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Stages of Prenatal Development

Nov 17, 2014

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Stages of Prenatal Development. Stages of Prenatal Development Conception Germinal Embryonic Fetal. Conception . Conception occurs when a sperm cell penetrates and fertilizes an egg cell Successful conception depends on ovaries releasing one healthy egg cell

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• embryonic stage
• health care
• birth canal head
• birth profoundly affects women

Presentation Transcript

Stages of Prenatal Development • Conception • Germinal • Embryonic • Fetal

Conception • Conception occurs when a sperm cell penetrates and fertilizes an egg cell • Successful conception depends on • ovaries releasing one healthy egg cell • egg cell migrates most of the way down the fallopian tube • One sperm must penetrate the ovum to form a zygote

Infertility • About 15 percent of couples are unable to conceive or carry a pregnancy to term after one year of unprotected intercourse. • Causes of male infertility involve the quantity or strength of sperm produced.

Infertility (2) • Causes of female infertility involve structural abnormalities in the Fallopian tubes or uterus or a failure to ovulate and release mature eggs. • New technologies are now available to help overcome infertility

The Germinal Stage (first two weeks) • 1. The blastocyst is differentiated into three layers: the ectoderm, the endoderm, and the mesoderm. • 2. The blastocyst moves down the fallopian tube into the uterus for implantation. • 3. The embryonic stage begins with implantation, and the fully implanted blastocyst is referred to as the embryo.

Blastocyst at day six

Another blastocyst, day six

Embryonic Stage (3rd through 8th weeks) • 1. Growth in the embryonic and fetal stages follows a cephalocaudal (head-to-tail) pattern and a proximodistal (near-to-far) pattern. • 2. The head, blood vessels, heart, and most vital organs begin to develop before the arms, legs, hands, and feet.

Early Embryonic Stage

Embryonic stage (slide 2) • 3. The placenta forms as an area of the uterine wall through which oxygen and nutrients reach the fetus. • 4. The umbilical cord connects the embryo to the placenta and provides nutrients and carries away waste products. • 5. The amniotic sac surrounds the embryo and protects it.

Later embryonic stage

Fetal Stage (9th to birth) • 1. The fetal stage is marked by the development of the first bone cells. The embryo is now called the fetus. • 2. By the third month, the fetus is able to move its head, legs, and feet. By the fourth month, the mother may feel quickening, or fetal movement. • 3. The beginning of the seventh month is considered the age of viability. • 4. At the end of nine months, the fetus weighs on average 7.5 pounds and is almost 20 inches long.

Fetus at 12 weeks

Fetus at 18 weeks

The experience of pregnancy • 1. Physical complaints such as nausea are common. • 2. Normal weight gain is about thirty pounds and is dispersed in organs, baby, and bodily fluid. • 3. Changes in the woman's body bring mixed feelings.

Prenatal influences on the child • A. Key concepts • 1. Canalization is seen in prenatal development. • 2. Drugs and other harmful environmental influences can also canalize development, usually in negative ways. • 3. Risk factors can interfere with canalized processes that lead to the development of specific organs.

Maternal diet and nutrition • 1. Poor nutrition leads to specific physical deformities and increased risk for prematurity and infant mortality; later nutritional deprivation leads to a reduced number of brain cells. • 2. Pregnant women should eat between two hundred and one thousand calories more per day, adding mainly carbohydrates and protein.

Prenatal health care (1 of 2) • 1. Adequate early prenatal health care is critical to infant and maternal health. • 2. There are racial differences in adequacy of care. • 3. Special programs have been implemented in communities to help high-risk mothers.

Prenatal health care (2) • Stress • 1. Prolonged anxiety just before or during pregnancy increases the likelihood of medical complications. • 2. Emotional stress is related to spontaneous abortion as well as to labor and birthing problems.

The birth episode • Birth • After about thirty-eight weeks in the womb, the baby is considered "full term," or ready for birth. Fetal presentation refers to the body part closest to the mother's cervix. There are three types of presentation: Cephalic (normal), breech, and transverse.

Stages of labor • 1. During the last weeks of pregnancy, it is common for the mother to experience false labor, or Braxton-Hicks contractions. • 2. The first stage of labor usually begins with relatively mild contractions, leading to stronger contractions and the dilation of the cervix to accommodate the baby's head (10 centimeters).

