Unit 3

GROWTH & DEVELOPMENT

OF THE FETUS
&
ASSESSMENT OF FETAL WELL-
BEING
Fertilization
Conception occurs not as an isolated event, but as a
part of a sequential process
- Gametes formation (egg and sperm)
- Ovulation
- Union of the gametes
- Implantation in the uterus

At ovulation , the ovum is released from the ruptured

ovarian follicle. High estrogen levels increase the
motility of the uterine tubes so that their cilia are
able to capture the ovum and propel it forward.

Ova are considered fertile for approximately 24 hours

after release – if unfertilized the ovum degenerates
and is reabsorbed.
Fertilization
- Ejaculation during intercourse normally
propels about 200-500 million sperm.
- Sperm remain viable within the
woman's reproductive system for an
average of 2–3 days!
- Sperm can reach an egg in as little as 5
minutes, however the average transit
time is 4-6 hours.
- Once the sperm penetrates the ovum,
the cell membrane changes and doesn’t
allow other sperm in.
- Once sperm penetrates the ovum the
chromosomal material fuses a zygote is
formed
 Fertilization
Fertilization is never a certain occurrence.
1.Equal maturation of both sperm and ovum
2.Ability of the sperm to reach the ovum
3.The ability of the sperm sperm to penetrate
the ovum and reach fertilization
Fertilization: Takes place in the
outer third of the fallopian tube, near
the ovary
 IMPLANTATION
 Zygote
 Undergoes rapid cell division/ 3-4 days
 Blastocyst
 Stem cells are derived from the inner
cell mass, the out cells become the
trophoblast
 Trophoblast
 The trophoblast cells displace
endometrial cells at the implantation
site and the blastocyst embeds in the
endometrium (6-10 after feralization)
 The First Stage of Fetal
Development

 Pre-embryonic
 Lasts from conception until day 14
 This period covers cellular replication,
blastocyst formation, initial development of
the embryonic membranes, and
establishment of the primary germ layers.
The Second Stage of Fetal
Development
 Embryonic
 Lasts from approximately day 15 to 8
weeks after conception.
 This is the most critical time for the
development of the organ systems and
the main external features.
 Developing areas with rapid cell division
are the most vulnerable areas to
malformation caused by teratogens.
The Third Stage of Fetal
Development
 Fetal
 This stage lasts from 9 weeks until the
end of the pregnancy.
 Changes during this period are not as
dramatic because refinement of the
structure and function is taking place.
 The fetus is less vulnerable to
teratogens, except those that affect the
central nervous system.
Embryonic structures
 Chorionic villi
 Formed from the blastocyst after implantation is complete
 Reach into the uterine endometrium and begin forming the
placenta
 Placenta
 Grows out of the trophoblast tissue
 Oxygen and other nutrients (e.g. glucose) move from
maternal blood through chronic villi to embryo
 Serves as the fetal lungs, kidneys and digestive tract while
in utero
 By term the placenta weighs 400-600 grams
 Decidua
 The thickening of the endometrium wall. This is
sloughed off after birth
 Amniotic Membranes
 Chorion
 Tough tick membrane covering the amnion,
embryo & yolk sac, closest to the uterine
wall, gives rise to the placenta
 Amnion
 Thinner membrane envelops and protects and protects the
embryo. The amnion and chorion form amniotic sac
 Produces amniotic fluid
 Yolk sac
 Only supplies nourishment until
implantation after that supplies source of
RBC’s until fetal system is mature enough to
produce own (12th week of intrauterine life)
 Germ layers
 Ectoderm, mesoderm, and endoderm
 Prenatal development
Placenta
 Organ for fetal
respiration, nutrition,
and excretion
 Maternal side forms
where the blastocyst
burrows into the uterine
lining
 Fetal side formed by
thick chorionic villi
 Produces many
hormones
 Progesterone
 Estrogen
 hCG – human chorionic
gonadotropin
 hPL: human placental
lactogen hPL
 Amniotic Fluid EXAM
 Amniotic fluid
 is clear, colourless
 maintains even temp
 prevents sac from adhering to embryo
 Constantly being made
 allows for movement, symmetrical development
 cushions to protect fetus/baby
 Temperature
 30 mL -10weeks
 350ml – 20weeks
 1200ml – TERM
 Umbilical Cord
 Umbilical Cord is made up of 2 Arteries and 1 Vein. It
is approximately 22 inches long and covered in
Wharton’s jelly (protection).

