Growth and Development of the Embryo/Fetus The act of fertilization begins the first of three stages of development in the

human being: Fertilized Ovum Morula Blastocyte (inner cell mass) Ectoderm (outermost layer) Epidermis, cutaneous glands Sweat glands Nails, hair Nervous system, including cranial and spinal nerves Sense organs- neuroepithelium Optic lens, epithelium of portions of eye Sensory epithelium of ear Pituitary gland Adrenal medulla Upper pharynx and nasal passages Nasopharynx and mouthepithelium Teeth-enamel Salivary glands Mammary glands Urethra Lower portion of anal canallining Mesoderm (middle layer) Dermis Skeleton Cartilage Muscles (all types) Connective tissue Lining of auditory canal, tympanic membrane Thyroid gland Adrenal cortex Pleura, pericardium, peritoneum Pharynx, tonsils Trachea, bronchi. lungs Lining of larynx, trachea, air passages,-alveoli Teeth-dentine (all but enamel) Gastrointestinal tract Heart Pancreas, liver, gallbladder Spleen Blood, bone marrow Blood and lymphatic vessels Urinary bladder Kidneys, ureters Lining of alimentary tract Gonads, uterus (except that arising from ectoderm) Entoderm (innermost layer)

PRECONCEPTION

Length (approximate :

Crown rump 0.8 mm Crown heel 0.5 mm

weight : not known internal development no organ differentiation

Appearance Fertilization of ovum in distal third of fallopian tube Zygote divided (mitotic division) Morula Early and late blastocyst Implantation begins

Length (approximate :

Crown rump 0.8 mm Crown heel 0.5 mm

weight : not known internal development flat embryonic disk ectoderm and entoderm

Appearance Blostocyte superficially than completely buried in endoperidium

Primitive placental circulation

Length (approximate): Crown-rump 1.5-3mm Crown-heel 1.5-3 mm Appearance Primitive streak develops in posterior midline of embryo Streak thickens: embryonic disk elongates Neural groove closes partially (Later becomes central nervous system) Head and tail folds form

Weight: not known Internal Development Trilaminar embryo: mesoderm develops between ectoderm and entoderm Thyroid begins to develop Heart tubes begin to fuse and to circulate early blood cells formed in the yolk sac Lung buds present Somites, thickened groups of mesodermal cells, form in pairs alongside the neural folds (later becomes skeleton and muscles of the skeleton, etc.)

Four weeks

Length (approximate): Crown-rump 3-4 mm Crown-heel 3-4 mm Appearance Head is at right angle to body; the embryo is C shaped because the neural tube grows faster than ventral surface Head is 1/3 of body length Primordia of eye and ear present Primitive jaws formed (as branchial arches) Limb buds present Tail prominent Yolk sac diminishing in size

Weight: 0.4 gm (approximate) Internal Development Initial stages of most organs have begun to develop Vitelline duct present Heart begins to beat Aortic arches and major veins developed Right and left primary bronchi form Neural folds fusing: anterior end forms brain; posterior end forms spinal cord (if anterior end does not close, anencephaly or absence of cranial vault results; if posterior

end does not close, meningocele, see p. 516, results) Esophagotracheal septum divides trachea and esophagus (if esophagotracheal septum does not develop correctly, tracheoesophageal fistula. see p. 448, results) Early beginning of peritoneal and pleural cavities All 42 somites present

Five week

Length (approximate): Crown-rump 7-8 mm Crown-heel 7-8 mm Appearance Primitive umbilical cord developing from body stalk Head much larger in proportion to trunk (1/2 size of fetus) Lens pits and optic cups formed and nasal pits forming Primitive mouth Facial features move closer together Hand plates (paddle-shaped) Wrist and elbow develop Leg buds (paddle-shaped)

Weight: 1 gm (approximate) Internal Development Brain differentiated into 5 areas 10 pairs of cranial nerves forming Division of cardiac atria occurring Beginning of primitive kidneys

Length (approximate): Crown-rump 10-13 mm Crown-heel 10-13 mm

Weight: 1.5 gm (approximate)

Appearance Upper lip formed (cleft lip and palate developed between 5 to weeks, see page 497) Upper and lower jaw recognizable Oral and nasal cavities confluent Palate developing buds forming Formation evident Finger rays present Foot plate forming Rail still present, but regression evident Placenta begins to support maternal placental circulation

