stages of fetal development.pptx

8/11/2019 STAGES OF FETAL DEVELOPMENT.pptx

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By: Melissa D. Sarmiento, RN, RM, MSN


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THREE PERIODS OF FETAL GROWTH &

DEVT.

1. Pre- embryonic

2. Embryonic

3. Fetal


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I. FERTILIZATION

Ampulla portion of the fallopian tube where

fertilization takes place

72 hours total critical time span during

which sexual relations must occur for

fertilization to be successful


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1. ZONA PELLUCIDA

2. CORONA RADIATA

FIMBRIAEfine hairlike structures that lines theopenings of the fallopian tubes

FLAGELLAtail of the spermatozoa

HYALURONIDASEprotective enzyme releasedby

the spermatozoa and acts to dissolve the

layers of cell protecting the ovum


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HYDATIDIFORM MOLE (H-MOLE) multiple

sperm enter the ovum that leads to

abnormal growth

FERTILIZATION IS NEVER CERTAIN, ITDEPENDS ON THREE SEPARATE FACTORS

1. Equal maturation of both sperm and ovum

2. Ability of the sperm to reach the ovum3. Ability of the sperm to penetrate the zona

pellucida and cell membrane


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II. IMPLANTATION contact between thegrowing structure and the endometrium

- occurs approximately 8-10 days afterfertilization

3-4 days zygote migrates towards the body ofthe uterus

MORULA the zygote that reaches the body of

the uterusBLASTOCYSTstructure that attaches to the

uterine endometrium leaving a fluid spacesurrounding an inner cell mass


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TROPHOBLASTcells in the outer ring

PARTS THAT WILL FORM THE PLACENTA

AND MEMBRANE1. Blastocyst

2. Trophoblast

EMBRYOBLAST CELL portion of the structurethat

will form the embryo


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APPOSITION process whereby the blastocyst

brushes against the rich uterine

endometrium in the secretory phase

ADHESION blastocyst attaches to the surface

of endometrium

INVASIONblastocyst settles down into its soft

folds


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EMBRYOthe implanted zygote

III. EMBRYONIC

DECIDUAendometrium growing in thickness

and vascularity

3 SEPARATE AREAS OF THE DECIDUA

1. Decidua Basalis

2. Decidua Capsularis

3. Decidua Vera


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About the 10thto 14thday of conception, theblastocyst cells differentiate into the primarygerm layers

1. Ectoderm2. Mesoderm

3. Endoderm


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CHORIONfirst and outermost membrane toform

CHORIONIC VILLI miniature villi or probing

fingers on the surface of the chorion- at term almost 200 villi will have formed

LAYER OF TROPHOBLAST CELL IN THE

CHORIONIC VILLI DIFFERENTIATION1. Syncytiotrophoblast (Syncytial layer)

2. Cytotrophoblast (Langhanslayer)


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Begins to form at the time of implantation

A. THE PLACENTA

- arises out of trophoblast tissue

- 15-20 cm in diameter and 2-3 cm in

depth at term

- serves as the fetal lungs, kidneys, GI tract

and as a separate endocrine organ

throughout pregnancy


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2 PARTS OF THE PLACENTA

1. maternal portion

2. fetal portion


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CIRCULATION

As early as the 12thday of pregnancy, maternalblood begins to collect in the intervillous spaces

of the uterine endometrium surroundingchorionic villi

By the 3rdweek, oxygen and other nutrientsand water diffuse from the maternal bloodthrough the cell layers of the chorionic villi tothe villi capillaries; nutrients are thentransported back to the developing embryo


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COTYLEDONS 30 separate segments in a

mature placenta; makes the maternal side

of the placenta at term look rough and

uneven

100 MATERNAL UTERINE ARTERIES supply

the mature placenta


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1. hCG

2. Estrogen

3. Progesterone

4. Human Placental Lactogen

B. UMBILICAL CORD formed from the fetal

membranes and provides a circulatorypathway that connects the embryo to the

chorionic villi of the placenta


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Transport oxygen and nutrients to the fetusfrom placenta and to return waste productsfrom the fetus to the placenta