Stages of labor • 3. Toward the end of the first stage, which may take from eight to twenty-four hours, a period of transition begins, and the baby's head begins to move through the birth canal. • 4. The second stage of labor is from complete dilation of the cervix to birth, lasting about one to one and one-half hours. • 5. During the third stage of labor, which lasts only a few minutes, the afterbirth (consisting of the placenta and umbilical cord) is expelled

Childbirth settings and methods • Traditionally, childbirth was attended by a midwife and was seen as a natural process. With the advent of modern technology, births increasingly took place in medical settings. This resulted in decreased mortality rates, but birth was now seen as a medical event controlled by physicians.

1. Hospital births. Birthing rooms are becoming more popular in hospitals. • 2. Non-hospital settings • a. Freestanding birth centers are non-hospital facilities that provide family centered maternity care. • b. Birth centers have lower rates of Caesarean sections. • c. Home births are another alternative for pregnancies predetermined to be low risk. • 3. Prepared childbirth. Methods of prepared childbirth help parents rehearse the sensations of labor.

Programs emphasize educational, physical, and emotional preparation for the birth process and use of a coach. • b. Women who participate in birthing programs report favorable effects. • c. Leboyer claimed a gentle birth has benefits for the child.

Lamaze birth philosophy Integral to the work of Lamaze International is a fundamental philosophy of birth: Birth is normal, natural, and healthy. The experience of birth profoundly affects women and their families. Women's inner wisdom guides them through birth. Women's confidence and ability to give birth is either enhanced or diminished by the care provider and place of birth. Women have the right to give birth free from routine medical intervention. Birth can safely take place in birth centers and homes. Childbirth education empowers women to make informed choices in health care, to assume responsibility for their health, and to trust their inner wisdom.

Medicinal aids to birth • Despite good psychological preparation, the mother may experience considerable pain, which can be made bearable through pain-reducing drugs such as narcotics or other sedatives. • a. The most common anesthetics are epidural and spinal, which allow the mother to remain awake and alert during birth. • b. A general or local anesthetic delays the recovery of the mother as well as the bonding between mother and child.

Pain in childbirth • 5. Perceptions of pain during childbirth • a. It is difficult to determine how much discomfort or distress a laboring woman is in and how to respond appropriately. • b. There are cultural differences in the perceptions of pain.

Problems during labor and delivery (1 of 3) • 1. Faulty power is the failure of the uterus to contract strongly enough to make labor progress to an actual delivery. Induced labor can be stimulated by the hormone oxytocin. • 2. A faulty passageway condition occurs when the placenta develops so close to the cervix that it blocks the baby's passage down the birth canal during labor. This condition is called placenta previa.

Problems with Labor and Delivery (2 of 3) • 3. A faulty passenger condition occurs when problems exist with the baby's position or size. Usually babies enter the birth canal head first, but occasionally one turns in the wrong direction during contractions. Forceps sometimes are used to remedy the situation. • 4. In a Caesarean section, the mother receives a general anesthetic and the baby is removed surgically. Techniques for this surgery have improved; however, a common criticism is that too many Caesareans are performed.

Problems with Labor and Delivery (3 of 3) • To deal with such problems, in most hospitals, electronic fetal monitoring is used to record uterine contractions and the fetal heart rate.

Low-birth weight infants • Normal is around 7.5 pounds • Low-birth weight is 5.5 pounds or less • 6 or 7 percent of all births in U.S. • At risk for developmental, neurological, and health problems

Pre-term Babies • Formerly called premature • More than three weeks before due date • At risk for respiratory distress syndrome (RDS) • Extended oxygen use=Retinopathy of Prematurity

Negative Prenatal Influences on the Child • Window of opportunity concept--critical time of vulnerability • Teratogen is any substance or influence that can interfere with or damage a child’s growth

Teratogenic Medicinal drugs • Thalidomide is a sedative, also an anti-nausea drug--but deforms children. • Diethylstilbestrol (DES) was used to prevent miscarriages but causes damage to reproductive systems of offspring. • Other potentially harmful prescribed drugs are accutane, streptomycin, and tetra-cycline.

