EMBRYOLOGICAL AND FETAL DEVELOPMENT :-

Fertilization- It is the process of fusion of spermatozoon with the mature ovum. It

begins with sperm egg collision and ends with production of mononucleated single cell
called zygote. Fertilization occurs in ampullary part of uterine tubes. Fertilization life
span of oocyte ranges from 12-24 hours whereas of sperm is 48-72 hours.

Out of hundreds of millions sperms deposited in vagina at single ejaculation

Only thousands capacitated spermatozoa enter the uterine tube

While 300-500 reach the ovum. It takes few minutes for the sperm to reach the fallopian
tubes

Out of many sperms, one touches oolema and fusion occurs

Soon after the sperm fusion, penetration of other sperm is prevented by

zona reaction (hardening) and oolema block.

 After fertilization, meiosis II completes and female pronucleus (23, X) is formed.

Head and neck of spermatozoon become male pronucleus (23X or 23Y).Male and
female pronuclei unite and form diploid number of chromosomes (46).

 Thus zygote formed contains both paternal and maternal genetic materials.

 Sex of child is determined by pattern of sex chromosomes supplied by

spermatozoon.

 If the spermatozoon contains ‘X’ chromosome, female embryo(46, XX) is formed.

 If it contains Y chromosome, male embryo (46, XY) is formed.

Morula-After zygote formation, typical mitotic division of nucleus occurs producing

two blastomeres. This is called two cell stage and is reached approximately 30 hours
after fertilization.

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  Blastomeres continue to divide by binary division through 4,8, 16 cell stage, until
a cluster of cells is formed called morula.

 Morula after spending three days in uterine tube enters the uterine cavity through
narrow uterine ostium.

Blastocyst- After this, a fluid filled cavity or blatocele appears in morula which now
becomes blastocyst.

 Around the outside of blastocyst, there is single layer of cells known as

trophoblast and while the remaining cells are clumped together at one end
forming inner cell mass.

 The trophoblast will form the placenta and chorion, while inner cell mass will
become the fetus and amnion.

 When the blastocyst first tumbles into the uterus, it lies free for 2-3 more days.

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  The trophoblast, especially the part which lies over the inner cell mass then
becomes quite sticky and adheres to endometerium.

Implantation- Trophoblast then secretes substances which digest the endometrial cells,
allowing the blastocyst to become embedded in the endometrium. Embedding sometimes
is known as Nidation/ Implantation/Nesting. Implantation mainly occurs near the fundus
on 8-10 days after ovulation.

Decidua- This is the name given to endometrium during pregnancy.

 From the conception, the increased secretion of estrogen causes the endometrium
to grow four times than its non pregnant thickness.

 Corpus luteum also produces large amount of progesterone which stimulate the
secretary activity of the endometrial glands and increase the size of blood
vessels.

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  Three layers are found in endometrium-

 Basal layer- It lies immediately above myometrium. It remains unchanged in

itself but regenerates the new endometrium during puerperium.

 Functional layer- It consists of tortuous glands which are rich in secretions.

The spongy layer contains dilated uterine glands, decidual cells and blood
vessels. It is through this layer that the cleavage of placental separation
occurs.

 Compact layer- It forms the surface of decidua and is composed of closely

packed stroma cells.

 The decidua underneath the blastocyst is called Basal deciduas and the remainder
is called Parietal deciduas.

 Eventually, as the embryo grows and fills the uterine cavity, the capsular decidua
meets and fuses with the parietal decidua.

Trophoblast- Small projections begins to appear all over the surface of blastocyst are
termed as trophoblast. These trophoblastic cells differentiate into layers i.e.-

(a) Outer syncytiotrophoblast

(b) Inner cytotrophoblast

c) Below this a thin layer of mesoderm or primitive mesenchyme.

(a) Syncytiotrophoblast- It is composed of nucleated protoplasm which is capable of

breaking down tissue as in the process of embedding. It erodes the wall of blood vessels
of deciduas, making the nutrients in the maternal blood accessible to developing embryo.

(b) Cytotrophoblast- It is well defined single layer of cells which produces hormones
known as human chorionic gonadotrophin [HCG].

 This hormone is responsible for informing the corpus luteum that pregnancy has
begins. Corpus luteum continuous to produce estrogen and progesterone.

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  Progesterone maintains integrity of deciduas so that shedding does not take place.
In other words menstruation is suppressed.

 The high level of estrogen suppresses the production of FSH.

 Mesoderm- It consists of loose connective tissue.

