Chapter 12 CONCEPTION AND FETAL

DEVELOPMENT
Conception
Conception- union of single egg and sperm (BEGINNING OF PREGNANCY) sequential
process (gamete (egg and sperm) formation, ovulation (release of the egg) fertilization (union of
the gametes) and implantation in the uterus.
Cell Division
 Mitosis- body cells replicate to yield 2 cells w/ same genetic as parent
o First the cell makes a copy of DNA then it divides. Each daughter cell receives
one copy of the genetic material
o Facilitates growth & development & cell replacement
 Meiosis- germ cell divide & decrease chromosomal # by half/ make gametes (eggs &
sperm)
o Each parent gives 23 chromosomes= 46 total chromosomes
o Because these germ cells (a cell containing half the number of chromosomes of a
somatic cell and able to unite with one from the opposite sex to form a new
individual; a gamete) contains one chromosome received from the mother and one
from the father; thus meiosis resulting cells that contain one of each of the 23
pairs of chromosomes.
 This halving of genetic material is accomplished by replicating the DNA
once and then dividing twice.
o Female gamate (egg/ovum) + male gamete(spermatozoon) = zygote
 When this happen the diploid number of human chromosomes (46 or 23
pairs) is restored.
o The process of DNA replication and cell division in meiosis allows different
alleles for genes to be distributed at random by each parent and then rearranged
on the paired chromosome. Different combinations of genes are possible since we
have different genotypes from 4 different grandparents.
 This random mixing of alleles account for the variation of traits seen in the
offspring of the same two parents.
Gametogenesis
 Oogenesis, the process of egg (ovum) formation, begins during fetal life in the female.
o All the cells that may undergo meiosis in a women’s lifetime are contained in her
ovaries at birth.
o The primary oocytes (a cell in an ovary that may undergo meiotic division to form
an ovum) begin the first meiotic division during fetal life but they remain
suspended at this stage until puberty.
 Then monthly one primary oocyte matures and completes the first meiotic
division, yielding two unequal cells: the secondary oocyte and a small
polar body.
 Female oocyte contains 22 autosomes and X sex chromosome
o At ovulation the second meiotic division begins. However, the ovum does not
 complete the second meiotic division unless fertilization occurs.
 At fertilization, when the sperm is united with the mature ovum, a second
polar body and zygote (the united egg and sperm) are produced.
 When a male reaches puberty, his testes begin the process of spermatogenesis.
o The cells that undergo meiosis in the male are called spermatocytes.
o Male(spermatogenesis) 22 autosomes and X & Y chromosome
 When homologous chromosome fail to separate during gametogenesis
(nondisjunction) gamete has 24 chromosomes & others 22
 Abnormal gamete with 24 chromosomes + normal 23
chromosomes = trisomy which occurs in DOWN SYNDROME
o X+X=female
o X+Y=male
Ovum
 Meiosis occurs in the female ovarian follicles and produces and egg, or ovum.
o Each month one ovum matures with a house of surrounding supportive cells.
o At ovulation the ovum is released from the ruptures ovarian follicle.
o High estrogen levels = increase motility of uterine tubes so cilia capture ovum
 Ovum does not move
 Protected by 2 layers:
 zona pellucida (inner, thick )(acellular)
 corona radiate(outer)(thin)(elongated)
 OVA CONSIDERED FERTILE FOR 24 HRS AFTER OVULATION
 Not fertilized? Ova regenerated & resorbed
Sperm
• Ejaculation produces teaspoon of semen w/ 200-500 million sperm
o Can reach fertilization in 5 minutes, average transit time is 5-6 hours
o Sperm remain viable within the woman’s reproductive system for an average of 2-
3 days.
 Most lost in vagina, within the cervical mucus, endometrium, or enter
wrong tube(uterine tube)
o As travel- enzymes produced to aid capacitation ( removes protective coating
from head of sperm) enzymes escape to aid in penetration of protective layers
before fertilization
Fertilization
• Fertilization takes place in the ampulla (outer third of uterine tube)
• Zona Reaction
o Once sperm and ovum enclosed-membrane becomes impenetrable to other sperm
• The second meiotic division of the secondary oocyte is then complete and the
o Nucleus of ovum = female pronucleus
o Head of sperm= male pronucleaus
• These two nuclei fuse, and the chromosome combine, restoring the diploid number.