Teratogenic non-medicinal drugs (1 of 3) • Marijuana • Active ingredient is tetrahydra-conabaninol or THC • Is stored in fatty tissues of body • Placenta is no barrier • Babies are born with psych. if not physical addiction

Heroin • An opiate not totally unlike morphine, but more addictive • Severe withdrawal symptoms • Newborn babies of heroin addicts vomit, tremble, cry, and have fever, disturbed sleep, and abnormal cries

Fetal alcohol syndrome • CNS damage, heart defects, small head, distortion of joints, and abnormal facial features • Are evident in their inability to pay attention or maintain attention

Tobacco • Nicotine and carbon monoxide interfere with fetal oxygen supply • Smoking is associated with low birth weight, spontaneous abortion, higher infant mortality, and poor postnatal adjustment

Maternal Diseases (1 of 2) • Rubella, or German measles. Disastrous in first trimester. • Syphilis and gonorrhea. Blindness, jaundice, anemia, pneumonia, skin rash, early death. Silver nitrate in the eyes. • Genital herpes. (1) Disease of skin and mucous membranes, or (2) blindness, permanent brain damage, seizures, and developmental delay.

Maternal diseases (2 of 2) • Cytomegalovirus (CMV). High risk for infants; jaundice, microcephaly, deafness, and eye problems. • Toxoplasmosis. Parasite from uncooked meat and cat feces. Low birth weight, enlarged liver and spleen, microcephaly, anemia, and calcifications in the brain. • Pediatric AIDS.

Teenage Pregnancy “Babies having babies”--own growth is not complete Pelvic cradle not ready Threat to education Responsibility not yet learned Maternal malnutrition Domestic Violence Seven to Eight percent of pregnant women are beaten by partners; most more than once High rate of miscarriage Home Factors

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Variations in Fetal Position and Presentation |

During pregnancy, the fetus can be positioned in many different ways inside the mother's uterus. The fetus may be head up or down or facing the mother's back or front. At first, the fetus can move around easily or shift position as the mother moves. Toward the end of the pregnancy the fetus is larger, has less room to move, and stays in one position. How the fetus is positioned has an important effect on delivery and, for certain positions, a cesarean delivery is necessary. There are medical terms that describe precisely how the fetus is positioned, and identifying the fetal position helps doctors to anticipate potential difficulties during labor and delivery.

Presentation refers to the part of the fetus’s body that leads the way out through the birth canal (called the presenting part). Usually, the head leads the way, but sometimes the buttocks (breech presentation), shoulder, or face leads the way.

Position refers to whether the fetus is facing backward (occiput anterior) or forward (occiput posterior). The occiput is a bone at the back of the baby's head. Therefore, facing backward is called occiput anterior (facing the mother’s back and facing down when the mother lies on her back). Facing forward is called occiput posterior (facing toward the mother's pubic bone and facing up when the mother lies on her back).

Lie refers to the angle of the fetus in relation to the mother and the uterus. Up-and-down (with the baby's spine parallel to mother's spine, called longitudinal) is normal, but sometimes the lie is sideways (transverse) or at an angle (oblique).

For these aspects of fetal positioning, the combination that is the most common, safest, and easiest for the mother to deliver is the following:

Head first (called vertex or cephalic presentation)

Facing backward (occiput anterior position)

Spine parallel to mother's spine (longitudinal lie)

Neck bent forward with chin tucked

Arms folded across the chest

If the fetus is in a different position, lie, or presentation, labor may be more difficult, and a normal vaginal delivery may not be possible.

Variations in fetal presentation, position, or lie may occur when

The fetus is too large for the mother's pelvis (fetopelvic disproportion).

The uterus is abnormally shaped or contains growths such as fibroids .

The fetus has a birth defect .

There is more than one fetus (multiple gestation).

Position and Presentation of the Fetus

Variations in fetal position and presentation.

Some variations in position and presentation that make delivery difficult occur frequently.

Occiput posterior position

In occiput posterior position (sometimes called sunny-side up), the fetus is head first (vertex presentation) but is facing forward (toward the mother's pubic bone—that is, facing up when the mother lies on her back). This is a very common position that is not abnormal, but it makes delivery more difficult than when the fetus is in the occiput anterior position (facing toward the mother's spine—that is facing down when the mother lies on her back).

When a fetus faces up, the neck is often straightened rather than bent,which requires more room for the head to pass through the birth canal. Delivery assisted by a vacuum device or forceps or cesarean delivery may be necessary.

Breech presentation

In breech presentation, the baby's buttocks or sometimes the feet are positioned to deliver first (before the head).

When delivered vaginally, babies that present buttocks first are more at risk of injury or even death than those that present head first.

