Process of

Conception
 Process of Conception
Preparation for Conception in the Female:
A. Release of the ovum
mature ovum (contained in graafian follicle)
ruptures
release the mature ovum to the surface of the ovary

follicle is transformed into corpus luteum

B. Ovum Transport
mature ovum is released
picked
fimbrea of the fallopian tube
transported
through the tube
enters
uterus (approximately 3 days after ovulation)
Preparation for Conception in the Male:
A. Ejaculation
Ø 40 – 250 million of sperm (suspended in 2 to 5 ml of
seminal fluid)
Ø 50 – 90 % are morphologically normal
Ø Deposited at the upper vagina and over the cervix
B. Transport of sperm in the female reproductive tract
Ø tails of the spermatozoa propels through the cervix,
uterus and fallopian tubes
Ø Uterine contraction enhances movement of the
sperm towards the ovum
C. Preparation of sperm for fertilization
sperm undergo capacitation penetrating corona
radiata and zona pellucida surrounding the ovum
releases
hyaluronidase and acrosin

penetrating the ovum

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
Ø Mature ovum now contains 23 chromosomes in its nucleus
B. Fusion of the nuclei of sperm and ovum
Stages of Fetal Development
 Implantation
(preembryonic period)
A. Initiation of Cell Division:
zygote migrates 3 – 4 days towards body of the
uterus

mitotic cell division occurs

zygote reaches corpus consisting of 16 – 50 cells

(morula)
 blastocyst

trophoblast – cells in the outer ring

embryoblast – inner cell mass (ICM)

implantation occurs approximately 8 to 10 days after

fertilization
B. Entry of zygote into the uterus:
blastocyst (contains approximately 100 cells)
enters
uterus (lingers another 2 – 4 days before
implantation)

endometrium (decidua)
3 separate areas of decidua:
1. Desidua basalis – lies under the embryo
2. Desidua capsularis – stretches and encapsulates
surface of thophoblast
3. Desidua vera – remaining portion of lining
C. Implantation in the Decidua:
ØNidation
ØOccurs between 6th to 10th or 8th to 10th days after
conception

D. Maintaining the Decidua:

ØSupply of estrogen and progesterone
ØZygote secretes hCG to signal woman’s body that
pregnancy has begun persistence of corpus luteum
and secretion of estrogen and progesterone
Morula
Implantation
E. Location of Implantation:
Ø 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

may occur at the site (“spotting”)
*implantation bleeding
F. Mechanism of Implantation
enzymes (conceptus)
erodes decidua
tapping maternal sources of nutrition

primary chorionic villi (decidua basalis), lies

between the conceptus and wall of the uterus

Chorionic villi – forms the fetal side of the placenta

Decidua basalis – forms the maternal side of the
placenta
EMBRYONIC PERIOD and FETAL STRUCTURES:
Ø from the third week through the eight week 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:
Ø arise from the trophoblast
Ø 15 to 20 cm in diameter; 2 to 3 cm in depth at term
Function:
Fetal lungs, kidneys and gastrointestinal tract and
separate endocrine organ
A. Circulation:
12th day of pregnancy

maternal blood collects in the intervillous space of

endometrium surrounding chorionic villi
3rd week
oxygen and other nutrients diffuse from maternal
blood to the capillaries
transports
nutrients to the embryo
 placental osmosis

substances able to cross into fetal circulation

Placental Circulation
Ø increase number of chorionic villi
ØIntervillous space grow larger and larger, separated
by partitions or septa
ØMature placenta – cotyledons (30)
Ø about 100 maternal uterine arteries supply mature
placenta
Ø at term, placenta weighs 400 to 600 grams (1 lb)
Endocrine Function:
Hormones produced by the syncytial layer of chorionic villi:
1. Human Chorionic Gonadotropin
Purpose:
Ø act as fail-safe measure to ensure corpus luteum to continuously produce
estrogen and progesterone
Ø suppress maternal immunologic response so placenta will not be rejected
2. Estrogen
Purpose:
Ø development of mammary gland
Ø Stimulates uterine growth
3. Progesterone
Purpose:
Ø necessary to maintain endometrial lining
Ø reduce contractility of uterine musculature during pregnancy
(premature labor)

