FERTILIZATION & FETAL 24 hours (48 hours at the

DEVELOPMENT most). After that time, it

FERTILIZATION atrophies & becomes
nonfunctional.
✔ Is the union of mature egg cell
► Although one ovum reaches
(ovum) & sperm cell happening
maturity each month, a normal
in the ampulla (outer third) of
ejaculation of semen averages
the FT resulting in a fertilized
2.5 ml of fluid containing 50
ovum known as zygote.
to 200 million spermatozoa
✔ It is also termed conception,
per ml., or an average of 400
fecundation, impregnation.
million per ejaculation. To
✔ Following ovulation, as the
promote the possibility of a
ovum is extruded from the
sperm reaching the ovum,
Graafian follicle, it is
there is a reduction in the
surrounded by a ring of
viscosity (thickness) of
mucopolysaccharide fluid
cervical mucus at the time of
(the zona pellucida) & a circle
ovulation, making it easier for
of cells (the corona radiata).
spermatozoa to penetrate it.
These structures increase the
Sperm transport is so efficient
bulk of ovum, facilitating its
close to ovulation that
migration to the uterus, &
spermatozoa deposited in the
probably also serve as a
vagina during intercourse
protection from injury. The
generally reach the cervix of
ovum & the surrounding cell
the uterus within 90 seconds
are propelled into the near
after deposition & the outer
fallopian tube by currents
end of a fallopian tube in 5
initiated by the fimbriae, the
minutes (one reason why
fine, hair-like structures that
douching is not effective
line the openings of the
contraceptive measure).
fallopian tubes. The ovum is
► Spermatozoa move by means
propelled the length of the tube
of their flagella (tails) & uterine
by peristaltic action of the tube
contractions through the
& movement of the tube cilia.
cervix, the body of the uterus,
and into the fallopian tubes
Fertilization & Fetal Development
toward the waiting ovum.
► Fertilization must occur fairly
quickly after release of the
ovum because an ovum is
capable of fertilization for only
 contains so many sperm
although only one is necessary
for fertilization is probably to
provide enough enzymes to
dissolve the corona cells.
► Once one spermatozoon
effectively penetrates the zona
pellucida, a reaction sweeps
through the layer that makes it
difficult for other spermatozoa
to penetrate it. Only one
FERTILIZATION
spermatozoon is able to
► Capacitation is a final process
penetrate the cell membrane
that sperm must undergo to be
of the ovum. After it has done
ready for fertilization. This
so, the cell membrane becomes
process consists of changes in
impervious to other
the plasma membrane of the
spermatozoa.
sperm head which reveals the
❖ An exception to this is the
sperm-binding receptor sites.
formation of hydatidiform
► Fertilization usually occurs in
mole in which multi-sperm
the outer third of a fallopian
enter; this leads to abnormal
tube, the ampullar portion.
growth.
The functional life of a
⮚ Immediately after penetration
spermatozoa is about 48
of the ovum, the chromosomal
hours (may be as long as 72
material of the ovum &
hours), so sexual coitus as long
spermatozoon fuse. The
as this time interval before
resulting structure is zygote.
ovulation may result in
Because the spermatozoon &
fertilization.
ovum each carried 23
► All the spermatozoa that
chromosomes (22 autosomes
achieve capacitation reach
& 1 sex chromosome), a
the ovum & cluster around
fertilized ovum has 46
the protective layer of
chromosomes. If an X-carrying
corona cells. Hyaluronidase
spermatozoon enters the
(a proteolytic enzyme) is
ovum, the resulting child will
apparently released by the
have two X chromosomes &
spermatozoa & acts to
will be female (XX). If a Y-
dissolve the layer of cells
carrying spermatozoon
protecting the ovum. The
reason that an ejaculation
 fertilizes the ovum, the
resulting child be male (XY).
► Fertilization depends on
three separate factors:
• Maturation of both sperm and
ovum
• Ability of sperm to reach the
ovum
• Ability of the sperm to
penetrate the zona pellucida
& cell membrane & achieve
fertilization
CLEAVAGE/MITOSIS
► Zygote – the cell that results
from fertilization of the ovum
by a spermatozoan. This cell
undergoes mitosis which is the
process of cell replication
where each chromosome splits
longitudinally to form a
double-stranded structure.
► Cleavage – series of mitotic
cell division by the zygote
► Blastomeres – daughter cells
arising from the mitotic cell
division of the zygote (2-cell, 4-
cell, 8-cell blastomeres)
► Morula – solid ball od cells
produced by 16 or so
blastomeres; called the
“travelling” form because it is
in this form when it migrates
through the fallopian tube
(oviduct) & reaches the uterine
cavity about 3 to 4 days after
ovulation. (from the Latin word
morus, meaning “mulberry”).
