Prenatal

Development &
Birth
Zaitunnatakhin Zamli
Department of Biomedical Science,
Kulliyyah of Allied Health Sciences, IIUM.
[email protected]
 Learning Outcomes

At the end of this lecture, the students should be able to:

 Describe the prenatal development.
 Describe the effects of teratogens on prenatal development.
 Discuss the birth process.
 Explain the physical and psychological changes that take
place in the postpartum period.

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1. Prenatal
Development
Definition, Stages, Teratogenic influences and Antenatal care

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 Definitions

Prenatal development is the process of growth that occurs

between the conception and birth.

Conception
- The fusion of the an ovum and a sperm.
- It usually occurs in the ampulla of
fallopian tube.
- If no fertilization, the secondary oocyte
dies within 24 hours.
Birth
- The emergence of a new individual
from the body of its parent.

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 Definitions

Prenatal development:
- Pre-embryonic  Fetus
- Human gestation/pregnancy
lasts ~ 266 days/38 weeks.
- Fertilization date is seldom
known, therefore the gestational
calendar is usually calculated
from the last menstrual period
began, and birth is predicted to
occur ~ 280 days/40 weeks.
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 Stages of Prenatal Development - Al-Quran

Man We did create from a quintessence (of clay); Then We placed him as (a
drop of) sperm in a place of rest, firmly fixed; Then We made the sperm into
a clot of congealed blood; then of that clot We made a (foetus) lump; then we
made out of that lump bones and clothed the bones with flesh; then we
developed out of it another creature. So blessed be Allah, the best to create!
[Al-Mukminun: 12-14]

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 Stages of Prenatal Development - Clinically

Third trimester
First trimester Second trimester Week 25 – Birth
First 12 weeks Week 13 – Week 24
Rapid growth, but
Fertilization  First month of Most of the organs are
some organs not are
fetal life completely developed.
fully functioning.

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 Stages of Prenatal Development - Biologically

Germinal stage Embryonic stage Fetal stage

- begins with the zygote and
- Day 17 – Week 8 - Week 9 – Birth
lasts ~16 days.
- development of - fetal length and
- involves the process of
placenta and all the weight increases
cleavage and
organ systems dramatically.
implantation.

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 1. Germinal Stage

The germinal stage includes the process of

fertilisation, cleavage, blastocyst formation and
implantation.

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 2. Embryonic Stage

By the 3rd Week, the embryonic disc and extraembryonic structures

are formed. The development of embryo continues with gastrulation,
notocord formation, neurulation, embryo folding and organogenesis.

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Extraembronic membranes

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Embryo folding

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3. Fetal Stage

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 Teratogenic Influences

Maternal Diseases and Drugs, Alcohol and Tobacco Environmental Hazards

Disorders - Thalidomide - Radiation e.g. Hiroshima &
- Rubella - Antibiotics Nagasaki atomic bombing,
- Sexually transmitted - Anti-depressant drugs Chernobyl disaster.
diseases (STD) e.g. syphilis, - Chemicals and pollutants
genital herpes and AIDS - Hormones e.g. androgens, e.g. pesticides, heavy
progestins
- Other infectious diseases - Aspirin
metals.
e.g. toxoplasmosis, URTI,
etc. - Accutane Other factors
- Emotional stress - Diet pills - Age
- Alcohol - Diet
- Tobacco - Physical activity
- Caffeine 15
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 Alcohol Consumption

 Fetal Alcohol Syndrome (FAS) - A

condition in a child that results
from alcohol exposure during the
mother's pregnancy.

 Infants born with:

o Growth retardation
o Unusual facial features
o Mental retardation

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Nicotine

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Drugs Abused

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 Maternal Diet and Nutrition

 A developing fetus depends completely on its mother for

nutrition, which comes from the mother’s blood.

 Nutritional status of the embryo/fetus is determined by:

- total number of calories.
- levels of protein, vitamins and minerals.
- folic acid.

 Being overweight before and during pregnancy can also put

the embryo or fetus at risk.
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 Emotional Stress

 When a pregnant women experiences intense fears, anxieties

and other emotions, physiological changes occur that may
affect her fetus.

 For example: Producing adrenaline in response to fear

restricts blood flow to the uterine area and can deprive fetus
of adequate oxygen.

 Women under stress may experience irregular contractions,

difficult labor and about 4x more likely to deliver baby
prematurely.
 Maternal Age

Adolescence 30’s and beyond

 Premature infants are  Women have more difficulty
common. getting pregnant after the
 The mortality rate is double age of 30.
that of infants born to  Risk of having infant with
mothers in their twenties. Down Syndrome increases.
 This happens due to:
o immature reproductive
systems.
o poor nutrition.
o lack of prenatal care.
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 Paternal Factors

 Exposure to lead, radiation, certain pesticides and

petrochemicals can cause abnormalities in sperm that lead to
miscarriage or disease.