The reason for the risks to babies in breech presentation is that the baby's hips and buttocks are not as wide as the head. Therefore, when the hips and buttocks pass through the cervix first, the passageway may not be wide enough for the head to pass through. In addition, when the head follows the buttocks, the neck may be bent slightly backwards. The neck being bent backward increases the width required for delivery as compared to when the head is angled forward with the chin tucked, which is the position that is easiest for delivery. Thus, the baby’s body may be delivered and then the head may get caught and not be able to pass through the birth canal. When the baby’s head is caught, this puts pressure on the umbilical cord in the birth canal, so that very little oxygen can reach the baby. Brain damage due to lack of oxygen is more common among breech babies than among those presenting head first.

In a first delivery, these problems may occur more frequently because a woman’s tissues have not been stretched by previous deliveries. Because of risk of injury or even death to the baby, cesarean delivery is preferred when the fetus is in breech presentation, unless the doctor is very experienced with and skilled at delivering breech babies or there is not an adequate facility or equipment to safely perform a cesarean delivery.

Breech presentation is more likely to occur in the following circumstances:

Labor starts too soon (preterm labor).

The uterus is abnormally shaped or contains abnormal growths such as fibroids .

Other presentations

In face presentation, the baby's neck arches back so that the face presents first rather than the top of the head.

In brow presentation, the neck is moderately arched so that the brow presents first.

Usually, fetuses do not stay in a face or brow presentation. These presentations often change to a vertex (top of the head) presentation before or during labor. If they do not, a cesarean delivery is usually recommended.

In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.

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Fetal Presentation, Position, and Lie (Including Breech Presentation)

• Key Points |

Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography. Management is with physical maneuvers to reposition the fetus, operative vaginal delivery , or cesarean delivery .

Terms that describe the fetus in relation to the uterus, cervix, and maternal pelvis are

Fetal presentation: Fetal part that overlies the maternal pelvic inlet; vertex (cephalic), face, brow, breech, shoulder, funic (umbilical cord), or compound (more than one part, eg, shoulder and hand)

Fetal position: Relation of the presenting part to an anatomic axis; for vertex presentation, occiput anterior, occiput posterior, occiput transverse

Fetal lie: Relation of the fetus to the long axis of the uterus; longitudinal, oblique, or transverse

Normal fetal lie is longitudinal, normal presentation is vertex, and occiput anterior is the most common position.

Abnormal fetal lie, presentation, or position may occur with

Fetopelvic disproportion (fetus too large for the pelvic inlet)

Fetal congenital anomalies

Uterine structural abnormalities (eg, fibroids, synechiae)

Multiple gestation

Several common types of abnormal lie or presentation are discussed here.

Transverse lie

Fetal position is transverse, with the fetal long axis oblique or perpendicular rather than parallel to the maternal long axis. Transverse lie is often accompanied by shoulder presentation, which requires cesarean delivery.

Breech presentation

There are several types of breech presentation.

Frank breech: The fetal hips are flexed, and the knees extended (pike position).

Complete breech: The fetus seems to be sitting with hips and knees flexed.

Single or double footling presentation: One or both legs are completely extended and present before the buttocks.

Types of breech presentations

Breech presentation makes delivery difficult ,primarily because the presenting part is a poor dilating wedge. Having a poor dilating wedge can lead to incomplete cervical dilation, because the presenting part is narrower than the head that follows. The head, which is the part with the largest diameter, can then be trapped during delivery.

Additionally, the trapped fetal head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Umbilical cord compression may cause fetal hypoxemia.

Predisposing factors for breech presentation include

Preterm labor

Uterine abnormalities

Fetal anomalies

If delivery is vaginal, breech presentation may increase risk of

Umbilical cord prolapse

Birth trauma

Perinatal death

Face or brow presentation

In face presentation, the head is hyperextended, and position is designated by the position of the chin (mentum). When the chin is posterior, the head is less likely to rotate and less likely to deliver vaginally, necessitating cesarean delivery.

Brow presentation usually converts spontaneously to vertex or face presentation.

Occiput posterior position

The most common abnormal position is occiput posterior.

The fetal neck is usually somewhat deflexed; thus, a larger diameter of the head must pass through the pelvis.

Progress may arrest in the second phase of labor. Operative vaginal delivery or cesarean delivery is often required.

Position and Presentation of the Fetus

If a fetus is in the occiput posterior position, operative vaginal delivery or cesarean delivery is often required.

In breech presentation, the presenting part is a poor dilating wedge, which can cause the head to be trapped during delivery, often compressing the umbilical cord.

For breech presentation, usually do cesarean delivery at 39 weeks or during labor, but external cephalic version is sometimes successful before labor, usually at 37 or 38 weeks.

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