 Provides circulation between embryo – chorionic villi

of placenta – mom.
 Transports oxygen and nutrients to fetus from
placenta
 Transports waste away from fetus to placenta
 1 vein carries oxygenated blood to fetus
 2 arteries carries deoxygenated blood from fetus to
placenta
 Wharton’s jelly (mucopolysaccharide) makes up the
bulk of the cord and provides protection
 Umbilical cord has no nerve cells
Maternal-Fetal Circulation
Fetal & Maternal blood do not generally mix
Maternal blood spurts into intervillous spaces in the
decidua
Thin placental membranes separate maternal from
fetal blood.
Membrane not always an effective barrier –
substance cann cross…. Only thing that does not
cross is insulin!
 Fetal Circulation
 Fetal circulation is different from extrauterine
circulation.
 *EXAM 3 shunts in place to aid intrauterine
circulation that then close after birth.
 Ductus venosus- Allows blood to go through the
umbilical vein, and on the other side it meets up
with the inferior vena cava (large vein picking up
blood from legs), this blood dumps into the right
atrium
 Foramen ovale – Allows blood to go from one
atrium over to the other, due to increased
pressure on the right side of the heart
 Ductus arteriosus – pulmonary artery to aorta
(pulmonary artery has high pressure

Blood does not go in baby lungs because of high pressure

 Fetal Circulation
Ductus venosis
 Oxygenated blood enters fetus thru umbilical
vein and supplies brain, liver, heart, kidneys –
but most of blood is shunted via the ductus
venosus to the inferior vena cava . Shunted to
major organs
Foramen ovale
 Diverts blood from the Right atrium to the Left
Atrium bypassing the lungs; Small amount of
blood goes into Right Ventricle and to lungs
for nutrition only. Blood does not need to go
into lungs
Ductus arteriosus
 diverts blood from pulmonary artery into
descending aorta. (Remember: babe is not
breathing therefore not expanding lungs and
thus blood supply not needed). Goes through
the body system
 Respiratory System
 Alveoli and capillaries begin to form
between 24-28 weeks
 Spontaneous respiratory movements begin
at 3 months gestation
 Surfactant-formed at about 24 week-it
prevents alveolar collapse and improves
infant’s ability to maintain respirations
outside the womb
 36 weeks, mature
 LS ratio: 2:1 means baby is adequate or
baby gets betamethozone
 Nervous and Endocrine
 Nervous system develops early in
pregnancy-3-4 weeks of intrauterine life
 By 24 weeks, the ears are capable of
responding to sound
 As soon as endocrine organs mature in
utero –function begins
 Neural tube defects (most common are
spina bifida and anencephaly) can occur
because of a lack of folic acid prenatally.
 Fetal pancreas produces insulin as maternal
insulin does not cross the placenta.
 Digestive System
 Digestive tract grows rapidly
 Meconium (collection of wastes, bile, fats etc)
accumulates in the intestines as early as 16
weeks
 Meconium is sticky and is black in color
 GI tract is sterile before birth
 Vitamin K is synthesized by action of bacteria
in intestines-therefore vitamin k levels are low
at birth
 Remaining Systems
 Musculoskeletal system
 Week 12 = ossification of cartilage into bone
 Reproductive system
 Sex determined at conception
 At 6 weeks either ovaries or testes are formed
 Urinary system
 Rudimentary kidneys formed at 4 weeks
 Urine is formed by 12 weeks and excreted into the amniotic fluid by
16 weeks
 Integumentary system
 Vernix is formed at approx. 20 weeks (white cheesy)
 Lanugo covers body by 21 weeks (
 Immune system
 Maternal antibodies cross placenta to fetus at approx. 20 weeks to
give fetus temporary passive immunity. Levels peak at birth and then
decrease over next 8 months.
Milestones of Fetal Growth – 4 weeks
 Heart develops, double chamber are visible
and begins to beat

