NCM 107: MATERNAL AND CHILD HEALTH NURSING

PPT based lecture

MODULE 3: Process of Conception
Implantation (preembryonic period)
Preparation for Conception in Female
A. Initiation of Cell Division:
A. Release of the ovum zygote migrates 3 – 4 days towards body of the uterus
mature ovum (contained in graafian follicle)
ruptures mitotic cell division occurs
release the mature ovum to the surface of the ovary
zygote reaches corpus consisting of 16 – 50 cells (morula)
follicle is transformed into corpus luteum
blastocyst
B. Ovum Transport
mature ovum is released trophoblast – cells in the outer ring
picked embryoblast – inner cell mass (ICM)
fimbrea of the fallopian tube
transported implantation occurs approximately 8 to 10 days after
through the tube fertilization
enters
uterus (approximately 3 days after ovulation) B. Entry of zygote into the uterus:
blastocyst (contains approximately 100 cells)
Preparation for Conception in the Male: enters
A. Ejaculation uterus (lingers another 2 – 4 days before implantation)
➢ 40 – 250 million of sperm (suspended in 2 to 5 ml of
seminal fluid) endometrium (decidua)
➢ 50 – 90 % are morphologically normal 3 separate areas of decidua:
➢ Deposited at the upper vagina and over the cervix 1. Desidua basalis – lies under the embryo
B. Transport of sperm in the female reproductive tract 2. Desidua capsularis – stretches and encapsulates
➢ tails of the spermatozoa propel through the cervix, surface of thophoblast
uterus and fallopian tubes 3. Desidua vera – remaining portion of lining
➢ Uterine contraction enhances movement of the C. Implantation in the Decidua:
sperm towards the ovum ➢ Nidation
C. Preparation of sperm for fertilization ➢ Occurs between 6th to 10th or 8th to 10th days after
sperm undergo capacitation penetrating corona radiata and conception
zona pellucida surrounding the ovum D. Maintaining the Decidua:
releases ➢ Supply of estrogen and progesterone
hyaluronidase and acrosin ➢ Zygote secretes hCG to signal woman’s body that
pregnancy has begun persistence of corpus luteum and
penetrating the ovum secretion of estrogen and progesterone
Fertilization:
A. Entry of one spermatozoon into the ovum
entry has 3 results:
1. zona reaction
2. cell membranes (ovum and sperm) fuse and break
down, allowing sperm head to enter
3. the ovum completes meiosis
➢ Mature ovum now contains 23 chromosomes in its
nucleus
B. Fusion of the nuclei of sperm and ovum
Stages of Fetal Development

Morula
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 3: Process of Conception
Morula Chorionic villi – forms the fetal side of the placenta
Decidua basalis – forms the maternal side of the placenta

Embryonic Period and Fetal Structures

➢ from the third week through the eight weeks after conception
Chorionic Villi:
implantation

thophoblast begins to mature rapidly

11th or 12th day
chorionic villi reached the endometrium
central core of chorionic villi, surrounded by double
layer of trophoblast cells contains fetal capillaries

syncytial layer (syncytiotrophoblast)

produces hormones
hCG, hPL, estrogen and progesterone

Langhans’ layer (cytotrophoblast) – present at

12 AOG but disappears between 20th to 24th week of
AOG
The Placenta:
➢ arise from the trophoblast
➢ 15 to 20 cm in diameter; 2 to 3 cm in depth at term
E. Location of Implantation:
➢ upper uterus (often on posterior wall than anterior)
3 Reasons:
1. Richly supplied with blood
2. Lining is thick in the upper uterus
3. Limits blood loss after birth because of strong interlacing
muscle fibers

conceptus is fully embedded within decidua by 10 days

during implantation, a small amount of bleeding Function:

may occur at the site (“spotting”) Fetal lungs, kidneys and gastrointestinal tract and
*implantation bleeding separate endocrine organ
A. Circulation:
F. Mechanism of Implantation
enzymes (conceptus) 12th day of pregnancy
erodes decidua
tapping maternal sources of nutrition maternal blood collects in the intervillous space of
endometrium surrounding chorionic villi
primary chorionic villi (decidua basalis), lies 3rd week
oxygen and other nutrients diffuse from maternal
between the conceptus and wall of the uterus
blood to the capillaries
transports
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 3: Process of Conception
no nerve supply
nutrients to the embryo ➢ Nuchal cord – loop of cord around fetal head
Function:
placental osmosis 1. Transport oxygen and nutrients to fetus from placenta
2. Return waste products from the fetus to the placenta
substances able to cross into fetal circulation
Amniotic Membranes:
Placental Circulation medial surface of chorionic villi of trophoblast

