STAGES OF FETAL DEVELOPMENT Usually only one of a woman’s ova will reach

• In just 38 weeks, a fertilized egg (ovum) maturity each month. Once the mature ovum is
matures from a single cell to a fully released, fertilization must occur fairly quickly
developed fetus ready to be born. because an ovum is capable of fertilization for
• Fetal growth and development are only 24 hours (48 hours at the most). After that
typically divided into three periods: time, it atrophies and becomes nonfunctional.
− Pre-embryonic (first 2 weeks, Because the functional life of a spermatozoon is
beginning with fertilization) also about 48 hours, possibly as long as 72 hours,
− embryonic (weeks 3 through 8) the total critical time span during which sexual
− fetal (from week 8 through birth) relations must occur for fertilization to be
Terms Used to Denote Fetal Growth successful is about 72 hours (48 hours before
• Ovum ovulation plus 24 hours afterward). As the ovum
is extruded from the graafian follicle of an ovary
− From ovulation to fertilization
with ovulation, it is surrounded by
• Zygot
− a ring of mucopolysaccharide
− From fertilization to implantation
fluid (zona pellucida)
• Embryo
− and a circle of cells (corona
− From implantation to 5–8 weeks
radiata).
• Fetus The ovum and these surrounding cells (which
− From 5–8 weeks until term increase the bulk of the ovum and serve as
• Conceptus protective buffers against injury) are propelled
− Developing embryo or fetus and into a nearby fallopian tube by currents initiated
placental structures throughout by
pregnancy − the fimbriae—the fine, hairlike structures
• Age of viability that line the openings of the fallopian
− The earliest age at which fetuses tubes.
could survive if they were born at A combination of peristaltic action of the tube
that time, generally accepted as 24 and movements of the tube cilia help propel the
weeks, or fetuses weighing more ovum along the length of the tube.
than 400 g. Normally, an ejaculation of semen averages 2.5
mL of fluid containing 50 to 200 million
FERTILIZATION spermatozoa per milliliter, or an average of 400
• also referred to as conception and million sperm per ejaculation. At the time of
impregnation ovulation, there is a reduction in the viscosity
• is the union of an ovum and a (thickness) of the cervical mucus, which makes
spermatozoon. it easy for spermatozoa to penetrate it. Sperm
• This usually occurs in the outer third of a transport is so efficient close to ovulation that
fallopian tube, the ampullar spermatozoa deposited in the vagina generally
reach the cervix within 90 seconds and the outer
FACTORS THAT MAY AFFECT end of a fallopian tube within 5 minutes after
FERTILIZATION: deposition. This is one reason why douching is
➢ equal maturation of both sperm and not an effective contraceptive measure.
ovum Spermatozoa move by the combination
➢ ability of the sperm to reach the ovum movement of their flagella (tails) and uterine
➢ ability of the sperm to penetrate the zona
pellucida and cell membrane and contractions through the cervix➡️body of the
achieve fertilization. uterus➡️fallopian tube toward where the ovum
is.
Capacitation IMPLANTATION
− final process that sperm must undergo to • Once fertilization is complete, a zygote
be ready for fertilization. migrates over the next 3 to 4 days toward
− This process happens as the sperm move the body of the uterus, aided by the
toward the ovum, consists of changes in currents initiated by the muscular
the plasma membrane of the sperm head, contractions of the fallopian tubes.
which reveal the sperm-binding receptor • Mitotic cell division, or cleavage, begins.
sites The first cleavage occurs at about 24
hours; cleavage divisions continue to
All of the spermatozoa that achieve capacitation occur at a rate of about one every 22
reach the ovum and cluster around the protective hours.
layer of corona cells. • By the time the zygote reaches the body
Hyaluronidase (a proteolytic enzyme) is released of the uterus, it consists of 16 to 50 cells.
by the spermatozoa and dissolves the layer of • Morula a bumpy outward appearance
cells protecting the ovum. One reason that an (from the Latin word morus, meaning
ejaculation contains such a large number of “mulberry”). The morula continues to
sperm is probably to provide sufficient enzymes multiply as it floats free in the uterine
to dissolve the corona cells. Under ordinary cavity for 3 or 4 additional days. Large
circumstances, only one spermatozoon is able to cells tend to collect at the periphery of the
penetrate the cell membrane of the ovum. Once ball, leaving a fluid space surrounding an
it penetrates the cell, the cell membrane changes inner cell mass.
