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Development of the
Fetus and Placenta 2
C H A P T E R
LEARNING OBJECTIVES
CONCEPTION
Conception (fertilization) depends upon ovulation, patency of the genital tract
and a proper endometrial growth for the implantation of the fertilized egg in
the uterus. Similarly, the development of spermatid into mature spermatozoa,
a patent passage and proper ejaculation are necessary on the part of the male
(Figure 2.1). Lack of even one of these components can cause infertility, abor-
tion or an abnormal embryo.
Testis Ovary
Primary oocyte
Primary
46, XX
spermatocyte
First 46, XY
meiotic
division
23, X 23, Y
Secondary spermatocytes
Second First meiotic division
meiotic
division
Secondary
23, X 23, X 23, Y 23, Y oocyte 23, X
First polar
body
Second meiotic
division
Sperm
Second polar body
23, X
23, X 23, X 23, Y 23, Y Mature
oocyte 23, X
Oogenesis
In the ovaries, oogenesis occurs before birth and completes only much
later during reproductive years. The primordial germ cells appear in the
yolk sac as early as the fourth week of gestation. The germ cells scatter in
the ovary and the stromal cells surrounding each germ cell form the flat
cells which after puberty develop into granulosa cells. Each unit contain-
ing the germ cells and a surrounding layer of granulosa cells is known as
primordial follicle (Figure 2.2).
The ovary of the fetus is packed with 47 million primordial follicles, but
many degenerate and only 400 000 follicles are present at puberty. During
Oocyte
The primitive ovum or oocyte begins its first meiotic division before birth,
but completes its meiotic division just before ovulation and forms a sec-
ondary oocyte and first polar body. This secondary oocyte is called ovum
after ovulation. The ovum is covered by an acellular structure called the
zona pellucida and scattered group of granulosa cells called corona radiata.
The ovum is picked up by the ovarian fimbria and propelled towards the
ampulla for fertilization.
Spermatogenesis
Spermatogenesis begins at puberty. Once the embryonic testes are formed, the
multiplication of germ cells ends and they enter into resting phase. At puberty,
these germ cells known as spermatogonia (Figure 2.1) start multiplying and
develop into spermatids and spermatozoa. The sperms develop from Sertoli
cells lining the seminiferous tubules. Spermatogenesis takes 72 days, and 18
days in the transport to the male genital tract. Unlike ovulation which occurs
only once a month, spermatogenesis is a continuous process.
Sperm
The sperm consists of a head and tail. The head contains condensed nucleus
and an acrosomal cap. The tail contains a neck, middle piece and end piece.
Fertilization
Fertilization occurs in the Fallopian tube when the sperm meets the ovum. The
ovum can be fertilized for up to 48 hours after release from the ovary, while the
sperm is viable for 3 days after ejaculation.
The sperms travel up the reproductive tract of the female to reach the tubes.
Release of prostaglandin from the sperm cap helps contract the uterine muscle
and makes the sperm reach the ampulla of the tube. Of the 500600 million
sperms released, only one penetrates the zona pellucida of the ovum (Figure
2.3), following which a chemical reaction occurs, making it impossible for other
sperms to penetrate the ovum.
In absence of fertilization, the ovum fails to undergo second meiotic division
and degenerates.
After the fertilization, the chromosome number is restored to 46, and the
zygote (fertilized egg) contains a mixture of paternal and maternal chromo-
somes.
The gonadal sex of the human being is determined by the sex chromosome
of the sperm. Y sex chromosome induces the development of the testes by the
The window of seventh or eighth week of embryonic life. Absence of Y chromosome results in
opportunity for a the development of the ovaries and a female baby by the tenth week. Abnor-
woman to get
pregnant is three
mal chromosome in either ovum or sperm results in infertility, abortion or
days before and 2 abnormal baby.
days after ovulation In an in vitro fertilization (test tube baby), capacitation and fertilization are
because of the developed in a culture medium and the early embryo is transferred into the
lifespan of the
sperms and egg.
uterine cavity during the late secretory phase of the menstrual cycle.
inner cell mass develops into an embryo, yolk sac and amnion, and is referred
as embryonic cell mass (Table 2.1). The trophoblastic layer splits into an outer
layer of nucleated protoplasm without cell outline called the syncytium and
inner layer of large cells called cytotrophoblast or Langhans layer, and converts
a morula into a blastocyst (Figure 2.4).
