CHAPTER 6

THIRD MONTH TO
BIRTH
FETUS AND PLACENTA
DR.NAJMA MOHAMED

Dr.Najma Mohamed MON 21 0CTOBER 1

Dr.Najma Mohamed MON 21 0CTOBER 2
DEVELOPMENT OF FETUS

 The period from the beginning of the ninth

week to birth known as fetal period .
 Its characterised by maturation of tissue and
organs and rapid growth of body ,

Dr.Najma Mohamed MON 21 0CTOBER 3

 The length of the fetus usually is indicated
CRL crown rump length (sitting height) or
CHL (standing height ) from vertex to heel.

Dr.Najma Mohamed MON 21 0CTOBER 4

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 These measurement expressed in
centimetres are correlated with age of fetus
in weeks or months
 Growth in length is particularly increase
during 3rd 4th and 5th months
 While increase in weight is most seen in last
2 months of gestation

Dr.Najma Mohamed MON 21 0CTOBER 6

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 In general the length of pregnancy is
considered 280 days or 40weeks after the
onset of last menstrual period LMP or more
accurately 266days or 38weeks .

Dr.Najma Mohamed MON 21 0CTOBER 8

MONTHLY CHANGES

 One of the most striking changes taking place

during fetal period is relatively slow down
the growth of head compared to the rest of
body

Dr.Najma Mohamed MON 21 0CTOBER 9

 The 3rd month the head approximately is half
of CRL
 By the beginning of 5th month the size of
heard is about one-third of CHL, and at birth
is one-four of CHL.

Dr.Najma Mohamed MON 21 0CTOBER 10

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 Hence over time growth of body accelerates
but the head slows down
 During the 3rd month the face becomes more
human looking

Dr.Najma Mohamed MON 21 0CTOBER 12

 The eyes initially directed laterally move to
the ventral aspect of the face , and ears
come close to lei their definitive position at
the sides of heard

Dr.Najma Mohamed MON 21 0CTOBER 13

 The limbs reach their relative length in
comparison with the rest of body although
the lower limbs are still shorter and less well
developed than the upper limp.

Dr.Najma Mohamed MON 21 0CTOBER 14

 The 12th week external genitalia to a such
that the sex fetus can be determined by
ultrasound
 during the 6th week intestinal loops herniated
in the umbilical cord but by 12th week they
withdraw into the abdominal cavity

Dr.Najma Mohamed MON 21 0CTOBER 15

 During the 4 and 5 month the fetus lengthen
rapidly and at the end of first half of
intrauterine life is CRL is approximately
15cm which near to total length of newborn

Dr.Najma Mohamed MON 21 0CTOBER 16

 5th month during this period fatal movement
can be felt by mother.
 During the second half of intrauterine life
weigh increases particularly during last 2.5
month 50% of full term baby weight is added

Dr.Najma Mohamed MON 21 0CTOBER 17

 The weight of fetus increase little during this
period and by the end of 5th month is still
less then 500g
 The fetus is covered by fine hair called
lanugos hair , eye brow and hair head is also
visible.

Dr.Najma Mohamed MON 21 0CTOBER 18

 During the second half of intrauterine life
weigh increases particularly during last 2.5
month 50% of full term baby weight is added
 In 6th month the skin of fetus is reddish and
has wrinkled due to lack of subcutaneous
tissue

Dr.Najma Mohamed MON 21 0CTOBER 19

 A fetus born in six month has great difficult
of surviving
 Although several organs are able to function
the respiratory system and CNS has not
sufficiently formed and coordination
between the two system is not yet
established

Dr.Najma Mohamed MON 21 0CTOBER 20

 By 7month the fetus has 90% chance of
surviving .
 During the last 2 month fetus has well round
counter body due to deposition of
subcutaneous fat.

Dr.Najma Mohamed MON 21 0CTOBER 21

 By the time of birth fetus is covered whitish
fatty substance called (vernix caseosa)
produced from sebaceous gland.
 At the time of birth fetal weight is 300-3400g
CRL 36cm CHL 50cm.

Dr.Najma Mohamed MON 21 0CTOBER 22

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TIME OF BIRTH

 Most women deliver 266 days or 38 weeks

 If they are born much earlier they
categorized prematurity , if born later they
considered post term.