gradually thin, smooth

chorionic membrane (chorion) - supports the sac

containing amniotic fluid

amniotic membrane (amnion) – supports and produces

amniotic fluid

Amniotic Fluid:
➢ Never stagnant
- 800 to 1,200 ml (at term)
- Hydramnios (more than 2,000 ml/pockets larger than
➢ increase number of chorionic villi 8cm)
➢ Intervillous space grow larger and larger, separated - Oligohydramnios (less than 300 ml, no pocket larger
by partitions or septa than 1 cm)
➢ Mature placenta – cotyledons (30) ➢ Serves to protect fetus
➢ about 100 maternal uterine arteries supply mature ➢ Shields against pressure
placenta ➢ Protects from temperature changes
➢ at term, placenta weighs 400 to 600 grams (1 lb) ➢ Aids muscular development
➢ Protects umbilical cord
Endocrine Function:
Hormones produced by the syncytial layer of chorionic villi: Amniotic Membranes:
1. Human Chorionic Gonadotropin
Purpose:
➢ act as fail-safe measure to ensure corpus luteum to
continuously produce
estrogen and progesterone
➢ suppress maternal immunologic response so placenta
will not be rejected
2. Estrogen
Purpose:
➢ development of mammary gland
➢ Stimulates uterine growth
3. Progesterone
Purpose:
➢ necessary to maintain endometrial lining
➢ reduce contractility of uterine musculature during
pregnancy (premature labor)
4. Human Placental Lactogen
Purpose:
➢ promotes growth of mammary glands for lactation
➢ regulates maternal glucose, protein, and fat levels

Umbilical Cord:
➢ From fetal membranes (amnion and chorion)
➢ Provides circulatory pathway
➢ Contains one vein and two arteries
➢ length – 53 cm; 2 cm thick
➢ Wharton’s jelly – gelatinous mucopolysaccharide
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 3: Process of Conception

A. Stem Cells
zygote (1st 4 days of life) – totipotent stem cells
embryo (another 4 days) – pluripotent stem cells
another few days – multipotent

Embryonic Shield:
• 3 cells layers meet
• 8 weeks gastation – all organs (organogenesis)
are complete in a rudimentary from
Cardiovascular System:
➢ network of blood vessels and single heart tube –
forms at 16th day of life and beats at 24th day
➢ septum – develops at 6th or 7th week
➢ HB – may be heard as early as 10th to 12th week
(doppler)
- 28th week – HR has variability of about 5 bpm on a
strip

Fetal Circulation:
1. Oxygenated blood enters the umbilical vein from the
placenta
2. Enters ductus venosus
3. Passes through inferior venacava
B. Zygote growth 4. Enters the right atrium
cephalocaudal development 5. Enters the foramen ovale
➢ Body organs develops from specific tissue layers 6. Goes to the left atrium
(germ layers) 7. Passes through left ventricle
8. Flows to ascending aorta to supply nourishment to
C. Primary Germ Layers the brain and upper extremities
Implantation 9. Enters superior vena cava
10. Goes to right atrium
blastocyst (2 cavities of inner structure) 11. Enters the right ventricle
12. Enters pulmonary artery with some blood going to the
amniotic cavity (lined with ectoderm cells) lungs to supply oxygen and nourishment
yolk sac (lined with entoderm cells) 13. Flows to ductus arteriosus
➢ Supply nourishment until implantation 14. Enters descending aorta ( some blood going to the lower
➢ source of RBC extremities)
third layer of primary cells (mesoderm) 15. Enters hypogastric arteries
16. Goes back to the placenta
The three germ layers of the embryo develop into:
• Ectoderm: most nervous tissue and skin epidermis. Special Structures in Fetal Circulation:
• Mesoderm: connective tissue and muscle a. Placenta – Where gas exchange takes place during
fetal life
b. Umbilical Arteries – Carry unoxygenated blood from
the fetus to placenta
c. Umbilical Vein – Brings oxygenated blood coming
from the placenta to the fetus
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 3: Process of Conception
28th Week of Gestation 32nd week of gestation
d. Foramen Ovale – Connects the left and right atrium.
It pushes blood from the right atrium to the left atrium
so that blood can be supplied to brain, heart and kidney
e. Ductus Venosus - Carry oxygenated blood from
umbilical vein to inferior vena cava, bypassing fetal
Liver

Fetal Circulation: 36th Week of Gestation 40th Week of Gestation

Estimating EDD/EDB:
Nagele’s Rule:
➢ first day of the last menstrual period
➢ count three months backwards and add 7 days

Assessment of Fetal Growth and Development

A. Health History
Milestone of Fetal Development ➢ nutritional intake
➢ personal habits and lifestyle
4th Week of Gestation 5th Week of Gestation
B. Estimating Fetal Growth
McDonald’s Rule – symphysis – fundal height measurement

Fundic Height Measurement:

12th Week of Gestation 16th Week of Gestation

Assessing Fetal Well-Being:

A. Fetal Movement
Quickening - begins 18 to 20 weeks of pregnancy
20th Week of Gestation 24th Week of Gestation - peaks at 28 to 38 weeks of pregnancy
- more than 10 times a day
Methods:
1. Sandovsky Method
- 2 every 10 minutes or 10 to 12 times an hour
2. Cardiff Method
-Count – to – ten
B. Fetal Heart Rate
➢ 120 to 160 bpm
➢ heard and counted as early as 10th to 11th week
(doppler)
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 3: Process of Conception
Rhythm Strip Testing: Ultrasound
➢ Semi-fowler’s position
➢ external fetal heart rate and uterine contraction are
monitor
➢ recorded for 20 minutes
➢ Baseline - average rate of the FHB per minute
➢ Short-term variability (beat-to-beat variability) – small
changes in rate occur from second to second
➢ Long-term variability – difference in HR occur over a 20-
minute time period
Measuring Biparietal Diameter:
➢ used to measure fetal maturity
➢ 8.5cm or greater – infant weigh more than 2,500 g
(5.5 lb) 40 weeks AOG
Head circumference:
➢ 34.5 cm – 40 weeks AOG

Nonstress Testing:
➢ measures FHR to fetal movement
➢ no increase in FHB – poor oxygen perfusion
➢ done 10-20 minutes
➢ performed after the 28th week Doppler Umbilical Velocimetry:
Non-reactive: ➢ measures velocity at which RBC in the uterine and
- no accelerations occur with fetal movement fetal vessels are traveling
- no fetal movement Placental Grading – Placental grades are number
- low short term FHR variability (less than 6 bpm) values assigned to a placenta on the basis of its
appearance on an ultrasound examination
Vibroacoustic Stimulation: Graded as:
➢ acoustic stimulation (acoustic stimulator) 0 – placenta is 12 to 24 weeks
Contraction Stress Testing: 1 – placenta is 30 to 32 weeks
2 – placenta is 32 t0 36 weeks
➢ FHR analyzed with contractions
➢ stimulation of breast (oxytocin) 3 – placenta is 38 weeks (mature)
➢ 3 contractions of 40 seconds duration or longer must Fetal ECG:
be present in 10 minutes ➢ early as 11th week
Result: ➢ BUT, inaccurate before 20th week
negative (normal) – no FHR decelerations are present
with contractions MRI:
Positive (abnormal) – 50% or more of contractions ➢ diagnose ectopic pregnancy or trophoblastic disease
cause late deceleration Maternal Serum Alpha-Fetoprotein:
➢ assessed at 15th week
Ultrasonography:
➢ AFP – produced by amniotic fluid and maternal serum
Purposes:
➢ - open spinal of abdominal defect
➢ diagnose pregnancy (6 weeks) ➢ - chromosomal defects
➢ confirm presence, size, and location of placenta and
amniotic fluid Chorionic Villi Sampling:
➢ establish that fetus is growing and has no gross anomalies ➢ biopsy and chromosomal analysis of chorionic villi
➢ establish sex ➢ done at 10 to 12
➢ establish presentation and position of the fetus ➢ weeks
➢ predict maturity by measuring biparietal diameter of the
head
➢ discover complications of pregnancy and fetal anomalies
and fetal death
 NCM 107: MATERNAL AND CHILD HEALTH NURSING
PPT based lecture
MODULE 3: Process of Conception

Amnioscopy:
➢ Visual inspection of the amniotic fluid through the
cervix and membranes
with amnioscope
➢ Detect meconium staining
Fetoscopy:
➢ visualization of fetus through a fetoscope
➢ 16th or 17th week
Pupose:
1. Obtain biopsy samples of fetal tissue and fetal blood samples
Amniocentesis:
➢ aspiration of amniotic fluid from the pregnant uterus for Fetal Endoscope
examination
➢ done 14th and 16th weeks; 15 ml of fluid
Complications:
1. Hemorrhage from penetration of the placenta
2. Infection of the amniotic fluid
3. Puncture of the fetus
4. Premature labor
How:
➢ empty the bladder
➢ supine position (folded towel under the buttock)
➢ attach fetal monitors/guided by UTZ Biophysical Profile: (fetal apgar)
➢ combines five parameters (fetal re-activity, fetal
Amniocentesis: breathing movements, fetal body movement, fetal
tone, and amniotic fluid volume)
➢ has 5 components: 4 ultrasound (US) assessments
and a nonstress test (NST)
➢ each scores 2 (10 as the highest possible score)
➢ 8-10 = maximal score
6 = suspicious; 0-4 = severe fetal compromise; delivery
indicated

Percutaneous Umbilical Blood Sampling:

➢ cordocentesis or funicestesis
➢ aspiration of blood from the umbilical vein for
analysis
Kleihauer-Betke test:
- used to measure the amount of fetal hemoglobin
transferred from a fetus to a mother's bloodstream.