• Conception achieved
• Cleavage (mitotic cellular replication) begins as zygote travels to uterus
o Takes 3-4 days
o Because the fertilized egg divides rapidly with no increase in size, successively
smaller cells, blastomeres (a cell formed by cleavage of a fertilized ovum), are
 formed with each division.
• 16-cell Morula created for development
o a solid ball of cells
o produced within 3 days and is still surrounded by the protective zona pellucida
o further development occurs as the morula floats freely within the uterus. Fluid
passes through the zona pellucida into the intercellular spaces between the
blastomeres
 Blastomeres separate into
 Trophoblast =gives rise to placenta
 Embryoblast= gives rise to embryo
 A cavity forms within the cell mass as the spaces come together, forming a
structure called he blastocyst activity
 When the cavity become recognizable, the whole structure of the
developing embryo is called blastocyst.
o Stem cells are deprived from the inner cell mass of the
blastocyst.
o The outer layer of cells surrounding the blastocyst cavity is
the trophoblast.
o The trophoblast differentiates into villous and extravillous
trophoblast.
 Extravillous trophoblast are found outside the villus
and can be subdivided into:
 Endovascular: invade and transform spiral
arteries during pregnancy to create low-
resistance blood flow that is characteristics
of the placenta.
 Interstitial: invade the decida and surround
spiral arteries

Implantation
• The zona pellucida degenerate
• The trophoblast cells displaced endometrial cells at the implantation site
• The blastocyst embeds in the endometrium (mucus membrane lining of uterus), usually in
the anterior or posterior fundal region.
• Implantation- 6-10 days after conception, trophoblast secrete enzyme that enable to
burrow into endometrium until entire blastocyst is covered
o May have slight implantation bleeding- at time of first missed period
• Chorionic villi
o Fingerlike projections, developed out of the trophpblast and extend into the blood-
 filled spaces of the endometrium
o provide oxygen & nutrients from maternal bloodstream
o dispose of carbon dioxide & waste products into maternal blood
• after implantation the endometrium is termed the decidua.
o The portion directly under the blastocust, where the chorionic villi tap into the
maternal blood vessels, is the decidua basalis
o The portion covering the blastocyst is the decidua capsularis
o The portion lining the rest of the uterus is the decidua vera

EMBRYO AND FETUS

• pregnancy
o length of pregnancy- from first day of last menstrual period (LMP) to birth
o last 10 lunar months (4 weeks/month), 9 calendar months, 40 weeks, or 280 days
o conception occurs approx.. 2 weeks after the first day of the LMP
 postconception age is 266 days or 38 weeks
 used in discussion of fetal development
• Intrauterine development is divided into three stages: ovum or preembryonic, embryo,
and fetus.
Primary Germ Layers
• 3rd week after conception embryonic disk differentiates into 3 primary layers ectoderm,
mesoderm, endoderm(entoderm)
o Upper layer of embryonic disk ECTODERM gives rise to:
 Epidermis
 Glands(anterior pituitary, cutaneous, mammary)
 Nails & hair
 Central peripheral nervous systems
 Lens of eye
 Tooth enamel
 Floor of amniotic cavity
• Middle layer MESODERM
o Bones
o Teeth
o Muscles (skeletal, smooth, cardiac)
o Dermis
o Connective tissue
 o Cardiovascular system & spleen
o Urogenital system
• Lower layer ENDODERM
o Epithelium lining of respiratory & digestive tracts
o Glandular cells associated with organs (oropharynx, liver, pancreas, urethra,
bladder, vagina)
o Forms roof of yolk sac
Development of the Embryo
• Stage from day 15 to 8 weeks after conception when embryo is 3cm from crown to rump
o MOST CRITICAL TIME FOR DEVELOPMENT OF ORGAN SYSTEMS &
MAIN EXTERNAL FEATURES
o Teratogens(substances/exposures)- cause malformation during rapid cell division
o End of 8 weeks?
 ALL ORGAN SYSTEMS & EXTERNAL STRUCTES ARE PRESENT
 embryo is unmistakably human

Membranes
• At time of implantation 2 fetal membranes that will surround the developing embryo
begin to form
o Chorion forms from trophoblast has villi on surface
 The villi burrow into the decidua basalis and increase in size and
complexity as the vascular processes develop into the placenta.
 Becomes covering of fetal side of placenta
 Contains major umbilical blood vessels as they branch out
 As embryo grows the decidua capsularis stretches.
