51

BLOCK 2.1
CONCEPTION, FETAL GROWTH &
CONGENITAL ANOMALY







PRACTICAL SESSION OF ANATOMY:
EMBRYOLOGY & FETAL GROWTH



Name : ..................................................................
NIM : ..................................................................
Group : ..................................................................
Date : ..................................................................






Department of Anatomy, Embryology & Anthropology
Faculty of Medicine Gadjah Mada University
Yogyakarta
2012
52

PREFACE

This Anatomy practical sessions support the learning process and content of Block 2.1
(Conception, fetal growth and congenital anomaly) in order to make easier understanding the
human growth and development. The topics of this practical sessions are embryology and
fetal growth (external morphology of fetus).

We hope that after completion the Anatomy practical sessions, students can increase their
capabilities of basic reasoning in learning of the problem of the block 2.1 scenarios and
competencies in skills especially; obstetric physical examination (leoplold examination) and
anatomy imaging (fetal ultrasonogram), fetal gestational age in forensic medicine. For
improving this manual of Anatomy practical session, we accept any correction and suggestion.


Contributor:
Dr. dr. Djoko Prakosa, PA(K)
dr. Dwi Cahyani Ratna Sari, M.Kes.,PA(K)
dr. Efrayim Suryadi, SU.,PA(K).,MHPE
dr. Santosa Budiharjo, M.Kes.,PA(K)
dr. Ch. Tri Nuryana, M.Kes
dr. Mawaddah Ar Rochmah




















53

REGULATION OF ANATOMY PRACTICAL SESSION


1. Two practical sessions supervised by the instructor. Students must attend practical session
(100% attendance). If students are unable to accomplish full (100%) attendance, they are
not allowed to attend the laboratory exam
2. If students are unable to attend one or more practical session because of an acceptable
reason, Students must reschedule practical session before the laboratory exam. The
replacement will be arranged regarding to each block's schedule.
3. Pretest in practical session if twice has score less than half of the highest score will be
given an assignment, which must be submitted one day after the practical session, if not yet
submitted, students not allowed follow the practical examination.
4. In each practical session, a test will be carried out which will influence mark professional
behavior. This test will be used as a proof of attendance and may be conducted at the
beginning or at the end of a practical session, if twice the pretest score is not satisfying
(below half of the highest score), students have to do an assignment and should be
collected before the next practical session.
5. The minimum score to pass the practical session examination is 50%. If the students score
less than 50% (<50%), students should take a remedial practical examination. There is
only once remedial practical examination could be taken. If some students have score
more than 50% (>50%) and want to take remedial examination, they can take remedial
practical examination with permission.
6. The maximum score of remedial practical examination is 70%, if the score>70% will
convert to 70%, if score<70% will not convert(original score).
7. The Anatomy practical sessions end score is the best score taken from the main and
remedial practical examination.
8. Further items regarding to practical session regulation will be informed later.




















54

Laboratory Practical Session I

EMBRYOLOGY

Learning Objective:
1. Identify and describe growth and development of embryo and gastrulation stages

2. Identify and describe growth and development of the brain and cranial nerves in
embryonic period
a. Five stage of early brain and cranial nerves development
b. Embryology of the brain

3. Identify and describe growth and development of face in embryonic period:
a. week 4
th
(length 3,5mm)
b. week 5
th
(length 6,5 mm)
c. week 5,5
th
(length 9 mm)
d. week 6
th
(length 12mm)
e. week 7
th
(length 19mm)
f. week 8
th
( length 28 mm)

A. Identify and describe morphology of embryo (2nd 4th weeks age):

1. Give explanation on the figure 1 using the structures in right column and model GE-1

Figure 1 Embryo Structures












a. Endometrium
b. Chorion
Syncytiotrophoblast
Cytotrophoblast
Mesodermal extraembryonicum
c. Coelom extraembryonicum
d. Connecting stalk
e. Yolk sac (saccus vitellinus)
f. Cavitas amniotica
g. Discus embryonicum trilaminaris







55

2. Give explanation on the figure 2 using the structures in right column and model GE-2
(early gastrulation)

Figure 2 Structures












a. Endometrium
b. Chorion villi choriales
c. Connecting stalk
d. Cavitas amniotica
e. Saccus vitellinus
f. Coelom extraembryonicum
g. Allantois
h. Notochorda
i. Ectoderma & neural plate
j. Mesoderma
Mesoderma cardiogenicum
Mesoderma
Intraembryogenicum
Mesoderma extraembryogenicum
k. Endoderma