► Blastocyst – a fluid-filled
cavity that reaches the uterine
cavity
BLASTOCYST
► The reorganization of the
morula follows forming a
blastocyst. This is the stage
when there is already a cavity
in the morula called the
blastocoele, & when it enters
the uterine cavity. The cavity
enlarges &pushes the morula
cells into an outer layer of cells
called trophoblast. Along with
this is an inner cell mass
attached to one side of the
blastocyst. The divisions & the
 reorganization have already
consumed energy stores
available in the zygote, such
that it becomes necessary for
the blastocyst to embed or
implant in the uterine wall.
This is necessary for it to
obtain nourishment for its
further development.
IMPLANTATION
► Also called nidation
► Time: 6 to 9 days (average is 7
days) after fertilization
► Site: upper fundal portion or
upper 1/3 of the uterus; can be
anterior (towards the mother’s
front) or posterior (towards
the mother’s back). Abnormal
implantation sites are the FT
which leads to ectopic
pregnancy & the lower uterine
segment which causes placenta
previa.
► At the time of implantation, the
blastocyst is completely buried
in the endometrium. While the
blastocyst is the stage of
implantation, its outer layer
the trophoblast, is responsible
for actual implantation
(nidation). Once implanted the,
the zygote is an embryo.
CHORIONIC VILLI
► Are villi that sprout from the
chorion to provide maximal
contact area with maternal
blood. Villi are part of the
border between maternal &
fetal blood during
pregnancy.
► Chorionic villi have a central
core of loose connective
tissue surrounded by a double
layer of trophoblast cells. The
central core of connective
tissue contains fetal
capillaries.
► The outer of the two covering
layers is termed the
syncytiotrophoblast, or the
syncytial layer. This layer of
cells is instrumental in the
production of various
placental hormones, such as
HCG, somatomammotropin
(human placental lactogen),
estrogen & progesterone.
► The inner layer, known as the
cytotrophoblast or Langhans’
layer, is present as early as 12
days’ gestation & appears to
 be functional early in ⮚ the endometrium is now
pregnancy but then termed decidua (the Latin
disappears between the 20th word for “falling off”), because
& 24th week. This layer of cells it will be discarded following
protect the growing embryo the birth of the child. The
& fetus from certain decidua has three separate
infectious organisms such as areas:
the spirochete of syphilis. • Decidua basalis – or the
This is why syphilis is part of the endometrium
considered to have high lying directly under the
potential for fetal damage late embryo (or the portion
in pregnancy, when where the throphoblast cells
cytotrophoblast cells are not are establishing
functioning. Unfortunately, the communication with
layers appear to offer little maternal blood vessels)
protection against viral • Decidua capsularis – or the
portion of the endometrium
that stretches or
encapsulates the surface of
the trophoblast
• Decidua vera – or the
remaining portion of the
uterine lining
Layers of Decidua Basalis and
Decidua Vera
• Zona Compacta –
uppermost/surface layer made
up of compact cells
invasion. • Zona Spongiosum – middle,
spongy layer; with glands and
small blood vessels
THE DECIDUA
• Zona Basalis – lowest
most/basal layer
✔ The zona basalis & zona
spongiosum together form
the functional layer (zona
functionales). Implantation is
up to the level of spongiosum
✔ The zona basalis remains after
delivery/placental separation
Decidual Aging: Nitabuch’s layer,
a zone of fibrinoid degeneration, is
where invading trophoblast meets
the decidua. This layer is usually
absent whenever the decidua is
defective.
fibrous tissue with sparse
vessels confined mainly to the
base
• Average weight at term: 500
gm
• Feto-placental weight ratio at
term – 6:1

► Placenta is formed by the union

THE PLACENTA
of chorionic villi and decidua
► Dimension
basalis
• Discoid: 15 to 20 cm in
► Placental maturity: 12 or 3
diameter & 2 to 3 cm in
months; functions most
thickness
effectively through 40 to 41
• Location: in the uterus,
weeks; may be dysfunctional
anteriorly or posteriorly near
beyond 42 weeks.
the fundus
► As the number of chorionic villi
• Fetal side: covered with
increases with pregnancy, the
amnion; beneath it the fetal
villi form a network of
vessels course with the
communication with the
arteries passing over the
maternal blood that becomes
veins. Amnion: 0.02 to 0.5
more & more complex.
mm in thickness; a sac that
Intervillous spaces grow larger
engulfs the growing fetus.
& larger and become separated
Amniotic fluid: clear fluid
by a series of partitions or
that collects within the
septa. In a mature placenta
amniotic cavity.
there are as many as 30
• Maternal side: divided into
separate segments called
irregular lobes; consists of
 cotyledons. These
compartments are what make
the maternal side of the
placenta at term look rough
and uneven.
PLACENTA
► Placenta comes from the Latin
word for a type of cake.
► Is formed by the union of the
chorionic villi & decidua basalis
► The umbilical cord inserts at
the chorionic plate (has an
eccentric attachment).
