Fertilization.

Stages of intrauterine
development, the influence of
harmful factors on the fetus

Terehina Lyudmila Anatolyevna

Candidate of Medical Sciences
Department of Obstetrics and Gynecology №1
 FERTILIZATION
 As a result of the fusion of two nuclei with haploid sets of chromosomes, a
diploid zygote is formed (a cell that is a single-celled organism of a new
daughter generation)
 FERTILIZATION
 Fertilization is the fusion of an egg and a sperm
 It occurs in the upper third of the fallopian tube. The best conditions for this are
usually within 12 hours of the release of the egg from the ovary (ovulation).
Numerous spermatozoa approach the egg, surround it, come into contact with
its membrane
 OVUM
 The ovum is the largest cell in the female body
 Its diameter is 0,2-0,3 mm
 It was discovered in 1827 by the Russian academician K.E. Baer
Oocyte
Shiny shell Core
(zona pellucida) Radiant crown
Shiny shell
(follicular cells)
(zona pellucida)

Cell membrane

Core

Cytoplasm with
yolk
Radiant crown
(follicular cells)
 SPERMATOZOON
 The spermatozoon was discovered by the
student Gam in 1677 and described by Antony
Leeuwenhoek
 The ejaculate contains about 200-500 million
spermatozoa
 The speed of movement of spermatozoa is 2-3
mm at one o'clock
OVUM AND SPERM

1 Sperm
2 Ovum
 FERTILIZATION PHASES
 Activation - the meeting of a
homologous sperm with an egg and
attaching to its surface
 Fusion of the nuclei of two cells
INTRAUTERINE DEVELOPMENT OF THE
ORGANISM
PERIODS OF FETAL DEVELOPMENT DURING
PREGNANCY
 Pre-implantation (from the moment of fertilization of the egg by the sperm until
the introduction of the fertilized egg into the mucosa of the uterine wall)
 Implantation (attachment of a fertilized egg to the wall of the uterus)
 Organogenesis and placentation (the period of formation of all organs and
tissues of the fetus, as well as the placenta)
 Fetal - a period of growth and development of formed organs and tissues
 IN THE PROCESS OF EMBRYOGENESIS THE
FOLLOWING MAIN STAGES CAN BE DISTINGUISHED

 Fertilization
 Cleavage (7-8 days)
 Gastrulation (from 7-8 to 15 days)
 Histogenesis, organogenesis,
systemogenesis
 CLEAVAGE

 The period of crushing begins from the moment of the first division of the zygote into two
daughter cells and lasts until the formation of a single-layer multicellular embryo - the blastula
 Cells formed during cleavage are called blastomeres. Initially, an internal cell mass is formed -
a complex of 8-12 blastomeres, resembling a raspberry (so-called morula) in shape
 Cleavage, which began even in the process of moving the developing embryo through the
fallopian tube, accelerates sharply after the morula enters the uterus
 CLEAVAGE

 The nutrition of the embryo is carried out due to the

reserves of the yolk in the ovum
 As a result of the crushing process, a multicellular
embryo is formed with a cavity inside (the blastula is a
spherical single-layer embryo, the cavity is the blastocoel)
 The walls of the cavity are formed by cells of the
trophoblast - a special provisional (temporary) device
involved in nutrition
 For about two days, the embryo remains in the uterine
cavity (the ovum moves to the place of attachment -
implantation)
IMPLANTATION

 On the 7th day, the embryo begins to penetrate

into the uterine mucosa due to the release of
enzymes that destroy it, and gradually sinks into it
(the process continues for 48 hours)
 The outer layer of the embryo begins to produce
a hormone called chorionic gonadotropin. It is he
who signals the mother's body: pregnancy has
come, you need to rebuild!
 GASTRULATION

 At the same time, on the 7th day, the process of gastrulation begins (the formation
of germ layers), as well as the formation of germ layers, providing the necessary
conditions for development
 GASTRULATION

 The transformation of a single-layer embryo into a two-layer (gastrula), consisting of

