CARE OF MOTHER, CHILD AND ADOLESCENTS

LECTURE NOTES (12/04/23)

STAGES OF FETAL DEVELOPMENT

DEFINITION
● In just 38 weeks, a fertilized egg (ovum) matures : Gradual Process
from a single cell to a fully developed fetus : Occurs between 6th- 7th week
ready to be born.
○ Pre-embryonic (first 2 weeks,
PLACENTA
beginning with fertilization)
○ Embryonic (weeks 3 through 8) The placenta (Latin for “pancake,” which is
○ Fetal (from week 8 through birth) descriptive of its size and appearance at 418 term)
grows from a few identifiable trophoblastic cells at the
beginning of pregnancy to an organ 15 to 20 cm in
diameter and 2 to 3 cm in depth, covering about half the
surface area of the internal uterus at term
FUNCTION:
● Fully functional by week 12
● Respiration
● Nutrition
● Waste Removal
● Protection
● Endocrine
FERTILIZATION
(also referred to as conception and
impregnation) is the union of an ovum and a
spermatozoon. This usually occurs in the outer third of a
fallopian tube, termed the ampullar portion
● Once the mature ovum is released (i.e.,
ovulation), fertilization must occur fairly quickly
because an ovum is capable of fertilization for
only about 24 hours (48 hours at the most)
● the functional life of a spermatozoon is also
about 48 hours, possibly as long as 72 hours,
the total critical time span during which sexual
relations must occur for fertilization to be
successful is about 72 hours (48 hours before
ovulation plus 24 hours afterward).
● ejaculation of semen averages 2.5 ml of fluid
containing 50 to 200 million spermatozoa per
milliliter or an average of 400 million sperm
per ejaculation
● spermatozoa deposited in the vagina generally AMNIOTIC MEMBRANES
reach the cervix within 90 seconds and the outer
end of a fallopian tube within 5 minutes ● is a dual-walled sac with the chorion as the
Fertilization is never a certain occurrence because it outermost part and the amnion as the innermost
depends on at least three separate factors: part.
● Equal maturation of both sperm and ovum ● not only offers support to amniotic fluid but also
● Ability of the sperm to reach the ovum actually produces the fluid.
● Ability of the sperm to penetrate the zona
pellucida and cell membrane and achieve AMNIOTIC FLUID
fertilization
● Clear, slightly yellow, alkaline fluid
IMPLANTATION ● Approximately 1L at term
contact between the growing structure and the ● Derived from
uterine endometrium, occurs approximately 8 to 10 days ○ Maternal Plasma
after fertilization ○ Cells of amnion
Nidation: Process of attachment to an organ ○ Feral fluids from lungs, skin, fetal urine

DEQUIROS, G. 1
 CMCA

● the amount of amniotic fluid has grown so much

it ranges from 800 to 1,200 ml.
● excessive amniotic fluid or hydramnios
● oligohydramnios or a reduction in the amount
of amniotic fluid
● Amniotic fluid is slightly alkaline, with a pH of
about 7.2
FUNCTIONS:
● Cushions fetus from trauma
● Facilitates fetal development
● Facilitates symmetrical growth
● Regulates intrauterine temperature
● Provides source of oral fluid
● Cushions umbilical cord
● Receptacle for fetal substances
UMBILICAL CORD
● One vein, two arteries (AVA)
● Wharton’s jelly
● Amnion
● is formed from the fetal membranes, the amnion
and chorion, and 423 provides a circulatory
pathway that connects the embryo to the
chorionic villi of the placenta.
● transport oxygen and nutrients to the fetus from
the placenta and to return waste products from
the fetus to the placenta
● 53 cm (21 in.) in length at term and about 2 cm
(0.75 in.) thick
MILESTONE OF FETAL GROWTH AND
DEVELOPMENT
END OF 4TH GESTATIONAL WEEK
● The length of the embryo is about 0.75 cm;
weight is about 400 mg.
● The spinal cord is formed and fused at the
midpoint.
● The head is large in proportion and represents
about one third of the entire structure.
● The rudimentary heart appears as a prominent
bulge on the anterior surface.
● Arms and legs are bud-like structures;
rudimentary eyes, ears, and nose are
discernible.
END OF 8TH GESTATIONAL WEEK
● The length of the fetus is about 2.5 cm (1 in.);
weight is about 20 g.
● Organogenesis is complete.
● The heart, with a septum and valves, beats
rhythmically.
● Facial features are definitely discernible; arms
and legs have developed.
● External genitalia are forming, but sex is not yet
distinguishable by simple observation.
● The abdomen bulges forward because the fetal
intestine is growing so rapidly.
● A sonogram shows a gestational sac, which is
diagnostic of pregnancy

NOTES FROM THE DISCUSSION:

GENETICS
● Chromosomes
○ Autosomal (22 chromosomes)
○ Sex (1 Chromosome)
○ 23 pairs of chromosomes
● Chromosomal Syndrome
● Modes of Inheritance
PATTERNS OF INHERITANCE
● Dominant
● Recessive
● X-linked