► Cotyledons – are villous tree
structures, grouped into
lobules on the maternal side
► Maternal blood fills the
intervillous space (there is high
pressure) through the spiral
arteries which bathe the fetal
villi in blood, nutrients, water,
& gases are actively & passively
exchanged, then deoxygenated
blood flows back through the
endometrial veins as the
pressure decreases between
pulses.
PLACENTAL FUNCTIONS
► Nutritive: transports
nutrients & water-soluble
vitamins to fetus
• fluid/gas transport
✔ Diffusion: oxygen, carbon
dioxide, water & electrolytes
move from greater to lesser
concentration
✔ Facilitated transport: glucose
✔ Active transport: amino acid,
calcium, iron
✔ Pinocytosis: fat, gamma
globulin, albumin
✔ Leakage allows fetal &
maternal blood to mix slightly
because of placental defects;
normally, there is no mixture of
fetal & maternal blood.
► Excretory with the amniotic
fluid as the medium of
excretion
► Respiratory organ of the fetus
► The placenta acts as a
protective barrier to some
substances & organisms like
heparin & bacteria; ineffective
for virus, alcohol, nicotine,
antibiotics, depressants &
stimulants.
► Endocrine: secretes hormones
estrogen, progesterone, human
chorionic gonadotropin (HCG),
and human placental lactogen
(HPL), also called chorionic
somatomammotropin (HCS)
ESTROGEN
► Referred to as “hormone of
women”
► Primarily estriol is produced
as a second product of
syncytial cells of the placenta
► Contributes to the mother’s
mammary gland
development in preparation
for lactation & stimulates the
uterus to grow to
accommodate the developing
fetus.
► Assessing the amount of estriol
in maternal serum can be used
 as a test of fetal welfare ✔ The first hormone to be
because the immediate produced
precursor of estrogen synthesis ✔ Secreted as early as 8 to 10
by the placenta is a compound days after fertilization;
produced by the fetal adrenal detected in serum as early as
gland & liver. When the fetus is the time of implantation by the
stressed, the production of this most sensitive pregnancy test,
fetal compound is decreased; the radioimmunoassay (RIA);
estrogen, therefore cannot be and detected in urine 10 days
synthesized, & the level of (2 weeks) after missed period
estriol in maternal serum will by simple pregnancy test.
then decrease. ✔ Functions: prolongs the life of
► After the 32nd week of the corpus luteum; serves as
pregnancy, a level less than 14 the basis for pregnancy tests
ng/mL suggests that fetal well- ✔ The hormone found elevated in
being is in jeopardy. excessive vomiting
PROGESTERONE ✔ Normal value: 400,000 I.U./24
► Referred to as the “hormone hours
of mothers” ✔ Purpose: is to act as a fail-safe
► Function: Necessary to measure to ensure that the
maintain the endometrial corpus luteum of the ovary
lining of the uterus during continues to produce
pregnancy & to reduce the progesterone & estrogen;
contractility of the uterine suppresses the maternal
musculature during pregnancy, immunologic response so
which prevents premature placental invasion is not
labor rejected.
► Present in serum as early as ► Because the structure of HCG is
the 4th week of pregnancy as a similar to luteinizing hormone
result of the continuation of the of the pituitary gland, if the
corpus luteum fetus is male, it exerts an effect
► When placental synthesis on the fetal testes to begin
begins (at around the 12th testosterone production. The
week), the level rises presence of testosterone
progressively during the causes the maturation of male
remainder of pregnancy. reproductive tract
HUMAN CHORIONIC ► At about 8th week of
GONADOTROPIN pregnancy, the outer layer of
cells developing placenta
 begins to produce are always available to the
progesterone – corpus luteum fetus
is no longer needed so the Mechanisms by which Nutrients Cross
production of HCG which the Placenta
sustained it begins to decrease. Mechanism Description
► The mother’s serum will be Diffusion When there is a
completely negative for HCG greater
within 1 to 2 weeks after concentration of a
delivery. Testing of HCG substance on one
following delivery can be used side of a
as a proof that all the placental semipermeable
membrane than on
tissue has been delivered. the other,
Human Chorionic substances of
Somatomammotropin (HCS) or correct molecular
Human Placental Lactogen (HPL) weight cross the
membrane from the
✔ Produced by the placenta as area of higher
early as the 6th week of concentration to the
area of lower
pregnancy. It can be assayed
concentration.
in both maternal serum & urine Oxygen & carbon
✔ Is a hormone with both dioxide cross the
growth-promoting and placenta by simple
lactogenic (milk-producing) diffusion.
properties. Facilitated In order that the
diffusion fetus receives
✔ The principal diabetogenic
enough
factor as it is the major insulin concentrations of
antagonist, or glucose sparing necessary growth
hormone substances, some
✔ Functions: substances cross
• Promote mammary gland the placenta more
rapidly or more
(breast) growth in
easily than would
preparation for lactation in occur if only simple
the mother (accounting for its diffusion were
name) operating. Glucose
• Serves the important role of is an example of a
regulating maternal glucose, substance that
crosses by this
protein, & fat levels so that
process.
adequate amounts of these
Active transport This process
 requires that an
enzyme act to
facilitate transport.
