FETAL GROWTH AND DEVELOPMENT

By S.R. Muheriwa 3rd Feb.2011

INTRODUCTION
Understanding

of the fetal development is a constructive step towards achieving a positive pregnancy outcome. provides prospective parents with opportunity to make conscious decisions about their health and lifestyle.

It

INTRODUCTION CONTD
The

midwifes role in fetal development is focused on health education for maternal and fetal well being. involves providing parents with information about the effects of maternal lifestyle such as diet, smoking, alcohol, drugs and exercise on fetal growth and development

This

OBJECTIVES
Explain

the overview of fetal growth and development

Describe

the developmental changes that take place in the following systems:

Cardiovascular

system

OBJECTIVES CONTD
Respiratory

system Urogenital system Endocrine system Digestive system

OBJECTIVES CONTD
Nervous

system Integumentary, skeletal and muscular system

Explain

factors that influence fetal growth and development

OVERVIEW OF FETAL GROWTH & DEVELOPMENT

FETUS - This name is used during the period from the beginning of the 9th week after fertilization to term (end of 38th week - 40th week).

OVERVIEW CONTD
By

the beginning of the 9th fertilization, the human embryo has developed into a recognizable human being and most of the body structures have commenced development.

OVERVIEW CONTD
The

fetal period is mainly concerned with differentiation and growth of tissues and organs which have already appeared.

OVERVIEW CONTD

The

fetus is less vulnerable than the embryo, to the harmful and deforming effects of teratogenic agents.

OVERVIEW CONTD
Tissues

grow by cell proliferation, cell enlargement and accretion (building up) of extracellular material. average, the baby at term weighs 3400 grams (3.4 kg) and is 500mm long.

On

DEVELOPMENTAL CHANGES IN THE SYSTEMS

The cardiovascular system Is the first to function in the embryo. The heart and the vascular system commences development in the 3rd week By 4th week a primitive heart is visible and is beginning to

DEVELOPMENTAL CHANGES CONTD

Beating

starts at around 22 days but can not be heard until after 1620 weeks. is pumped around the vessels from the 4th week .

Blood

DEVELOPMENTAL CHANGES CONTD

The red cell formation There are three phases of red blood cell formation. York sac period :- from 3rd 13th week Hepatic /liver period:- from weeks 536 Born marrow period:- from week 12 throughout life.

DEVELOPMENTAL CHANGES CONTD

The

red blood cells known as erythrocytes produced by the York sac and the liver contain fetal hemoglobin.

DEVELOPMENTAL CHANGES CONTD

Fetal

hemoglobin (HbF) has a much greater affinity for oxygen and is found in greater concentrations (18 -20g/dl at term).

This

enhances the transfer of oxygen across the placental site.

DEVELOPMENTAL CHANGES CONTD

Fetal

erythrocytes have a life span of 90 days which is shorter than the adult erythrocytes which is around 120 days. short life span contributes to neonatal physiological jaundice.

This

DEVELOPMENTAL CHANGES CONTD

The respiratory system Development of the respiratory system begins in the 4th week.
The

lungs originate from the bud growing out of the pharynx, which sub divides to form the branching structure of the brachial tree.

DEVELOPMENTAL CHANGES CONTD

Lung

development occurs on several levels and continues after birth until about 8 years of age when the full number of bronchioles and alveoli will have developed.

DEVELOPMENTAL CHANGES CONTD

At

20 weeks development of type II alveolar commences. cells are necessary for the production of surfactant a lipoprotein that reduces the surface tension in the alveoli and assist gaseous exchange.

These

DEVELOPMENTAL CHANGES CONTD

The

amount of surfactant increases until the lungs are mature at 30 34 weeks. born before 24 weeks gestation have a reduced chance of survival due to immaturity of the capillary system in the lungs and the lack of surfactant.

Babies

DEVELOPMENTAL CHANGES CONTD

By

3rd month there is some movement of the thorax and more definite diaphragmatic movements from the 6th month. does not constitute breathing as gaseous exchange is via the placenta.

This

DEVELOPMENTAL CHANGES CONTD

The urogenital system This is divided into the urinary/renal system and genital/reproductive system.
Both

develop from the intermediate mesoderm.

DEVELOPMENTAL CHANGES CONTD

The

kidneys develop from the 4th week and produce small amounts of urine from the 9th week. become more functional around 15th week when more urine is produced.

They

DEVELOPMENTAL CHANGES CONTD

The

urine does not constitute a route for excretion as elimination of the waste products is via the placenta. urine forms much of the amniotic fluid and production increases with maturity.

The

DEVELOPMENTAL CHANGES CONTD

The

sex of the fetus is determined at fertilization. The gonads develop in the 5th week.

In

the two sexes genital development is the similar and is referred as indifferent state of sexual development.

DEVELOPMENTAL CHANGES CONTD

Differentiation

occurs from 7th week, but female gonad development occurs slowly and the ovaries may not be identifiable until the 10th week.

DEVELOPMENTAL CHANGES CONTD

External

genitalia in both sexes develop in the 9th week, but males and females are not distinguishable until 12th week.

DEVELOPMENTAL CHANGES CONTD

The Endocrine system The adrenal glands develop from the 6th week, and grow to 10-20 times larger than the adult adrenals.
Their

size regresses during the first year of life.

DEVELOPMENTAL CHANGES CONTD

They

produce the precursor s for placental formation of oestriols

influence maturation of the liver, the lungs and the epithelium of the digestive tract.

