Maternal 1 Side-notes: Fetal Development ⁃ Fetal enzymes into maternal

bloodstream
Human Chorionic Gonadotropin (hCG) ⁃ Synthesize by fetal liver
⁃ growth of endometrium ⁃ Abnormal level: chromosomal or
spinal disorders
Decidua
⁃ falling of endometrium (placenta) Utero Placental Blood
1. Decidua Basalis ⁃ 10weeks: 50mL/min
⁃ innermost ⁃ Term: 500-600mL/min
⁃ Trophoblast communicates with ⁃ Perfusion and circulation efficient
maternal blood vessels when lies on left side

2. Decidua Capsularis Left-side position

⁃ encapsulates trophoblast ⁃ prevents blood trapping in lower
extremities
3. Decidua Vera ⁃ Prevents pressure in inferior vena
⁃ Remains of uterine lining cava
⁃ Vena cava located RIGHT SIDE
Note:
⁃ vera + capsularis = hemorrhage and Supine Position
infection ⁃ Uterus compress vena cava
⁃ Reduced placental circulation=
Chorionic Villi SUPINE HYPOTENSION
⁃ Trophoblastic layer of cells mature
rapidly Supine Hypotension
⁃ Low maternal blood pressure
Miniature Villi ⁃ Poor uterine circulation
⁃ begins formation of placenta
Small Placenta
Syncytiotrophoblast (sunctional layer) ⁃ Inadequate fetal circulation
⁃ Double layer of trophoblast
⁃ Produces placental hormones Large Placenta
⁃ Outer layer ⁃ fetus is threatened

Cytotrophoblast (Langhan’s Layer) Diabetic Mother

⁃ middle layer ⁃ larger placenta due to excess fluid
⁃ Present 12 days of gestation accumulation between cells
⁃ Protection from infectious organism
(spirochete syphilis) Placental Hormones
⁃ Disappear 20-24th weeks AOG ⁃ From syncytial or outer layer of
chorionic villi
Placenta
⁃ latin “pancake” 1. Human Chorionic Gonadotropin
⁃ Growth of trophoblast tissue (hCG)
⁃ 1st placental hormones
Placental Osmosis ⁃ Maternal blood and urine
⁃ few substance to cross from mother ⁃ Detects pregnancy test
into fetus ⁃ Suppress maternal immunologic
⁃ No direct exchange response
⁃ “Fail-Safe Measure” for corpus
Alpha-fetoprotein luteum
⁃ outer chorionic villi breaks
 2. Estrogen (Women Hormone) ⁃ Larger fluid pocket >8cm
⁃ primarily estriol
⁃ 2nd placental hormone 2 Factors Polyhydramnios:
⁃ Mammary gland development 1. Esophageal Atresia
⁃ Uterine growth 2. Anencephaly

3. Progesterone (Mother’s Hormone) Fetal Urine (Active Kidney)

⁃ Hormone of pregnancy ⁃ contributes to amniotic fluid
⁃ Maintains endometrial lining of ⁃ Poor Kidney: Oligohydramnios
uterus
⁃ 4th week of pregnancy Oligohydramnios
⁃ Corpus luteum ⁃ <300mL amniotic fluid
⁃ Reduce contraction prevents ⁃ No pocket <1cm
premature labor
Amnitoic Fluid
4. Human Placental Lactogen (Human ⁃ yellowish fluid
Chorionic Somatomammotropin) ⁃ shield against trauma
⁃ Promotes growth ⁃ Temperature protection
⁃ Lactogenic properties ⁃ Fetus free to move
⁃ 6th week of pregnancy ⁃ Protect cord from compression =
⁃ Regulates glucose, CHON and fats establish O2 supply
for adequate nutrients to fetus ⁃ Alkaline: 7.2 pH
⁃ Average: 1000mL
Placental Proteins
⁃ contribute to decreasing Umbilical Cord
immunologic impact of growing placenta ⁃ amnion + chorion
⁃ Circulatory pathway
Chorion Laeve (smooth chorion) ⁃ Connects embryo to chorionic villi
⁃ Outermost fetal membrane ⁃ Whartons Jelly (gelatinous
⁃ Forms sac holds amniotic fluid mucopolysaccharide)= prevents pressure vein and
⁃ Chorionic membrane arteries
⁃ AKA: amniotic membrane or amnion ⁃ NO pain receptors
⁃ Produces fluid and phospholipids
⁃ Prostaglandin= uterine contraction AVA (2 Artery: 1 Vein)
Artery- blood back to placenta
Series of Events Vein- blood towards fetus
1. Amniotic Membrane
2. Phospholipids Nuchal cord
3. Prostaglandins ⁃ Loop of cord around fetal neck
4. Uterine contraction
5. Triggers labor Primary Germ Layers
1. Amniotic Cavity
Amniotic Fluid ⁃ Large with distinction
⁃ reabsorbed by amniotic membrane ⁃ ECTODERM
⁃ Fetus continually swallows fluid
⁃ Term: 800-1200mL 2. Yolk Sac
⁃ smaller cavity
Polyhydramnios ⁃ ENTODERM
⁃ >2000mL amniotic fluid ⁃ Source of RBC (embryo
⁃ Fetus unable to swallow hematopoietic system immature)
⁃ DM Mothers: hyperglycemia = fluid
shift into amniotic space 3. Mesoderm
 ⁃ 3rd layer ⁃ Droplet infection