THE UMBILICAL CORD/FUNIS
Essential amino
acids & water ► Develops from and contains
soluble vitamins remnants of the yolk sac and
cross the placenta allantois. It forms by the 5th
against the pressure week of development,
gradient or from an replacing the yolk sac as the
area of lower
source of nutrients for the
molecular
concentration to an embryo.
area of greater ► Length:50 - 55 cm, 1 inch
molecular across at term
concentration. ► Parts:
Amino acid • One left umbilical vein;
concentrations in
carries oxygenated blood to
fetal plasma are
twice what they are the fetus
in the mother, a • Two umbilical arteries (left &
situation that must right): carry deoxygenated
occur to provide blood from fetus to placenta
building substances • Wharton’s jelly, gelatinous
for active fetal
substance
growth.
Pinocytosis Absorption by the (mucopolysaccharides):
cellular membrane specialized connective tissue,
of microdroplets of an extension of the amnion;
plasma & dissolved surrounds the umbilical cord.
substances. Gamma The blood volume in the cord
globulin, also helps prevent cord
lipoproteins,
phospholipids, and compression.
other molecular ⮚ The cord extends from the fetal
structures that are surface of the placenta to the
too large for fetal umbilicus
diffusion and that ⮚ Function: to transport oxygen
cannot participate & nutrients to the fetus & to
in active transport
cross in this return metabolic wastes
manner. including carbon dioxide from
Unfortunately, the fetus to the placenta.
viruses that then
infect the fetus may
also cross in tis
manner.
 ► Serve as a protective
cushion/shock absorber
► Separates fetus from
membranes allowing
symmetrical growth & free
movement
► Acts as a medium of excretion
► Serves as fetal drink (if there is
an abnormality in the
deglutition center of the brain
or if there is esophageal atresia
that the fetus could not
swallow, amniotic fluid
THE AMNIOTIC FLUID accumulates
► Clear, straw-colored fluid in (polyhydramnios).
which the fetus floats ► Serves as a specimen for
► Origin: both fetal & maternal; periodic diagnostic exams to
amniotic epithelium maternal examine to determine fetal
serum & in later part (10th well-being or its absence
week), fetal urine; constantly ► Maintains fetal temperature
being replaced so there is no ► Equalizes uterine pressure &
“dry labor” in premature prevents marked interference
rupture of the bag of water. with placental circulation
► Amount: 500 to 1000 ml at during labor.
term; polyhydramnios – STAGES OF INTRAUTERINE
excessive amount of amniotic DEVELOPMENT
fluid greater than 1,000 to ► The Ovum
1,500 ml; oligohydramnios –
amount less than 300 to 500
ml.
► Reaction: neutral to alkaline
(pH 7 to 7.25)
► Abnormal colors: green-tinge
in a non-breech presentation is
a sign of fetal distress;
golden-colored fluid may be
found in hemolytic disease. ✔ From fertilization to 2 weeks
AMNIOTIC FLUID FUNCTIONS ✔ The period of pre-
differentiation of organs
✔ When the ovum is exposed to ⮚ Mesoderm: the middle layer;
teratogen, the ‘all-or-none’ law develops into:
applies, meaning the ovum is ✔ Dermis
damaged & is out in ✔ Cardiovascular system & blood
spontaneous abortion or is not cells
affected at all & continues to ✔ Reproductive system
grow normally. ✔ Musculo-skeletal system
⮚ The Embryo ✔ urogenital system, except the
✔ From 2 weeks to 2 months bladder
✔ The period of organ ► Endoderm/Entoderm: the
differentiation inner layer, develops into:
(organogenesis). ✔ Linings of gastrointestinal tract
✔ Most Dangerous Period: a from pharynx to rectum
teratogen introduced at this ✔ Liver, pancreas, thyroid,
stage may result in severe parathyroid
organ malformation & ✔ Respiratory tract
dysfunction. ✔ Bladder, thyroid, thymus (for
► The Fetus immunity building)
✔ From 8 weeks to birth FETAL CIRCULATION
✔ The period of post-
differentiation of organs
✔ When exposed to a teratogen, a
malformation is least likely to
occur. If ever the fetus is
affected, the effects will most
likely be alteration in size or
function but not in for.

THE EMBRYONIC GERM LAYERS

► Ectoderm: the outer layer;
develops into: ► Three unique structures
✔ Nervous system function during fetal
✔ Hair, nails, skin (epidermis), development to provide
sebaceous & sweat glands sufficient blood flow for
✔ Salivary glands, mucous metabolic & nutrient functions
membrane of mouth of the placenta: ductus
✔ Epithelium of nasal-oral venosus, foramen ovale, ductus
passages arteriosus.