composition to become impervious to other • At this stage, the structure becomes a
spermatozoa. An exception to this is the blastocyst. It is this structure that attaches
formation of hydatidiform mole, in which to the uterine endometrium. The cells in
multiple sperm enter an ovum; this leads to the outer ring are trophoblast cells. They
abnormal zygote formation. are the part of the structure that will later
form the placenta and membranes. The
Immediately after penetration of the ovum, the inner cell mass (embryoblast cells) is the
chromosomal material of the ovum and portion of the structure that will form the
spermatozoon fuse to form a zygote. Because the embryo.
spermatozoon and ovum each carried 23
chromosomes (22 autosomes and 1 sex
chromosome), the fertilized ovum has 46
chromosomes.
− If an X-carrying spermatozoon entered
the ovum, the resulting child will have
two X chromosomes and will be female
(XX).
− If a Y-carrying spermatozoon fertilized
the ovum, the resulting child will have an
X and a Y chromosome and will be male
(XY).
Implantation or contact between the growing EMBRYONIC & FETAL STRUCTURES
structure and the uterine endometrium, occurs The placenta, which will serve as the fetal lungs,
approximately 8 to 10 days after fertilization. kidneys, and digestive tract in utero, begins
Ater 3rd to 4th day of free floating (about 8 days growth in early pregnancy in coordination with
since ovulation), the blastocyst sheds the last embryo growth.
residues of the corona and zona pellucida.
The structure brushes against the rich uterine The Decidua
endometrium (in the second [secretory] phase of − Latin word for “falling off”
the menstrual cycle), a process termed After fertilization, the corpus luteum in the ovary
apposition. It attaches to the surface of the continues to function rather than atrophying,
endometrium (adhesion) and settles down into its because of the influence of human chorionic
soft folds (invasion). gonadotropin (hCG), a hormone secreted by the
trophoblast cells. This causes the uterine
The touching or implantation point is usually endometrium to continue to grow in thickness
high in the uterus, on the posterior surface. If the and vascularity, instead of sloug. hing off as in a
point of implantation is low in the uterus, the usual menstrual cycle. The decidua has three
growing placenta may occlude the cervix and separate areas:
make birth of the child difficult (placenta previa). 1. Decidua basalis, the part of the
The blastocyst is able to invade the endometrium endometrium that lies directly under the
because, as the trophoblast cells on the outside of embryo (or the portion where the
the structure touch the endometrium, they trophoblast cells establish communication
produce proteolytic enzymes that dissolve any with maternal blood vessels)
tissue they touch. This action allows the 2. Decidua capsularis, the portion of the
blastocyst to burrow deeply into the endometrium that stretches or
endometrium and receive some basic encapsulates the surface of the
nourishment of glycogen and mucoprotein from trophoblast
the endometrial glands. As invasion continues, 3. Decidua vera, the remaining portion of
the structure establishes an effective the uterine lining
communication network with the blood system
of the endometrium.

Implantation is an important step in pregnancy,

because as many as 50% of zygotes never
achieve it. In these instances, the pregnancy ends
as early as 8 to 10 days after conception, often
before a woman is even aware she was pregnant.
Occasionally, a small amount of vaginal spotting As the embryo continues to grow, it pushes the
appears on the day of implantation because decidua capsularis before it like a blanket.
capillaries are ruptured by the implanting Eventually, the embryo enlarges so much that
trophoblast cells. A woman who normally has a this action brings the decidua capsularis into
particularly scant menstrual flow may mistake contact with the opposite uterine wall (the
implantation bleeding for her menstrual period. decidua vera). Here, the two decidua areas fuse,
If this happens, the predicted date of birth of her which is why, at birth, the entire inner surface of
baby (based on the time of her last menstrual the uterus is stripped away, leaving the organ
hperiod) will be calculated 4 weeks late. Once highly susceptible to hemorrhage and infection.
implanted, the zygote becomes an embryo.
Chorionic Villi ➔ Estrogen
Once implantation is complete, the trophoblastic “hormone of women”
layer of cells of the blastocyst begins to mature (primarily estriol) is produced as a second
rapidly. As early as the 11th or 12th day, product of the syncytial cells of the
miniature villi that resemble probing fingers, placenta. Contributes to the woman’s
termed chorionic villi, reach out from the single mammary gland development in
layer of cells into the uterine endometrium to preparation for lactation and stimulates
begin formation of the placenta. At term, almost uterine growth to accommodate the
200 such villi will have formed. developing fetus.