About 53 cm in length at term and about 2 cmthick

WHARTONS JELLY a gelatinous

mucopolysaccharide which gives the cord body

and prevents pressure on the veins and arteries

that pass through it


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C. AMNIOTIC MEMBRANES (AMNION)

- second membrane lining the chorionic

membrane and forms beneath the chorion

Chorionic membranes outermost fetalmembranes; arises from the smooth chorion leftby the chorionic villi not involved in

implantation


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D. AMNIOTIC FLUID

- constantly being newly formed by the

amniotic membrane

- 800 to 1,200 ml at term

HYDRAMNIOS excessive amniotic fluid

OLIGOHYDRAMNIOSreduction in the

amountof amniotic fluid


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Important protective mechanism for the fetus

Protects fetus from changes in temperature

Aids in muscular development

Protects umbilical cord from pressure


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PREGNANCY IS CALCULATED TO LASTAN AVERAGE OF 10 LUNAR MONTHS, 40

WEEKS OR 280 DAYS

Embryonic stage starts on day 15 andcontinues approximately the 8thweek or untilthe embryo reaches a crown-to-rump (C-R)length of 3cm (1.2in)


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Embryonic disc becomes elongated and pearshape with a broad cephalic end and a narrowcaudal end

Ectoderm has formed a long cylindric tube forbrain and spinal cord development

GIT created from the endoderm

Most advanced organ is the heart, a singletubular heart forms just outside the body cavityof the embryo


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Days 21-32, somites form an either side of the embryosmidline, it is where the vertebrae of the spinal columnwill develop

Prior to 28 days, arms and leg buds are not visible, butthe tail bud is present

Pharyngeal arches which will form the lower jaw,hyoid bone and larynx develop

Pharyngeal pouches appears, form the eustachian tubeand cavity of the middle ear, the tonsils and theparathyroid and thymus glands

Primordia of the ear and eye are present End of 28 days, tubular heart is beating at a regular

rhythm


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Head structure are more highly developed and the trunk isstraighter than in earlier stages

Recognizable upper and lower jaws External nares are well formed Trachea has developed and its caudal end is divided for beginning

lung formation Upper lip has formed, palate is developing Ears are developing rapidly Arms extend ventrally across the chest and both arms and legs

have digits (still webbed) Slight elbow bend in the arms Prominent tail will recede Heart has more of its definitive characteristics Fetal circulation begins to be established Liver starts to produce blood cells


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Embryo is rounded and nearly erect

Eyes have shifted and are closer together,eyelids beginning to form

Beginning of all essential external and internalstructures are present


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Clearly resembles a human being Facial features continue to develop Eyelids begin to fuse Auricles of external ears begin to assume their final

shape, but still set low External genital appear, but sex is not clearly

discernable Rectal passage opens with the perforation of the anal

membrane

Circulatory system is well established through theumbilical cord Long bones beginning to form and the large muscles

are capable of contracting


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Every organ system and external structuresthat will be found in the full-term newborn ispresent

Remainder of gestation is devoted to refiningstructures and perfecting functions


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End of 9thweek, fetus reaches a C-R length of 5cm (2in) and weighs about14g (0.5oz)

Head is large and comprises almost half of the fetus entire size At 12 weeks, face is well formed with nose protruding, chin is small and

the ear acquiring a more adult shape Sucking reflex has been observed

Tooth buds appear for all 20 childs baby teeth Limbs are long and slender with well formed digits Fetus begin to make tiny fist Legs are still shorter and less developed than the arms Urogenital tract complete Well-differentiated genitals appear Kidneys begin to produce urine Red blood cells produced primarily by the liver Spontaneous movements of the fetus occur Fetal heart rates can be ascertained by electronic devices