► Oxygenated blood & nourished
blood from the placenta enters
the fetus through umbilical
vein. Soon after it enters the
abdominal wall, the umbilical
vein branches. The smaller
branch enters the hepatic
circulation & later empties into
the inferior vena cava through
the hepatic vein.
► The second larger branch
enters the inferior vena cava
directly through the ductus
venosus.
► Blood from the inferior vena
cava empties directly into the
right atrium, where it mixes
with blood from the superior
vena cava through the hepatic
vein.
► The majority of this blood
passes through the foramen
ovale & into the left atrium,
where it mixes deoxygenated
from the lungs.
► This blood is then pumped into
the left ventricle & out to the
fetal body through the aorta.
❖ The remaining blood in the
right atrium is pumped
through the tricuspid valve into
the right ventricle & out to the
pulmonary artery only a small
portion of this blood continues
to the nonfunctioning lungs to
nourish them; the remainder
passes through the ductus
arteriosus & enters the body
circulation directly.
❖ Deoxygenated blood returns to
the placenta through the
umbilical arteries, where the
process repeat itself.
MILESTONES OF FETAL GROWTH
& DEVELOPMENT
End of 4 Gestation Weeks
✔ Does not resemble a human
being yet
✔ Spinal cord has formed & fused
at midpoint
✔ The head will fold forward &
become prominent, comprising
about 1/3 of the entire
structure
✔ Arms & legs are bud-like
structures
✔ Rudimentary formation:
heart; eyes, ears, & nose are
discernible
✔ Length is 0.75 to 1 cm
✔ Weight is 400 mg
End of 8 Weeks Gestation
✔ Length is 2.5 cm (1 inch)
✔ Weight is 20 g
✔ Organogenesis is complete
✔ Heart has a septum & valves
& is beating rhythmically
✔ Facial features – definitely
discernible
✔ Legs, arms, fingers, toes,
elbows, & knees have
developed
✔ External genitalia – present
(male & female are not
distinguishable by simple
observation)
✔ Sonogram – demonstrates a
gestational sac & is diagnostic
of pregnancy
End of 12 Gestation Weeks (First
Trimester)
✔ Length is 7 to 9 cm. weight is
45 g
✔ Nailbeds are forming on
fingers and toes. The fetus is
capable of spontaneous
movements, although they are
usually too faint to be felt by
the mother.
✔ Some reflexes are present,
notably the Babinski reflex.
✔ Ossification centers are
forming in bones, and tooth
buds are present.
✔ Male and female fetuses are
distinguishable by outward
appearance.
✔ Kidney secretion has begun,
although urine may not yet be
evident in amniotic fluid. The
heart beat is audible by a
Doppler instrument.
End of 16 Gestation Weeks
✔ Length is 10 to 17 cm weight is
55 to 120 g.
✔ It may be possible to hear fetal
heart sounds through an
ordinary stethoscope.
✔ The formation of lanugo (the
fine, downy hair on the back
and arms of NB, apparently
serving as a source of
insulation for body heat) is
well formed.
✔ The liver & pancreas are
functioning. At this time, the
fetus actively swallows
amniotic fluid, demonstrating
an intact swallowing reflex.
End of 20 Gestation Weeks
✔ Length is 25 cm. weight is 223
g.
✔ The spontaneous movements
of the fetus have become
strong enough for the mother
to feel. The sensation is like the
fluttering of wings or fluid
moving rapidly through the
bowels. This event is termed
quickening. It is a major
milestone in pregnancy.
✔ Capable of antibody
production
✔ Hair formation extends to
include eyebrows and hair on
the head.
✔ Meconium is present in the
upper intestine.
✔ Brown fat, a special fat that
will aid in temperature
regulation at birth, begins to be
formed behind the kidneys,
sternum and posterior neck.
✔ Fetal heart beat is strong
enough to be heard readily
through the abdomen with an
ordinary stethoscope.
✔ Developed biorhythms that
will guide sleep/wake
patterns throughout life.
End of 24 Gestation weeks
(Second Trimester)
✔ Length is 28 to 36 cm. weight is
550 g.
✔ Passive antibody transfer from
mother to fetus probably
begins as early as the 20th week
of gestation, certainly by the
24th of gestation. Infants born
before antibody transfer has
taken place have no natural
immunity & need more than
the usual protection against
infectious disease in the NB
period until the infant’s own
store of immunoglobulins can
build up.
✔ Vernix caseosa, a cream
cheese-like substance
produced by the sebaceous
glands that serves as a
protective skin covering during
intrauterine life, begins to form
following the 20th week.
✔ Meconium is present as far as
the rectum.
✔ Active production of lung
surfactant begins, and features
as detailed as eyebrows and
eyelashes are well defined. The
eyelids of the fetus have been
fused since the 12th week. Now
the membrane that had fused
them dissolves, the eyes can
open, and the pupils are
capable of reacting to light.