 Primary lung buds appear

 Rudimentary ureteral buds appear

 Genital ridge appears (5th week)

 0.4 – 0.5 cm crown to rump

 Weighs 0.4 g
Milestones of Fetal Growth – 8 weeks

 Body is fairly well formed: nose flat, eyes far

apart, digits well formed, eyes, ears, nose and
mouth are now recognizable.
 2.5 – 3 cm
 Weighs 2 g
 First indication of ossification
 Spinal Cord extends along entire length of spine
 Testes and ovaries are distinguishable, however
the external structures remain sexless (they are
however beginning to differentiate)
 Intestinal villi are developing, small intestines coil
within the umbilical cord. Needs the room to grow
 Organs are formed
Milestones of Fetal Growth – 12
weeks
 Nails appearing, head erect but disproportionally
large
 Skin is pink and delicate
 Intestine have withdrawn from the umbilical cord
and assume characteristic position
 Blood is forming in marrow
 Kidney is able to secrete urine
 Brain structural configuration is almost complete
 Earliest taste buds are formed
Milestones of Fetal Growth – 16
weeks
 Urine is present in the amniotic fluid
 Arm/leg ratio is now proportionate
 Meconium is in the bowel
 Anus is open
 Heart muscle is well developed
 11.5 – 13.5 cm in length
 weighs100 g
 Sex can be determined by Ultrasound
Milestones of Fetal Growth – 20
weeks
 Vernix caseosa and lanugo (hair) appear.
 Legs lengthen considerably
 Ascending colon is now recognizable
 Sternum Ossifies
 Primitive respiratory like movements begin
 The brain is grossly formed and cord myelination
occurs
 Brown fat begins to form and will aid in
temperature regulation at birth.
Milestones of Fetal Growth – 24
weeks
 Active production of surfactant has begun
 Fetus “practices” breathing by inhaling amniotic
fluid into it’s lungs
 Body is lean, but fairly well proportioned
 Blood formation increases in bone marrow and
decreases in the liver
 Is able to hear sounds
 23 cm in length
 Weighs 600 g
Milestones of Fetal Growth – 32
weeks
 Subcutaneous fat is beginning to collect, more
rounded appearance
 Begins to move into the birth position
 Sense of taste present, aware of sounds
 Testes are descending into the scotum
 Weighs1800 – 2100g
 Is approx. 31 cm in length
Milestones of Fetal Growth
38 – 40 weeks
 Now 7-8lbs
 At birth the cord will slowly
stop pulsating
 Placenta will detach from
the inside of the uterus
 The baby's breathing will
trigger changes in the
structure of the heart &
will bypass arteries which
will force all blood to now
travel through the lungs.
 Twin pregnancy:
Occurs once in 90 pregnancies

Monozygotic Twins Dyzgotic Twins

 Identical  Fraternal
 one fertilized ovum divides  2 separate ova, 2 separate
sperm
 may share placenta, chorion
& amnion.  2 chorions, 2 amnions and 2
placentas, (placentas and
 Risk of prematurity due to
chorions sometimes fuse)
over distended uterus
 Risks are the same
 Growth restriction due to
placental insufficiency
Assessing Fetal Growth &
Wellbeing
 Reasons for testing
 Predict outcome of pregnancy
 Manage remaining weeks of pregnancy
 Plan for possible complications at birth
 Plan for problems that may occur in newborn
 Decide whether to continue pregnancy
 Find conditions that may affect future pregnancies
 Fetal Wellbeing
 How do YOU know that the fetus is doing well and meeting its
growth and development milestones?
 SFH; symphysis fundal height (Macdonald’s rule)
 Used to monitor fetal growth
 Most accurate 18-30 weeks
 Inaccurate during 3rd trimester due to fetus growing more in weight
than height
 What SIMPLE assessments could you do in order to determine
health of the fetus?
 Fetal Heart rate – what is the ‘normal range’? 110- 160 *EXAM
 Non-stress test monitoring
 Fetal movements are monitored ensuring appropriate acceleration in FHR.
Same time a day 6-10 movements an hour. Semi reclined or on left side or
they do not bottom out
 Average 10-12 movements in a one hour period
 What questions would you ask the mother?
diet, smoking, vegetarians
 Fetal Wellbeing-Assessment
 Health history
 Nutritional intake
 Smoking
 ETOH
 Exercise
 Any past medical history of disease
 What are some things that put the pregnancy at risk?

