MUHIMBILI UNIVERSITY HEALTH AND ALLIED SCIENCE

MATERNAL AND CHILD HEALTH

GROUP ASSIGMENT 2 Topic: revising the anatomy of the reproductive organs

QUESTION NO:4 The fetus

Development Fetal organs Fetal circulation and adaptation to extra-uterine life The fetal skull

FETAL DEVELOPMENT
Development - the gradual modification of anatomical structures during the period from fertilization to maturity Fetal development during pregnancy is measured in number of weeks after fertilization .The duration of pregnancy is about 40 weeks from the time of fertilization .this equates to 9 calendar months or aproximetetely to 266 to 280 calendar days

PRE-EMBRYONIC STAGE
Fertilization takes place in ampulla of the fallopian tube through the second week Union of the sperm and ovum forms a zygote 46 chromosomes Cleavage cell division continues to form a Morrula (mass of 16 cells) The Morrula about 72 hours reach uterine

cont
Morrula of center filled with fluid transforming it into hollow ball cell called blastocyst inner form amnion ,the outer is called trophoblast embryonic membrane ,the chorion help to form placenta

Important Dates
DAY 1: The fertilized egg is one cell = ZYGOTE. DAY 3: The egg has begun to divide = MORULA. It enters the uterus in this stage. DAY 7: The egg is thousands of cells = BLASTOCYST, which begins to implant into the uterus by burrowing into it like a parasite.

cont
DAY 8: The egg is now called an embryo, although the embryonic period includes the first week also. DAY 60: The egg has now developed into a FETUS Fertilization occurs on about day 14 of the menstrual cycle. Implantation occurs on about day 21 of the menstrual cycle.

cont
For the first 3 weeks following conception the term fertilized ovum or zygote is used From 3-8 weeks after conception it is known as the embryo After 8 weeks this its the fetus until birth, when it become a baby

Fertilization in the ampulla

Figure 3.3

DEVELOPMENT OF FETUS WITHIN UTERUS

0-4 Weeks after conception (First Trimester) rapid growth Formation of embryonic plate Primitive central nervous system forms Heart develops and begins to beat Limb buds form Baby is 1/4 inch in length

4-8weeks
Very rapid cell division Head and facial features develop All major organ laid down in primitive form External genitalia organ present not sex distinguishable Early movements Visible on ultrasound from 6 weeks

8-12 weeks
Eyelid fuse Kidneys begin to function and the fetus passes urine from 10 weeks Fetal circulation function properly Sucking and swallowing begin Sex apparent Moves freely (not felt by mother) Some primitive reflexes present

12-16 weeks
Rapid skeletal development Meconium present in gut Lanugo appears Nasal septum and palate fuse 16-20 Weeks Quickening-mother feel fetal movement Fetal heart heard on auscultation Vernix caseosa appears Fingernail can be seen Skin cell begin to renewed

20-24 weeks
Most organ become capable of functioning Periods of sleep and activity Respond to sound Skin red and wrinkled

Survival may be expected if born Eyelid reopen Respiratory movement

24-28 Weeks

28-32 weeks
Begins to store fat and iron Testes descend into scrotum Lanugo disappears from face Skin become paler and less wrinkled

32-36 weeks
Increase fat makes body more rounded Lanugo disappears from body Head hair lengthens Nail reach tips of fingers Ear cartilage soft Plantar creases soft

36-40 week after conception(38-42 weeks after LMP)

Term is reached and birth is due contours rounded skull firm

FETAL ORGAN
The development of fetal organ and their physiology are special relevance to the midwifery and nurses because of their effect on the new born baby

BLOOD
Origin of fetal blood is from the inner cell mass along with all other organ of its body Fetal haemoglobin (hbf) is difference type from adult haemoglobin Hbf has a much greater affinity for oxygen an found in greater concentration Toward the end of pregnancy the fetus begin to make adult type haemoglobin(HBA) In utero the red blood cells have a shorter life span this being about 90 days by the time baby is born

THE RENAL TRACT

The kidney begin to function and the fetus passes urine from 10 weeks gestation The urine is very dilute and does no constitutes a route for excretion since mother eliminates waste products which cross placenta

THE ADRENAL GLANDS

The fetal adrenal glands produce the precursor for placental formation of oestriols. They also thought to play a part in the initiation of labour although the exact mechanism is not full understood

THE LIVER
The fetal liver is comparatively large in size ,taking up much of the abdomen cavity especially in early months From the 3rd to 6th month of intrauterine life , the liver is responsible for formation of red blood cells ,after which they are mainly produced in the red bone marrow and the spleen Towards the end of pregnancy ,iron stores are laid down in the liver

THE ALIMENTARY TRACT

The digestive system is mainly nonfunctional before birth. It form from the yolk sac

FETAL CIRCULATION
Fetal circulation is the fact that oxygen derived from placenta There are several temporary structure in addition to the placenta itself and the umbilical cord and these enable the fetal circulation to take place while allowing for the changes at birth

Structures in fetal circulation

The Umbilical vein: this vein leads from umbilical cord to the liver and carries blood rich in oxygen and nutrients The ductus venosus :this connect the umbilical vein to the inferior vena cava. At this point The blood mixes with deoxygenated blood returning from the lower part.carries. The foramen ovale:this is a temporary opening between the atria that allow the majority of blood entering from inferior vena cava to pass across into the left atrium.

