Embryology and Fetal Development

Fertilization
Fertilization is also called
conception/impregnation/fecundation.
Is the fusion of the sperm with the ovum, to
form the zygote
-The prerequisites for fertilization includes: -
Adequate and matured sperm.
Ability of sperm to reach and penetrate the
zona pellucida and cell membrane of the
ovum.
Matured ovum.
Patent genitalia.
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The fertilized cell continues its passage through
the uterine tube & reaches the uterus 3 - 4 days
later.
During this time segmentation or cell division
continues.
 Implantation is normally complete by the 11 th
day after ovulation.
The fertilized ovum is called a zygote till it will
be 3 weeks after conception.
After 3 wks up to 8 wks we call it an embryo.
After 8 weeks up to delivery we call it a fetus
which when born will be called a baby.
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 The Fetal Development
1. The zygote: -
The zygote is the beginning of the embryo.
 After the zygote formation, typical mitotic division of the
segmentation nucleus occur producing two blastomeres.
 The blastomeres continue to divide by binary division through 4, 8,
16 cells stage until a cluster of cells called Morula is formed.
2. The Morula: -
The Morula after spending about 3 days in the uterine tube enters the
uterine cavity through the narrow uterine ostium (1mm) on the fourth
day in the 16 - 64 cell stage.
The transportation is controlled by muscular contraction and cilia in
the fallopian tubes.
The central cell of the Morula is known as inner cell mass.
The inner cell mass develop to form the embryo proper.
The peripheral cells of the Morula are called outer cell mass.
The outer cell mass develop to form protective and nutritive
membrane of the embryo. 4
3. Blastocyst: -
While the Morula remains free in the uterine cavity on the 4 th
and 5th day it is covered by a film of mucus.
The fluid passes through the canaliculi of the zona pellucida
which separates the cells of Morula and is now termed as
Blastocyst.
The blastocyst consists two parts.
3.1 . The outer part Trophoblast – develop in to placenta and
chorion.
-The placenta provides nourishment to the fetus and the
chorion covers the fetus.
3.2 . The inner part inner cell mass - develops into fetus,
amnion & umbilical cord.
-Embryonic stem cells of the inner cell mass differentiate in to
three germ layers (ectoderm, mesoderm, & endoderm) which
are able to produce mature somatic (body) cells.
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 Development of the fertilized ovum
Zygote Morula Blastocysts

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 Fetal development
 0-4 weeks after conception
o Rapid growth, formation of the embryonic plate
o Primitive central nervous system forms
o Heart develops and begins to beat
o Covered with a layer of skin
o Limb buds form
 4-8 weeks
o Very rapid cell division
o Head and facial features develop
o All major organs laid down in primitive form
o External genitalia present but sex not distinguishable
o Early movements visible on ultrasound from 6 weeks

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Fetal dev’t…

 8-12 weeks
o Eye lids fuse
o Kidneys begin to function and the fetus passes
urine from 10 weeks
o Fetal circulation functioning properly
o Sucking and swallowing begin
o Sex apparent
o Moves freely (not felt by the mother)
o Some primitive reflexes present

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 Fetal dev’t...

 12-16 weeks
o Rapid skeletal development
o Meconium present in gut
o Lanugo appears
o Nasal septum and palate fuse

 16-20 weeks
o Quickening – mother feels fetal movements
o Fetal heart heard on auscultation
o Fingernails can be seen
o Skin cells begin to be renewed

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Fetal dev’t...

 20-24 weeks
o Most organs become capable of functioning
o Periods of sleep and activity
o Responds to sound
o Skin red and wrinkled
 24-28 weeks
o Survival may expected if born
o Eyelids reopen
o Respiratory movements
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 Feta dev’t...

