midline of the embryo.The vertebras that form the spinal
column develop from these somites.Arm and leg buds are not visible
but tail bud is visible.By this time 4 pirs of pharyngeal pouches are
developed.The first arch forms the lower jaw, second-the hyoid bone
and the third and fourth-cartilage of the laynx.The primordia of the
eye and ear are also present.By 30th day, the arm and leg buds
become prominent and by day 35, they are well developed.
Fifth week:

During the 5th week, the optic cups and lens vesicles of the eye are
formed and nasal pits develop.Partitioning of the heart occurs.The
embryo has marked C- shaped body with rudimentary tail and a large
head folded over a protuberant trunk.The heart,circulatory system
and brain show the most advanced development.The brain
differentiates into 5 areas and 10 pairs of cranial nerves.

Sixth week:

At 6 weeks, the head structures are more highly developed and the trunk
is straighter.The upper and lower jaws are recognizable and the external
nares are well developed.Trachea is well developed and lung formation
begins.The upper lip is forced and the palate ear, and other post brachial
body parts begin to develop.The arm begins to extend ventrally across
the chest and both arms and legs have digits though webbed.The embryo
has prominent tail, but begins to regress.Foetal circulation begins to
establish and the liver begins to produce blood cells.

Seventh week

At the seventh week, the head of the embryo is rounded and nearly
erect.The eyes shift from their original position to a forward location,
grow closer and the eyelids begins to form.The formation of the
palate is nearly completed and tongue develops.The gastrointestinal
and genitourinary tracts undergo significant changes.Now, the rectal
and urogenital passages which were blind ended pouch separate into
two tubular structures.The beginnings of all external and internal
structures are present.

Eight week

Embryo is approximately 3cm long and clearly resembles a human

being.Face and features continue to develop and external genitalia
appears but are not discernible and the rectal passage opens, with
the anal membrane now perforated.The circulatory system through
the umbilical cord is well established.Long bones begins to form and
the large muscle develop and are capable of contracting.By the end
of the embryonic period, all major organ systems and the external
structures are almost completely established.
Fetal stage:The embryo is now called a fetus, an offspring.No further
primordial forms and every structure is present as found in the full-
term neonate.The remaining gestational period is devoted to
refinement of structures and organization and perfection of function.

9-12 weeks

The fetus by 10 weeks reaches 5cm in length and weighs about

14gm.The large head comprises of almost half of the fetus entire
size.The neck is distinct from the head and both are straighter.The
face is well formed with nose nose protruding,the chin small and
receding and the ear acquiring a more adult shape.The eyelids closes
at about the 10th week and remain so till the 28th weeks. Some reflex
movement of the lips suggestive of sucking reflex can be observed
and tooth buds appear.The limbs are longer and slender with well
formed digits.The legs are shorter and less developed.The urogenital
tract completes development and well differentiated genitals appear
and the kidney begins to produce.RBC are produced primarily by the
liver and spontaneous movement of the fetus now occur.

13-16 weeks

At 13 weeks,the fetus weigh 55-60 gm and is about 9cm.Lanugo

hairs begins to develop.The skin is transparent and blood vessels
are visible beneath it.More muscle tissue and body skeleton
develops that holds the fetus more erect.Active movements are
present and sucking motions, swallows amniotic fluid and
produces meconium in the intestinal tract.Bronchial tubes
branches out and the sweat glands develops.The liver and
pancreas begin production of secretions.

17-20 weeks

Growth is rapid during 17-20th week period.The fetus almost doubles in

length and measures about 20 cm or 8 inch. Fetal weight also increases
to 435-460 gm.Lanugo covers the entire body and subcutaneous
deposits of brown fat make the skin less transparent.Nipples appear and
the head fetus has nails on both the fingers and toes. Muscles are well
developed and the fetus is active. Fetal movement ‘quickening’ is felt
by the mother and the heart beat is audible.