Chorion- The chorion is one of the membranes that exist during pregnancy between the
developing fetus and mother. It is formed by mesoderm and the two layers of trophoblast
and surrounds the embryo and other membranes. The chorionic villi emerge from the
chorion, invade the endometrium, and allow transfer of nutrients from maternal blood to
fetal blood. The chorion consists of two layers: an outer formed by the trophoblast, and
an inner formed by the somatic mesoderm; the amnion is in contact with the latter.

The trophoblast is made up of an internal layer of cubical or prismatic cells, the

cytotrophoblast or layer of Langhans, and an external layer of richly nucleated
protoplasm devoid of cell boundaries, the syncytiotrophoblast.

Inner cell mass- While the trophoblast is developing into the placenta, which will
nourish the fetus, the inner cell mass is forming fetus itself. The cells differentiate into
three layers, each of which will form particular parts of the fetus.

 Ectoderm- It mainly forms the skin and nervous system.

 Mesoderm- it forms bones, muscles and also the heart and blood vessels,
including those which are in the placenta. Certain internal organs also originate in
the mesoderm.

 Endoderm- It forms mucous membrane and glands.

Three layers together are known as embryonic plate. Two cavities appear in the inner cell
mass, on either side of embryonic plate. These are-

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  Amniotic cavity- It lies on the side of the ectoderm. The cavity which is
filled with the fluid gradually enlarges and folds around the embryo to
enclose it. The embryo forms from its lining.

 Yolk sac- It lies on the side of endoderm and provides nourishment for the
embryo until the trophoblast is sufficiently developed to take over. Part of
it contributes to the formation of primitive gut, the remainder resembles a
balloon floating in front of the embryo until it atrophies and becomes
trapped under the amnion on the surface of placenta. After birth, all the
remains of yolk sac is a vestigial structure in the base of umbilical cord
known as vitelline duct.

Embryo- This name is applied to developing offspring after implantation and until 8
weeks after conception.

Placenta- Human placenta is discoid, because of its shape, hemochorial because of

direct contact of the chorion with the maternal blood and deciduate because some
maternal tissue is shed at parturition. The placenta is attached to the uterine wall and
establishes connection between mother and fetus through the umbilical cord.

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Development of placenta- Placenta is developed from two sources. The principal
component is fetal which develops from the chorion and maternal component consists of
deciduas basalis. It begins at 6th week and is completed by 12th week.

 Until the end of 16th week, the placenta grows both in thickness and
circumference due to growth of chorionic villi.

Umbilical cord- The umbilical cord or funis forms the connecting link between the fetus
and the placenta through which the fetal blood flows to and from the placenta. It extends
from the fetal umbilicus to the fetal surface of the placenta.

Development of umbilical cord- The umbilical cord is developed from the connective
stalk, which is a band of mesoblastic tissue stretching between the embryonic disc and
the chorion.

Attachment- In the early period, the cord is attached to the ventral surface of embryo
close to the caudal extremity but as the yolk sac atrophies, the point of attachment is
moved permanently to the centre of the abdomen at fourth month.

Embryonic period
HUMAN EMBROYOGENESIS
The initial stages of human embryogenesis
The embryonic period in humans begins at fertilization and continues until the end of the 10th
week of gestation

The embryo spends the next few days traveling down the Fallopian tube. It starts out as a single
cell zygote and then divides several times to form a ball of cells called a morula. Further cellular
division is accompanied by the formation of a small cavity between the cells. This stage is called
a blastocyst. Up to this point there is no growth in the overall size of the embryo, as it is confined
within a glycoprotein shell, known as the zona pellucida. Instead, each division produces
successively smaller cells.

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The blastocyst reaches the uterus at roughly the fifth day after fertilization. It is here that lysis of
the zona pellucida occurs. This process is analogous to zona hatching, a term that refers to the
emergence of the blastocyst from the zona pellucida, when incubated in vitro. This allows the
trophectoderm cells of the blastocyst to come into contact with, and adhere to, the endometrial
cells of the uterus. The trophectoderm will eventually give rise to extra-embryonic structures,
such as the placenta and the membranes. The embryo becomes embedded in the endometrium in a
process called implantation. In most successful pregnancies, the embryo implants 8 to 10 days
after ovulation .

Week 6

Gestational age: 5 weeks old. 36–42 days from last menstruation.

Embryonic age: Week nr 4. 3 weeks old. 22–28 days from fertilization.

 The embryo measures 4 mm (1/8 inch) in length and begins to curve into a C shape.

 The heart bulges, further develops, and begins to beat in a regular rhythm. Septum primum
appear.

