ALL INDIA INSTITUTE OF MEDICAL SCIENCES, JODHPUR

COLLEGE OF NURSING

SEMINAR PRESENTATION

SUBJECT: Obstetrical & Gynecological nursing

UNIT: II (Human Reproduction)
TOPIC: Formation of the body systems-2

Submitted to: Submitted by:

Himanshu Vyas Mahima Joshi
Associate Professor MSc. (N) 1st year
College of Nursing College of Nursing
AIIMS, Jodhpur AIIMS, Jodhpur

Date of Submission:
Respiratory System
The respiratory system begins development during embryonic life and continues through fetal
life and into childhood. The development of the respiratory tract begins in week 4 and continues
through week 17 with formation of the larynx, trachea, bronchi, and lung buds.
When the embryo is approximately 4 weeks old, the respiratory diverticulum (lung bud) appears
as an outgrowth from the ventral wall of the foregut. The location of the bud along the gut tube is
determined by signals from the surrounding mesenchyme, including fibroblast growth factors
(FGFs) that “instruct” the endoderm. Hence epithelium of the internal lining of the larynx,
trachea, and bronchi, as well as that of the lungs, is entirely of endodermal origin. The
cartilaginous, muscular, and connective tissue components of the trachea and lungs are derived
from splanchnic mesoderm surrounding the foregut. Initially the lung bud is in open
communication with the foregut. When the diverticulum expands caudally, however, two
longitudinal ridges, the tracheoesophageal ridges, separate it from the foregut. Subsequently,
when these ridges fuse to form the tracheoesophageal septum, the foregut is divided into a dorsal
portion, the esophagus, and a ventral portion, the trachea and lung buds.

A. Embryo of approximately 25 days gestation showing the relation of the respiratory

diverticulum to the heart, stomach, and liver.
B. Sagittal section through the cephalic end of a 5-week embryo showing the openings of the
pharyngeal pouches and the laryngotracheal orifice.
 Between 16 and 24 weeks the bronchi and terminal bronchioles enlarge, and vascular structures
and primitive alveoli are formed. Between 24 weeks and term birth, more alveoli form.
Specialized alveolar cells, type I and type II cells, secrete pulmonary surfactants to line the
interior of the alveoli. After 32 weeks, sufficient surfactant is present in developed alveoli to
provide infants with a good chance of survival.
Trachea and bronchi: The trachea develops from the part of the respiratory diverticulum, that
lies between the point of its bifurcation and the larynx. The two primary divisions of the
respiratory diverticulum form the right and left principal bronchi. The left division comes to lie
more transversely than the right. It soon shows two subdivisions that represent the two lobar
bronchi of the left lung. The right division divides into three lobar bronchi.
Larynx: The larynx develops from the cranial-most part of the respiratory diverticulum. The
communication between the diverticulum and the pharynx persists as the inlet of the larynx. The
caudal part of the hypobranchial eminence forms the epiglottis. The thyroid, cricoid and
arytenoid cartilages are derivatives of the fourth, fifth and sixth pharyngeal arches. The laryngeal
muscles are also derived from branchial mesoderm as indicated by their nerve supply.
Pulmonary surfactants: The detection of the presence of pulmonary surfactants (surface-active
phospholipids) in amniotic fluid has been used to determine the degree of fetal lung maturity, or
the ability of the lungs to function after birth. Lecithin (L) is the most critical alveolar surfactant
required for postnatal lung expansion. It is detectable at approximately 21 weeks and increases in
amount after week 24. Another pulmonary phospholipid, sphingomyelin (5), remains constant in
amount. Therefore, the measure of lecithin in relation to sphingomyelin, or the L/S ratio, is used
to determine fetal lung maturity. When the L/S ratio reaches 2:1, the lungs are considered to be
mature, which occurs at approximately 35 weeks of gestation.
Certain maternal conditions that cause decreased maternal placental blood flow, such as maternal
hypertension, placental dysfunction, infection, or corticosteroid use, accelerate lung maturity.
This process is apparently caused by the resulting fetal hypoxia, which stresses the fetus and
increases the blood levels of corticosteroids that accelerate alveolar and surfactant development.
Conditions such as gestational diabetes and chronic glomerulonephritis can retard fetal lung
maturity. The use of intrabronchial synthetic surfactant in the treatment of respiratory distress
syndrome in the newborn has greatly improved the chances of survival for preterm infants.
Fetal respiratory movements have been seen on ultra- sound as early as the eleventh week. These
fetal respiratory movements may aid in development of the chest wall muscles and regulate lung
fluid volume. The fetal lungs produce fluid that expands the air spaces in the lungs. The fluid
drains into the amniotic fluid or is swallowed by the fetus.
Before birth, secretion of lung fluid decreases. The normal birth process squeezes out
approximately one third of the fluid. Infants of cesarean births do not benefit from this squeezing
process; therefore, they may have more respiratory difficulty at birth. The fluid remaining in the
lungs at birth is usually reabsorbed into the infant's blood- stream within 2 hours of birth.
Hepatic system
The liver and biliary tract develop from the foregut during the fourth week of gestation.
Hematopoiesis begins during the sixth week and requires that the liver be large. The embryonic
liver is prominent, occupying most of the abdominal cavity. Bile, a constituent of meconium,
begins to form in the twelfth week.
Glycogen is stored in the fetal liver beginning at week 9 of 10. At term, glycogen stores are twice
those of the adult. Glycogen is the major source of energy for the fetus and for the neonate
stressed by in utero hypoxia, extra- uterine loss of the maternal glucose supply, the work of
breathing, or cold stress. Iron is also stored in the fetal liver. If maternal intake is sufficient, the
fetus can store enough iron to last for 5 months after birth.
During fetal life the liver does not have to conjugate bilirubin for excretion because the
unconjugated bilirubin is cleared by the placenta. Therefore, the glucuronyl transferase enzyme
needed for conjugation is present in the fetal liver in amounts less than those required after birth.
This circumstance predisposes the neonate, especially the preterm infant, to hyperbilirubinemia.
Coagulation factors II, VII, IX, and X cannot be synthesized in the fetal liver because of the lack
of vitamin K synthesis in the sterile fetal gut. This coagulation deficiency persists after birth for
several days and is the rationale for the prophylactic administration of vitamin K to the newborn.
 Development of the biliary apparatus. (A) Hepatic bud arises from the gut at the junction of
foregut and midgut. (B) It grows towards the septum transversum through the ventral
mesogastrium. (C) The bud divides into the pars hepatica (that forms the liver) and the pars
cystica (that forms the gall bladder). The part of the hepatic bud proximal to its division forms
the bile duct.