 Father’s smoking during the mother’s pregnancy also can

cause lower birth weight and potential for their infants
developing cancer.
 Antenatal Care

Antenatal care is the periodic health

check-up provided by skilled health-
care professionals to pregnant women in
order to ensure the best health
conditions for both mother and baby
during pregnancy.
Purposes – (1) Risk identification; (2)
Prevention and management of
pregnancy-related or concurrent
diseases; and (3) Health education and
promotion.

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Antenatal visit and follow-up:

Below 28 Weeks – once a

month

28-35 Weeks – every 2 weeks

36 Weeks and above – every

week
 9 months
8 months
After
7 months
6 months dropping,
Placenta 5 months in preparation
4 months for delivery
Uterus 3 months
Umbilical
cord Amniotic fluid
Fetus at Cervix
16 weeks Vagina

Pregnancy at four months Pregnancy at three to nine months

Liver Small intestine

Stomach
Pancreas
Transverse colon
Fundus of uterus Aorta

Common
iliac vein
Umbilical cord
Cervical
Placenta (mucous)
plug in cervical
canal
Urinary bladder
External
Pubic symphysis os
Vagina Rectum

Urethra

Pregnant female (full-term infant) Nonpregnant female

2. Birth Process
Definition, Stages, Common medication, Types and Assessment

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 Definition

Labor or parturition is a the process of giving birth. The onset

involves a complex hormonal reaction (i.e. estrogen, oxytocin)

 False labor:
o Occasional spasms in uterine musculature.
o Irregular interval and impersistent contraction.
 True labor :
o Regular interval and persistent contraction.
o Localized pain in the back that intensified by walking.

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 Stages of Birth Process

o Dilation stage – complete

dilation of cervix and rupturing
of amniotic sac
o Expulsion stage – time between
complete dilation of cervix and
delivery of the baby
o Placental stage – time after
delivery until expulsion of the
placenta

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 Common Medications

 Analgesia
o To relieve pain.
o E.g. tranquilizers, barbiturates and
narcotics.
 Anaesthetic
o Administer at the late first-stage labor and
during the expulsion of baby.
o E.g. epidural.
 Oxytoxin
o To stimulate contraction.
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 Types of Birth Process

 Vaginal birth
o Through the birth canal.
 Episiotomy
o Incision through perineal musculature.
o Needed if vaginal canal is too small to pass fetus.
o Repaired with sutures after delivery.
 Cesarean section (C-section)
o Removal of infant by incision made through abdominal wall.
o Opens uterus just enough to pass infant’s head.
o Needed if complications arise during dilation or expulsion stages.
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 Types of Birth Process

 Forceps delivery
o Used to grasp head of fetus.
o Needed when fetus faces mother’s pubis instead of sacrum.
o Risks to infant and mother are reduced if forceps are used.
 Breech birth
o Legs or buttocks of fetus enter vaginal canal first instead of head.
o Umbilical cord can become constricted, cutting off placental blood flow.
o Cervix may not dilate enough to pass head.
o Prolongs delivery.
o Subjects fetus to severe distress and potential injury.
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 Types of Birth Process

 Immature delivery
o Refers to fetuses born at 25–27 weeks of gestation.
o Most die despite intensive neonatal care.
o Survivors have high risk of developmental abnormalities.

 Premature delivery
o Refers to birth at 28–36 weeks.
o Newborns have a good chance of surviving and developing
normally.

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 Assessment of the Newborn

 Apgar scale
o Is an assessment test on a
scale of 1-10.
o Performed by a pediatrician
at 1-5 min after birth.
o 7 or higher indicates baby in
good condition.
o 4 to 6 baby may need
assistance.
o Under a 4 baby may need life
saving techniques.
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 #apgarscore

When you are just born, people have already

started judging you on the basis of your score!

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3. Postpartum period
Definition, Physical , Emotional and Psychological Adjustment

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 Definitions

Postpartum period or Puerperium, refers to the time after

delivery when maternal physiological changes related to
pregnancy return to the nonpregnant state.

Learning to Father learning

Learning to Recovering
feel good as to care for
care for baby from childbirth
mother baby

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 Physical Adjustment

Most mothers feel

exhausted and
need rest

Type and A mother’s body

circumstances of undergoes sudden and
delivery affect the dramatic changes in
speed of readjustment hormone production
 Emotional and Psychological Adjustments

Emotional fluctuations are common for the mother in the

postpartum period and can be caused by:

Inexperience / The extensive

Lack of Hormonal time and
Fatigue
confidence in changes demands of
handling the baby care-giving
 Emotional and Psychological Adjustments

.Baby blues
o Last for about ten days and do not impair functioning.

Postpartum depression
o Persistent and severe mood changes during the
postpartum period, involving feelings of despair and
characterized by changes in appetite and sleep, low
self-esteem, and difficulty in concentrating.
o Affects 1 in 5 to 10 women
o May last for weeks or months
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 “
“My life has changed a lot since the baby came. I
don't feel like I get enough time alone with my
partner. She also seems better at taking care of
the baby than I am. I'm jealous -- how can I get
over these feelings?”

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 Thanks!

Any questions?
You can find me at:
[email protected]

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