21 -24 weeks

The fetus reaches a length of 28cm and weighs about 780 gm.The hairs
on the head grows longer and the eyebrows and eyelashes are well
formed.The eye is structurally complete and the fetus has a reflex hand
grip and by the end of the 6th month have startle reflex.The skin is
reddish and wrinkled with little subcutaneous fat.The skin on the hand
and feet are thickened with skin ridges on the palms and soles formed
distinct footprints and fingerprints.The skin over the entire body is
covered with a protective cheese-like fatty substance secreted by the
sebaceous glands called vernix caseosa.The alveoli in the lung begins to
develop.

25-28 weeks

At 6 months, the fetus has appearance of a little old man.The skin is still
wrinkled covered with vernix caseosa.The brain is rapidly developing
and the nervous system is complete enough to provide some regulation
of body functions.The eyelids open and close under neural control.In
male fetus,the testes begins to descend into the scrotal sac.Respiratory
and circulatory systems are sufficiently developed.28th week has been
traditionally considered the earliest period of extra uterine viability.The
lungs are still immature and the fetus requires intensive specialized
care to survive.The fetus at 28 weeks is about 35-38cm long and weighs
about 1250 gm.

29-32 weeks

The fetus weighs about 2000 gm and measure about 38-43 cm by 32

weeks of age. If born during this time, the infant has about 60% chance
of surviving with special care.The CNS has matured enough to direct
rhythmic breathing and partially control body temperature. However the
lungs are not fully matured and the bones are soft and flexible.The fetus
begins storing minerals-iron, calcium and phosphorus.In male, the
testicle are in the high inguinal canal.

33-36 weeks

The body and extremities begins to fill out.The skin becomes less
wrinkled.Lanugo hairs begins to disappear and the nails grow to reach
the edge of the fingertips.By 36 weeks, the weigh is 2600- 2750 gm and
42-48 cm in length.The infant born at this age has good chance of
survival but requires some special care.

37-40 weeks

The fetus is considered full term at 38 weeks.The crown to heel length

varies from 48-52 cm, with males longer than females.Males usually
weigh more than female.The weigh at term is about 3000-3600 gm.The
skin is pink and smooth with a polished look and the only lanugo hair
remaining is on the upper arms and shoulders.The head hair is coarse
and about an inch long.Varnix casosa is present but varies in amount
with heavier deposits in the creases and folds of skin.Good skin turgor
and finger nails extend beyond the fingertips.The chest is prominent but
smaller than the head and mammary glands begins to protrude in both
sexes.The testes are in the scrotum or are palpable in the inguinal
canals.As the fetus enlarges, amniotic fluid diminishes to about 500ml
or less and the fetal body mass fills the uterine cavity.The fetus
assumes a position of comfort or lie.Generally the head is pointed
downward.The extremities and often the head are well flexed.After the
5th month, feeding patterns, sleeping and activity patterns become
established.The fetus at term has its own body rhythms and individual
style to response.

THE FOETAL CIRCULATION

The umbilical vein carrying the oxygenated blood from the placenta,
enters the fetus at the umbilicus and runs along the three margin of
the falciform ligament of the liver, it gives off branches to the left
lobe of the liver and receives the deoxygenated blood from the portal
vein. The greater portion of the oxygenated blood, mixed with some
portal venous blod, short circuits the liver through the ductus venosus
to enter the inferior vena cava and thence to right atrium of the
heart.The terminal part of the inferior vena cava also contains the
deoxygenated blood from the caudal parts of the fetus below the
diaphragm.The amount of such draining venous blood is not large
enough to vitiate the pure blood from the ductus venosus to a great
extent.

In the right atrium, most of the blood(75%) is guided towards the

foramen ovale by the valve if the inferior vena cava and crista
dividens and passes into the left atrium.Here it is mixed with small
amount of venous blood returning from the lungs through the
pulmonary veins.This left atrial blood is passed on through the mitral
opening to the left ventricle.

Remaining lesser amount of blood(25%) after reaching the right

atrium via the superior and inferior vena cava passes through the
tricuspid opening into the right ventricle.