Neurologic system
The nervous system originates from the ectoderm dung the third week after fertilization. The
open neural tube forms during the fourth week. It initially closes at what will be the junction
ends open. The embryo folds in on leaving both itself lengthwise. At the time, forming a head
fold in the neural tube at this junction. The cranial end of the neural tube closes, then the caudal
end closes. During week 5, different growth rates cause more flexures in the neural tube,
delineating three brain areas: the forebrain, midbrain, and hindbrain.
The forebrain develops into the eyes (cranial nerve II) and the cerebral hemisphere. The
development of all areas of the cerebral cortex continues throughout fetal life and into childhood.
The olfactory system (cranial nerve I) and thalamus also develop from the forebrain. Cranial
nerves III and IV (oculomotor and trochlear) form from the mid- brain. The hindbrain forms the
medulla, the pons, the cerebellum, and the remainder of the cranial nerves. Brain waves can be
recorded on an electroencephalogram by week 8.
The spinal cord develops from the long end of the neural tube. Another ectodermal structure, the
neural crest, develops into the peripheral nervous system. By the eighth week, nerve fibers
traverse throughout the body. By week 11 or 12 the fetus makes respiratory movement moves all
extremities, and changes position in utero. The fetus can suck his or her thumb, swim in the
amniotic fluid pool, turn somersaults, and sometimes such fetal movements result in a knot in the
umbilical cord. Sometime between 16 and 20 weeks, when the movements are strong enough to
be perceived by the mother as "the baby moving, quickening has occurred. The perception of
movement occurs earlier in the multipara than in the primipara. The mother also becomes aware
of the sleep and wake cycles of the fetus.
Sensory awareness. Purposeful movements of the fetus have been demonstrated in response to a
firm touch transmitted through the mother's abdomen. Because it can feel, the fetus requires
anesthesia when invasive intrauterine procedures are performed.
Fetuses respond to sound by 24 weeks. Different types of music evoke different movements. The
fetus can be soothed by the sound of the mother's voice. Acoustic stimulation can be used to
evoke an FHR response. The fetus becomes accustomed (habituates) to noises heard repeatedly.
Hearing is fully developed at birth.
The fetus is able to distinguish taste. By the fifth month, when the fetus is swallowing amniotic
fluid, a sweetener added to the fluid causes the fetus to swallow faster. The fetus also reacts to
temperature changes. A cold solution placed into the amniotic fluid can cause fetal hiccups.
The fetus can see. Eyes have both rods and cones in the retina by seventh month. A bright light
shone on the mother’s abdomen in late pregnancy causes abrupt fetal movements mother's
abdomen in late pregnancy. During sleep time, rapid eye movements (REMs) have been
observed similar to those occurring in children and adults while dreaming.
At term the fetal brain is approximately one fourth the size off an adult brain. Neurologic
development continues. Stressors on the fetus and neonate (e.g., chronic poor nutrition or
hypoxia, drugs, environmental toxins, trauma, disease) cause damage to the central nervous
system long after the vulnerable embryonic time for malformations in other organ systems.
Neurologic insult can result in cerebral palsy, neuromuscular impairment, mental retardation, and
learning disabilities.