All chorionic villi have a central core of
connective tissue and fetal capillaries. A double ➔ Progesterone.
layer of trophoblast cells surrounds these. “hormone of mothers”
The outer of the two covering layers is the Maintain the endometrial lining of the
syncytiotrophoblast, or the syncytial layer. This uterus during pregnancy. reduce the
layer of cells produces various placental contractility of the uterus during
hormones, such as: pregnancy, preventing premature labor.

➔ hCG (human chorionic Gonadotropin) ➔ Hpl (Human Placental Lactogen /Human

1st hormone to be produced found in Chorionic Somatomammotropin).
maternal blood and urine as early as the a hormone with both growth-promoting
first missed menstrual period, o act as a and lactogenic (milk-producing)
fail-safe measure to ensure that the corpus properties. It is produced by the placenta
luteum of the ovary continues to produce beginning as early as the sixth week of
progesterone and estrogen. This is pregnancy, increasing to a peak level at
important because, if the corpus luteum term. It can be assayed in both maternal
should fail and the level of progesterone serum and urine. It promotes mammary
fall, the endometrial lining will slough gland (breast) growth in preparation for
and the pregnancy will be lost. lactation in the mother. It also serves the
Play a role in suppressing the maternal important role of regulating maternal
immunologic response so that placental glucose, protein, and fat levels so that
tissue is not detected and rejected as a adequate amounts of these nutrients are
foreign substance. Because the structure always available to the fetus (Taylor &
of hCG is similar to that of luteinizing Lebovic, 2007).
hormone of the pituitary gland, if the fetus
is male, it exerts an effect on the fetal The middle layer, the cytotrophoblast or
testes to begin testosterone production. Langhans’ layer, is present as early as 12 days’
The presence of testosterone causes gestation. It appears to function early in
maturation of the male reproductive tract. pregnancy to protect the growing embryo and
At about the eighth week of pregnancy, fetus from certain infectious organisms such as
the outer layer of cells of the developing the spirochete of syphilis. This layer of cells
placenta begins to produce progesterone, disappears, however, between the 20th and 24th
making the corpus luteum, which was weeks. This is why syphilis is not considered to
producing progesterone, no longer have a high potential for fetal damage early in
necessary. In coordination with this, the pregnancy, only after the point at which
production of hCG, which sustained the cytotrophoblast cells are no longer present. The
corpus luteum, begins to decrease at this layer appears to offer little protection against
point. viral invasion at any point.
The Placenta woman take no nonessential drugs
− Latin word for “pancake” which is (including alcohol and nicotine) during
descriptive for its size and appearance. pregnancy
− arises out of the continuing growth of Mechanisms by which nutrients cross the
trophoblast tissue placenta
− Its growth parallels that of the fetus, • Diffusion
growing from a few identifiable cells at When there is a greater concentration of a
the beginning of pregnancy to an organ 15 substance on one side of a semipermeable
to 20 cm in diameter and 2 to 3 cm in membrane than on the other, substances
depth, covering about half the surface of correct molecular weight cross the
area of the internal uterus at term membrane from the area of higher
concentration to the area of lower
concentration. Oxygen, carbon dioxide,
Circulation sodium, and chloride cross the placenta
− As early as the 12th day of pregnancy, by this method.
maternal blood begins to collect in the
intervillous spaces of the uterine
endometrium surrounding the chorionic • Facilitated diffusion
villi. To ensure that a fetus receives sufficient
− By the third week, oxygen and other concentrations of necessary nutrients,
nutrients, such as glucose, amino acids, some substances cross the placenta
fatty acids, minerals, vitamins, and water, guided by a carrier so move more rapidly
osmose from the maternal blood through or easily than would occur if only simple
the cell layers of the chorionic villi into diffusion were operating. Glucose is an
the villi capillaries. From there, nutrients example of a substance that crosses by
are transported to the developing embryo. this process.