 Physical examination
 Symphysis fundal height
 Fetal movement at appropriate gestational age
 Kick counting
 Assessing Fetal Wellbeing
 Fetal well-being
 Ultrasonography
 Blood tests
 First trimester screen – Nuchal translucency
(fetal anomolize) 11 – 14 weeks
 Second trimester screen – Maternal serum alpha
fetoprotein (neuro tubal defects) 15 – 22 weeks
however 16 – 18 weeks ideal
 Fetal movement (kick counts)
 Fetal heart rate
 Biophysical profile
 Assessment of Fetal Well
being
 One can gather much information about fetal health and
well being
 Ensure consent signed if needed, explain any
procedures
 Provide support during procedures
 Assess maternal and fetal response during and post
procedure

 Amniocentesis:
 Procedure to obtain amniotic fluid sample containing fetal
cells
 What are the risks involved with Amniocentesis?
 TERATOGENS

 Adversely affects the fertilized

ovum, embryo, fetus
 Can be:
 Viral, bacterial, chemical, radiation, live virus vaccines

 Diseases that cross the placenta:

TORCH
 Toxoplasmosis, rubella, cytomegalovirus, herpes simplex
virus. (This could also include HIV, syphilis, hepatitis B)
 Many other viral diseases
 Teratogens
 Maternal infections that affect the fetus
 Toxoplasmosis
 A protozoan infection spread through contact, Found in uncooked meat and cat
stool
 Rubella
 It’s a virus. Major organ damage. All pregnant omen should avoid other children
with rashes, hearing impairment, IUGR, cleft lip/palate
 Cytomegalovirus
 Member of the herpes family. Causes extensive damage in the fetus with very
little symptoms for mother. Slight malaise. Wash hands before eating avoid lots
of children at nursey school or daycare. Hydrocephalus, liver disease
 Herpes simplex virus
 Genital herpes- Primary first episode during pregnancy poses risk to babe
( miscarriage, premature birth, congenital abnormality) and will cross the
placenta and damage baby. If has history of genital herpes then subsequent out
breaks do not cross placenta as mom has antibodies and outbreak not so
severe. However, if have lesion or sore when in labor then deliver baby by
cesarean birth so baby does not come into contact with lesion.
 Syphilis
 Puts fetus at risk for intrauterine or congenital syphilis a pregnancy fetus at risk
16-18 weeks if left untreated will cause hearing impairment, cognitive challenges
, fetal death (should have serologic testing done at first prenatal visit.
 Teratogens
 Infections that cause illness at birth
 Gonorrhea
 Candidiasis
 Chlamydia
 Streptococcus B
 Teratogens
 Live virus vaccines
 Herbs
 herbal supplements all freely cross placenta. Herbs are
unregulated (e.g., ginseng-birth defects)
 Alcohol
 FAS, craniofacial deformity, cognitive impairment-no amount
safe
 Tobacco
 Tobacco growth restriction, increase risk for still birth, (get
vasoconstriction of uterine vessels)
 Recreational drugs
 Environmental Teratogens
 Metal and Chemical Hazards
 Radiation

 Implantation to 6 weeks most damaging

time for exposure and the nervous
system is most affected (tissue high
affinity for teratogens)
Teratogens

Nursing Care of Pregnant Client:

Teaching about fetus at various points in
pregnancy to help parents visual coming newborn
Teaching about healthy behaviors
Showing ultrasound to help initiate bonding
Individualize care