Integumentary system
The epidermis begins as a single layer of cells derived from the ectoderm at 4 weeks. By the
seventh week, two layers of cells have formed. The cells of the superficial layer are sloughed and
become mixed with the sebaceous gland secretions to form the white, cheesy vernix caseosa, the
material that protects the skin of the fetus. The vernix is thick at 24 weeks but becomes scant by
term.
The basal layer of the epidermis is the germinal layer, which replaces lost cells. Until 17 weeks
the skin is thin and wrinkled, with blood vessels visible underneath. The skin thickens, and all
layers are present at term. After 32 weeks, as subcutaneous fat is deposited under the dermis, the
skin becomes less wrinkled and red in appearance.
By 16 weeks the epidermal ridges are present on the palms of the hands, the fingers, the bottom
of the feet, and the toes. These handprints and footprints are unique to that infant.
Hairs form from hair bulbs in the epidermis that project into the dermis. Cells in the hair bulb
keratinize to form the hair shaft. As the cells at the base of the hair shaft proliferate, the hair
grows to the surface of the epithelium. Very fine hairs, called lanugo, appear first at 12 weeks on
the eyebrows and upper lip. By 20 weeks they cover the entire body. At this time the eyelashes,
eyebrows, and scalp hair are beginning to grow. By 28 weeks the scalp hair is longer than the
lanugo, which thins and may disappear by term gestation.
Fingernails and toenails develop from thickened epidermis at the tips of the digits beginning
during the tenth week. They grow slowly. Fingernails usually reach the fingertips by 32 weeks,
and toenails reach the toe tips by 36 weeks.

Immunologic system
During the third trimester, albumin and globulin are present in the fetus. The only
immunoglobulin (Ig) that present in crosses the placenta, IgG, provides passive acquired
immunity to specific bacterial toxins. The fetus produces IgM immunoglobulins by the end of
the first trimester. These immunoglobulins are produced in response to blood group antigens,
gram-negative enteric organisms, and some viruses. IgA immunoglobulins are not produced by
the fetus; however, colostrum, the precursor to breast milk, contains large amounts of IgA and
can provide passive immunity to the neonate who is breastfed. The normal-term neonate can
fight infection, but not as effectively as an older child. The preterm infant is at much greater risk
for infection.

Musculoskeletal system
Bones and muscles develop from the mesoderm by the fourth week of embryonic development.
At that time the cardiac muscle is already beating. The mesoderm next to the neural tube forms
the vertebral column and ribs. The parts of the vertebral column grow toward each other to
enclose the developing spinal cord. Ossification, or bone formation, begins. If the bony fusion
has a defect, various forms of spina bifida may occur. A large defect affecting several vertebrae
may allow the membranes and spinal cord to pouch out from the back, producing neurologic
deficits and skeletal deformity.
The flat bones of the skull develop during the embryonic period, and ossification continues
throughout child- hood. At birth, connective tissue sutures exist where the bones of the skull
meet. The areas where more than two bones meet (called fontanels) are especially prominent.
The sutures and fontanels allow the bones of the skull to mold, or move during birth, enabling
the head to pass through the birth canal.
The bones of the shoulders, arms, hips, and legs appear in the sixth week as a continuous
skeleton with no joints. Differentiation occurs, producing separate bones and joints. Ossification
will continue through childhood to allow growth. The bones of the shoulders, arms, hips, and
legs appear in the sixth week as a continuous skeleton with no joints. Differentiation occurs,
producing separate bones and joints.
Related Article
Prevalence of neural tube defect and its identification during antenatal period: a cross-
sectional study in eastern Indian state
Santosh Kumar Mahalik , Arvind Kumar Singh , Akash Bihari Pati , Lipipuspa Rout , Subhra
Mallisha
PMID: 38760039
A population-based cross-sectional study with a household survey for neural tube defects using
pictorial card as well as a hospital-based study for antenatal ultrasonography data.
The sample population was selected through multistage random sampling. In the first stage, one
district from each zone was selected randomly. In the second stage, using simple random
sampling, one community health centre and one urban primary health centre were selected from
each district. In the third stage, the population from a block and ward were picked from the
selected rural and urban settings, respectively.
All married women in the reproductive age group (18–49 years) residing in these cluster villages
in the selected districts were enrolled.
This study found a low prevalence of neural tube defect in Odisha, which is far lower compared
with the older studies from India. There is an urgent need to strengthen the quality of antenatal
care services provided under Pradhan Mantri Surakshit Matritva Abhiyan through better training
regarding anomaly scans and better data keeping at public healthcare facilities.

Reference
 Sadler T.W., Lagman’s Medical Embryology, Lippincott Williams & Wilkins; 15th edition
(13 January 2023)
 Singh I., Pal GP, Human Embryology, MACMILLAN PUBLISHERS INDIA LTD, 2010
 Lowdermilk D.L., Perry S.E., Maternity and Women's Health Care (Ninth Edition),
Publisher : Mosby; 9th edition (1 March 2007)