Internal Development Lung formation beginning due to tracheal bifurcation Liver forming red blood cells Some intestines outside abdominal cavity; abdomen too small to hold all intestines. (If they remain outside the abdomen, the neonate will have an omphalocele, a defect in the abdominal wall, see page 455, or gastroschisis, a defect of the bottom of the umbilical stalk, see page 457) Primitive skeletal shape beginning to form Muscle and cartilage formation beginning

Length (approximate): Crown-rump 16-30 mm (3 cm) Weight: 2 gm (approximate) Crown-heel 16-35 mm (3.5 cm) Internal Development Appearance Presence of beginnings of all essential Presence of beginnings of all essential external internal structures structures Optic nerve formed Recognizable eyes, ears, nose, mouth Pericardial and pleural cavities form Eyelids forming of nose distinct Valves and septa of heart, and inferior vena Digits formed cava form Arms longer and bent at elbows Heart fairly well developed and beating 40Anal membrane perforated 80 beats a minute (most cardiac anomalies External genitalia are sexless but have begun to developed by end of 7th week) differentiate Abdominal and thoracic cavities are Toe rays appear separated by diaphragm (If the diaphragm Trunk elongating and straightening does not develop normally, a diaphragmatic Tail almost gone hernia, see page 451, results) Fetal movements begin Stomach well developed Umbi1ical cord organized Gastrointestinal tract rotates midgut

Urethra and bladder are separating from rectum Urogenital membrane degenerating Anal canal developed (if there is abnormal development of the urorectal septum, an imperforate anus, see page 457, results) Urine is first formed and excreted into amniotic fluid Sex glands beginning to differentiate into ovaries or testes Ossification of bones begins in occiput, mandible, humerus (diaphysis) Muscles continue to develop Reflex arc ready to function Sensory organ development progressing

Length (approximate): Crown-rump 6 cm (2.5 inches) Crown-heel 9 cm (3.5 inches) Appearance Face and mouth developing Eyelids fuse Palate fusing Tooth enamel beginning to be formed Beginning of nail growth Male and female external genitalia, which develop from analogous structures, still appear fairly similar Responds to tactile stimulation

Weight: 10 gm (approximate) Internal Development Basic division of brain Erythropoiesis in liver but gradually regresses Intestines return to abdomen Bladder sac forms; urine continues to form Testes forming testosterone Bone marrow formation and functioning begins

Length (approximate): Crown-rump 7-8 cm (3 inches) Crown-heel 11.5 cm (4.5 inches) Appearance Skin delicate and pink Human-like in appearance, but head is still large in proportion to body (1/3 of size of fetus) Fusion of palate complete Respiratory motion is visible Distinctive external genitalia present Sucks thumb and begins to swallow Lower trunk moves more freely

Weight: 19-30 gm (approximate) (1 oz) Internal Development Brain appearance roughly complete Growth hormone produced in pituitary gland Erythropoiesis in spleen begins Uterus and testes now specific; uterus is no longer bicornuate (having 2 horns) Ossification of upper cervical to lower sacral arches and bodies

Length (approximate): Crown-rump 13.5 cm (5.25 inches) Crownheel 1 5-1 9 cm (6-7 .5 inches) Appearance Rapid growth-appears human Hair begins to grow on scalp Lanugo begins to grow on body (the amount

Weight 100- 200 gm (31/3-62/3OZ) Internal Development Cerebral lobes present; rapid growth of neurons, (If rubella occurs during this period, inhibition of neuronal growth could occur, resulting in decreased intellectual ability,)

at birth indicates gestational age, see page 362) Hard and soft palates differentiated Nipples present Fetus quite active: sucks thumb, upper lip protrudes on stimulation, grasp reflex Maternal 16-20 weeks: mother feels fetal movements (quickening)

Myelinization beginning Heart muscle well developed 16-20 weeks-heart tones of fetus can be heard using fetoscope at 120-160 beats per minute 30% nephrons in kidney mature Bladder has adult form Meconium in intestines, (Presence of meconium in amniotic fluid indicates fetal distress,) Anal canal open Vagina open Bone ossification evident on radiography; ischium is ossified Sense organs differentiated

