Physiology of Pregnancy and

Prenatal Development
NP03L001 / Version 1.4

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Terminal Learning Objective
Given a scenario of a developing fetus
and the five elements of the nursing care
process, determine approaches for patient
care, by correctly responding to written,
oral, and experiential assessment
measures.

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Enabling Learning Objectives
A: Describe the process of gametogenesis.

B: Relate ovulation and ejaculation to the

process of human conception.

C: Explain implantation and nourishment of

the embryo before development of the
placenta.

D: Describe normal prenatal development

from conception through birth.

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ELOs Con’t
E: Identify the structure and functions of
the placenta, amniotic sac, umbilical cord,
and fetal membranes.

F: Compare fetal circulation to neonatal

circulation.

G: Explain the similarities and differences

in the two types of twins.

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Gametogenesis
Gametogenesis: the development of ova
in the woman and sperm in the man.
Gametes:
◦ Oogenesis: formation of female gamete.
◦ Spermatogenesis: formation of male
gamete.
◦ Meiosis: the process in which cells divide
to form gametes.

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Check On Learning
QUESTION: What is female
gametogenesis called?

ANSWER: Oogenesis.

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Ovulation and Ejaculation
Conception: human fertilization occurs
when the sperm penetrates an ovum and
unites it.
NOVA Online | Life's Greatest Miracle |
Watch the Program Here

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Preparation for Conception in the Female
Release of the ovum:
◦ Ovulation occurs approximately 14 days
before a woman’s next menstrual cycle would
begin.
◦ Is estimated to survive no longer than 24 hrs
after its release at ovulation.

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Conception in the Female Con’t
Ovum transportation:
◦ Mature ovum is released on the surface of the
ovary where it is picked up by the fallopian
tube and transported through the tube and
awaits fertilization.
◦ The ovum fertilized or not, enters the uterus
approximately 3 days after its release from the
ovary.

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Preparation for Conception in the
Male
Ejaculation: most sperm survive no
longer than 24 hours in the female
reproductive tract, but a few may remain
fertile for up to 5 days.

Transport of sperm in the female

reproductive tract:
◦ Only sperm cells enter the cervix.
◦ Most are lost along the way and fewer than
200 reach the fallopian tube.

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Conception in the Male Con’t 
Preparation of sperm for fertilization:
◦ Sperm are not immediately ready to fertilize
the ovum.
◦ During the trip to the ovum, they undergo
changes that enable one of them to penetrate
the protective layers surrounding the ovum, a
process called capacitation.

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Fertilization

© Copyright 1999-2001 by M. Terwilliger for the Westside PRC

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Fertilization
Occurs when one spermatozoon enters the ovum
and the two nuclei containing the parents’
chromosomes merge.
 
Sperm entrance into ovum: ovum is fertilized in
the distal third of the fallopian tube near the
ovary.

Fusion of the nuclei of sperm and ovum:

◦ The 23 chromosomes from the sperm unite with the
23 from the ovum restoring the total number to 46.
◦ Fertilization is complete and cell division can begin
when the nuclei of the sperm and ovum unit.

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Check on Learning
QUESTION What is Conception?

ANSWER: Human fertilization occurs

when the sperm penetrates an ovum and
unites it.

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Implantation

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Pre-embryonic Period
Consists of the first 2 weeks
after conception.
 
Around the 4th day after
conception, the fertilized
ovum, now called a zygote,
enters the uterus.
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Initiation of Cell Division
The zygote divides until it reaches 16
cells at which time it is called a morula
because it resemble a mulberry.
 The outer cells of the morula secrete
fluid, forming a blastocyst a sac of cells
with an inner cell mass placed off center
within the sac.
The inner cell mass develops in the
fetus.
 Part of the outer layer of cells develops
as the placenta and fetal membranes.
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Entry of the Zygote into the Uterus
When the blastocyst contains approximately
100 cells, it enters the uterus.

Itlingers in the uterus another 2 to 4 days

before beginning implantations.

The endometrium, now called the decidua,

secretes rich fluids to nourish the zygote
before placental circulation is established.

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Implantation in the Decidua
Implantation at the proper time and
location in the uterus is critical for
continued development.
 
It occurs between the 6th and 10th days
after conception.

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Maintaining the Decidua
Implantation and survival of the zygote
the deciduas in the secretory phase.

The zygote secretes HCG to signal the

woman’s require a continuing supply of
estrogen and progesterone to maintain
body that a pregnancy has begun.

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Location of Implantation
Site of implantation is important because
that is where the placenta develops.
 
Normal implantation occurs in the upper
uterus, slightly more often on the
posterior wall than the anterior wall.

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Mechanism of Implantation
 Primary chorionic villi form that nourish the zygote
by diffusion because the circulatory system is not yet
established.
 
 The villi will eventually form the fetal side of the
placenta.
 
 The zygote is fully embedded within the uterus by 10
days.
 
 As it implants, usually near the time of the next
menstrual period, a small amount of bleeding may be
confused with the normal period.