✔ When the reach 24 weeks, or
601 g, they have achieved a
practical low-end age of
viability if they are cared for
after birth in a modern
intensive care facility.
End of 28 Gestation Weeks
✔ Length is 35 to 38 cm. Weight
is 1200 g.
✔ The lung alveoli begin to
mature, and surfactant can be
demonstrated in amniotic fluid.
✔ In the male fetus, the testes
begin to descend into the
scrotal sac from the lower
abdominal cavity.
✔ The blood vessels of the
retina are extremely
susceptible to damage from
high oxygen concentrations
(an important consideration
when caring for low-birth-
weight infants who need
oxygen).
End of 32 Gestation Weeks
✔ Length is 38 to 43 cm. weight is
1600 g.
✔ Subcutaneous fat begins to be
deposited in the fetus during
this month, & the former
stringy, “little old man”
appearance is lost. The fetus is
aware of sounds outside the
mother’s body, has an active
Moro reflex, and in some cases,
has already assumed delivery
position (vertex or breech).
✔ Iron stores to provide iron for
the time during which he or
she will ingest only milk
following birth begin to be laid.
✔ Fingernails grow to reach the
end of fingertips.
End of 36 Gestation Weeks
✔ Length is 42 to 49 cm. Weight
is 1900 to 2 700 g (5 to 6 lb).
✔ In the last 2 months of
intrauterine life, body stores
of glycogen, iron,
carbohydrate, and calcium
are augmented and additional
amounts of subcutaneous fat
are deposited.
✔ The sole of the foot has only
one or two crisscross creases
compared with the full
crisscross pattern that will be
evident at term.
✔ The amount of lanugo present
begins to diminish.
✔ Many babies turn into a vertex
or head presentation during
this month.
End of 40 Gestation Weeks
(Third Trimester)
✔ Length, crown to heel, is 48 to
52 cm. Weight is 3000 g (7 to 7
½ lb.).
✔ The fetus kicks actively
during these weeks, hard
enough to cause the mother
considerable discomfort.
✔ Fetal hemoglobin begins its
conversion to adult
hemoglobin. The conversion is
so rapid that, at birth, about
20% of hemoglobin will be
adult in character.
✔ Vernix caseosa is fully formed.
✔ Fingernails extend over tips of
fingers.
✔ Creases on the soles of feet
cover at least two-thirds of
their surface.
✔ In primiparas, the fetus often
sinks into the birth canal
during these last 2 weeks. This
event is termed lightening. It
is fetal announcement that the
third trimester of pregnancy
has ended and birth is at hand.
SPECIAL CONCERNS:
TERATOGENIC EFFECTS OF DRUGS
Teratogenesis: the dysgenesis of
fetal organs as evidenced either
structurally or functionally.
Teratogen – is any factor, chemical
or physical that adversely affect the
fertilized ovum, embryo, or fetus.
Manifestations: restricted growth
or death of the fetus,
carcinogenesis, and malformations
defined as defects in organ
structure or function. These
abnormalities vary in severity &
major malformations may be life-
threatening, or may have cosmetic
functional effects & require major
surgery.
Safety Risk: Because any
medication can present risks in
pregnancy, and because not all risks
are known, the safest pregnancy –
related pharmacy is as little as
pharmacy possible. Prescribing
drugs for women during the
antenatal and postnatal period is a
balancing act and that no risk-free
alternatives exist. Each drug should
be assessed, and its risks and
benefits should be weighed.
PATERNAL EXPOSURE
✔ Exposure to medication may
alter the quality, size, shape,
performance, and production
of sperm. This observation
suggests that drug exposure in
the male may put the fetus at
risk. Animal studies have
shown that maternal
teratogenic exposure may lead
to pregnancy loss or failure of
✔ the embryo to develop, but no
evidence shows that paternal
exposure directly increases the
risk of birth defects.
SAFETY GUIDES IN PREGNANCY
✔ For any ailment seek medical
attention. Take only prescribed
drugs.
✔ Do not self medicate.
✔ Do not take OTC drugs
including vitamins and
minerals.
✔ Do not take alcohol no matter
how slight.
✔ The US Federal Drug
Administration (FDA), the
government agency that
oversees the safety of drugs,
provides the most widely used
system to grade the teratogenic
effects of medications using a
5-letter systems: A, B,C, D, and
X.
Teratogenic Maternal Infections
► Has been described collectively
under the umbrella term
TORCH, which is an
abbreviation for
toxoplasmosis, rubella,
cytomegalovirus, and herpes
simplex virus. Some sources
identify “O” with “other
infections,” which could
include syphilis, hepatitis B
virus (HBV), and HIV.
► These are all the infections
known to cross the placenta &
affect the fetus during
pregnancy.
► The TORCH screen was
developed as an immunologic
survey to determine whether
these infections exist in either
the pregnant woman (to
identify fetal risk factors) or
the NB (to detect if an
antibodies against the common
infectious teratogens are
present).