Length (approximate): Crown-rump 18.5 cm (71/4 inches) Weight: 300-400 gm (10-13'/3 oz)(approximate) Crown-heel 22-25 cm (8,75-9,75 inches) Appearance Vernix caseosa forming and will be present at birth (see page 362) Eyebrows and eyelashes developing Tooth enamel and dentin continue to form Primitive respiratory rhythms Lower abdomen from umbilicus to pubis increases in length Legs elongate to final proportions with body length Sucking reflex increasingly apparent Internal Development Sebaceous glands appear Brain stem, and spinal cord myelinization begins Ossification of sternum Bone marrow is more important In blood formation Storage of iron begins (premature infants have less iron stored, therefore, may have iron deficiency anemia, see page 649) Brown fat forming

Maternal Stronger and more frequent fetal movement that mother can feel

Length (approximate): Crown-rump 23 cm (9 1/8 inches) Crown-heel 30 cm (12 inches) Appearance Vernix apparent Skin wrinkled and red (blood is visible in capillaries) Small amount of subcutaneous fat Structure of eyes complete Respiratory-like movements

Weight: 600-960 gm (1,25-2 pounds) (approximate) Internal Development Beginning development of primordia of permanent teeth Alveolar ducts and sacs evident in lungs Alveolar cells begin to make surfactant Testes present at inguinal ring Os pubis ossifies IgG levels rise to maternal values to protect fetus and neonate from diseases for which the mother has immunity Survival rate: few, but fetus is viable

Length (approximate): Crown-rump 27cm (10% inches) Crown-heel 35cm (14 inches)

Weight: 1200 gm (2.5 Ib) (approximate) Internal Development Cerebral fissure appears Convolutions appear on brain Formation of

Appearance Subcutaneous fat minimal Skin less wrinkled and red Nails more obvious Pupils respond to light Movements not well sustained

glial cells and myelinization of brain. (If mother is poorly nourished at this time or during infancy, infant may have learning difficulties and other neurologic problems) Capillaries develop around alveoli Surfactant forming on surface of alveoli; lungs capable of breathing air Testes below inguinal ring Bone marrow is major area in formation of blood; liver decreasing in importance Ossification of astragalus Survival rate: 10% with optimal care because gas exchange is possible

Length (approximate): Crown-rump 31 cm (12 inches) Crown-heel 40 cm (16 inches) Appearance Lanugo starting to disappear Skin smooth and pink Subcutaneous fat increasing. (Length increases proportionately less than weight) Pupillary light refiex-30 weeks Increased muscle tone in legs and trunk Movements better sustained Responds to sounds from outside world Moro's reflex present-30 weeks Delivery position is assumed

Weight: 1900 gm (4 Ib) (approximate) Internal Development Lecithin/sphingomyelin (LS) ratio = 1.2: 1 Testes descending to scrotum Ossification of middle and 4th phalanges Survival rate: 33% with optimal care

Length (approximate): Crown-rump 35 cm (13.5 inches) Crown-heel 45 cm (17.5 inches) Appearance Skin pink Body rounded: limbs flexed Lanugo disappearing Fuzzy hair growth Lobes of ears soft little cartilage Umbilicus near center of body Scrotum small. few rugae Few creases in soles of foot spontaneous orientation to light Firm grasp Cries when hungry May show greater or less activity because of tightness of uterine space

Weight: 2900, gm (6 Ib) (approximate) Internal Development Lecithin/sphingomyelin ratio 2: 1 or more Iron storage increased in liver New nephrons no longer form Spinal cord ends at L3 level Testes in inguinal canals Distal ossification centers of femurs present Survival rate: 70-80% with optimal care

Length (approximate): Crown-rump 40 cm (15.5 inches) Crown-heel 50 cm (19.5-20 inches) Appearance Flexed limbs Muscle tone well developed Skin pink. smooth, plump Vernix caseosa covers skin Lanugo remains on upper part of body and shoulders May have moderate-to-profuse silky hair Cartilage present in nose and ears . Nails extend over ends of fingers and toes Creases cover soles Strong sucking reflex

Weight: 3200-3400 gm (7-7.5 Ib) (approximate) Internal Development Pulmonary branching 66% complete Myelinization reaches level of hemispheres Testes in rougous scrotum Labia majora well developed Bones and skull continue to firm Proximal tibial ossification centers present Continuing to store minerals and fat Absorption of maternai hormones Ready to be born Survival rate: over 95% with optimal care