They

DEVELOPMENTAL CHANGES CONTD

It

is also thought that they play a part in the initiation of labour (the exact mechanism not fully established).

DEVELOPMENTAL CHANGES CONTD

The digestive system The primitive gut develops from the endodemal layer in the 4th week of life. It starts as a straight tube and proceeds on several levels: foregut, midgut and hindgut.

DEVELOPMENTAL CHANGES CONTD

By

the 5th week, the foregut (oesophagus, stomach and duodenum) is visible.

The

midgut (small intestines, caecum and appendix, ascending colon and transverse colon) undertakes much of its development in the 6th week

DEVELOPMENTAL CHANGES CONTD

The

hindgut (rectum, and anal canal ) completes its development in the 7th week.

DEVELOPMENTAL CHANGES CONTD

The

liver grows rapidly and from the 5th -10th week, fills much of the abdominal cavity.
It is responsible for about 10% of fetal weight by the 9th week.

DEVELOPMENTAL CHANGES CONTD

Around

12 weeks the digestive tract is well formed and the lumen is patent. of the digestive juices are present before birth and act on the swallowed substances to form meconium.

Most

DEVELOPMENTAL CHANGES CONTD

Meconium

is normally retained in the gut until after birth when it is passed as the first stool of the newborn.

DEVELOPMENTAL CHANGES CONTD

The nervous system The brain begins to develop from around day 19 and three structures the fore brain; midbrain and hind brain are visible.

DEVELOPMENTAL CHANGES CONTD

By

5th week, the major structures, the thalamus and the hypothalamus are differentiated.
neural tube is derived from the ectoderm.

The

DEVELOPMENTAL CHANGES CONTD

This

ectoderm folds in wards by a complicated process to form the neural tube which is then covered over by the skin. process is occasionally incomplete, leading to a condition called open neural tube defect

This

DEVELOPMENTAL CHANGES CONTD

The

development of the sensory organs is associated with the development of the head and neck which begin early in fetal life and continues until the cessation of growth in the late teens.

DEVELOPMENTAL CHANGES CONTD

Eyes

develop from around 22 days and are complete by 20 weeks but the eyelids are fused up until the 6th month. developing eyes are sensitive to light.

The

DEVELOPMENTAL CHANGES CONTD

The

inner ear which contains the structures for hearing and balance commences early in life and are completed by 25th week. fetus is able to hear external sound.

The

DEVELOPMENTAL CHANGES CONTD

Motor

output in the form of movement begins around 8 weeks. movements are not usually felt until around 16 weeks and are usually referred to as quickening

These

DEVELOPMENTAL CHANGES CONTD

Integumentary, skeletal and muscular systems

The

epidermis is develops from a single layer of ectoderm to which other layers are added.

DEVELOPMENTAL CHANGES CONTD

By

the end of the first month, a thin outer layer of flattened cells covers the embryo. development continues until the sixth month.

Further

DEVELOPMENTAL CHANGES CONTD

From

18 weeks, the fetus is covered with a white creamy substance called vernix caseosa. protects the skin from the amniotic fluid and any friction against itself.

This

DEVELOPMENTAL CHANGES CONTD

At

20 weeks, the fetus is covered with a fine downy (silky, velvety) hair called lanugo, at the same time the head hair and eye brows begin to form.

Lanugo

is shed from 36 weeks and by term there is little left.

DEVELOPMENTAL CHANGES CONTD

Fingernails

develop from about 10 weeks but the toenails do not form until 18 weeks.

By

term, the nails usually extend beyond the fingertips. of the nails is unreliable guide to maturity.

Length

DEVELOPMENTAL CHANGES CONTD

The

skeleton first appears as cartilage

At

specific periods the cartilage is replaced is replaced by the true bone through a process of ossification.

DEVELOPMENTAL CHANGES CONTD

Nevertheless,

the skull and the facial bones develop from direct ossification with no intermediate cartilage stage. cardiac and smooth muscles are formed during the fetal period and continues into childhood.

Skeletal,

FACTORS NECESSARY FOR FETAL DEVELOPMENT

Oxygen: Necessary for all metabolic processes Nutrients: Glucose: The primary source of energy for metabolism and growth

FACTORS CONTD
Aminoacids,

vitamins,minerals, iron and calcium: Necessary for metabolism and growth.

FACTORS CONTD

Insulin: Necessary for the metabolism of glucose but this later is secreted by the fetal pancreas.

FACTORS ADVERSELY AFFECTING FETAL GROWTH & DEVELOPMENT

Placental insufficiency or impaired utero placenta blood flow Maternal conditions such as hypertension, chronic infections, and cardiac disease have detrimental effect upon the efficiency of the placenta to transmit nutrients from the mother to the fetus.

FACTORS CONTD

Genetic factors Babies born with abnormalities e.g Downs syndrome and dwarf syndromes are small for gestational age at birth.

FACTORS CONTD

Alcohol and narcotic addiction This causes fetal growth retardation. Besides this, babies born to these mothers can also be addicted and may have congenital abnormalities.

FACTORS CONTD

Infections and hyperpyrexia of the mother Many viruses such as Rubella and HIV and other organisms can pass through the placental membrane and adversely affect fetal growth.

FACTORS CONTD

Multiple pregnancy Each placenta is usually reduced in size and there is an increased nutritional burden upon the mother for each additional fetus.

FACTORS CONTD

Maternal malnutrition If the mother is lacking certain necessary nutrients, the fetus will also be deprived of them.