► Teratogenic infections can be
viral, bacterial, or protozoan.
Most cause relatively mild, flu-
like symptoms in the woman,
yet have much more serious
effects on the fetus or NB.
 Drugs with Proven humans; use only if
Teratogenic Effects benefits outweigh
risk to fetus
Drugs Teratogenic Effects Category X Contraindicated;
Methotreaxate CNS and limb benefit does not
malformations outweigh risk
NSAIDs Constriction of
ductus arteriosus,
necrotizing
entercolitis
TERATOGENIC MATERNAL
Phenytoin Growth
retardation, CNS INFECTIONS
defects RUBELLA
Psychoactive Neonatal ✔ The rubella virus usually
drugs withdrawal causes mild systemic illness in
(barbiturates, syndrome when the mother, but the teratogenic
opioids, given in late effects on the fetus is
benzodiazepines) pregnancy
Tetracycline Teeth
devastating
staining/defects, ✔ Fetal damage from maternal
bone defects infection with rubella (German
measles) includes deafness,
FDA Categories for Labeling of
Drugs with Proven Teratogenic Effects
Prescription Drugs to Indicate the
Risk of Their Use in Pregnancy Drugs Teratogenic Effects
Anticholinergic drugs Neonatal meconium
Category A Fetal risk not
ileus
revealed in
Antithyroid drugs Fetal &neonatal
controlled studies (Prophylthiouracil, goiter,
in humans methimazole) hypothyroidism
Category B Fetal risk not
confirmed in Cyclophosphamide CNS malformation,
studies in humans secondary cancer
but has been Diethylstilbestrol Vaginal cancer, other
GU defects in male or
shown in some
female offspring
studies in animals
Hypoglycemic drugs Neonatal
Category C Fetal risk revealed hypoglycemia
in studies in Warfarin (Coumadin) Skeleton & CNS
animals but not defects (heparin is
established or not the anticoagulant of
studied in humans; choice in pregnancy;
may be used if does not pass-
benefit outweigh through placental
risk to fetus barriers)
Category D Fetal risk shown in
 mental and motor
retardation, cataracts,
cardiac defects (patent ductus
arteriosus & pulmonary
stenosis being the most
common), retarded
intrauterine growth (SGA),
thrombocytopenic purpura,
and dental and facial clefts,
such as cleft lip & palate.
✔ Greatest risk – organogenesis
period in early pregnancy
( first 12 weeks – 80%; 13 to
14 weeks – 54%; after the
second trimester – 25%). In
addition, there is 30% chance
of spontaneous abortion or
stillbirth if the infection occurs
in the first trimester.
RUBELLA
✔ All women of childbearing age
should be immunized with
rubella so that this teratogen
can be eradicated.
✔ A woman who is not
immunized before pregnancy
cannot be immunized during
pregnancy because the vaccine
uses live virus that would have
effects similar to those
occurring with a subclinical
case of rubella.
✔ Following a rubella
immunization a woman is not
advised to become pregnant
for three months.
CYTOMEGALOVIRUS (CMV)
✔ A member of the herpes family
✔ Another teratogen that can
cause extensive damage to a
fetus
✔ Transmitted by droplet
infection from person to
person. If a woman acquires
primary CMV infection during
a pregnancy, transplacental
transmission of the virus may
result in congenital CMV
infection.
✔ Mother – no symptom, infant
– may be born with severe
brain damage (hydrocephalus,
microcephaly, spasticity), eye
damage (optic atrophy,
chorioretinitis), deafness or
chronic liver disease, skin –
covered with large petechiae
(“blue berry muffin” lesions).
CYTOMEGALOVIRUS (CMV)
✔ Diagnosis – established by
isolation of CMV antibodies in
serum.
✔ No treatment or vaccine
exists – routine screening is
not recommended
✔ Primary CMV infection may
become latent & then reactive
periodically. These recurrences
are not thought to have
teratogenic effect on the fetus,
but they can cause infection of
the NB during birth from
genital secretions or
postpartum exposure to CMV-
infected breast milk.
✔ CMV infection contracted at
birth is not associated with
 serious adverse effects except
in babies of very low birth
weight.
HERPES SIMPLEX VIRUS
(GENITAL HERPES INFECTION)
✔ A primary, first-episode genital
herpes infection in a pregnant
woman poses a substantial risk
to the fetus. First time infection
– systemic involvement – the
virus spreads into the
bloodstream (viremia) & OTHER VIRAL DISEASES
crosses the placenta to the
fetus.
✔ If the infection takes place in
the
• first trimester – severe
congenital anomalies or
spontaneous abortion may
occur
• Second or third trimester –
there is a high incidence of
premature birth, IUGR, &
continuing infection of the NB
at birth. Fetal mortality &
morbidity rate is as high as
40%.