4. Human Placental Lactogen

Purpose:
Ø promotes growth of mammary glands for lactation
Ø regulates maternal glucose, protein, and fat levels
Umbilical Cord:
Ø From fetal membranes (amnion and chorion)
Ø Provides circulatory pathway
Ø Contains one vein and two arteries
Ø length – 53 cm; 2 cm thick
Ø Wharton’s jelly – gelatinous mucopolysaccharide
Ø no nerve supply
Ø Nuchal cord – loop of cord around fetal head
Function:
1. Transport oxygen and nutrients to fetus from placenta
2. Return waste products from the fetus to the placenta
Amniotic Membranes:
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:
ØNever stagnant
- 800 to 1,200 ml (at term)
- Hydramnios (more than 2,000 ml/pockets larger than
8cm)
- Oligohydramnios (less than 300 ml, no pocket larger
than 1 cm)
ØServes to protect fetus
ØShields against pressure
ØProtects from temperature changes
ØAids muscular development
ØProtects umbilical cord
Amniotic Membranes:
 ORIGIN AND DEVELOPMENT OF ORGAN
SYSTEMS
A. Stem Cells
zygote (1st 4 days of life) – totipotent stem cells
embryo (another 4 days) – pluripotent stem cells
another few days – multipotent
B. Zygote growth
cephalocaudal development
Ø Body organs develops from specific tissue layers (germ layers)
C. Primary Germ Layers
implantation

blastocyst (2 cavities of inner structure)

amniotic cavity (lined with ectoderm cells)

yolk sac (lined with entoderm cells)

Ø Supply nourishment until implantation

Ø source of RBC

third layer of primary cells (mesoderm)

 The three germ layers of the embryo develop into:
•Ectoderm: most nervous tissue and skin epidermis.
•Mesoderm: connective tissue and muscle.
•Endoderm: epithelial lining of gut.
•
Embryonic Shield:
3 cells layers meet

8 weeks gastation – all organs (organogenesis) are

complete in a rudimentary from
Cardiovascular System:
Ø network of blood vessels and single heart tube –
forms at 16th day of life and beats at 24th day
Ø septum – develops at 6th or 7th week
Ø 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 Monitor:
Fetal Circulation:
1. Oxygenated blood enters the umbilical vein from the
placenta
2. Enters ductus venosus
3. Passes through inferior venacava
4. Enters the right atrium
5. Enters the foramen ovale
6. Goes to the left atrium
7. Passes through left ventricle
8. Flows to ascending aorta to supply nourishment to
the brain and upper extremeties
9. Enters superior vena cava
10. Goes to right atrium
11. Enters the right ventricle
12. Enters pulmonary artery with some blood going to the lungs
to supply oxygen and nourishment
13. Flows to ductus arteriosus
14. Enters descending aorta ( some blood going to the lower
extremeties)
15. Enters hypogastric arteries
16. Goes back to the placenta
Special Structures in Fetal Circulation:
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
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:
 MILESTONE OF FETAL DEVELOPMENT:
4th Week of Gestation
8th Week of Gestation
12th Week of Gestation
16th Week of Gestation
20th Week of Gestation
24th Week of Gestation
28th Week of Gestation
32nd Week of Gestation
36th Week of Gestation
40th Week of Gestation
 Estimating EDD/EDB:
Nagele’s Rule:
Ø first day of the last menstrual period
Ø count three months backwards and add 7 days
ASSESSMENT OF FETAL GROWTH &
DEVELOPMENT:
A. Health History
Ø nutritional intake
Ø personal habits and lifestyle

B. Estimating Fetal Growth

McDonald’s Rule – symphysis – fundal height measurement
Fundic Height Measurement:
 ASSESSING FETAL WELL-BEING:
A. Fetal Movement
Quickening - begins 18 to 20 weeks of pregnancy
- peaks at 28 to 38 weeks of pregnancy
- more than 10 times a day
Methods:
1. Sandovsky Method
Ø 2 every 10 minutes or 10 to 12 times an hour
2. Cardiff Method
Ø Count – to – ten
B. Fetal Heart Rate
Ø 120 to 160 bpm
Ø heard and counted as early as 10th to 11th week
(doppler)

Rhythm Strip Testing:

Ø Semi-fowler’s position
Ø external fetal heart rate and uterine contraction are
monitor
Ø recorded for 20 minutes
Ø Baseline - average rate of the FHB per minute
Ø Short-term variability (beat-to-beat variability) – small
changes in rate occur from second to second
Ø Long-term variability – difference in HR occur over a
20-minute time period
Nonstress Testing:
Ø measures FHR to fetal movement
Ø no increase in FHB – poor oxygen perfusion
Ø done 10-20 minutes
Ø performed after the 28th week
Non-reactive:
- no accelerations occur with fetal movement
- no fetal movement
- low short term FHR variability (less than 6 bpm)
Vibroacoustic Stimulation:
Ø acoustic stimulation (acoustic stimulator)

Contraction Stress Testing:

Ø FHR analyzed with contractions
Ø stimulation of breast (oxytocin)
Ø 3 contractions of 40 seconds duration or longer must
be present in 10 minutes
Result:
negative (normal) – no FHR decelerations are present
with contractions
Positive (abnormal) – 50% or more of contractions
cause late deceleration
Ultrasonography:
Purposes:
Ø diagnose pregnancy (6 weeks)
Ø confirm presence, size, and location of placenta and amniotic fluid
Ø establish that fetus is growing and has no gross anomalies
Ø establish sex
Ø establish presentation and position of the fetus
Ø predict maturity by measuring biparietal diameter of the head
Ø discover complications of pregnancy and fetal anomalies and fetal death
Ultrasound
 Measuring Biparietal Diameter:

Ø used to measure fetal maturity

Ø 8.5cm or greater – infant weigh more than 2,500 g
(5.5 lb) 40 weeks AOG

Head circumference:
Ø 34.5 cm – 40 weeks AOG
 Doppler Umbilical Velocimetry:
Ø measures velocity at which RBC in the uterine and
fetal vessels are traveling

ØPlacental Grading – Placental grades are number

values assigned to a placenta on the basis of its
appearance on an ultrasound examination
Graded as:
0 – placenta is 12 to 24 weeks
1 – placenta is 30 to 32 weeks
2 – placenta is 32 t0 36 weeks
3 – placenta is 38 weeks (mature)
Fetal ECG:
Ø early as 11th week
Ø BUT, inaccurate before 20th week

MRI:
Ø diagnose ectopic pregnancy or trophoblastic disease

Maternal Serum Alpha-Fetoprotein:

Ø assessed at 15th week
Ø AFP – produced by amniotic fluid and maternal serum
Ø - open spinal of abdominal defect
Ø - chromosomal defects
Chorionic Villi Sampling:
Ø biopsy and chromosomal analysis of chorionic villi
Ø done at 10 to 12 weeks
Amniocentesis:
Ø aspiration of amniotic fluid from the pregnant uterus for examination
Ø 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:
Ø empty the bladder
Ø supine position (folded towel under buttock)
Ø attach fetal monitors/guided by UTZ
Amniocentesis:
Percutaneous Umbilical Blood Sampling:
Ø cordocentesis or funicestesis
Ø 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.
Amnioscopy:
Ø Visual inspection of the amniotic fluid through the cervix and membranes
with amnioscope
Ø Detect meconium staining

Fetoscopy:
Ø visualization of fetus through a fetoscope
Ø 16th or 17th week
Pupose:
1. Obtain biopsy samples of fetal tissue and fetal blood samples
Fetal endoscope
Biophysical Profile: (fetal apgar)
Ø combines five parameters (fetal re-activity, fetal
breathing movements, fetal body movement, fetal
tone, and amniotic fluid volume)
Øhas 5 components: 4 ultrasound (US) assessments
and a nonstress test (NST)
Ø each scores 2 (10 as the highest possible score)
Ø 8-10 = maximal score
6 = suspicious; 0-4 = severe fetal compromise; delivery
indicated
Parameter Normal (2 points) Abnormal (0 points)
NST/Reactive FHR At least 2 accelerations in 30 Less than two accelerations
minutes to satisfy the test in 30
minutes

US: Fetal breathing At least one episode of > 30s None or less than 30s or 20s
movements or >20s in 30 minutes
US: Fetal activity / gross At least two movements of Less than three or two
body movements the torso or limbs movements
US: Fetal muscle tone At least one episode of No movements or
active bending and movements slow and
straightening of the limb or incomplete
trunk

US: Qualitative AFV At least one vertical pocket> Largest vertical

2 cm or more in the vertical pocket</=2cm
axis