TERATOGENS
● Causes low intelligence
○ Tobacco
○ Alcohol
○ Marijuana
○ Cocaine END OF 12TH GESTATIONAL WEEK (1ST
● Facial Deformities TRIMESTER)
○ Anticonvulsants
● The length of the fetus is 7 to 8 cm; weight is
○ Anticoagulants
about 45 g.
○ Acne Medications
● Nail beds are forming on fingers and toes.
MULTIFETAL PREGNANCY
● Spontaneous movements are possible, although
● Dizygotic twinning- Fraternal
they are usually too faint to be felt by the mother.
● Monozygotic Twinning- Identical
● Some reflexes, such as the Babinski reflex, are
present.
● Bone ossification centers begin to form.
● Tooth buds are present.

DEQUIROS, G. 2
 CMCA
● Sex is distinguishable on outward appearance.
● Urine secretion begins but may not yet be
evident in amniotic fluid.
● The heartbeat is audible through Doppler
technology
END OF 16TH GESTATIONAL WEEK
● The length of the fetus is 10 to 17 cm; weight is
55 to 120 g.
● Fetal heart sounds are audible by an ordinary
stethoscope.
● Lanugo is well formed.
● Both the liver and pancreas are functioning.
● The fetus actively swallows amniotic fluid,
demonstrating an intact but uncoordinated
swallowing reflex; urine is present in amniotic
fluid.
● Sex can be determined by ultrasonography.
END OF 20TH GESTATIONAL WEEK
● The length of the fetus is 25 cm; weight is 223 g.
● Spontaneous fetal movements can be sensed
by the mother.
● Antibody production is possible.
● Hair, including eyebrows, forms on the head;
vernix caseosa begins to cover the skin.
● Meconium is present in the upper intestine.
● Brown fat, a special fat that aids in temperature
regulation, begins to form behind the kidneys,
sternum, and posterior neck.
● Passive antibody transfer from mother to fetus
begins.
● Definite sleeping and activity patterns are
distinguishable as the fetus develops biorhythms
that will guide sleep/wake patterns throughout
life.
END OF 24TH GESTATIONAL WEEK (SECOND
TRIMESTER)
● The length of the fetus is 28 to 36 cm; weight is
550 g.
● Meconium is present as far as the rectum.
● Active production of lung surfactant begins.
● Eyelids, previously fused since the 12th week,
now open; pupils react to light.
● Hearing can be demonstrated by response to
sudden sound.
● When fetuses reach 24 weeks, or 500 to 600 g,
they have achieved a practical low-end age of
viability if they are cared for after birth in a
modern intensive care nursery.
END OF 28TH GESTATIONAL WEEK
● The length of the fetus is 35 to 38 cm; weight is
1,200 g.
● Lung alveoli are almost mature; surfactant can
be demonstrated in amniotic fluid.
● Testes begin to descend into the scrotal sac
from the lower abdominal cavity.
● The blood vessels of the retina are formed but
thin and extremely susceptible to damage from
high oxygen concentrations (an important
consideration when caring for preterm infants
who need oxygen)
DEQUIROS, G.
●
END OF 32ND GESTATIONAL WEEK
● The length of the fetus is 38 to 43 cm; weight is
1,600 g.
● Subcutaneous fat begins to be deposited (the
former stringy, “little old man” appearance is
lost).
● Fetus responds by movement to sounds outside
the mother’s body.
● An active Moro reflex is present.
● Iron stores, which provide iron for the time
during which the neonate will ingest only breast
milk after birth, are beginning to be built.
● Fingernails reach the end of fingertips.
END OF 36TH GESTATIONAL WEEK
● The length of the fetus is 42 to 48 cm; weight is
1,800 to 2,700 g (5 to 6 lb).
● Body stores of glycogen, iron, carbohydrate, and
calcium are deposited.
● Additional amounts of subcutaneous fat are
deposited.
● Sole of the foot has only one or two crisscross
creases compared with a full crisscross pattern
evident at term.
● Amount of lanugo begins to diminish.
● Most fetuses turn into a vertex (head down)
presentation during this month.
END OF 40TH GESTATIONAL WEEK (THIRD
TRIMESTER
● The length of the fetus is 48 to 52 cm (crown to
rump, 35 to 37 cm); weight is 3,000 g (7 to 7.5
lb).
● Fetus kicks actively, sometimes hard enough to
cause the mother considerable discomfort.
● Fetal hemoglobin begins its conversion to adult
hemoglobin.
● Vernix caseosa starts to decrease after the
infant reaches 37 weeks gestation and may be
more apparent in the creases than the covering
of the body as the infant approaches 40 weeks
or more gestational age.
● Fingernails extend over the fingertips.
● Creases on the soles of the feet cover at least
two thirds of the surface.
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