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Period of rapid growth

LANUGO or fine downy hair begins to developespecially on the head

Blood vessels clearly visible

More muscle tissue and body skeleton developed

Active movement are present

Fetus stretches and exercises its arms and legs

Makes sucking motions, swallows amniotic fluidand produces MECONIUM in the intestinal tract

Skeletal ossification is clearly identifiable by thebeginning of 16thweek


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Lanugo covers the entire body, prominent onthe shoulder

Nipples appear over the mammary gland

Head is covered with fine, wooly hair Eyebrows and eyelashes beginning to form

Muscles are well-developed, fetus is active

Mother feels fetal movement (QUICKENING) Fetal heartbeat audible through stethoscope


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Hair is growing long

Eyebrows and eyelashes have formed

Eyes structurally complete and will soon open

Has a reflex hand grip (GRASP REFLEX)

End of 6 months, (STARTLE REFLEX)

Skin covering the body is reddish and wrinkled withlittle subcutaneous fat

Thickened skin on the hands and feet with skin ridges

on palms and soles forming distinct foot andfingerprints

Skin of entire body is covered with VERNIX CASEOSA

Alveoli in the lungs just beginning to form


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At 6 months, fetal skin is still red, wrinkled andcovered with vernix caseosa

Brain is developing rapidly and nervous system is

complete enough to provide degree of regulationof body functions

Eyelids can open and close under neural control

Nails are present on fingers and toes

In male, testes begin to descend into the scrotal sac Respiratory and circulatory systems have

developed


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At 30 weeks, pupillary light reflex is present

Fetus is gaining weight from an increase in bodymuscle and fat

CNS has matured enough to direct rhythmicbreathing movements and partially controlledbody temperature, lungs are not yet fully mature

Bones fully developed but soft and flexible

Fetus begins to store iron, calcium and phosphorus Active MORO REFLEX


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Fetus begins to get plump

Less wrinkled skin covers the deposits ofsubcutaneous fats

Lanugo begins to disappear and nails reach theedge of the fingertips

By 35 weeks fetus has a firm grasp and exhibitsspontaneous orientation to light

Infant born at this time has a good chance ofsurvival but require some special care


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considered full term Skin has a smooth polished look Only lanugo left is on the upper arms and shoulders Hair on head is coarse about 1 inch long Vernix caseosa with heavier deposit in the creases and folds

of the skin Body and extremities are plump with good skin turgor Chest is prominent but still a little smaller than the head Mammary glands protrude in both sexes Fingernails extend beyond fingertips Testes are in the scrotum Fetal assumes position of comfort (LIE) Extremities and head are well-flexed


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Postterm labor labor that occurs after 42 weeks gestation

Gravida any pregnancy, regardless of duration, including presentpregnancy

Nulligravida a woman who has never been pregnant

Primigravida a woman who is pregnant for the first time

Multigravida a woman who is in her second or any subsequent

pregnancy

Para birth after 20 weeks gestation regardless of whether the infant isborn alive or dead

Nullipara a woman who has had no births at more than 20 weeks

gestation Primipara a woman who has one birth at more than 20

weeks gestation regardless of whether the infant was born alive ordead

Multipara a woman who has had two or more births at more than 20

weeks gestation


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LMP last menstrual period

EDC expected date of confinement

EDB estimated date of birth

EDD expected date of delivery

AOG age of gestation

NAGELES RULE standard method used to

predict the length of pregnancy Mc Donalds Rule a symphysis-fundal height

measurement


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NAGELES RULE

FOR LMP JAN. TO APRIL

-3MONTHS +7 DAYS

FOR LMP MAY TO DEC.