two germ layers - the outer (ectoderm) and the inner (endoderm)
 In vertebrates, already during gastrulation, a third germ layer, the mesoderm,
appears between the ectoderm and endoderm
 The peripheral layer of mesoderm cells adjacent to the trophoblast forms the
connective tissue basis of the chorion - the outer villous membrane of the fetus.
 Contacting with the mucous membrane of the uterus, the chorion provides the
exchange of substances between the mother and fetus, forming the fetal part of the
placenta.
 As a result of the fouling of the mesenchyme of the amniotic and yolk vesicles, the
amnion and the yolk sac are formed
 The amnion forms around a closed sac filled with liquid - amniotic fluid; it protects
from harmful influences and creates favorable conditions for its development
 In the early stages of ontogenesis, the trophoblast forms protoplasmic outgrowths
consisting of cytotrophoblast cells (primary villi)
 Primary villi do not have vessels, and the supply of nutrients and oxygen to the
body of the embryo from the maternal blood surrounding them occurs according to
the relatively simple laws of osmosis and diffusion
 By the end of the 2nd week of pregnancy, connective tissue grows into the primary
villi and secondary villi form
 They are based on connective tissue, and the outer cover is represented by
epithelium (trophoblast)
 The epithelium of the secondary villi consists of two layers: the cytotrophoblast layer
(Langhans layer) and the syncytium (symplast)
 Both primary and secondary villi are evenly distributed over the surface of the ovum
 From the 3rd week of development of the embryo, the vascularization of the villi
begins and their transformation into tertiary, containing vessels
 The formation of placental vessels occurs both from the angioblasts of the embryo
and from the umbilical vessels growing from the allantois
 The vessels of the allantois grow into the secondary villi, as a result of which each
secondary villus receives vascularization
 Starting from the 2nd month of ontogenesis, on the larger surface of the fetal egg,
the villi atrophy, while at the same time, the villi facing the basal part of the decidua
develop luxuriantly
 This is how a smooth and branched chorion is formed
 On the 14-15th day, direct contact is established between the villi of the developing
membranes of the embryo and the vessels of the mother
 The nutrition and supply of the embryo with oxygen begins to be carried out directly
from the mother's blood (by this time the supply of nutrients in the egg is depleted)
 HISTOGENESIS, ORGANOGENESIS,
SYSTEMOGENESIS

 Gastrulation is followed by the differentiation of the germ layers and the processes
of organogenesis (the chord is laid - the forerunner of the spine; the first blood
vessels appear)
 21st day - the heart has already formed and began to beat! The brain and spinal
cord are formed. Sexual gonads are formed
 On the 4th week, eye sockets are formed, the
rudiments of arms and legs appear. The embryo Embryo at 4 weeks
resembles a tiny pinna and is surrounded by a small
amount of amniotic fluid
 The laying and development of internal organs
begins: intestines, liver, kidneys, urinary tract.
Improved, developing the heart and brain. Its growth
by the end of the first month is 4 mm
 On the 8th week, the most intensive process of
development of external and internal organs,
especially the genitals Embryo at 8 weeks

 By the end of the 8th week, the embryonic period of

development ends: all the main structures and
organ systems are differentiated (growth by the end
of the second month is 3 cm)
 FROM THE 9TH WEEK, THE FETAL PERIOD BEGINS

 One of the membranes - water - secretes amniotic fluid, in

which the fetus develops
 The internal organs continue to develop. There is an active
growth of muscles, ligamentous apparatus
 The fetus is able to move. Movements can still be called
chaotic: their main coordinator is the cerebellum has not yet
matured
 Embryo at 12 weeks
 By the end of the 12th week, the formation of the
placenta
 The heart of the fetus beats at a frequency of 130-
150 beats per minute (height - 9 cm)
 Critical is the period of intrauterine development with increased sensitivity of the
embryo and embryo to damaging agents
 1st critical period from 0 to 7-8 days - there is no connection with the mother's
body, the embryo either dies or develops («all or nothing» principle)
 The nutrition of the embryo is autotropic, due to the substances contained in the
ovum, and then due to the liquid secretion of the trophoblast in the blastocyst
cavity
 The 2nd critical period from 7-8 days to 12 weeks – the formation of organs and
systems occurs, the occurrence of multiple malformations is characteristic. What
matters is not so much the gestational age as the duration of exposure to an
adverse factor
 The 3rd critical period (within the 2nd) - the beginning of the formation of the
placenta and chorion. Violation of its development leads to placental
insufficiency and, as a result, to the death of the embryo or the development of
fetal hypotrophy
 The 4th critical period 18-22 weeks – completion of the formation of the nervous
system
 FIRST CRITICAL PERIOD (PREIMPLANTATION)

 It starts from the moment of fertilization and continues until the moment the
embryo attaches to the wall of the uterus - 7-8 days after fertilization)
 The embryo, at this stage, is relatively resistant to the action of damaging
agents
 Unfavorable factors have an embryotoxic effect, leading to the death of the
embryo
 The blastomeres of the embryo of the pre-implantation period are characterized
by pluripotency and a high ability to regenerate, therefore, if individual
blastomeres are damaged, further embryonic development is not disturbed
 If many blastomeres are damaged, then, as a rule, the embryo dies
 SECOND CRITICAL PERIOD