− Placental osmosis is so effective that all • Active transport
except a few substances are able to cross This process requires the action of an
from the mother into the fetus. Because enzyme to facilitate transport. Essential
almost all drugs are able to cross into the amino acids and water-soluble vitamins
fetal circulation, it is important that a cross the placenta by this process. The
 process ensures that a fetus will have blood to the placenta. In the intervillous spaces,
adequate amino acid concentrations for maternal blood jets from the coiled or spiral
fetal growth. arteries in streams or spurts and then is propelled
• Pinocytosis from compartment to compartment by the
This is absorption by the cellular currents initiated. As the blood circulates around
membrane of microdroplets of plasma the villi and nutrients osmose from maternal
and dissolved substances. Gamma blood into the villi, the maternal blood gradually
globulin, lipoproteins, and phospholipids loses its momentum and settles to the floor of the
all have molecular structures too large for cotyledons. From there, it enters the orifices of
diffusion so cross in this manner. maternal veins located in the cotyledons and is
Unfortunately, viruses that then infect the returned to the maternal circulation. Braxton
fetus can also cross in this manner. Hicks contractions, the barely noticeable uterine
contractions that are present from about the 12th
All of these processes are influenced by maternal week of pregnancy, aid in maintaining pressure
blood pressure and the pH of the fetal and in the intervillous spaces by closing off the
maternal plasma. A potential complication of uterine veins momentarily with each contraction.
twins is that nutrients vessels may fuse in utero, Uterine perfusion, and thus placental circulation,
causing one twin to receive more blood than the is most efficient when the woman lies on her left
other (twin-to-twin transfusion). side. This position lifts the uterus away from the
For practical purposes, because the process of inferior vena cava, preventing blood from being
osmosis is so effective, there is no direct trapped in the woman’s lower extremities. If the
exchange of blood between the embryo and the woman lies on her back and the weight of the
mother during pregnancy. Because the outer uterus compresses the vena cava, placental
chorionic villi layer is only one cell thick after circulation can be so sharply reduced that supine
the third trimester minute breaks do occur and hypotension (very low maternal blood pressure
allow occasional fetal cells to cross into the and poor uterine circulation) occurs (Knuppel,
maternal bloodstream, as well as fetal enzymes 2007). At term, the placental circulatory network
such as alpha-fetoprotein (AFP) from the fetal has grown so extensively that a placenta weighs
liver. 400 to 600 g (1 lb), onesixth the weight of the
As the number of chorionic villi increases with baby. If a placenta is smaller than this, it suggests
pregnancy, the villi form an increasingly that circulation to the fetus may have been
complex communication network with the inadequate. A placenta larger than this may also
maternal blood. Intervillous spaces grow larger indicate that circulation to the fetus was
and larger, becoming separated by a series of threatened, because it suggests that the placenta
partitions or septa. In a mature placenta, there are was forced to spread out in an unusual manner to
as many as 30 separate segments, or cotyledons. maintain a sufficient blood supply. The fetus of a
These compartments are what make the maternal woman with diabetes may also develop a larger-
side of the placenta look rough and uneven. than-usual placenta from excess fluid collected
About 100 maternal uterine arteries supply the between cells.
mature placenta. To provide enough blood for
exchange, the rate of uteroplacental blood flow Placental Proteins
in pregnancy increases from about 50 mL/min at The placenta also produces several plasma
10 weeks to 500 to 600 mL/min at term. No proteins. The function of these has not been well
additional maternal arteries appear after the first documented, but it is thought that they may
3 months of pregnancy; instead, to accommodate contribute to decreasing the immunologic impact
the increased blood flow, the arteries increase in of the growing placenta through being part of the
size. The woman’s heart rate, total cardiac complement cascade (Knuppel, 2007).
output, and blood volume increase to supply
The Amniotic Membranes the two most common reasons), excessive
The chorionic villi on the medial surface of the amniotic fluid, or hydramnios (more than 2000
trophoblast (those that are not involved in mL in total, or pockets of fluid larger than 8 cm
implantation, because they do not touch the on ultrasound), will result. Hydramnios also
endometrium) gradually thin, leaving the medial tends to occur in women with diabetes, because
surface of the structure smooth (the chorion hyperglycemia causes excessive fluid shifts into
laeve, or smooth chorion). The smooth chorion the amniotic space (Bush & Pernoll, 2007). Early
eventually becomes the chorionic membrane, the in fetal life, as soon as the fetal kidneys become
outermost fetal membrane. Its purpose is to form active, fetal urine adds to the quantity of the
the sac that contains the amniotic fluid. A second amniotic fluid. A disturbance of kidney function
membrane lining the chorionic membrane, the may cause oligohydramnios, or a reduction in the
amniotic membrane or amnion, forms beneath amount of amniotic fluid (less than 300 mL in
the chorion (Fig. 9.4). Early in pregnancy, these total, or no pocket on ultrasound larger than 1
membranes become so adherent that they seem cm) (Knuppel, 2007). The most important
as one at term. At birth they can be seen covering purpose of amniotic fluid is to shield the fetus
the fetal surface of the placenta, giving that against pressure or a blow to the mother’s
surface its typically shiny appearance. There is abdomen. Because liquid changes temperature
no nerve supply, so when they spontaneously more slowly than air, it also protects the fetus
rupture at term or are artificially ruptured, from changes in temperature. As yet another
neither woman nor child experiences any pain. In function, it aids in muscular development,
contrast to the chorionic membrane, the amniotic because it allows the fetus freedom to move.