 Branchial arches, grooves which will form structures of the face and neck, form.

 The neural tube closes.

 The ears begin to form as otic pits.

 Arm buds and a tail are visible.

 Pulmonary primordium, the first traits of the lung appear.

 Hepatic plate, the first traits of the liver appear.

 Buccopharyngeal membrane ruptures. This is the future mouth.

 Cystic diverticulum, which will become the gallbladder, and dorsal pancreatic bud, which
will become the pancreas appear.

 Urorectal septum begins to form. Thus, the rectal and urinary passageways become separated.

 Anterior and posterior horns differentiate in the spinal cord

 Spleen appears.

 Ureteric buds appear.

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Week 7

Gestational age: 6 weeks old. 43–49 days from last menstruation.

Embryonic age: Week nr 5. 4 weeks old. 29–35 days from fertilization.

 The embryo measures 9 mm (1/4 inch) in length.

 Lens pits and optic cups form the start of the developing eye.

 Nasal pits form.

 The brain divides into 5 vesicles, including the early telencephalon.

 Leg buds form and hands form as flat paddles on the arms.

 Rudimentary blood moves through primitive vessels connecting to the yolk sac and chorionic
membranes.

 The metanephros, precursor of the definztive kidney, starts to develop.

 The initial stomach differentiation begins.

Week 8

Gestational age: 7 weeks old. 50–56 days from last menstruation.

Embryonic age: Week nr 6. 5 weeks old. 36–42 days from fertilization.

 The embryo measures 13 mm (1/2 inch) in length.

 Lungs begin to form.

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 The brain continues to develop.

 Arms and legs have lengthened with foot and hand areas distinguishable.

 The hands and feet have digits, but may still be webbed.

 The gonadal ridge begins to be perceptible.

 The lymphatic system begins to develop.

 Main development of external genitalia starts.

Week 9

A six week embryonic age or eight week gestational age intact Embyotic human.

Gestational age: 8 weeks old. 57–63 days from last menstruation.

Embryonic age: Week nr 7. 6 weeks old. 43–49 days from fertilization.

 The embryo measures 18 mm (3/4 inch) in length.

 Fetal heart tone (the sound of the heart beat) can be heard using doppler.

 Nipples and hair follicles begin to form.

 Location of the elbows and toes are visible.

 Spontaneous limb movements may be detected by ultrasound.

 All essential organs have at least begun

 The vitelline duct normally closes

Fetal period

The fetal period begins at the end of the 10th week of gestation (8th week of development). Since
the precursors of all the major organs are created by this time, the fetal period is described both
by organ and by a list of changes by weeks of gestational age.

Changes by weeks of gestation

From the 8th week until birth (around 38 weeks), the developing organism is called a fetus. All
major structures are already formed in the fetus, but they continue to grow and develop.

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Fetus at 8 weeks after fertilization.

Weeks 10–12

Gestational age: 9–11 weeks old.

Embryonic age: Weeks nr 8–10. 7–9 weeks old.

 Embryo measures 30–80 mm (1.2–3.2 inches) in length.

 Ventral and dorsal pancreatic buds fuse during the 8th week

 Intestines rotate.

 Facial features continue to develop.

 The eyelids are more developed.

 The external features of the ear begin to take their final shape.

 The head comprises nearly half of the fetus' size.

 The face is well formed

 The eyelids close and will not reopen until about the 28th week.

 Tooth buds, which will form the baby teeth, appear.

 The limbs are long and thin.

 The fetus can make a fist with its fingers.

 Genitals appear well differentiated.

 Red blood cells are produced in the liver.

Weeks 13 to 16

Gestational age: 12–15 weeks old.

Embryonic age: Weeks nr 11–14. 10–13 weeks old.

 The fetus reaches a length of about 15 cm (6 inches).

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 A fine hair called lanugo develops on the head.

 Fetal skin is almost transparent.

 More muscle tissue and bones have developed, and the bones become harder.

 The fetus makes active movements.

 Sucking motions are made with the mouth.

 Meconium is made in the intestinal tract.

 The liver and pancreas produce fluid secretions.

 At week 15, main development of external genitalia is finished

Fetus at 18 weeks after fertilization.

Week 20

Gestational age: 18 weeks old.

Embryonic age: Week nr 17. 16 weeks old.

 The fetus reaches a length of 20 cm (8 inches).

 Lanugo covers the entire body.

 Eyebrows and eyelashes appear.

 Nails appear on fingers and toes.

 The fetus is more active with increased muscle development.