 Embryo grown- chorionic villi on side atrophy and degenerate leaving a
smooth chorionic membrane
o Amnion inner membrane forms from blastocyst
 The cavity that develops between this inner cell mass and the outer layer
of cells (trophoblast) is the amniotic cavity
 Creates the amniotic cavity
 forms on the side opposite the developing blastocyst
 Embryo draws amnion around itself forming fluid filled sac
 Amnion is the covering of umbilical cord and covers the chorion of
fetal surface of placenta
 As the embryo grows larger the amnion enlarges to accommodate
the embryo/fetus and the surrounding amniotic fluid. The amnion
eventually comes into contact with surrounding the fetus.
Amniotic Fluid
• Maintains temperature, oral fluid, repository for waste, fluid & electrolyte homeostasis,
allows freedom of movement, cushion for fetus against trauma, infection barrier, allows
fetal lung development, prevents tangling
o If fetus becomes tangled deformities can exist
• Fluid derived by diffusion from maternal blood, fluid from respiratory & GI of fetus as
well
• Amount increases weekly, VOLUME important in assessing well-being of fetus
 o 700-1000 ml of transparent liquid is NORMAL
o 300 or less (oligohydramnios)
 Cause fetal renal abnormalities
o 2L(2000ml) or more
 Gastrointestinal & other malformations
o Week 11 fetus urinates = increases volume
• Contains: albumin, urea, uric acid, creatinine, lecithin, sphingomyelin, bilirubin, fructose,
fat, leukocytes, proteins, epithelia cells, enzymes, and lanugo hair (Lanugo is the
first hair to be produced by the fetal hair follicles, and it usually appears on the fetus at
about 5 months of gestation. Lanugo is very fine, soft, and usually unpigmented
• Karyotyping (genetic studies)=provides info about sex and number and structure of
chromosomes
• Lecithin/sphingomyelin (L/S) determine health or maturity of fetus
Yolk Sac
• Forms on the other side of he developing embryonic disk of amniotic cavity and amnion
• Aids in transferring maternal nutrients & oxygen, which has diffused through the chorion
to the embryo
o Blood vessels form to aid transport
• Blood cells & plasma are manufactured here during 2-3 weeks (beginning of
hematopoietic activity begins)
• End of 3 week heart begins to beat and circulate the blood through the embryo, the
connecting stalk, the chorion, and the yolk sac.
• At 4 week yolk remains as primitive digestive system
o Primordial germ cells arise in the yolk sac and more into the embryo. The
shrinking remains of the yolk sac degenerates.
• 5 week remnant has separated from embryo
Umbilical Cord
• by day 14 connection happens (embryonic disk, amniotic sac, ad yolk sac are attached to
the chronic villi by the connecting stalk)
• 3rd week blood vessels develop
o supply embryo with maternal nutrients and oxygen
th
• 5 week embryo connecting stalk to ventral side & becomes umbilical cord
• Umbilical cord normal? 2 arteries carry blood from embryo to chorionic villi, vein returns
blood to embryo
• AVA –Artery vein artery
• Two arteries carry blood from the embryo to the chorionic villi, and one vein returns
blood to the embryo.
• Umbilical cord abnormal?***1 vessel & 1 artery = congenital malformations
• Cord at term (37-42 weeks) is 2cm in diameter & 30 to 90 cm long
o It spirals on itself and loops around the embryo/fetus.
o A true not is rare but false knots occur as fold or kinks in the cord and can
jeopardize circulation to the fetus.
• Whartons jelly?
o Connective tissue; prevents compressions of blood vessels & ensures nourishment
o Compression can occur if the cord lies between the fetal head and the maternal
pelvis or is twisted around the fetal body
 o Nuchal cord-cord is wrapped around fetal neck
• Because the placenta develops from the chorion villi, the umbilical cord is usually located
centrally.
o A peripheral location is less common and is called Bayyledore Placenta
o The blood vessels are arrayed out from the center to all parts of the placenta.
Placenta
• The chorionic villi grow into spaces into two layers of the cells: the outer syncytium and
inner cytotrophoblast.
• A third layer develops into anchoring septa, dividing the projecting decidua into separate
areas called cotyledons.
o In each of the 15-20 cotyledons, the chorionic villi branch out, and a complex
system of fetal blood vessels form.
 Each cotyledon is a functional unit.
 The whole structure is the placenta.