 Those organs and systems that were at that time in the process of laying and
increased metabolism are affected
 For the defeat of the embryo during this period, the occurrence of deformities
(teratogenic effect) is characteristic
 The most sensitive to adverse factors are the central nervous system, organs of
vision, endocrine glands and sex glands, therefore, anomalies of these organs
are more common than others
 PLACENTATION PERIOD

 Damaging factors can disrupt the normal development of the allantois and the
associated vascularization of the chorion
 Violation of chorion vascularization underlies primary placental insufficiency,
with the progression of which intrauterine fetal death may occur
 STAGES OF VIOLATION OF UTEROPLACENTAL
CIRCULATION

1) Violation of endovascular trophoblast migration

2) Lack of invasion of the extravillous chorion
3) Violation of the differentiation of the villi of the placenta
 TYPES OF PLACENTATION

1) Epitheliochorial – chorionic villi pass only the epithelial layer, metabolism is

carried out through a number of layers
 TYPES OF PLACENTATION

2) Syndesmochorial – a more perfect type of placentation, the villi pass into the
connective tissue
 TYPES OF PLACENTATION

3) Endotheliochorial – villi are introduced to the level of the endothelium of the

vascular wall
At 18-22 weeks of pregnancy, the most important processes occur associated with
the formation of the activity of the fetal brain, the hematopoietic system, the
production of the most important hormones, and reflex reactions. Therefore, this
period is a critical period in its development
 FACTORS AFFECTING THE DEVELOPMENT OF THE FETUS ARE
DIVIDED INTO EXOGENOUS AND ENDOGENOUS

 Physical (temperature, gas composition of air, ionizing radiation, etc.)

 Chemical (substances used in industry, in everyday life, passing through the
placental barrier, medicinal substances, narcotic drugs, excess vitamins A, D, C,
alcohol, nicotine, etc.)
 Biological (infectious pathology, viral infection suffered by a pregnant woman)
 Alimentary (malnutrition increases fetal malformations by 3-4 times)
 Chronic oxygen starvation (chronic hypoxia leads to malnutrition)
 Extragenital pathology (diabetes, dysfunction of the thyroid gland, adrenal
glands)
Anencephaly - absence of the brain, the vault of the bones of the skull 28 days
Meningomyelocele - bulging of the membranes and tissues of the spinal cord through 28 days
a defect in the spine
Exstrophy of the bladder - the absence of the lower part of the anterior abdominal wall 30 days
and the anterior wall of the bladder
Split lip (hare) - a defect in the development of the upper lip 36 days
Atresia and fistulas of the rectum, the occurrence of diaphragmatic hernia, ventricular 6 weeks
septal defect of the heart
Cleft of the upper jaw and palate 9 weeks
Umbilical hernia (omphalocele) - due to a defect in the abdominal wall, internal organs 10
come out, covered with thinned tissues of the umbilical cord weeks
Hypospadias - the absence of the distal part of the urethra in male children, and its 12
external opening is located in the scrotum or perineum; in female children - the weeks
opening of the urethra opens in the vagina
 DEPENDING ON THE PERIOD OF OCCURRENCE, SEVERAL
TYPES ARE CONVENTIONALLY DISTINGUISHED

 Gametopathies
 Blastopathies
 Embryopathies
 Fetopathy
 GAMETOPATHIES

 Gametopathies include a pathology associated with changes in the hereditary

material in the process of laying and developing the germ cells of the parents
(gametogenesis), or during fertilization and the first stages of crushing a
fertilized egg (zygote)
 GAMETOPATHIES

Changes in hereditary structures can lead to:

 To the death of the embryo
 Spontaneous abortion
 Stillbirth
 Gross malformations
 Various hereditary diseases
 Including chromosomal (for example, down's disease)
 Fermentopathy
 BLASTOPATHY

 Blastopathy is a pathology of the embryo that occurs under the influence of

various harmful factors during the period of intensive crushing of a fertilized
ovum – from the 4th to the 15th day after fertilization
 BLASTOPATHY

Blastopathies are manifested:

 Ectopic implantation of a fetus (ectopic pregnancy)
 Violation of the formation of the placenta (primary placental insufficiency)
 The occurrence of gross malformations of the fetus (incompatible or compatible
with life)
 Most of the affected embryos are excreted by spontaneous abortion
 EMBRYOPATHIES

 Embryopathies include the pathology of the embryo, caused by the action of

harmful agents in the period from the 1st day after fertilization to the end of the
8th week of intrauterine development
 EMBRYOPATHIES

The clinical manifestations of embryopathy are:

 Malformations
 Possible death of the embryo
 Spontaneous abortion
 Preterm birth
 FETOPATHIES

 Fetopathies - damage to the fetus that occurs under the influence of exogenous
influences in the fetal period - from the beginning of the 9th week of intrauterine
development to childbirth