+9 MONTHS + 7 DAYS + 1 YEAR


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Mc Donalds Rule distance from the uterine

fundus to the symphysis pubis is equal to

AOG between the 20thand 31stweek of

pregnancy

APPROXIMATE HEIGHT OF FUNDUS AT

VARIOUS WEEK OF PREGNANCY:

Over the symphysis pubis 12 weeks Level of umbilicus 20 weeks

At the xiphoid process 36 weeks


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Multiple pregnancy

A miscalculated due date

A large for gestational age infant

Hydramnios

H-mole


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Intrauterine growth restriction

Miscalculated length of pregnancy

Anomaly (anencephaly)


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FETAL MOVEMENT

QUICKENINGfetal movement felt by the

mother

METHOD OF ASSESSING FETAL MOVEMENT

1. Sandovsky Method

2. Cardiff Method


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FETAL HEART RATE Counted and heard as early as 10thto 11th

weeks of pregnancy by using UltrasonicDoppler techn ique

Audible through stethoscope at 18-20 weeks

120-160 beats/min

FETAL TACHYCARDIA sustained rate of 161bpm or above

MARKED TACHYCARDIA 180bpm or above


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Early fetal hypoxia

Maternal fever

Maternal dehydration

Beta-symphatomimetic drugs Amnionitis

Maternal hyperthyroidism

Fetal anemia


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FETAL BRADYCARDIA is a rate less than120bpm

CAUSES:

Late fetal hypoxia

Maternal hypotension

Prolonged umbilical cord compression

Fetal arrhyhtmia

Uterine hyperstimulation

Abruptio placenta

Uterine rupture

Vagal stimulation in the second stage


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Any agent that can cause development ofabnormal structures in an embryo

Substances that affect the normal growth anddevelopment of the fetus


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TOBACCO specific mechanism of smokingseffect on the fetus is not known

Effects:Low birth weight

Risk of spontaneous abortion

Preterm birth

PROM

Placenta previa

Abruptio placentaHigher morbidity


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Greatest Risks: Intrauterine growth restriction or prematurity Intrauterine distress Neonatal neurobehavioral abnormalities

ALCOHOLEffects:

a. heavy drinkers FASb. moderate drinkers lowered birth weight,

neurologic effectsc. occasional drinkers does not carry any

known risk


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CAFFEINEEffects:

- increased risk of decreased birth weight has been

found in infants of mothers who consume at least

600mg of caffeine daily

DRUGS

Vit. A derivatives craniofacial, cardiac, CNS

anomalies Analgesics (ASA, NSAIDs) prolonged pregnancy,

maternal bleeding, patent ductus arteriosus

Antineoplastics multiple anomalies


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Anticonvulsants Phenytoin (Dilantin) neural tubedefects, fetal anomalies

Anticoagulants (Warfarin) fetal bleeding or anomalies

Antidepressants cardiovascular anomalies

Antischizophrenic (Lithium) hydramnios Antithyroid (Methimazole) hypothyroidism in fetus

Antibiotics (sulfonamides) hyperbilirubinemia innewborn

Antibiotics (Tetracycline) teeth and bone deformities

Antihelmintics (Lindane) limit exposure to 2 doses ACE inhibitors oligohydramnios

Softdrinks, chocolates low birthweight


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1. Toxoplasmosis CNS damage,hydrocephalus, microcephaly, intracerebralcalcification and retinal deformities

2. Rubella deafness, mental and motor challenges,

cataracts, cardiac defects, IUGR, dental andfacial clefts, cytopenic purpura3. Herpes Simplex (Genital Herpes) severe

congenital anomalies, spontaneous miscarriage,premature birth, IUGR, continuing infection atbirth

4. Syphillis congenital anomalies, congenitalsyphillis


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1. Metal and chemical hazards (pesticides, carbonmonoxide, formaldehyde, lead)cognitive orneurological abnormalities

2. Radiation

- exposure before implantation, the zygote iskilled

- causes nervous system, brain and retinal

damages

3. Hyperthermia abnormal fetal brain development,

seizure disorders, hypotonia, skeletal

deformities


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PRESUMPTIVE (SUBJECTIVE) CHANGESA. AmenorrheaB. Nausea & vomitingC. Urinary frequency