membrane not only offers support to amniotic Finally, it protects the umbilical cord from
fluid but also actually produces the fluid. In pressure, protecting the fetal oxygen supply.
addition, it produces a phospholipid that initiates Even if the amniotic membranes rupture before
the formation of prostaglandins, which can cause birth and the bulk of amniotic fluid is lost, some
uterine contractions and may be the trigger that will always surround the fetus in utero, because
initiates labor. Occasionally, fibrous amniotic new fluid is constantly formed. Amniotic fluid is
bands that can constrict an arm or leg of the fetus slightly alkaline, with a pH of about 7.2.
form in utero. These can close off the blood Checking the pH of the fluid at the time of
supply to the distal extremity and cause growth rupture helps to differentiate it from urine, which
of the extremity to halt at that point (Kumar, Das, is acidic (pH 5.0–5.5).
& Kumar, 2007).
The Umbilical Cord
The Amniotic Fluid The umbilical cord is formed from the fetal
Amniotic fluid is constantly being newly formed membranes (amnion and chorion) and provides a
and reabsorbed by the amniotic membrane, so it circulatory pathway that connects the embryo to
never becomes stagnant. Some of it is absorbed the chorionic villi of the placenta. Its function is
by direct contact with the fetal surface of the to transport oxygen and nutrients to the fetus
placenta. The major method of absorption, from the placenta and to return waste products
however, occurs because the fetus continually from the fetus to the placenta. It is about 53 cm
swallows the fluid. In the fetal intestine, it is (21 in) in length at term and about 2 cm (3 ⁄4 in)
absorbed into the fetal bloodstream. From there, thick. The bulk of the cord is a gelatinous
it goes to the umbilical arteries and to the mucopolysaccharide called Wharton’s jelly,
placenta, and it is exchanged across the placenta. which gives the cord body and prevents pressure
At term, the amount of amniotic fluid has on the vein and arteries that pass through it. The
increased so much it ranges from 800 to 1200 outer surface is covered with amniotic
mL. If for any reason the fetus is unable to membrane. An umbilical cord contains only one
swallow (esophageal atresia or anencephaly are vein (carrying blood from the placental villi to
the fetus) but two arteries (carrying blood from
the fetus back to the placental villi). The number
of veins and arteries in the cord is always
assessed and recorded at birth because about 1%
to 5% of infants are born with a cord that
contains only a single vein and artery. From 15%
to 20% of these infants are found to have
accompanying chromosomal disorders or
congenital anomalies, particularly of the kidney
and heart (Lubusky et al., 2007). The rate of
blood flow through an umbilical cord is rapid
(350 mL/min at term). The adequacy of blood
flow (blood velocity) through the cord, as well as
that of both systolic and diastolic cord pressure,
can be determined by ultrasound examination
during pregnancy. Blood can be withdrawn from
the umbilical vein or transfused into the vein
during intrauterine life for fetal assessment or
treatment (termed percutaneous umbilical blood
sampling [PUBS]). Because the rate of blood
flow through the cord is so rapid, it is unlikely
that a cord will twist or knot enough to interfere
with the fetal oxygen supply. In about 20% of all
births, a loose loop of cord is found around the
fetal neck (nuchal cord) at birth. If this loop of
cord is removed before the newborn’s shoulders
are born, so that there is no traction on it, the
oxygen supply to the fetus remains unimpaired
(Jackson, Melvin, & Downe, 2007). The walls of
the umbilical cord arteries are lined with smooth
muscle. Constriction of these muscles after birth
contributes to hemostasis and helps prevent
hemorrhage of the newborn through the cord.
Because the umbilical cord contains no nerve
supply, it can be cut at birth without discomfort
to either the child or woman.