 "Quickening" usually occurs (the mother and others can feel the fetus moving).

 The fetal heartbeat can be heard with a stethoscope.

Week 23

Gestational age: 22 weeks old.

Embryonic age: Week nr 21. 20 weeks old.

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 The fetus reaches a length of 28 cm (11.2 inches).

 The fetus weighs about 925g.

 Eyebrows and eyelashes are well formed.

 All of the eye components are developed.

 The fetus has a hand and startle reflex.

 Footprints and fingerprints continue forming.

 Alveoli are forming in lungs.

Week 27

Gestational age: 26 weeks old.

Embryonic age: Week nr 25. 24 weeks old.

 The fetus reaches a length of 38 cm (15 inches).

 The fetus weighs about 1.2 kg .

 The brain develops rapidly.

 The nervous system develops enough to control some body functions.

 The eyelids open and close.

 The cochleae are now developed, though the myelin sheaths in neural portion of the auditory
system will continue to develop until 18 months after birth.

 The respiratory system, while immature, has developed to the point where gas exchange is
possible.

Week 31

Gestational age: 30 weeks old

Embryonic age: Week nr 29. 28 weeks old.

 The fetus reaches a length of about 38–43 cm (15–17 inches).

 The fetus weighs about 1.5 kg .

 The amount of body fat rapidly increases.

 Rhythmic breathing movements occur, but lungs are not fully mature.

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 Thalamic brain connections, which mediate sensory input, form.

 Bones are fully developed, but are still soft and pliable.

 The fetus begins storing a lot of iron, calcium and phosphorus.

Week 35

Gestational age: 34 weeks old.

Embryonic age: Week nr 33. 32 weeks old.

 The fetus reaches a length of about 40–48 cm (16–19 inches).

 The fetus weighs about 2.5 to 3 kg (5 lb 12 oz to 6 lb 12 oz).

 Lanugo begins to disappear.

 Body fat increases.

 Fingernails reach the end of the fingertips.

 A baby born at 36 weeks has a high chance of survival, but may require medical
interventions.

Fetus at 38 weeks after fertilization.

Weeks 36 to 39

Gestational age: 35–38 weeks old.

Embryonic age: Weeks nr 34–37. 33–36 weeks old.

 The fetus is considered full-term at the end of the 37th week of gestational age.

 It may be 48 to 53 cm (19 to 21 inches) in length.

 The lanugo is gone except on the upper arms and shoulders.

 Fingernails extend beyond fingertips.

 Small breast buds are present on both sexes.

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 Head hair is now coarse and thickess

PRENATAL FACTORS AFFECTING GROWTH AND

DEVELOPMENT OF FETUS

1. NUTRITION

Expectant mothers have increased nutritional needs. Meeting these needs helps ensure
sufficient maternal gestational weight gain, which is related to appropriate fetal
weight gain. Adequate levels of both ensure the best pregnancy outcomes.
Supplementation with micronutrients (zinc, calcium, magnesium, vitamin A, folate,
iron, vitamin C and iodide) improves nutritional status during pregnancy. Prenatal
nutrition is thought to exert key effects on fetal development as well as, later in life,
on disease susceptibility, and even central nervous system function. It is equally
important that mothers continue to ensure appropriate nutritional intake while they
are breast-feeding. Maternal malnutrition increases the risk of poor pregnancy
outcomes including obstructed labour, premature or low-birth-weight babies and
postpartum haemorrhage. Severe anaemia during pregnancy is linked to increased
mortality at labour.

2. INFECTIOUS AGENTS

Cytomegalovirus infection is the most common cause of congenital infections. The

malformations include microcephaly, cerebral calcification and blindness. Perinatal
transmission of HIV has been a major concern. It was evident that a high
percentage of newborns were infected in utero. However, with treatment of infected
mothers with zidovudine, the incidence of transmission to the fetus is greatly
reduced. Toxoplasmosis results from exposure to infected excretions pets, handling
of infected animals. The parasite is transmitted during fetal life, not during the birth
process. Other infectious agents such as Rubella, herpes simplex virus, group B
streptococcus are also having great impact on development of fetus.