• Forms at implantation 3rd week , Completion of placenta at 12 weeks, will grow wider
until 20 weeks(where it covers about half of the uterine surface)
o The maternal-placental-embryonic circulation is in place by day 17 (when the
embryonic heart starts beating
o By end of 3rd week blood circulates between embryo and chorionic villi
 In the intervillous spaces, maternal blood supplies oxygen and nutrients to
the embryonic capillaries in the villi. Waste product and carbon dioxide
diffuse into the maternal blood.
• Placenta acts a metabolic exchange
o Exchange minimal because membrane is to thick
o Permeability increases as the cytotrophoblast thins and disappears by the 5th
month, only the single layer of syncytium is left between the maternal blood and
the fetal capillaries.
o The syncytium is the functional layer of the placenta,
• 5th month one single layer of syncytium left between maternal blood & fetal capillaries
• 8th week- genetic testing can be done by Aspiration Biopsy
o Recommended to wait til 10 weeks because of associated limb defectsafter week
20 it starts to grow thicker

• Metabolic functions
o Respiration, nutrition, excretion, & storage
o Placenta acts as lungs for fetal
o Glucose? Fetal concentration is lower because of rapid metabolism
• PINOCYTOSIS- transfers large molecules like albumin & gamma globulins across
placenta membrane
• Endocrine Gland Function (early function) **Main function is production of 4 hormones
to maintain the pregnancy and support the embryo and fetus.
o Hormones produces in syncytium
• Human chorionic gonadotropin (hCG) (protein hormone) detected by 8-10 days after
conception
o Basis of pregnancy test
o Pregnancy test- maximum levels at 50 to 70 days than decreases
 o Preserves function of ovaries corpus luteum= continued supply of estrogen &
progesterone NEEDED to maintain pregnancy
 Miscarriage???
 Occurs when corpus luteum stops functioning before placenta can
produce sufficient estrogen and progesterone
• Human Chorionic somatomammotropin (hCS)/ or placental lactogen (hPL)
o Similar to growth hormone
o Stimulates maternal metabolism to supply nutrients for growth
o Increases resistance to insulin
o Facilitates glucose to placenta
o Stimulates breast development for lactation
• Progesterone
o Maintains endometrium
o Decreases contractility of uterus
o Stimulates maternal metabolism
o Develop of breast alveoli
• 7 weeks placenta producing most estrogens
o the major estrogen secreted by placenta is estriol, where as the ovaries produce
mostly estradiol.
o ESTRIOL- increased greatly at end of pregnancy
 Can be measured to determine placental functioning
 Stimulates uterine growth
 Stimulates uteroplacental blood flow
 Proliferation of breast glandular tissue
 Stimulates myometrial contractility
o Placental estrogen production increases greatly toward the end of pregnancy,
 One theory for the cause of the onset of labor is the decline in the ratio of
circulating levels of progesterone to increase levels of estrogen.

• Facilitated and active transport assist in the transfer of glucose, amino acids, calcium,
iron, and substances with higher molecular weights.
• Amino acids and calcium are transported against the concentration gradient between the
 maternal blood and fetal blood.
• The fetal concentration of glucose is lower than the glucose level in the maternal blood
because of its rapid metabolism by the fetus.
o The fetal requirements demand larger concentration of glucose than simple
diffusion can provide.
o Maternal glucose moves into the fetal circulation by active transport.
• Pinocytosis is a mechanism used for transferring large molecules, such as albumin and
gamma globulins, across the placental membrane.
o This mechanism conveys the maternal immunoglobins that provide early passive
immunity to the fetus.
• Metabolism waste products of the fetus cross the placental membrane from the fetal
blood into the maternal blood.
o The maternal kidney then excrete them.
o Many viruses can cross the placental membrane
o Some bacteria and protozoa forst infect the placenta then the fetus
o Drugs can cross the membrane and harm fetus,
 Caffeine
 Alcohol
 Nicotine
 Carbon monoxide
 Cocaine
 Marijuana
• Fetal erythrocytes leak?
o Only one cell layer separates the maternal and fetal blood.
o Breaks occasionally occur in the placental membrane,
o Mother develops antibodies (becomes isoimmunized) Rh mother becomes
sensitized to erythrocytes
• Although the placenta and fetus are analogous to living tissue transplant….