 28-32 weeks
 Begins to store fat and iron
 Testes descend in to scrotum
 Lanugo disappears from face
 Skin becomes paler and less wrinkled
 32-36 weeks
 Increased fat makes the baby more rounded
 Lanugo disappears from body
 Head hair lengthens
 Nails reach tips of fingers
 Ear cartilage soft
 Plantar creases visible

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Fetal dev’t…

 37-40 weeks
Term is reached and birth is due/expected
Contour rounded
Skull firm

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 Summary of fetal development based
on trimester
First trimester (conception -12wk)
◦ Period of organogenesis
◦ Susceptible to teratogenic
◦ Heart functions at 3-4wks
◦ Eye formation at 4-5wks
◦ Arm and leg buds at 4-5wks
◦ Recognizable face and external genitalia at 8wk
◦ Placenta formed at 12wk
◦ Rapid growth of brain
◦ Bone ossified at 12wk
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Fetus at 8 Weeks

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Second trimester (13-24wk)
– Less susceptible for teratogens after 12wks
– Facial feature are formed at 16wk
– FHB heard by 16-20wks with
fetoscope/Doppler
– Vernix present
– Size of fetus is around 25cm

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20 weeks (5 Months)

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Third trimester (25-36wks)
◦ Surfactant production begins in increasing
amount
◦ Iron is stored
◦ Calcium stored at 28-32wks
◦ Fetal reflex at 28-32wks
◦ Subcutaneous fat deposits at 36wk
◦ Size of the fetus 45-55cm at 38-40wks

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Seven Months Eight Months

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 Nine Months

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Summary of the fetal development based on gestational
age
A gestational age is the age of pregnancy counted in
weeks.
During the first 3 weeks of life the fertilized ovum is
called a zygote.
 During this time cells have multiplied until Blastocyst
has been formed and it has implanted itself in the walls
of the uterus.
 During this time primitive trophoblastic villi have been
formed to reach down into the thick endometrium thus
giving contact with maternal blood.
Starting from week 3 up to 8th week it is called Embryo.
After 8th week up to delivery we call it a Fetus and after
birth it is called a baby. 20
 The Placenta
The placenta is a round flat mass which is
bluish red in color. It is about 20 cm in
diameter and 2.5 cm in thickness from the
center.
It measures about 1/6 part of the baby’s weight
at birth.
It links closely the fetus with the mother’s
circulation to carry out functions which the
fetus is unable to perform itself during
intrauterine life.

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The placenta has two surfaces: -
The maternal surface
Is made up of chorionic villi arranged in 18 –
20 lobes or cotyledons.
The maternal blood gives it a bluish red color
The fetal surface
The amnion covering the fetal surface of the
placenta gives it a whitish, shiny appearance.
Branches of umbilical vein and arteries are
visible and spreading out from the insertion
of the umbilical cord which is normally in the
center.
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There are two membranes on the placenta.
The chorion: -
It is the outer membrane of the placenta which is
opaque, friable and adherent to the uterine wall
until 3rd stage of labor.
 During the 3rd stage of labor, it detaches and
expelled with the placenta.
The amnion: -
It is the smooth, tough and translucent inner
membrane of the placenta.
The fetus and the liquor are in it.
It rupture during labor in order to expel the fetus.

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 Functions of the placenta
1.Nutrition: -
The fetus gets the required nutrient from the
mother through placenta.
2.Endocrine: -
The placenta secrets different hormones by the
cytotrophoblastic layer of the chorionic villi.
A. Human Chorionic Gonadotrophic hormone
(HCG)
helps to maintain suitable condition within the
uterus as the fetus develops.
It also gives the basis for pregnancy test.
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B/ Progesterone
Its level rises from the 12th week and lasts
throughout until the placenta is expelled
It is used to prevent premature uterine
contraction.
C/ Estrogen
Its production rises from the 6 th week until term
and fail after the expulsion of the placenta.
It is used to enhance the mammary gland and
enlargements of uterus.
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D/ Human placental lactogens (HPL)
Is a hormone w/c have a role in glucose metabolism in
pregnancy
It help to promote milk production and growth
3.Respiratory: -
The fetal lung is not functional in the uterus so that the
exchange of gas (CO2 & O2) is carried out by placenta.
Oxygen from the mother’s hemoglobin passes into fetal blood
vessels by simple diffusion and similarly the fetus gives off
CO2 into the maternal blood vessels.
4.Barrier (protection): -
It provides a limited protection against infection.
But few bacterial infections like syphilis and tubercle bacillus
can penetrate.
Some viruses, however, can cross freely and cause congenital
abnormalities as in the case of the rubella and HIV virus. 26
5.Excretion: -
The main substances excreted from the fetus
is CO2 and bilirubin