3. Give explanation on the figure 3 using the structures in right column and model GE-3 (late
gastrulation)

Figure 3 Structures

a. Chorion frondosum (placenta area)
b. Coelom extraembryonicum
c. Connecting stalk
d. Canalis allantois
e. Flexura cephalica
f. Flexura caudalis
g. Somite (mesoderma)
h. Tubus cardialis
i. Tuba neuralis
j. Cavitas amniotica
k. Stomodeum
l. Membrana buccopharyngeal
m. Pre enteron
n. Mesenteron
o. Metenteron
p. Membrana cloaca






56

B. Identify and describe growth and development of brain and cranial nerves in
embryonal period

1. Give explanation on the figure using the structures in the right column and Brain model
1a& 1b

Figure 4
brain development in embryo 7 mm (week 5)
Structures







Lateral view
a. Prosencephalon
Telencephalon
Diencephalon
b. Mesencephalon
c. Rhombencephalon
Isthmus rhombencephali
Ventriculus quartus (cranial)
Pedunculus cerebellaris superior
Velum medullare anterior
Metencephalon
Pons
Ventriculus quartus (media)
Cerebellum
d. Myelencephalon
medulla oblongata
ventriculus quartus (caudal)
e. Flexura cephalica
f. Flexura pontis
g. Copula optica







Sagital section

Give explanation on the figure using the structures in the right column and brain model 2

Figure 5 human embryo 27 mm (week 8)
(the roof of 4
th
ventricle is removed)
Embryo structures
a. Hemispherium cerebri
b. Insulae
c. Bulbus olfactorius
d. Nervus opticus
e. Hypophysis
f. Mesencephalon
g. Nervus trigeminus
h. Nervus facialis
i. Nervus acusticus
j. Cerebellum extraventricular
k. Cerebellum intraventricular





57

Give explanation on the figure using the structures in the right column and brain model 3 a &
b

Figure 6 brain development in embryo
(week 12 3 months)
Embryo structures


a. Telencephalon
b. Rhinencephalon
c. Lamina Terminalis
d. Thalamus
e. Epithalamus
f. Hypothalamus
g. Hypophysis
h. Chiasma Opticum
i. Corpus Striatum
j. Plexus Choroideus
k. Pedunculus Cerebri
l. Mesencephalon
m. Aqueductus Cerebri
n. Lamina Quadrigemina
o. Metencephalon
p. Isthmus Cerebellum
q. Pons
r. Fossa Rhomboidea
s. Myelencephalon
t. Medulla Oblongata

2. Identify and describe the five stages of early development of brain and cranial nerves
using the structures below & model BC 1s/d 5 as in figure 7 till 11








Figure 7 brain at 20 somites
(3,5 weeks)








Figure 8 brain at embryo 4 mm
(4 weeks)








Figure 9 brain at embryo
8 mm (5,3 weeks)







Figure 10 brain at embryo
17 mm (7 weeks)







Figure 11 brain at embryo 50-
60 mm
(11 weeks)

58


Structures


a. Proencephalon
b. Telencephalon
c. Diencephalon
d. Mesencephalon
e. Rhombencephalon
f. Metencephalon
Pons
Cerebellum
g. Myelencephalon
(medulla oblongata)

h. Nervus I
i. Nervus II
j. Nervus III
k. Nervus IV
l. Nervus V
m. Nervus VI
n. Nervus VII
o. Nervus VIII
p. Nervus IX
q. Nervus X
r. Nervus XI
s. Nervus XII
t. Vesiculla optica
u. Foveolae auditiva
v. Mandibula
w. Hyoid
x. Cor
y. Pharynx


C. Give explanation on the face development using the structures and model FE-1 - 6 as
in figure 12 till 17

Figure 12
Face : week 4
th
(length 3,5mm)
Structures








a. Processus frontonasalis
b. Placode nasalis
c. Oropharyngeal membran
d. Processus maxillaris
e. Arcus pharyngealis 1
(mandibular part)
f. Arcus pharyngealis 2
g. Stomodeum


Figure 13
face at week 5
th
(length 6,5 mm)

Structures










a. Processus frontonasalis
b. Cupula optica
c. Sulcus nasolacrimalis
d. Fovea nasalis
e. Prominentia nasalis medialis
f. Prominentia nasalis lateralis
g. Stomodeum
h. Processus maxillaris
i. Arcus pharyngealis 1
(mandibular part)
j. Arcus pharyngealis 2
k. Arcus pharyngealis 3 & 4

59

Figure 14
face at week 5,5
th
(length 9 mm)

Name of the structures









a. Fovea nasalis
b. Processus nasalis medialis
c. Processus nasalis lateralis
d. Fissura nasooptica
e. Processus maxillaris
f. Arcus mandibullis
g. Arcus hyoideus
h. Fissura hyomandibularis