o Fetus does not become destroyed
o Placental hormones suppress immunologic response/or no tissue response
• Circulation
o Necessary for placental function
o At term gestation 10% cardiac output goes to uterus
o VASOCONSTRICTION caused by hypertension/cocaine use decreases uterine
blood flow
 Decreased maternal blood pressure or cardiac output also
diminished uterine blood flow
 Hypotension- woman lies supine (back) the pressure of the uterus
compressing the vena cava, blood is diminished as returns to right atrium
o Excessive exercise- diverts blood away from uterus to muscles
 OPTIMAL CIRCULATION
 Lay at rest on her side
 Decreased uterine circulation can lead to intrauterine growth restrictions
of the fetus and to infants who are small for gestational age.
o Braxton Hicks contractions- painless contractions occur after first trimester
enhance blood flow
 o Prolonged contraction/ too-short intervals reduce blood flow to placenta
Fetal Maturation
• Stage
o From 9 weeks(when the fetus become recognizable as a human being) to end of
pregnancy
• Fetus less vulnerable unless teratogens that affect functioning of central nervous system
• Viability- capability of fetus to survive outside uterus= defined by fetal weight &
pregnancy duration
o Standard= 20 weeks gestation & birthweight 350g,400g,500g
 22-25 weeks are at threshold of viability
Fetal Circulatory System
• Cardiovascular system- first organ system to function
o 3rd week blood vessels & cells form begin to supply oxygen and nutrients from
mom
o End of 3rd week heart begins to beat
o 4th and 5th week heart develops into 4-chanbered organ
o End of embryonic stage heart is developed completely***
• Lungs
o Do not function
o Ductus arteriosus bypasses the lungs, from umbilical vein to abdomen, reaches
the liver divides into 2 branches one of them circulates oxygenated blood through
liver
o Most of the blood passes through the ductus venosus into the inferior vena cava
o Ductus venosus into inferioir vena cava- mixes with deoxygenated blood from
fetal legs & abdomen to right atrium
 Most of this blood passes straight through the right atrium anf through
foramen ovale, an opening into the left atrium.
 There it mixes deoxygenated blood returning from fetal lungs
through pulmonary veins
o Left ventricle blood out to aorta where arteries supply most blood to heart, head,
neck, arms
 This enhances CEPHALOCAUDAL (head-to rump) development
o Small amount of blood travels to lungs
o Blood goes into placenta and gives up waste & carbon dioxide in exchange for
nutrients & oxygen
 3 special characteristic enable fetus to obtain sufficient oxygen from
moms blood
 Fetal hemoglobin-has high affinity for O2 & carries 20%-30%
more oxygen than maternal hemoglobin
 Fetal hemoglobin is 50% greater than mothers
 Fetal heart rate is 110-160 beats/min- wich makes cardiac
output/per weight higher than adult
Hematopoietic System
• Is the formation of blood in yolk sac at 3 weeks
• Its stem cells seed the liver during the 5th weeks and hematopoiesis begin there during
the sixth week
 Accounts for the relatively (large liver at 7th & 9th week)
o Hematopoiesis in week 6
o Stem cells seed …..during week 8th-11th week
 bone marrow
 spleen
 thymus
 lymph nodes
o -what would the blood type be?
 Determined by erythrocytes soon after 6th week
 **** THIS PUTS A Rh-negative WOMAN AT RISK FOR
ISOIMMUNIZATION IN A PREGNANCY LASTING MORE
THAN 6 WEEKS
Respiratory System
• begins development during embryonic life and continues through fetal stages and into
childhood
• development of respiratory track begins formation at week 4 & continues through week
17
• 16&24 bronchi & terminal bronchioles enlarge & vascular structures and alveoli formed
• Type 1 & type 2 alveolar cells secrete pulmonary surfactants
• 32 weeks fetus has developed alveoli to provide infant good chance of survival
• the detection of surfactant in amniotic fluid has been used to determine the degree of fetal
lung maturity, or ability of the lungs to function after birth.
• Lecithin is the most critical alveolar surfactant required for postnatal lung expansion.
o detectable around 21 weeks and increase after 24 wks
• Sphingomyelin remains constant in amount
o The L/s ration, is used to determine fetal lung mature.
 When L/S reaches 2:1 the infant lungs are considered to be mature.
  Occurs in middle of third trimester
• Certain maternal conditions that cause decreased maternal placental blood flow can
accelerate fetal lung maturity.
• Conditions such as gestational diabetes and chronic glomerulonephritis an inhibit fetal
lung maturity,
o Using intrabronchial synthetic surfactant to treat respiratory distress syndrome in
newborns has greatly improved the chances of preterm infant survival.