Polar body
Zona pellucida
Blastomere
Trophoblast
Blastocyst cavity
E. Early blastocyst F. Late blastocyst
Implantation
The blastocyst contains 100 cells, each cell measuring 300 microns. At first,
it lies free in the uterine cavity for 2 days. During that period the zona pel-
lucida degenerates. On the seventh post-fertilization day, the blastocyst gets
implanted and gets embedded in the endometrium.
Following implantation, the trophoblast proliferates to form villi. The syn-
cytial layer penetrates the decidual lining (endometrium) and creates spaces
between the decidual cells and the trophoblastic layer. It also penetrates the
wall of the spiral arteries in the decidua and establishes a communication with
the maternal circulation.
Embryonic stage
During this phase, all the organ systems and the major structures develop,
making the embryo take a recognizable human form. Following the formation
of mesoderm in the third week of development, the bilaminar disc becomes
trilaminar and from it various tissues are formed. The ectoderm develops into
nervous system, skin and its appendages, and the pituitary gland.
The mesoderm forms the bones, cartilages, muscles, cardiovascular system,
suprarenal, kidneys, gonads, salivary glands, pleura, peritoneum and pericar-
dium.
The endoderm forms the epithelial lining of the gastrointestinal tract,
respiratory tract, bladder mucosa, liver, gall bladder and pancreas.
This is the phase of rapid cell division and differentiation. Exposure to terato-
genic agents in this period leads to the maximum fetal defects.
Fetal development
By the eighth post-fertilization week or tenth week from the last menstrual
period, the embryo has developed into a fetus with all identifiable human
features.
Thereafter, the fetus continues its growth in length and weight in a fixed
manner as shown in Table 2.2. The growth is characterized by cellular hyper-
plasia initially followed by hyperplasia and hypertrophy of the organs.
By the 32nd day, the sitting height of the embryo, i.e. crown-rump (CR)
length, is 5 mm. Up to the 55th day, the embryo grows by 1 mm per day and
thereafter.
CR length of 1.5 mm per day can be measured ultrasonically and duration of
gestation gauged. The amniotic sac measures 1 cm and a large yolk sac is seen
by the fifth week.
By the 12th week, the fetus measures 89 cm. During the fourth and fifth month,
the crown-heel (CH) length is gauged by Haases rule, i.e. CH length equals the
square of lunar months. CR length at the fourth month is 4 4 = 16 cm and
25 cm at the fifth month. From the seventh lunar month onwards, the CH length
in centimetres is the number of lunar months multiplied by 5 (Table 2.3).
Weight
The fetal weight increases in a linear fashion up to about 20 weeks. After
that, the fetal weight is influenced by extraneous environment and maternal
nutrition. The average fetal weight at term varies between 2.5 and 3.5 kg and
increases with maternal age and parity. Diabetes causes increased weight and
the baby weighs more than 4.5 kg, whereas multiple pregnancy and hyperten-
sion causes growth-retarded fetus.
The fetal characteristics at various gestational ages are shown in Table 2.2.
At fifth week of amenorrhoea the gestation sac measures 1 cm as seen on ultra-
sound. At 6 weeks, it measures 23 cm and the embryo measures 45 mm. At
8 weeks amenorrhoea, the embryo has grown to 2024 mm.
Decidua vera
Decidua
capsularis
Embryo
Decidua
basalis
Decidual
space
Decidua
Hormonal control
As mentioned earlier, fertilization causes the corpus luteum to persist and con-
tinue secreting progesterone. Progesterone is responsible for decidual growth
and maintenance of pregnancy up to the 10th12th week when the placenta
develops and carries on with the pregnancy.
Suboccipito-bregma
tic
Flexed diameter 9.5 cm
Submento-
vertex
bregmatic l
ca
diameter rti
9.5 cm - ve
to r
en te Brow
M ame
Occipito-frontal d i cm
space 11 cm 14 Deflexed
vertex
Partially
Face deflexed vertex
Occipito-frontal
Glabella diameter
Posterior
Nasion fontanelle
OCCIPUT
Suboccipito-
bregmatic
diameter
Supraoccipito-
mental diameter
Submento-bregmatic
diameter
when the head meets the resistance by the pelvic bones in the pelvis. Thus,
the size of the fetal head is reduced, and this allows an easy delivery. This
physiological moulding of up to 5 mm is beneficial for a safe vaginal delivery.
A normal moulding disappears in a few hours after birth.
Excessive overlapping or moulding can cause harm to the fetal brain, internal
cerebral haemorrhage and fetal death. In a preterm baby, even a slight moulding
can inflict intracranial injury. Therefore, utmost care is required during a vaginal
delivery of a preterm baby.