6.Storage: -
It metabolizes glucose, stores it in the form
of glycogen & reconverts it back to glucose
when needed.
The placenta can also store iron & the fat
soluble vitamin
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 The umbilical cord
-Extends from the fetal umbilicus to the fetal
surface of the placenta.
-The umbilical cord encloses: -
One umbilical vein - carrying oxygenated
blood from the mother to the fetus
Two umbilical arteries - carrying back
deoxygenated blood from fetus to the placenta
villi
-Warthon`s jelly – a sticky jelly like substance.
-Its average length is about 50 cm and it is about
2 cm thick.
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Types of umbilical cord insertion
Central insertion: - is a normal type of the cord
insertion w/c is in the middle of the placenta.
Battledore insertion: - It is a type of cord insertion
at the edge of placenta like tennis table bat.
Velamentous insertion: - Here the cord is inserted in
to the membranes some distance from the edge of
the placenta.
The umbilical vessels run through the membrane
from the cord to the placenta.
It is the dangerous type of cord insertion.
Its major complication is detachment and tear of the
blood vessels during active third stage of labor.
As a result sudden blood lose will happen.
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Velamentous cord insertion

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Placenta circumvallate: -
An opaque ring is seen on the fetal surface; w/c
means the chorion is attached on the fetal
surface at some distance away from the edge.
Placenta bipartite or tripartite: -
When the placenta is divided in to two or three
complete lobes each with a cord leaving it.
The bipartite cord joins a short distance from
the two parts of the placenta.
As a result there may be retentions of the extra
lobe during delivery.
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Abnormal placenta (bipartite)

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 Abnormal placenta
Placenta succentureta:-
A small extra lobe is present separated from
the main placenta.
It is joined to the main placenta by small blood
vessels w/c run through the membranes to
reach the placenta.
 It has a danger that this small lobe may be
retained during delivery preventing uterine
contraction resulting in PPH and infection

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 The amniotic fluid
It is clear, pale straw colored liquor in w/c the
fetus floats.
The normal amount is from 500 ml – 1500 ml
It has 99% water, and 1% dissolved organic
matters including: -
-Food substances (protein, glucose, minerals,
lipids),
-Waste products ( urea, uric acid, creatinine) and
-Hormones(insulin, prolactin,and rennin)
It is slightly alkaline in PH (7.2)

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Functions of the amniotic fluid
Acts as a shock absorber to the fetus and prevents
from injury
Allow for the growth and free movement of the
fetus
It protects the fetus from change in temperature,
because liquid changes temperature more slowly
than air.
It aids muscular development, because it allows the
fetus freedom to move
During labor it protects the placenta and umbilical
cord from the pressure of uterine contraction
Facilitate cervical effacement and dilation
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Thank you!!!

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FETAL CIRCULATION

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 Objective
At the end of this session students are expected to :
Recognize physiology of fetal circulation.

Recognize the changes under goes after delivery

Identify the regions on the fetal skull.

Show important land marks on the fetal skull

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 The feotal circulation
There is no mixture between the maternal and fetal blood.
The fetus although in utero has its own circula­tory system which
is quite rudimentary i.e. immature, different from an adult
circulation.

Fetal blood has begun to exchange nutrients with the maternal

circulation across the chorionic villi as early as 3rd weeks of
intrauterine life.