Figure 15
face at week 6
th
(length 12mm)
Name of the structure










a. Saccus nasalis (nasus)
b. Primary palate & nasal septum
c. Cupula optica
d. rima oris
e. sulcus nasolacrimalis
f. Processus maxillaris (maxilla)
g. Arcus mandibullaris (1st
pharyngeal arc)
h. Arcus hyoideus
i. Meatus acusticus externus (1st
pharyngeal cleft)
j. auricula

Figure 16 face at
week 7
th
(length 19
mm)
Figure 17 face at
week 8
th
( length 28
mm)
Structures


a. Oculus
b. Nasus
c. Philtrum (fusion of processus nasalis
medialis)
d. Site of canalis nasolacrimalis ( fusion of
processus nasalis lateralis and
maxillaris)
e. Site of fusion of processus nasalis
medialis and maxillaris
f. Auricula



















60

Laboratory Practical Session II

FETAL GROWTH

Learning Objective:
1. Identification of the external morphology on 3
rd
, 4, 5, 6, 7, 8, and 9
th
months fetal
age and full term fetus.
2. Identification of the fetal weight and crown-rump length on 3
rd
, 4, 5, 6, 7, 8, and 9
th

months fetal age.
3. Identification of the face development during on 3
rd
, 4, 5, 6, 7, 8, and 9
th
months
fetal age.
4. Identification of the development of external fetal characteristics such as skin,
lanugo, vernix caseosa and nail on 3
rd
, 4, 5, 6, 7, 8, and 9
th
months fetal age
5. Identification of the genitourinary development and differentiation during on 3
rd
,
4, 5, 6, 7, 8, and 9
th
months fetal age.

Practical session guideline:
Identify the external morphology of fetus using fetus model no. 1-8 in the embryology boxes,
and also see the fetal cadaver in the museum fill the description in the table.

1. Identify the external morphology of fetus: growth proportion of head, trunk and
extremity on 3, 4, 5, 6, 7, 8, 9 months fetal age.
External
Morphology
Months
2 3 4 5 6 7 8 9 Full term
Proportion body
segmented to the
whole body:
(Proporsion
head&neck to total
body)
1 : 1 1 : 4
Proportional
(chest width>head
width)

Upper limb
(arm & hand)


Lower limb
(leg & foot)


Lower
limbs
well-
devel
oped

61



2. Identify the fetal weight and crown-rump length on 3
rd
, 4, 5, 6, 7, 8, and 9
th
months
fetal age.
External
Morphology
Months
2 3 4 5 6 7 8 9 Full term
Weight (gr)

2.7
gram
3.2 kg
Crown-Rump
Length (CRL)

5
mm
34.6 cm

62

3. Identify the face development: auricula, eyelids, supercilia, and hair, during on 3
rd
,
4, 5, 6, 7, 8, and 9
th
months fetal age.

External
Morphology
Months
2 3 4 5 6 7 8 9 Full term
Fetus face

Face is
distinc
tly
human
in
appear
ance

Palpebral cleft:
(Closed)
(Open)
Eyelids
close
Eyelids
widely
open

Cilia and supercilia


Auricula

Basi
c ear
struc
ture

Capilli (head hair)

Head
and
body
hair
(lan
ugo)
visib
le




63

4. Identify the development of external characteristics such as skin, lanugo, vernix
caseosa and nail on 3
rd
, 4, 5, 6, 7, 8, and 9
th
months fetal age

External
Morphology
Months
2 3 4 5 6 7 8 9 Full term
Lanugo

Lanugo
visible
Lanugo
almost
absent

Body skin
Wrinkle
Thick
Skin
wrinkled,
translucen
t, pink to
red in
color

Vernix caseosa
Little
Thick
Vern
ix
case
osa
cove
rs
skin

Nail
Available
Tip of finger
Forma
tion of
nail
beds

Radix umbilical cord
(central)





















64

5. Identify the genitourinary development and differentiation during on 3
rd
, 4, 5, 6, 7,
8, and 9
th
months fetal age.

Fill the Genitourinary development and differentiation key events during each month:
Growth and Development
3
rd
month 4
th
month 6
th
month 7
th
, 8
th
, 9
th

Genitourinary
development
and
differentiation
Formation of
kidneys
(metanephros)

Formation of
gonads, ducts
genitalia;
oogonia in
female

Sex
distinguishable
externally

Degeneration of
embryonic
kidneys
(mesonephros)
Descent of testis


References
Cochard Larry R. 2002. Netter's Atlas of Human Embryology. Saunders Elsevier
Philadeplhia.
Moore KL, Persaud TVN, Shiota Kohei. 2000. Color Atlas of Clinical Embryology, 2
nd

edition. Saunders Elsevier Philadeplhia.