HERPES SIMPLEX VIRUS
(GENITAL HERPES INFECTION)
✔ If the woman has had herpes
simples virus type 1 infections
prior to the genital herpes
invasion or if the genital herpes
(type 2) infection is a
recurrence, antibodies to the
virus in her system prevent
spread of the virus to the fetus
across the placenta.
✔ If genital lesions are present at
the time of birth, the fetus may
contract the virus during birth,
so this is still serious.
✔ For women with a history of
genital herpes & existing
genital lesions when labor or
rupture of membrane occurs,
cesarean delivery is often
performed – reduce the risk of
neonatal infection.
✔ Rubeola (measles),
coxsackievirus, mumps,
varicella (chickenpox),
poliomyelitis, influenza, and
viral hepatitis all may be
teratogenic
✔ Parvovirus B19 is the
causative agent of erythema
infectiosum (also called fifth
disease). If the pregnant
woman contracts this infection,
the virus can cross the placenta
& attacks the RBC of the fetus.
Infection – early pregnancy –
fetal death; late in pregnancy –
infant may be born with
severe anemia & congenital
heart disease.
SYPHYLIS
✔ A sexually transmitted
infection caused by spirochete
Treponema pallidum
✔ Extensive damage to the fetus
after the 16th to 18th week of
intrauterine life, when the
cytotrophoblastic layer of the
 placental villi has atrophied & LYME DISEASE
no longer protects against it. ✔ Is a multisystem disease
✔ If detected & treated before caused by the spirochete
(16th to 18th ) this time, the Borrelia burgdorferi and
fetus is rarely affected. spread by the bite of a deer
✔ If left untreated beyond the tick. The highest incidence
18th week of gestation, occurs in the summer & early
deafness, mental fall.
retardation, osteochondritis, ✔ Following tick bite, a typical
& fetal death skin rash, erythema
SYPHYLIS chronicum migrans (large,
✔ Prevention – early detection & macular lesions with a clear
immediate treatment with center), develops. Pain in large
antibiotics to prevent body joints such as the knee
congenital syphilis. may be present.
✔ Benzathine penicillin – drug ✔ Infection in pregnancy results
often used since it may be in spontaneous abortion or
given safely during pregnancy. severe congenital anomalies.
✔ Serologic screening (either a ✔ Prevention:
VDRL or a rapid plasma regain) • Pregnant woman should
– done at the first prenatal avoid areas where they are
visit, may be repeated again apt to be bitten by the ticks
close to term (8th month) (woods and tall grass).
✔ The NB with congenital syphilis • If hiking – wear long, light –
may have congenital colored slacks tucked into
anomalies: extreme rhinitis socks to prevent legs from
(snuffles), & a characteristic being exposed.
syphilitic rash. • Avoid use of tick repellants
✔ Woman has been treated - containing diethyltoluamide
serum titer remains high for (ingredient) – teratogenic.
more than 200 days • Returning from outing –
(increasing titer suggest inspect body carefully &
additional infection has immediately remove any ticks
occurred). if find.
✔ Infant – serologic test may LYME DISEASE
remain positive for up to 3 ✔ To spread the spirochete, the
months even though the tick must be present on the
disease was treated during body possibly as long as 24
pregnancy. hours.
✔ Treatment:
• for pregnant women – a
course of penicillin may be
prescribed to reduce
symptoms.
• For non-pregnant women –
tetracycline & doxycycline –
cannot be used during
pregnancy, as they cause
tooth discoloration and,
possibly, long-bone
malformation in the fetus.
TOXOPLASMOSIS
✔ A protozoan infection, may be
contracted by eating
undercooked meat, cat stool in
soil or cat litter (organism is
spread most commonly).
✔ The woman may experience
almost no symptoms of the
disease except a few days of
malaise & posterior cervical
lymphadenopathy.
✔ Following placenta transfer of
the infection, the infant may be
born with CNS damage,
hydrocephalus, microcephaly,
intracerebral calcification, and
retinal deformities.
✔ Diagnosis – serum analysis
✔ Treatment – sulfonamides may
be given during pregnancy
(sulfa – increase bilirubin
levels in NB).
✔ Prevention:
• Avoid eating undercooked
meat
• Do not change a cat litter box
or work in soil in an area
where cats may defecate
INFECTIONS THAT CAUSE ILLNESS
AT BIRTH
► A number of infections are not
teratogenic to the fetus during
pregnancy but are harmful if
they are present at the time of
birth. Gonorrhea, candidiasis,
chlamydia and hepatitis B are
example of these.
POTENTIAL TERATOGENICITY OF
VACCINES
► Live virus vaccines, such as
measles, mumps, rubella,
and poliomyelitis (Sabin
type), are contraindicated
during pregnancy because they
may transmit the virus
infection to the fetus.
► Make sure that adolescents
about to be vaccinated are not
pregnant or do not become
pregnant until 3 months
afterward.
► Women who work in biologic
laboratories where vaccines
are manufactured are well
advised not to work with live
virus products during
pregnancy.