Embryonic Shield 7. Herpes Simplex Virus

⁃ 3 germ layers fused together ⁃ genital herpes= C-section
(ectoderm, entoderm, mesoderm)
8. Parvovirus B19
Organogenesis ⁃ Erythema Infectiosum (5th Disease)
⁃ vulnerable time for invasion of ⁃ Attack fetal RBC
teratogens ⁃ Severe anemia and congenital heart
disease
Zygote Growth
⁃ cephalocaudal direction 9. Syphilis
⁃ intact cytotrophoblast cannot cross
Fetal Circulation placenta
1. Placental Blood- Highly O2 ⁃ Benzathine Penicillin (antibiotic
2. Vein- O2 blood towards fetus treatment)

3. Ductus Venosus 10. Lyme Disease

⁃ O2 blood to liver ⁃ spirochete bonelia burydorferi
⁃ By pass portal circulation ⁃ TICK

4. Foramen Ovale 11. Vaccines

⁃ Opens atrial septum ⁃ LAV (measles, HPV, mumps,
⁃ By pass lungs rubella, poliomyelitis)
⁃ Blood flow (right to left)
12. Drugs and Recreational Drugs
5. Ductus Arteriosus ⁃ Sulfonamides
⁃ towards aorta ⁃ Aminoglycosides
⁃ By pass lungs ⁃ Fluroquinolones
⁃ Erythromycin
Teratogenic Infection ⁃ Metronidazole
1. Syphilis and Toxoplasmosis ⁃ Tetracycline
⁃ avoid undercooked meat ⁃ Ribavirin
⁃ avoid cat liter ⁃ Griseofulvin
⁃ Chloramphenicol & clarithromycin
Pyrimethamine
⁃ anti-protozoal agent Mnemonic : SAFE MOMS TAKE REALLY GOOD
⁃ Anti-folic acid drug (prevent reducing CARE
folic acid levels)
13. Alcohol
2. Lead & Mercury- nervous tissue ⁃ congenital and cognitive impairment
3. Thalidomide- focamelia ⁃ Vitamin B deficiency
4. Tetracycline- bone deformity
Fetal Alcohol Syndrome (FAS)
5. Rubella Virus ⁃ cognitively challenged
⁃ eyes, ears, heart, brain
⁃ Cannot immunized during pregnancy 14. Nicotine
⁃ Immunized: NOT to get pregnant ⁃ Fetal growth restrictions
3MONS ⁃ Stillborn babies
⁃ Infant to be ISOLATED ⁃ Sudden Death Infant Syndromes
⁃ Low birth weight
6. Cytomegalovirus (CMV)
 15. Radiation ⁃ spinal cord disorders
⁃ Attacks rapid growing cells ⁃ Lack of folic acid
⁃ Implantation to 6weeks: damaging ⁃ Sac pushes outside spine
time (unaware of pregnancy) ⁃ Type of spina bifida

Note: Folic Acid

⁃ childbearing age scheduled pelvic X- ⁃ Green leafy vegetables
ray ONLY in 1st 10 days of menstrual cycle ⁃ Vitamins
⁃ Serum PT= before Dx X-ray
4. Neurological System
Age of Viability ⁃ 3rd week (ectoderm)
⁃ survival extrauterine life
⁃ 24 weeks >400g 5. Digestive System
⁃ 22-24th weeks ⁃ 4th week
⁃ Survival factor: CNS and Lung ⁃ Sterile before birth
Maturity ⁃ Vitamin K low level newborns