D. Changes in the breastE. QuickeningF. FatigueG. Uterine enlargement

H. Linea nigraI. Melasma

J. Striae gravidarum


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PROBABLE (OBJECTIVE) CHANGESA. Changes in pelvic organs

1. GoodellsSign2. Chadwicks Sign3. HegarsSign

4. Mc Donalds SignB. Enlargement of the abdomenC. Braxton Hicks ContractionsD. Uterine SouffleE. Palpation of fetal outlineF. BallotementG. Presence of hCG in serum laboratory testH. Sonographic evidence of gestational sac


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POSITIVE (DIAGNOSTIC CHANGES)

A. Fetal heartbeat audible

B. Fetal movement felt by examiner

C. Visualization of fetus by ultrasoundexamination (evidence of fetal outline)


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Vaginal bleeding

Persistent vomiting

Chills and fever

Sudden gush of clear fluid from the vagina Abdominal or chest pain

PIH

Increase or decrease in fetal movement


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A major strategy for helping to reduce the numberof low-birthweight babies born yearly.

Essential for ensuring the overall health ofnewborns and their mothers.

1. Health history Demographic data

Chief concern

- LMP, result of pregnancy test

- use of pregnancy test

- signs of early pregnancy

- discomforts of pregnancy


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- danger signs of pregnancy- ask if pregnancy was planned

2. History of Past Illnesses/Past Medical History- history of kidney disease, HPN, STI, diabetes,

thyroid disease , recurrent seizures, gallbladderdisease, UTI, varicosities, phenylketonuria, TBand asthma

- childhood diseases like chickenpox, mumps,measles, German measles, or poliomyelitis

- ask about allergies and any past surgeries- surgical procedures and presence of bleeding

disorders or tendencies


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3. History of Family Illnesses/Family MedicalHistory

- cardiovascular and renal diseases, cognitiveimpairment, blood disorders, or any known

genetically inherited diseases or congenitalanomalies

- occurrence of multiple births- occurrence of caesarian births and causes

4. Social Profile- current nutrition, elimination, sleep, exercise,recreation, and interpersonal interactions


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5. Gynecologic History Age of menarche Usual cycle (interval, duration, amount of

menstrual flow)

Presence of discomforts Monthly perineum self-examination Past surgery on reproductive tract Family planning methods used

Sexual history Assess possibility of stress incontinence Pap Smear Previous infections


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6. Obstetric History Review pregnancy briefly Previous miscarriage or abortions GTPAL or GTPALM, TPAL/FPAL Score

G number of times she has been pregnantT number of full-term infants bornP number of preterm infantsA number of spontaneous or induced

abortionL number of living childrenM multiple pregnancies


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7. Current Medical History Weight Blood type and Rh factor Any medications presently taken

Previous or present use of alcohol Drug use or abuse Drug allergies and other allergies Potential teratogenic insults

Presence of diabetes, HPN, cardiovascular disease,renal problems, thyroid disease Record of immunization


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8. Review of systems

9. Physical Examination

Baseline data

System assessment Pelvic examination

- pregnant women should remain in a lithotomy

position for a short time to prevent

thromboembolism and supine hypotensionsyndrome


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10. Laboratory Assessment Blood assessment Urinalysis TB

Ultrasound11. Nutritional status

- woman must eat adequately to supplyenough nutrients to the fetus

- woman will not have to increase thequantity of food but they will have toincrease the quality of food they eat


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Systematic way to evaluate thematernal abdomen

Preparation:

Empty the bladder

Lie on her back with her feet on thebed and her knees bent


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1. First maneuver

Facing the woman, palpate the upper abdomenwith both hands.

Note the shape, consistency, and mobility ofthe palpated part.

Fetal head is firm and round and movesindependently of the trunk. The buttocks feelssofter, and it moves with the trunk.


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4. Fourth Maneuver.

Facing the womans feet, place both hands onthe lower abdomen and move hands gently

down the sides of the uterus toward the pubis. Note the cephalic prominence or brow.