The anterior fontanelle is called bregma which is a kite-shaped unossified
membrane lying between the two frontal bones in front and the parietal bones
behind. The anterior fontanelle is felt as a depression about 3 2 cm (Figure
2.8). The posterior fontanelle is a depression produced by the occiput bone
being depressed below the posterior borders of the parietal bones (Figure 2.9).
These two fontanelles are of clinical importance. They can be identified during
vaginal examination during labour, and from their position, the presentation
Frontal eminence
The posterior
fontanelle closes at
the third month in
the newborn. The Anterior fontanelle
anterior
fontanelle closes at
about 18 months.
In the newborn, an
increased size of
the fontanelle can
raise the suspicion Parietal eminence
of hydrocephalus. Posterior fontanelle
Whereas, depressed
fontanelle is seen in
dehydration. Figure 2.9 Posterior fontanelle
Occipital bone
Lambdoid suture
Posterior fontanelle
Biparietal diameter
Parietal eminence
Sagittal suture
Frontal bone
Anterior fontanelle
(bregma)
Frontal suture
Caput succedaneum
In the first stage of labour, the pressure of the uterine contractions and the
bony pelvis on the fetal head is through the bag of water, so there is no change
over the scalp. Once the membranes rupture and amniotic fluid is drained, the
fetal scalp comes under the direct compressive forces. The fetal scalp below
the compression develops an effusion or oedema due to obstruction to the
venous blood flow. This swelling is known as caput succedaneum. The size
of the caput depends upon the duration of the pressure. It can be huge in
prolonged labour and premature rupture of membranes. The site of the caput
is related to the fetal presentation. In the left occipito-anterior presentation,
caput forms over the right parietal bone and in the right occipito-anterior pres-
entation, it forms over the left parietal bone. In face presentation, it presents
as a bluish swelling over the face. The caput disappears in 12 days, and leaves
no trace of its ugly appearance.
Caput is recorded as zero when absent, one plus when minimal and two plus
when moderate. The caput is considered excessive when it is three plus and is
a warning sign of prolonged labour.
KEY POINTS
Fertilization occurs in the ampullary portion of the Fallopian tube when the sperm fuses with the ovum.
Implantation occurs around the seventh post-fertilization day.
The endometrium develops into decidua.
The fertilized egg develops into an embryo through the ovular stage which lasts 3 weeks after fertilization.
The embryonic stage extends from the third to eighth week of post-fertilization period. During this period,
inner cell mass and trophoblast develop. The inner cell mass differentiates into trilaminar plate and forms a
fetus.
In the fetal stage, by the tenth week, the fetus continues to grow in length and weight till term.
The trophoblast invades the decidua, creates a choriodecidual space and establishes feto-maternal
circulation by penetrating into the spiral arteries.
The body stalk develops into the umbilical cord.
The fetal skull is the most important structure as it is the largest and least compressible.
The vertex is the leading point on the fetal head.
The diameters of the fetal head are important in determining whether a vaginal delivery is possible.
In the cephalic presentation with a flexed fetal head, the suboccipito-bregmatic diameter is the engaging
diameter and is 9.4 cm.
The flexed fetal attitude presents the smallest diameter of the fetal head to the maternal pelvis.
The part of the fetus closest to the cervix is the presenting part.
The relationship of the fetal axis to the maternal axis is called the lie, and the commonest fetal lie is the
longitudinal lie.
The caput succedaneum forms after the membranes have ruptured.
A large caput is a warning sign of prolonged labour.
MULTIPLE-CHOICE QUESTIONS
1 Which is the process of maturation of the female egg?
A Spermatogenesis
B Conception
C Oogenesis
D Gestation
2 Which is the process of maturation of the sperm?
A Conception
B Gestation
C Oogenesis
D Spermatogenesis
3 The initial mitotic division of the zygote after fertilization results in the formation of which of the following
cells?
A Follicles
B Blastomeres
C Oocytes
D Spermatocytes
4 Which layer helps in the implantation of the zygote?
A Myometrium
B Cortex
C Medulla
D Trophoblast
5 The bones on either side of the vault of the fetal skull are called
A parietal bones
B occipital bones
C frontal bones
D maxilla bones
6 Which suture is situated between the two parietal bones?
A Coronal suture
B Lambdoid suture
C Sagittal suture
D Frontal suture
ESSAY QUESTIONS
1 List the stages of fetal development highlighting the major events.
2 Discuss in brief the process of placental development and functions.