Dr.Najma Mohamed MON 21 0CTOBER 24

FETAL AND PLACENTA
MEMBRANES

 As the fetus grow its demand of nutrition and

other factors increases causing ,major
change in the placenta
 The surface area is also increase between
fetal and mother to facilitate exchange.
 the production of amniotic fluid is also
increase

Dr.Najma Mohamed MON 21 0CTOBER 25

STRUCTURE OF PLACENTA

 By the beginning of four month placenta has

two component
I. A fetal portion
II. Maternal portion

Dr.Najma Mohamed MON 21 0CTOBER 26

 On the fetal side placenta is bordered by
chorionic plate, on the maternal side its
bordered by deciduas basalis.
 In the place where trophoblast and decidua
cells intermingle is called junctional zone

Dr.Najma Mohamed MON 21 0CTOBER 27

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 Between chorionic and decidua plated there
are intervillous spaces where blood is filled.
 As fetus grow the uterus and placenta also
enlarges

Dr.Najma Mohamed MON 21 0CTOBER 29

FULL TERM PLACENTA
 Placenta is discoid in shape 15-25cm and 3cm
thick and its weight is 500-600g
 After birth when placenta viewed from
maternal side it has 15-20 bulging called
cotyledons coved by thin layer decidua
basilis.

Dr.Najma Mohamed MON 21 0CTOBER 30

 Fetal side its covered by chorionic place
 A number of great vessels ( arties and veins)
converge towards umbilical cord

Dr.Najma Mohamed MON 21 0CTOBER 31

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 Chorion is covered by amnion
 Attachment of cord is usually eccentric and
occasionally marginal
 Rarely it insert in chorionic plate called
velamentous insertion

Dr.Najma Mohamed MON 21 0CTOBER 33

CIRCULATION OF PLACENTA
 Cotyledons receive their blood through 80-
100 spiral atreites that pierce through
decidua plate and enter intervillous space.
 The lumen of spiral artery is narrow so blood
pressure in villous is high.
 This pressure help the blood to pass deep in
villous in oxygenation of blood .

Dr.Najma Mohamed MON 21 0CTOBER 34

 As pressure decreases the blood flow from
chorionic to decidua plate where it goes back
to maternal endometrial veins.
 The intervallic spaces of a mature placenta
contain approximely 150ml of blood which
replenish 3-4 times per minute

Dr.Najma Mohamed MON 21 0CTOBER 35

FUNCTION OF PLACENTA
 The min function of placenta are
I. Exchange of metabolic and gaseous
product between mother and fetus:
II. Production of hormone
III. Transmition of maternal antibody

Dr.Najma Mohamed MON 21 0CTOBER 36

PLACENTA CHANGED AT THE END OF
PREGNANCY
I. An increase in fibrous tissue in the core of
the villas
II. Thikinening of basement membranes in
fetal capillaries
III. Obliteration in small capillaries of villa
IV. Deposition of fibriniod in juctional zone
These changes may indicate the reduction of
exchange between mother and fetas

Dr.Najma Mohamed MON 21 0CTOBER 37

AMNIOTIC FLUID

 The amniotic cavity is filled with clear

watery fluid that is produced from amniotic
cells and also from maternal blood
 The fluid is 30ml in 10 weeks of pregnancy ,
increase 450ml in 20 weeks and 800-1000 in
37 weeks.

Dr.Najma Mohamed MON 21 0CTOBER 38

FUNCTION OF AMNIOTIC FLUID

I. Absorb shock
II. Prevent adherent to embryo amnion
III. Allows fetal movement

Dr.Najma Mohamed MON 21 0CTOBER 39

 The volume of fluid is replaced in every 3
hours
 The beginning of 5th month fetus start to
swallow fluid around 4ooml which is half of
total amount

Dr.Najma Mohamed MON 21 0CTOBER 40

 Fetal urine is added daily to the amniotic
fluid in the 5th month but the urine is mostly
water as the placenta works exchange of
metabolic waste
 During birth the amino-chorionic membrane
form hydrostatic wedge to dilate cervical os .

Dr.Najma Mohamed MON 21 0CTOBER 41

PARTURITION (BIRTH)

 For the first months of pregnancy the uterine

myometrium doesn't respond to signals for
birth.
 For the last 2-4weeks of gestation it undergo
for transitional phase for preparation of
labour

Dr.Najma Mohamed MON 21 0CTOBER 42

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 This phase ends by thickening of
myometrium in upper region and softening in
lower region

Dr.Najma Mohamed MON 21 0CTOBER 44

STAGES OF LABOUR
I. Effacement: thinning ,softening and
dilation of cervix It ends compete dilation
10cm
II. Delivery of fetus
III. Delivery of placenta

Dr.Najma Mohamed MON 21 0CTOBER 45

 Thanks 4 UR listening

Dr.Najma Mohamed MON 21 0CTOBER 46