Placental Mechanism Vitamin K

1. Diffusion - high to low ⁃ Synthesize gut bacteria
2. Facilitated Diffusion - with carrier ⁃ Flavobacterium Meningosepticum
3. Active Transport - with enzyme
Sucking and swallowing reflex
4. Pinocytosis ⁃ 32 weeks weighs 1500g
⁃ cellular absorption
⁃ Way of viruses to infect fetus Meconium
⁃ dark green stool (bile pigment)
Fetal Development:
1. Cardiovascular System 6. Musculoskeletal System
⁃ 1st to function ⁃ Fetal movement 11th week
⁃ FHR: 120-160bpm/min (10-12week)
⁃ Doppler Quickening
⁃ Fetal circulation 3rd week ⁃ movement felt
⁃ 16-20 weeks
Artery- without O2 ⁃ Peaks: 28-38 weeks
Vein- with O2
Healthy Fetus
2. Respiratory System ⁃ moves 10x a day
⁃ 3rd week
⁃ 4th week: divides esophagus from 7. Renal System
trachea Kidney
⁃ 4-5th week
Surfactant ⁃ Urine 500mL/day (mix with amniotic)
⁃ 24th week of pregnancy ⁃ Low urine volume= renal dysfunction
⁃ Decrease alveolar surface tension
⁃ Prevent alveolar collapse GFR (Glomerular Filtration Rate)
⁃ low at birth
3. Nervous System
⁃ 3rd to 4th week 8. Integumentary System
⁃ Extreme early (before pregnancy ⁃ thin and translucent
was noticed) ⁃ SQ Fat at 36 weeks

Meningocele Lanugo
 ⁃ fine downy hairs ⁃ bright pink and transparent
⁃ Premature signs ⁃ Lanugo

Vernix Caseosa 5. 5th Month (20weeks)

⁃ Creamy cheese substance ⁃ Lanugo whole body
⁃ Lubrication ⁃ Quickening
⁃ Prevent skin maceration utero (skin ⁃ Visceral organs maturing
breakdown) ⁃ Facial features
⁃ Hair on head
Finger and Toenails ⁃ Length: 8-10 inches
⁃ 10th week ⁃ Weight: 1 pound

9. Endocrine System 6. 6th Month (24weeks)

⁃ thyroid gland 1st to develop ⁃ Eyelids apart
⁃ Insulin 20 weeks ⁃ Eyes open
⁃ Vernix caseosa
10. Immune System ⁃ Hiccup
Immunoglobulin (IgG) ⁃ Length: 11-14 inches
⁃ Maternal antibodies ⁃ Weight: 1 3/4-2 pounds
⁃ Crosses placenta (20-24th week)
⁃ Temporary passive immunity 7. 7th Month (28weeks)
⁃ Taste buds
Fetal Months ⁃ Fat layers
1. 1st Month (4weeks) ⁃ Organs maturing
⁃ 1/4 inch length ⁃ Length: 14-16 inches
⁃ Weight: 2 1/2-3 1/2 pounds
2. 2nd Month (8weeks)
⁃ heart functional Skin
⁃ Penis appears (boys) ⁃ Red and wrinkled
⁃ 1 and 1/8 inches length ⁃ Premature= SPECIAL CARE
⁃ Movement NOT felt
8. 8th Month (32weeks)
3. 3rd Month (12weeks) ⁃ rapid growth
⁃ recognizable form ⁃ Brain growth
⁃ Nails and earlobes ⁃ All develop except LUNGS
⁃ Extremities fully formed ⁃ Skin less wrinkled
⁃ Eyes ⁃ Fingernail beyond fingertips
⁃ HR = doppler ⁃ Strong kick (visible outside)
⁃ Length: 2 1/2-3 inches ⁃ Length: 16 1/2-18 inches
⁃ Weight: 1/2- 1 ounce ⁃ Weight: 4-6 pounds

4. 4th Month (16weeks) 9. 9th Month (38weeks)

⁃ Sucking and swallowing reflex ⁃ Lungs matured
⁃ Suck own thumb ⁃ Baby fully developed
⁃ Tooth buds ⁃ Engaged and less active
⁃ Sweat glands ⁃ Survive extrauterine life
⁃ Defined finger and toes ⁃ Length: 19-20 inches
⁃ Sexual identity ⁃ Weight: 7- 7 1/2 pounds
⁃ Length: 6 1/2-7 inches
⁃ Weight: 6-7 ounces

Skin