• Fetal respiratory movements have been seen on ultrasound examination as early as 11
weeks.
o The fetal lungs produce fluid that expands the air spaces in the lungs.
o The fluid drains into the amniotic fluid or is swallowed by fetus
• Shortly after birth, secretion of lung fluid decreases
o The normal birth process squeezes out approximately one third of the fluid.
o Infants born by cesarean may have respiratory difficulty at birth, which is due to
not having the benefits of this squeezing process.
o The fluid remaining in lungs s usually reabsorbed into bloodstream
Gastrointestinal System
 Week 4 the shape of embryo change from being almost straight to a C shape
o A portion of the yolk sac is incorporated into the body from head to tail as the
primitive gut.
 Forgut
o Produces
 Pharynx
 Part of lower respiratory tract
 Esophagus
 Stomach
 First half of duodenum
 Liver
 Panaceas
 Gallbladder
o Evolve during 5 and 6 weeks
 Midgut
o Distal half od duodenum
o Jejunum
o Ileum
o Cecum
o Appendix
o Proximal half of the colon
o Projects into the umbilical cord between 5-10 wk
 Hindgut
o Distal half of colon
o Rectum
o Parts of anal canal
o Urinary bladder
o Urethra
 5 month fetus swallows amniotic fluid
th
 o gastric emptying and intestinal peristalsis occurs
o fetal nutrition and elimination needs are taken care of by the placenta
o as the fetus near term, fetal waste accumulate in the intestine as dark green to
black, tarry meconium
 usually passes through rectum within 24 hours of birth
 sometimes with breach or fetal hypoxia, meconium is passed in
utero into amniotic fluid
o failure to eliminate meconium places problems
 matured by wk 36
o digestive enzymes (except pancreatic amylase and lipase) are present in sufficient
quantity to facilitate digestion.
 Cannot digest starches or fat efficiently; little saliva produced
Hepatic System
 Liver and biliary tract develops form the foregut during the fourth week of gestation
o Live is prominent, occupying most of the abdominal cavity.
 Glycogen is stored in the fetal liver beginning at wk 9/10
o At term, glycogen stores are two those of adults
o Major source of energy for fetus and neonates stressed by intrauterine hypoxia,
extrauterine loss of maternal glucose supply, the work of breathing, or cold
 Iron is also stored in fetal liver.
 During fetal life the liver does not have to conjugate bilirubin for excretion because the
unconjugated bilirubin is cleared by the placenta.
 Coagulation factor 2, 7, 9, and 10 cannot be synthesized in the fetal liver because of the
lack of Vit K synthesis in the sterile fetal gut.
o This coagulation deficient persist after birth fro several days
o Rational for prophylactic administration of Vit K to new born
Renal System
 The kidney from during the 4th wk and begin to function 4 wks later
o Urine is excreted into the amniotic fluid and dorms a major part of amniotic fluid
volume,
o Oligphydramniosis is indicative of renal dysfunction.
o Fetus does not need functioning kidneys while in utero, but required immediately
at birth
 Most newborns void within 24 hours of birth.
o Usually scanty until fluid intake increases
Neurologic System
 Originates from ectoderm during 3rd wk of fertilization
 The forebrain develops into the eyes and cerebral hemispheres.
o Development of all areas or cerebral cortex contents through fetal life and into
childhood
o Olfactory system and thalamus develop from forebrain
o Cranial nerve 3 and 4 (ocular motor and trochlear) form from the midbrain.
o The hindbrain forms the medullar, pons, cerebellum, and remainder of cranial
nerve
o Brian waves can be recorded on an electroencephalogram by wk 8
 Sensory Awareness
  Purposeful movement’s of the fetus have been demonstrated in response to firm touch
transmitted through mothers abdomen,
 Fetus respond to sound by wk 24
 The fetus becomes accustomed to noises heard repeatedly.
o Hearing is fully developed at birth
 The fetus is able to distinguish taste,
o 5ht month when the fetus is swallowing amniotic fluid, a sweetener added
to the fluid causes the fetus to swallow faster
o also reacts to temperature changes
 the fetus can see
o eyes have both rods and cones in retina by 7th month
o a bright light shone on the mothers abdomen late in pregnancy causes abrupt fetal
movement
o during sleep time rapid eye movement have been observes similar to those of
adults while dreaming.