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2. Second Maneuver

Moving the hands on the pelvis, palpate theabdomen with gentle but deep pressure.

The fetal back on one side of the abdomen feelssmooth, and the fetal extremities on the other sidefeels knobby.

3. Third Maneuver

Place one hand just above the symphysis pubis. Note whether the part palpated feels like the fetal

head or the breech and whether it is engaged.


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NURSING DIAGNOSES IN EARLY PREGNANCY Health-seeking behaviors related to interest in using

herbal medicines to relieve discomforts of pregnancy Disturbed body image related to breast and abdominal

enlargement in pregnancy Constipation related to reduced peristalsis in

pregnancy Fatigue related to increased physiologic need for sleep

and rest during pregnancy Acute pain related to frequent muscle cramps

secondary to physiologic changes of pregnancy Disturbed sleep pattern related to frequent need to

empty bladder during night


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1. Breast tenderness2. Palmar erythema3. Constipation4. Nausea, vomiting and pyrosis

5. Fatigue6. Muscle cramps7. Hypotension8. Varicosities9. Hemorrhoids10. Frequent urination11. Abdominal discomforts12. Leukorrhea


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Health seeking behaviors related todiscomforts of middle to late pregnancy

Acute pain related to sudden postural change

in pregnancy Anxiety related to shortness of breath resulting

from expanding uterine pressure ondiaphragm

Deficient knowledge related to occurrence ofBraxton Hicks contractions in late pregnancy


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1. Backache

2. Headache

3. Dyspnea4. Ankle edema

5. Braxton Hicks contractions


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LOCAL CHANGES- involves the uterus, ovaries, vagina and breasts

1. Uterine changes

a. increase in size (length,depth, width, weight, wall thickness andvolume)

length 32cm Depth 22cm

Width 24cm Weight 1,000g Thickness early pregnancy 2cm; end of pregnancy 0.5cm

thick Volume more than 1,000ml


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b. Stretching of muscle fibers of the uterus

c. HegarsSign

2. Amenorrhea

3. Cervical changes more vascular and edematous

Darken to violet

GoodellsSign

Cervical hypertrophy and hyperplasia

Mucus filled cervical canal


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4. Vaginal changes Hypertrophic vaginal epithelium Increase in vascularity Change in vaginal secretion pH5. Ovarian changes

Halt in FSH and LH production Increase in size of the corpus luteum at the surface of the ovary

until 16thweek6. Changes in the breast Feeling of fullness, tingling, or tenderness Increase breast size Darkened and increase diameter of the areola Prominent blue veins Supple nipple Breast secretes milk


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SYSTEMIC CHANGES1. Integumentary system

Striae gravidarum

Protruding umbilicus

Linea nigra

Melasma

Vascular spider

Increase perspiration Palmar erythema

Increased scalp hair growth


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2. Respiratory system Marked congestion of the nasopharynx

Shortness of breath

Total O2 consumption increase by as much as 20%

3. Cardiovascular system

Increased circulatory blood volume

Needs iron supplementation

Increase cardiac output and heart rate

Decrease BP at 2

nd

trimester and rises at third trimester Impaired blood flow at lower extremities

Supine hypotension syndrome

Increased circulating fibrinogen


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4. Gastrointestinal system Heartburn, constipation and flatulence

Hemorrhoids

Nausea and vomiting

Some women with hypertrophy of gumlines Hypertyalism

5. Urinary system

Fluid retention

Gradual increase in urinary output

Increase urinary frequency


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6. Skeletal system Increased calcium and phosphorous needs Gradual softening of the pelvic ligaments and joints pride of pregnancy

7. Endocrine system Placenta Halt in FSH and LH production Increase production of melanocyte stimulating hormone Enlarged thyroid gland

Increase production of insulin Adrenal glands activity increases

8. Immune system Decreased immunologic competency

stages of fetal development.pptx

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