cont
The ductus arteriosus:this leads from the bifurcation of the pulmonary artery to the descending aorta, entering it just beyond the point where the subclavian and carotid arteries leave The hypogastric arteries: these branch off from the internal iliac arteries and become the umbilical arteries when they enter the umbilical cord. They return blood to placenta .These only vessel in fetus that carries unmixed blood.

cont
The ductus venous carries blood to the inferior vena cava where its mixes with blood from the lower body.from here blood passes into right atrium and most is direct across the foramen ovale into the left atrium . Following normal route it enter the left ventricle and passes into aorta. The heart and brain each receives a supply of relatively well-oxygenated blood since the coronary and carotid arteries are branches from the aorta

CHANGES OF THE FETAL CIRCULATION AT BIRTH

CLOSURE OF UMBILICAL ARTERIES: Obliteration takes place about 2-3 mths. The distal parts from the lateral umbilical ligaments and the proximal parts remain open as superior vesical arteries. CLOSURE OF UMBILICAL VEIN: The Obliteration occurs a little later than the arteries. After obliteration, the umbilical vein from the ligamentum teres and the ductus venosus become ligament venosum CLOSURE OF THE DUCTUS ARTERIOSUS: Functional closure of the ductus may occur soon after the establishment of pul. circulation, the anatomical obliteration takes about 1-3mths and becomes ligamentum arteriosum. CLOSURE OF THE FORAMEN OVALE: Functional closure occurs soon after birth but anatomical closure occurs in about 1yr. (After birth CO is 500ml/min. and heart rate varies from 120-140 /min

THE FETAL SKULL

The fetal skull contains the delicate brain, which may be subjected to a great pressure as the head passes through the birth canal. It is large in relation to the fetal body and in comparison with the true pelvis. The head is the most difficult to deliver whether it comes first or last.

Ossification
The bones of the fetal head originate in two different ways The face is laid down in cartilage and is almost completely ossified at birth The bones of the vault are laid down in membrane are much flatter and more pliable. They ossify from the centre outwards and this process is incomplete at birth, leaving small gaps which forms the sutures and fontanelles.

Bones Of The Vault

five main bones in the vault of the fetal skull 1. The occipital bones. Lies at the back of the head and forms a region of occipital ,which contribute to base of the skull 2. The two parietal bones These lies on either side of the skull. The ossification centre of each is called the parietal eminence. 3. The two frontal bones These form the forehead . At the centre of each is the frontal boss or frontal eminence. The frontal bones fuse into a single bone by 8 years of age. The upper part of the temporal bone is also flat and forms a small part of the vault

Sutures and Fontanelles

1. The lambdoidal suture It separates the occipital bone from the two parietal bones. 2. The sagittal suture Lies between the two parietal bones. 3. The coronal suture It separates the frontal bones from the parietal bones, passing from one temple to the other. 4. The frontal suture Runs between the two halves of the frontal bones.

Cont

Fontanelles:
The posterior fontanelle or lambdoidal Situated at the junction of the lambdoidal and sagittal sutures. It is small, triangular in shape It usually closes by 6 weeks of age Can be recognized during vaginal examination because a suture leaves from each of the three angles.

cont
The anterior fontanelle or bregma Is found at the junction of the sagittal, coronal and frontal sutures. It is broad, kite shaped. Can be recognized during vaginal examination because a sutures leaves from each of the four corners

The regions and land landmarks

1. The occiput: Lies between the foramen magnum and the posterior fontanelle The part below the occipital protuberance is known as the sub occipital region 2. The vertex: Is bounded by the posterior fontanelle the two parietal eminences and the anterior fontanelle.

cont
3. The sinciput or brow: Extends from the anterior fontanelle to the coronal sutures to the orbital ridges 4. The face: Is small in the new born baby. It extends from the orbital ridges and the root of the nose to the junction of the chin and the neck. NB: - The point between the eye brows is known as the glabella. The chin is called mentum.

The Diameters Of The Fetal Skull

1. Biparietal diameter - 9.5 cm measured between the two parietal bones. 2. Bitemporal diameter - 8.2 cm measured between the furthest point of the coronal sutures at the temples 3. Suboccipitobregmatic - 9.5 cm measured from below the occipital protuberance to the centre of the anterior fontanelle or bregma. 4. Suboccipitofrontal - 10 cm measured from below of the occipital protuberance to the centre of the frontal suture.

cont
5. Occipitofrontal - 11.5 cm measured from the occipital protuberance to the glabella. 6. Mentovertical -13.5 cm measured fro the point of the chin to the highest point on the vertex, slightly near to the posterior than the anterior fontanelle 7. Submentovertical - 11.5 cm measured from the point where the chin joins the neck to the highest point in the vertex. 8. Submentobregmatic - 9.5 cm measured from the point where the chin joins the neck to the centre of the bregma

DIAMETERS OF SKULL

MOULDING:

cont

It is the alteration of the shape of the forecoming head while passing thru the resistant birth passage during labour. Moulding is a protective mechanism and prevents the fetal brain from being compressed.

IMPORTANCE:

Enables head to pass more easily, thru the birth canal. Shape of the moulding can be an useful information about the position of head occupied in the pelvis.