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Check On Learning
Question: What is the Pre-embryonic
Period?

Answer: The first 2 weeks after

conception.

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 Normal Prenatal Development
Embryonic Period:
extends from the
beginning of the
3rd week through
the 8th week after
conception.

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Differentiation of Cells
By the end of the 8th week, all major organ
systems are in place and many are
functioning, although in a simple way.
 
Structures are vulnerable to damage from
teratogens (drugs, viruses, radiation, and
infectious agents) because they are
developing rapidly.
 
Unfortunately, a woman may not realize she
is pregnant at this time.

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Weekly Embryonic Developments
Terms:
◦ Zygote: cell formed by union of
sperm and ovum.
◦ Embryo: 3rd week to 8th week of
development.
◦ Fetus: 9th week until birth.

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Zygotic Stage
Amniotic cavity.
Yolk Sac.
Mesoderm.
Trilaminar embryonic disk.
Week 2: occurs simultaneously in all
organ systems and proceeds in a
cephalocaudal and central-to-peripheral
direction.

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Embryonic Stage
3 primary cell layers differentiate:
◦ Ectoderm
◦ Mesoderm
◦ Endoderm
Growth is RAPID!!

Embryo develops ‘human’ appearance.

Teratogenic agents can seriously harm

embryo.

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Prenatal Development Week 3
The first body segments appear:

◦ Neural tube forms.

◦ Primitive brain.

◦ Primitive spinal cord.

◦ A primitive or tubular heart begins beating

at 22 to 23 days.
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 Prenatal Development Week 4
 The embryo is now 1/5th inch
long, and the head is a third of its
total length.
◦ Embryos shape changes
resembling a “C” shape with a
tail and a head.
◦  Neural tube closes.
◦  Face and upper respiratory
tract begin.
◦  Ears and eyes are apparent.
◦  Upper extremities appear as
buds.
◦  Partitioning of the heart into 4
chambers begins.
◦  Esophagus and trachea
separate.
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Prenatal Development Week 5
Heart is beating and continuing to
develop 4 chambers.
 
Limbs continue to form.
 
Head is large due to rapid brain growth.

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Prenatal Development Week 6

Heart has 4 chambers.

Facial development begins with eyes,
ears, and nasal pits.

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 Prenatal Development Week 7
Development is
proceeding rapidly.
◦ Face is more human
looking.

◦ Eyelids begin to form.

 
◦ Fast intestinal growth.
 

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Prenatal Development Week 8
 The embryo is now a
little more than 1 inch
long.
 Fingers and toes are
formed.
 Purposeful movements
occur but mother can't
feel these yet.
 Heartbeats at 40-80
beats/minute.

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Fetal Period
Longest part of prenatal development.

Begins 9 weeks after conception and ends

with birth.

Teratogens may damage already formed

structures but are less likely to cause
major structural alterations.

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Weeks 9 through 12
Head is half the total length of the fetus at the
start of this period.

First fetal movements begin but are too slight for

the mother to detect.
 
Eyes close at 9 weeks and reopen at 26 weeks.
 
Urine production begins.
 
End of 12th week, fetal gender can be determined.

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Fetus at 12 Weeks

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Weeks 13 through 16
Grows rapidly in
length.

Quickening (fetal
movement)
occurs.

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Weeks 17 through 20
 Vernix covers skin.

 Lanugo is present.
 
 Eyebrows and head hair
appear.
 
 Brown fat (special heat-
producing fat that helps
newborn maintain
temperature stability
after birth) is deposited.
Fetus at 18 weeks.

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Fetus at 20 Weeks

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Weeks 21 through 24
Fetus appears thin due to minimal fat.
 
Skin is translucent and red.
 
Lungs begin to produce surfactant
although alveoli immature.
 
Most systems still extremely immature
and fetal survival is not likely.

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Fetus at 24 Weeks

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Weeks 25 through 28
Fetuses more
likely to survive if
born as lungs and
CNS have
matured.

Fetus assumes
head down
position.
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Weeks 29 through 32
Toenails and
fingernails are
present.
 
Subcutaneous fat
increases.
 
Skin is pigmented
and smooth.

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Weeks 33 through 38
Rateof growth slows, mainly gaining
weight.

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Check On Learning
QUESTION: What is an example of
teratogenic agent?

ANSWER: Any drug, virus or irradiation

that the mother is exposed to can cause
malformation of the fetus. An example is
the virus Rubella.

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Check on Learning
QUESTION: What is formed by the
union of the sperm and ovum?

ANSWER: Zygote.

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Structure and Functions of Placenta,
Umbilical Cord and Amniotic Fluid

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Placenta
Placenta: disk-like organ made up of about 15-
20 segments (cotyledons) that are present only
during pregnancy.
Produces four hormones:
◦ Progesterone.
◦ Estrogen.
◦ Human chorionic gonadotropin (hCG).
◦ Human placental lactogen (hPL).
The site of exchange of nutrients, oxygen and
waste products.