Endocrine System
 the thyroid glans develops along with structures in the head and neck furign the third and
fourth weeks.
o the secretion of thyroxine begins during the 8th wks
 the adrenal cortex is formed during the 6th wk and produced hormones by the 8th/9th wk
o as term approaches, the fetus produce more cortisol
 the pancreas forms from the foregut during the 5th through 8th week
o insulin is produced by wk 20
o in fetuses of mothers with uncontrolled diabetes, maternal hyperglycemia
produces fetal hyperglycemia, stimulating hyperinsulinemia and islet cell
hyperplasia.
o The hyperinsulemia also blocks lung maturation, placing the neonate at risk for
respiratory distress
Reproductive System
 Sex differentiation begins in the embryo dringthe 7th wk
o Female and male external genitalia are indistinguishable until after the 9th wk
o Fully differentiated by 12th wk
o When Y chromosome present, testes formed
o By the end of embryonic period, testosterone is being secreted and causes
formation of the male genitalia
o By wk 28 testes began descending into scrotum
 The female, XX, forms ovaries and femal external genitalia
o 16th wk oogenesis has been establish
o at birth ovaries contain female lifetime supply of ova
Musculoskeletal System
 Bones and muscles develop from mesoderm by the 4th wk of embryonic development.
o At this time cardiac muscles already beating
o The bones of the shoulders, arms, hips, and legs appear in the 6th wk as a
continuous skeleton with no joints.
o 7th wk muscle contractions spontaneously
o wk 11 fetus makes respiratory movement, moves all extremities, and changes
 positon in utero.
o Can suck thumb and swim in amniotic fluid.
o Arm and leg movements are visible on ultrasound examination, although the
mother does not perceive them until sometimes between 16-20 1ks
Integumentary System
 The epidermis begins as a single layer of cells derived from the ectoderm at 4 wks.
o 7th wk 2 layers of cells
o the cells of the superficial layer are sloughed and becomes mixed with the
sebaceous glans secretions to form the white, cheesy vernix caseosa, the material
that protects the fetus’s skin.
 Until 17wk skin is thin and winkled
o Blood vessels visible underneath
o Skin thickens 32 wks fat is deposited under the dermis
 Wk 16 epidermal ridges are present on palms of hands, fingers, bottom of feet, toes.
o Handprint and footprint are unique to each infant
 Hairs form from the hair bulb in the epidermis that project into the demis,
o They keratinize to form the hair shaft.
o Very fine hair , lanugo, appears first 12 wks on eyebrows and upper lip
o By wk 20 they cover entire body
 at this time the eyelashes, eyebrows, and scalp hair are beginning to grow.
o By wk 28 the scalp hair is longer than the lanugo, which thins and may disappear
by tem
 Fingernails and toenails develop form thickened epidermis at the tips of the fingers
begining during the 10 wk
Immunologic system
 During the 3rd trimester albumin and globulin are present in the fetus
o The only immunoglobin that crosses the placenta, IgG,
 Provides passive acquired immunity to specific bacterial toxins
o The fetus produces IgM by end of first trimester
 Produce in the response to blood group antigen, gram negative organism,
and some viruses
o IgA not produced by fetus; colostrum, the precursor to breast milk contains large
amounts of IgA and can provide passive immunity to the neonate who is breast
fed.
o The normal term neonate can fight infection but not so effective as older child

Multifetal pregnancy
Dizygotic Twin
 When two mature ova are produces in one ovarian cycle, both have the potential to be
fertilized by separate sperm.
o Results in two zygotes
o Fraternal
o Can be same sex or different and are genetically no more alike than siblings born
at different times
o More often among African American
 o Increase in frequency with maternal age up to 35 years, parity, and the use of
fertility drugs
Monozygotic Twins
 Identical
 Develop from one fertilized ovum which then divides
 Same sex and have the same genotype
 If division occurs soon after fertilization, two embryos, amnions, two chorion, and two
placentas that can be fused will develop
Conjoined
 Siamese twins
 Type of monozygotic twins
 Cleavage is incomplete and occur late
 prenatal diagnosis is possible with 3D ultrasonography.
 Cesarean birth minimize trauma to mother and fetus
Other Multifetal Prenancies
 Multifetal pregnancies with 3 or more fetuses
 Occur from the divisions one zygote into two, with one of the two dividing again,
producing identical triplets.
 Can also produce from two zygotes, one dividing into a set of identical twins, and the
second zygote developing as a single fraternal sibling