During ventricular systole, the left ventricular blood is pumped into

the ascending and arch of aorta and distributed by their branches to
the heart,head,neck,brain, and arms.The right ventricular blood with
low oxygen content is discharged into the pulmonary trunk.Since the
resistance in the pulmonary arteries during fetal life is very high, the
main portion of the blood passes directly through the ductus
arteriosus into the descending aorta by passing the lungs where it
mixes with the blood from the proximal aortaThe mixed blood is
distributed by the descending aorta and leaves the body by way of
two umbilical arteries.The deoxygenated blood leaves the body by
way of two umbilical arteries to reach the placenta where it is
oxygenated and gets ready for recirculation.The mean cardiac output
is comparatively high in fetus and is estimated to be 255ml per kkkg
per minute.

FETAL SKULL:

It consists the delicate brain, which gives great pressure as the head
passes through the birth canal. It is large in relation to the fetal body
and in comparison with the mother’s pelvis; therefore some
adaptation between skull and pelvis must take place during labour.

Ossification:

The bones of the fetal head originate in two different ways. The face
is laid down in cartilage and is almost completely ossified at birth, the
bones being fused together and firm. The bones of the vault are laid
down in membrane and are much flatter and more pliable. They
ossify from the centre outwards and this process is incomplete at
birth leaving small gaps, which form the sutures and fontanelles.The
ossification centre on each bone appears as a boss or protuberance.

BONES OF THE VAULT

1. The occipital bone

2. The two parietal bone
 3. The two frontal bone

SUTURES AND FONTANELLES

Sutures are cranial joints and are formed where two bones adjoin.

1. The lambdoidal suture: This suture separates the occipital bone

from the two parietal bones.
2. The sagittal suture: This lies between the two parietal bones.
3. The coronal suture: This separates the frontal bones from the
parietal bones, passing from one temple to the other.
4. The frontal suture: This runs between the two halves of the
frontal bone.

Fontanelles

1. The posterior fontanelle or lambda: This is situated at the

junction of the lambdoidal and sagittal sutures. It is small,
triangular in shape and can be recognised vaginally because a
suture leaves from each of the three angles. It normally closes
by 6 weeks of age.
2. The anterior fontanelle or bregma. This is found at the junction
of the sagittal , coronal and frontal sutures .It is broad, kite
shaped and recognisable vaginally because a suture leaves
from each of the four corners. It measures 3-4 cm long and 1.5-
2cm wide and normally closes by the time the child is 18
months old.

REGIONS AND LANDMARKS OF THE FOETAL SKULL

The occiput: This region lies between the foramen magnum and the
posterior fontanelle.The part below the occipital protuberance is
known as the suboccipital region. The protuberance itself can be seen
and felt as a prominent point on the posterior aspect of the skull

The vertex: This is bounded by the posterior fontanelle, the two

parietal eminences and the anterior fontanelle. Of the 96% of the
babies born head first, 95% present of the vertex.

The sinciput or brow: This extends from the anterior fontanelle and
the coronal suture to the orbital ridges.

The face: The face is small in the newborn baby. It extends from the
orbital ridges and the root of the nose to the junction of the chin and
the neck. The point between the eyebrows is known as the
glabella.The chin is termed the mentum and is an important
landmark.

DIAMETERS OF THE SKULL

There are two transverse diameters

Biparietal diameter: This is 9.5cm –the diameter between the two

parietal eminences

Bitemporal diameter: This is 8.2 cm –the diameter between the

furthest points of the coronal suture at ht temples

The remaining diameters described are anteroposterior or

longitudinal

Suboccipitobregmatic: This is 9.5cm –the diameter from below the

occipital protuberance to the centre of the anterior fontanelle or
bregma.

Suboccipitofrontal: This is 10 cm –the diameter from below the

occipital protuberance to the centre of the frontal suture.

Occipitofrontal: This is 11.5 cm – the diameter from the occipital

protuberance to the glabella.

Mentovertical: This is 13.5cm –the diameter from the point of the

chin to the highest point on the vertex, slightly nearer to the posterior
than to the anterior fontanelle.

Submentovertica: This is 11.5cm –the diameter from the point

where the chin joins the neck to the highest point on the vertex.

Submentobregmatic: This is 9.5cm –the diameter from the point

where the chin joins the neck to the centre of the bregma.
SUBMITTED TO:MRS SUNDARAM

HOD OBG NURSING

P.I.O.N.

SUBMITTED BY:MS DIMSEY .R.MARAK

MSC NURSING1ST YEAR

P.I.O.N