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During intra­uterine life the fetal gastro-intestinal
and respiratory systems are not functioning.

So it obtains the necessary nutrient and oxygen

from the mother through the placenta.

There are several temporary structures in addition to

the placenta itself and the umbilical cord.

These enable the fetal circulation to take place but

undergo changes after birth.
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There are five temporary structures in the fetal circulation:
The umbilical vein:-leads from the umbilical cord to the
underside of the liver and carries blood rich in oxygen and
nutrient to the fetus.

The ductusvenosus: - vein to vein.

-It connects the umbilical vein to the inferior vena cava.
-At this point the oxygenated blood from the umbilical vein
mixes with the deoxygenated blood returning back through the
vena cava

The foramen ovale: - an oval opening.

-Temporary opening between the atria w/c allows the majority
of blood entering from the inferior vena cava to the right atrium
to pass directly in to the left atrium. 41
The ductusarteriosus: - artery to artery.
- An opening w/c allows the mixture of the blood in
the pulmonary artery to the blood in the aorta.
-It is at a point where the pulmonary artery comes in
to contact with the descending arch of the aorta.

The hypogastric arteries:

-These are the branches of the internal iliac artery.
- Become the umbilical artery when they enter the
umbilical cord.
-They return the deoxygenated blood from the fetus
to the placenta.
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Physiology of the fetal circulation

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44
 Physiologic changes at birth
The main factor which helps the physiologic
changes at birth is the establishment of respiration.
On inspiration: -
When the infant cries immediately after the birth, it
means that the baby has taken the first breath.
At this time the lungs expand and their field is
increased.
 So the blood capillaries suck the blood in to the
pulmonary circulation from the right ventricles.

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The pulmonary veins now returns blood back to
the left atrium and this causes the pressure in the
left side of the heart to rise and become more than
the pressure on the right side of the heart.
This is responsible for the closure of the foramen
ovale.
The blood from the right ventricles finds its easiest
way to the lung and so now flows directly to the
lung.
 So this is responsible for the closure of the ductus
arteriosus.
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The cutting of the umbilical vein: -

The clumping of the umbilical vein stops the flow

of the blood in the umbilical vein, the hypogastric
arteries, and this is responsible for the closure of the
ductus venosus.

This is also responsible for the reduction of pressure

in the inferior vena cava and in the right side of the
heart as well.

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Changes on fetal circulation at birth
1. Ductus venous – becomes the
ligamentumvenosum
2. Foramen ovale – becomes the fossa ovalis
3. Ductus arteries – becomes the
ligamentumarteriosum
4. Umbilical vein – becomes the
ligamentumteres

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 The Fetal Skull
The Fetal skull is a bony box like cavity which
contains and protects the delicate brain tissues.
These delicate brain tissues may be injured during
the birth process as they are subjected to great
pressure.
The feotal head is large in comparison to the true
pelvis and it is the most difficult part to deliver
whether it comes first or last.

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For a feotal head to be delivered without trauma
to the mother and the fetus, some adaptation
between the fetal skull and maternal pelvis must
take place during labor.

Therefore; an understanding of the land marks

and measurements of the fetal skull enables to
recognize normal presentation and positions and
facilitate delivery with least possible trauma to
mother and child.

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Divisions of the feotal skull
The fetal skull if divided in to 3: the face, the base, the
vault
The face- Is composed of 14 small bones w/c are firmly
united and non compressible
The base - Is composed of bones w/c are firmly united to
protect vital center in the medulla
The vault -
The vault is large dome shaped parts above the imaginary
lines drown between the orbital ridge and the nape of the
neck.
They are separated by sutures, and this allows the head to
mould during delivery, and makes delivery easier.
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Bones of the Vault

2 Frontal - which lie at the front

2 Parietal - which are at the sides
2 Temporal -
1 Occiput - which is at the back
Each bone has an ossification centre, where
growth started.
The most important one is on the parietal
bones and is known as the parietal eminences.
The Frontal bones fuse at 8 years old.