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3. DRINKING

Alcohol consumption can harm a developing embryo or fetus, although how much is too
much remains unclear. "The only way to be absolutely certain that your baby is not
harmed by alcohol is not to drink at all during pregnancy or while you are trying for a
baby," says the Royal College of Obstetricians and Gynaecologists (RCOG). Pregnant
women who continue to drink are at increased risk of experiencing a miscarriage or
stillbirth. Infants exposed to alcohol before birth may show signs of Fetal Alcohol
Spectrum Disorder (FASD), including learning problems, behavior problems and
physical disabilities, the RCOG reports. Fetal Alcohol Syndrome, which results in mental
retardation and facial abnormalities, is uncommon. Unlike FASD, which can occur with
only moderate exposure to alcohol, Fetal Alcohol Syndrome only occurs due to heavy
drinking during pregnancy. We associate caffeine with tea and coffee. Caffeine has been
associated with a number of prenatal risks. When consumed in high doses, caffeine has
even been linked with increased rates of miscarriage. Caffeine is a diuretic, it can also
affect the nutrition your baby receives from you. Caffeine intake may cause you to absorb
less iron and calcium from foods, a possible detriment to your baby's overall fetal
development.

4. SMOKING
Smoking during pregnancy greatly increases the risk of low birthweight and prematurity.
Both conditions put a newborn at risk for early complications, including respiratory
distress and possible death, and are associated with later health and learning issues.
Fortunately, pregnant women can choose to stop smoking during their pregnancy. The
adverse effects of smoking are due to the following factors:
1. carbon monoxide, which inactivates fetal and maternal hemoglobin, reducing the
amount of oxygen delivered to the fetus.
2. nicotine, the vasoconstrictor action of which reduces placental perfusion.
3. reduction in maternal appetite, leading to a reduction in caloric intake

5. RECREATIONAL DRUGS

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The use of recreational or illicit drugs by the pregnant woman have potential effect of
these drugs on fetus. Chronic use by expectant mother of such substances as opium
derivatives, barbiturates, amphetamines, heroin, marijuana, cocaine during pregnancy can
cause higher rates of spontaneous abortions, fetal deaths, low birth weight and small for
gestation infants, and infants with depression of interactive behaviour and poor
organizational response to stimuli, as well as possible learning disabilities.

6. MEDICALLY PRESCRIBED DRUGS

Any substance given in large enough doses at critical periods of development can be
classified as teratogenic. drugs other than those considered recreational or illicit also have
harmful effects on the developing fetus. Thalidomide, a drug once used as an antiemetic
during pregnancy, has been proven to cause deformities of the arms, legs, and face in the
fetus. Early exposure to high dese of androgenic steroid hormones leads to
masculinization( the development in a woman of male secondary sexual characteristics)
of female fetus. Exposure to antineoplastic drugs during pregnancy results in abortion or
malformations. Tetracyclines have been proven to cause dental staining in offspring.
Drugs taken in the first trimester of pregnancy can cause malformations in the fetus
because organogenesis occurs in this period.

7. MATERNAL AGE

If you are over the age of 35 and pregnant, you are at higher risk of developing problems
for both your baby and yourself. The risk of birth defects, miscarriage and stillbirths is
higher. You can develop high blood pressure or diabetes during pregnancy. The chance of
needing a Caesarean section is also slightly higher in this case. Those woman who are
below 21, have chances of miscarriage, still births, and foetal malformations. The reason
is that the reproductive organs of the female are not fully mature.

8. RADIATIONS

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Exposure to radiations can have teratogenic effects; the nature of the malformations
depends on the dose of the radiations. Organogenesis is the period of development that is
most sensitive to radiations. Malformations include ophthalmic defects, impaired motor
performance , spina bifida, cleft palate, and defects of the extremities.

9. OCCUPATIONAL HAZARDS
Several occupational hazards have also been identified that may effect on reproduction
and cause birth defects in the fetus. For pregnant women, even limited exposure can cause the
death of the fertilized egg or fetus, retarded growth, malformation or deficits in postnatal
function. Noise may damage fetuses and newborns. Many pregnant women are exposed to
noise in the workplace. Fetuses and newborns exposed to excessive noise may suffer
noise-induced hearing loss and other health effects.

10. EMOTIONAL STATUS OF MOTHER

Emotions can temporarily affect the child. The activity level of the foetus is increased
when the mother is emotionally upset. Difficulty of labour and delivery is also related to
the mother’s level of tension during the preceding months. Antenatal stress and anxiety
during pregnancy increase the risk of slower growth and smaller babies, increase risk of
preterm delivery

BIBLIOGRAPHY:-
1. Dutta D.C. Text book of obstetrics.6th ed.New central book agency.Pp 21-27.
2. Myles.Text book of Midwifes.13th ed. Churchill Livingstone publishers.Pp 45-49.
3. Kumari Neelam,Sharma Shivani.Midwifery and gynecological nursing.S.Vikas
and Company(Medical Publishers).Pp 67-70.

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