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Placenta

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Placenta Circulation

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Placenta Con’t
The maternal side of the placenta has a "beefy"
red appearance due to the large number of
arterioles and venules. Often referred to as
“Dirty Duncan”.
The amniotic fetal membrane of the placenta has
a grayish, shiny appearance at term. Often
referred to as “Shiny Schultz”.
The placenta has no use after pregnancy and is
expelled through the vagina after birth.

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Placenta Maternal Side

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Placenta Fetal Side

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Fetal Membranes
The two fetal
membranes are the
amnion (inner
membrane) and the
chorion (outer
membrane).

The two membranes

are so close as to be
one (the “bag of
waters”), but they can
be separated.

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 Amniotic Sac

A sac made up of the

chorion and the
amnion that contains
the fetus and
amniotic fluid.

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Amniotic Fluid

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Amniotic Fluid Function
Protectsthe growing fetus and promotes
normal prenatal development.
◦ Cushioning against impacts to the maternal
abdomen.
◦ Maintaining a stable temperature.
◦ Allowing symmetric development as the major
body surfaces fold toward the midline.
◦ Preventing the membranes from adhering to
developing fetal parts.
◦ Allowing room and buoyancy for fetal movement.

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Amniotic Fluid Compounds
Albumin.
Urea.
Bilirubin.
Vernix.
Lanugo.
Fructose.
Fat.

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Amniotic Fluid
This fluid may be tested to determine the
health and development of the fetus
during the later stages of pregnancy but
may be tested as early as 8 weeks.

Volume: is approximately 700-800 ml at

40 weeks.

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Umbilical Cord
Joinsthe embryo to the placenta.
Contains 2 arteries and one vein:
◦ The vein carries freshly oxygenated and
nutrient-laden blood to the fetus.
◦ The arteries carry deoxygenated blood back
and waste products away from the fetus to the
placenta.
Vessels of the umbilical cord are protected
from compression by Wharton's jelly.
It has no pain receptors.

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Umbilical Cord

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Check on Learning
QUESTION: What is the Amniotic Sac?

ANSWER: A sac made up of the chorion

and the amnion that contains the fetus and
amniotic fluid.

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Check on Learning 
QUESTION: Which hormone provides
for the expansion needed during
pregnancy of the uterus, breast and breast
glandular tissues? It also plays a role in
increasing vascularity and vasodilatation
of the villous capillaries of the placenta.

ANSWER: Estrogen.

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 Check On Learning
QUESTION: Identify 3 parts of the
umbilical cord.
 
ANSWER: Two arteries, one vein, and
Wharton's jelly.

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Fetal vs. Neonatal Circulation

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Fetal Circulation
Oxygenated blood is brought to the fetus by the
umbilical vein and enters the fetal liver, where it
branches.
The first branch (portal sinus).
The second branch (ductus venosus). 
Blood entering the heart from the vena cava is
directed across the right atrium through the
foramen ovale to the left atrium.
Blood is then ejected from the left ventricle into
the aorta and further circulated to the coronary
arteries, brain, and upper extremities.

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Fetal Circulation Con’t
Venous blood returning from this region returns
to the right atrium through the superior vena
cava and is directed downward through the
tricuspid valve into the right ventricle.
It is then pumped into the pulmonary artery,
where the majority of the blood is shunted to the
descending aorta through the ductus arteriosus
and perfuses the lower body.
Only a small amount of blood enters the fetal
lungs as a result of high pulmonary resistance.

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Changes in Circulation After Birth

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 Circulation Changes at Birth
With the first breath, the newborn's lungs expand
and the fluid within them is absorbed into the
pulmonary circulation.
With that first breath, pulmonary and right heart
pressures fall and systemic pressures begin to rise
with the removal of the placenta.
The foramen ovale closes as the pressure in the left
atrium exceeds the pressure in the right atrium.
The ductus arteriosus closes with the increased
oxygen content of the newborn's blood.

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Multifetal Pregnancy

Monozygotic Dizygotic
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Twins
Twins are classified as monozygotic or
dizygotic.
Monozygotic twins: 
◦ The twins carry the same genetic code and are the
same sex.
◦ They share a placenta, but each has a separate
umbilical cord.
Dizygotic twins: 
◦ These twins have a separate placenta, and the sex and
genetic makeup can vary.
◦ Dizygotic twins are no more closely related than
siblings born at different times.

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 Multifetal Pregnancy Complications
Complications with the Mother:
◦ Spontaneous abortions.
◦ Prematurity.
◦ Uterine over distension that can cause preterm labor.
◦ Maternal anemia.
◦ Pregnancy Induced Hypertension (PIH).
◦ Placenta Previa.
◦ Abruptio Placentae.
◦ Polyhydramnios.

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Complications with Fetal Twins
Congenital anomalies.

Problems with entangled cords.

Growth problems.

Birth defects are more common in twins.

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Review of Main Points
Gametogenesis
Fetal development and maturation of
body systems
Functions of placenta, umbilical cord and
amniotic fluid
Fetal and neonatal circulation
Twins

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Questions???

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