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54
 Sutures and fontanels
A suture- is a membranous space between two
bones of the skull. They are the cranial joints. There
are 8 sutures on the fetal skull
1 Frontal suture - between the Frontal bones
1 Sagital suture - between the parietal bones
2 Coronal sutures - between the frontal and
parietal bones on each side.
2 Temporal sutures - between the parietal and
temporal bones.
2 Lambdoidal sutures - between the parietal
bones and the occiput. 55
 Importance of sutures
Itpermits gliding movement of one bone over
the other during moulding of the head.

Digital palpation of sagittal suture during internal

examination in labor gives an idea of the manner
of engagement of the head, degree of internal
rotation of the head and degree of moulding of
the head.

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A Fontanel-is the area where two or more sutures meet. There
are 6 fontanel’s in the fetal skull; but only two are important.
The Anterior Fontanel or Bregma - This is found at the
junction of the sagital, coronal, and frontal sutures. It is 3 cm
long, 1.5 cm wide and diamond shaped. It normally closes by
the time the child is 18 months old. Pulsation of the cerebral
vessels can be felt through it. Failure to ossify even after 24
month is pathological.
Importance of anterior fontanel
Its palpation through the internal examination denotes the
degree of flexion of the head
It facilitate moulding of the head
Palpation of the floor reflects intracranial status - depressed
in dehydration, elevated in raised intracranial tension
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 The Posterior Fontanel or Lambda
 This is situated at the junction of the
Lambdoidal and sagital sutures.
 It is small, triangular in shape and normally
closes by the age when the child is 6 wks.
-The main function of posterior fontanel is to
denote the position of head in relation to
maternal pelvis.

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Regions or land marks of the feotal skull

The vertex: -is the area on the fetal head w/c is bounded by the
anterior fontanel, posterior fontanel and the two parietal eminences.
The sinciput or brow:- is the area on the fetal head covering the
frontal bones.
It extends from the anterior fontanel& the coronal suture to the
orbital ridge.
The occiput: -is the area covering the occipital bone.
 It lies between the foramen magnum and the posterior fontanel.
-The part below the occipital protuberance is called the sub-
occipital region.
The face: - it extends from orbital ridges and the root of the nose
(glabella) to the junction of the chin and the neck.
The chin: -is also termed as a mentum and is an important land mark
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 Diameters of the feotal skull
A diameter of the fetal skull is a measurement from one point to another.
There are two types:
Longitudinal
Sub Occipito Bregmatic - 9.5 cm.

Is from below the occipital protuberance to the center of the Bregma.
Sub Occipito Frontal - 10 cm.

From below the occipital protuberance to the center of the frontal suture
Occipito Frontal - 11. 5 cm.

Is from the occipital protuberance to the glabella
Sub Mento Bregmatic - 9.5 cm

Is from the point where the chin joins the neck to the center of the
bregma.
Sub Mento Vertical - 11.5 cm

Is from the point where the chin join the neck to the highest point on the
vertex
Mento Vertical - l3. 5 cm.

Is from the point of the chin to the highest point of the vertex.
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 Transverse

Bi Parietals - 9.5 cm.

-Is measured between the two
parietal eminences.
Bi Temporal - 8.2 cm.
-Is measured between the
furthest points of the coronal
sutures at the temples
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 Presenting Diameters
Sub Occipito – Bregmatic - 9.5cm - engages in a
well flexed vertex presentation.
Sub Occipito - Frontal - 10 cm - engages in a
moderately flexed vertex presentation
Occipito – Frontal - 11. 5 cm - engages in a badly
flexed vertex presentation
Sub Mento - Bregmatic - 9.5 cm - engages in a well
extended face presentation.
SubMento Vertical - 11.5 cm - engages in a badly
extended face presentation
Mento vertical – 13.5 cm – engage in partial
extension brow presentation 62
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