Chapter 29 Development and Growth There are three stages of fetal life the first two weeks, or germinal

l period where the three germ layers develop, followed by the embryonic period, which lasts until the end of the eighth week, and the embryonic period from the beginning of week 9 to birth. A pregnancy from the date of the last menstrual period takes 40 weeks to complete. Since ovulation occurs 14 days after the beginning of the last menstrual period, gestational age is actually 38 weeks. To calculate when a baby is due, take the date of the last menstrual period, (ex. Feb 15) go back three months (Nov. 15) and add seven days (Nov. 22) Fertilization (page 1134) Fertilization occurs in the ampulla of the fallopian tube when the acrosomal head of sperm manages to negotiate through the zona pellucida and corona radiate of the oocyte. The release of hyaluronidase, an enzyme that dissolves connective tissue, enables the sperm to penetrate the oocyte. Once a sperm enters the membrane of the oocyte, depolarization of the membrane occurs, which prevents polyspermy, and doesnt allow any other sperm to enter. Once sperm enters the oocyte, the second meiotic division, which has been stalled in metaphase II, is completed and the second polar body is formed. Once the sperm pronucleus and female pronucleus unite, there is now a single diploid cell called a zygote.

Usually 24-36 hours following fertilization, the first cell division occurs (figure 29.2, page 11135) the zygote becomes a two cell mass, then a four celled mass, then an eight celled mass. Once the cellular mass reaches the 16 cell stage, it is called a morula (mulberry) another division to 32 cells, 4-5 days after fertilization and some changes begin to occur. The solid ball of cells now surrounds a hollow fluid-filled cavity called a blastocele. This group of cells is called a blastocyst. The blastocyst will differentiate into a trophoblast (which will be come the placenta) and an inner cell mass, which will develop into an embryo. (figure 29.3, page 1136) About 5 days following fertilization, the blastocyst enters the uterus and usually implants on the endometrium of the uterine wall on day 6 or 7. At this time, it begins sending hormonal signals of human chorionic Gonadotropin back to the corpus luteum, informing that fertilization and implantation has occurred, and to continue secreting progesterone for the next 12 weeks. This hCG appears in urine, and will cause an EPT (early pregnancy test) to register positive. The cell mass attaches to the endometrium by finger-like processes called chorionic villi.

Placental problems If the placenta covers the cervical os, there is usually some bleeding. Any bleeding in an expectant mother is

termed a threatened abortion. This is called placenta previa, and it is painless. It usually occurs at around 30-1 weeks of gestation. If the placenta moves away from the os, bleeding will stop and delivery can continue as normal. If not, a Caesarian delivery is required. If the placenta pulls away from the uterine wall, there is bleeding as well as severe cramping. This is called abruptio placenta, and could precipitate delivery. The key in vaginal bleeding during pregnancy is whether or not there is pain. Formation of the germ layers and Gastrulation (page 1140) Germ layers generally form within two weeks following fertilization. There is now an amnion, and chorion, two of the extra embryonic membranes, and then there is differentiation into endoderm, ectoderm, and mesoderm. The endoderm forms lining tissue and epithelium, while ectoderm forms skin and nervous tissue. Everything else is from mesoderm. A small primitive yolk sac forms (the third extra embryonic membrane, and the final membrane, the allantois (will form part of the umbilical cord) will form later. In birds, which have a very large yolk sac this will feed a growing avian embryo, but in humans, it is the sight of the first blood cell formation. Maternal changes during pregnancy Blood volume increases 30% Lung capacity decreases 25% Pressure from the growing fetus puts pressure on

the bladder Increased intrabdominal pressure causes constipation, hemorrhoids Venous return increased 30% Increased size of the uterus can cause gastroesophageal reflux Development of fetal organ systems can be seen in the chronological table on page 1074-5. Growth of the Fetus (page 1150) The embryonic phase up to 60 days is when organ systems are developing. After 60 days, in the fetal phase, all organs are present. At 60 days, the fetus is just over an inch long and weighs 2.5 grams and grows to an average of 20 inches and 3300 grams (7 lbs, 4 oz) at birth. In addition to growth, during the fetal period the organ systems continue to grow. Subcutaneous adipose grows under the skin, which is covered by a fine hair (lanugo) and a thick sebaceouslike product called vernix caseosa, which protects the skin. **The box about fetal surgery on page 1082 is pretty fascinating. In most cases, it is done for fetuses with spina bifida and hydrocephalus. Prenatal Diagnostic Tests (page 1153) In mothers over the age of 35, some fetal testing is usually in order. The normal incidence of Downs syndrome (trisomy 21) is 1 in 900 births. In women 35 years of age, this increases to 1 in 300, 40 years of age,

1 in 200, and 45 years of age, 1 in 100. Amniocentesis takes a sample of amniotic fluid, as illustrated in figure A, page 1084. The sample of fluid is karyotyped indicating any chromosomal abnormality. The fetal tissues may also be sampled by chorionic villus sampling, but this is a slightly higher risk for spontaneous abortion. The presence of alpha fetoprotein is done early in the second trimester. This will show evidence of spinal cord problems such as spina bifida. Ultrasound is a procedure that is safe to the mother and fetus. It is generally done in the fifth month of gestation. The purpose of ultrasound is to show fetal maturity, not to indicate sex. It is accurate to within one week in the first trimester, to within two weeks in the second trimester, and within three weeks in the third trimester. Fetal heart monitoring is possible with a Doppler at around ten weeks. Normal is between 110 and 160 bpm. Labor and Partuition (page 1158) Partuition is the process of birth. From the last menstrual period, birth occurs ten months or 40 weeks later. Any fetus born before 37 weeks is considered premature. Women who have first born before age 18, or after age 35, who are smokers, or who have had another premature birth are at risk for premature delivery. As mentioned in the respiratory chapter, the lungs are the last system to mature. Babies born before surfactant forms enabling the lungs to be elastic are at

risk for respiratory distress system of the newborn. As the time of delivery gets closer, the uterus becomes more irritable and begins to contract. Unless these contractions include thinning of the cervix, they are termed Braxton-Hicks contractions, or false labor. As the uterine contractions result in thinning of the cervix, this is the onset of labor. The first stage of labor is contractions of the uterus with thinning and dilation of the cervix. Once the cervix dilates to 10 cm in diameter (4 inches) the first stage of labor is complete. The time of the first stage of labor varies, but the initial pregnancy is always the longest first stage. Usually, subsequent pregnancies have considerably shorter first stages of labor. Once the cervix is completely dilated, the second stage of labor begins. It lasts until the baby is born. The third stage of labor begins after the baby is born and concludes when the placenta is delivered (usually within 20 minutes of birth)

Apgar scores This is a way to assess the newborn infant in the first minutes of life. Appearance deals with color; white or blue gets 0 points, body pink, limbs blue gets 1 point, and pink all over gets 2 points Pulse gets 0 points for less than 100, 1 point for 100, and 2 points for >

100. Grimace is for limb movement. 0 points for no response or limp, 1 point for facial grimaces and slight body movement, and 2 points for full body movement. Activity is for muscle tone. If the baby is limp with no movement, the score is 0; if there is some flexion of limbs, the score is 1, and full movement and good muscle tone, the score is 2. Finally, Respiratory effort gets no points if the infant is not breathing on his/her own, 1 point for slow irregular respiration, and 2 points for good strong cry and regular respiration. Apgar scores are generally done at one minute after birth, and five minutes after birth. Scores of 8-10 at five minutes are considered normal. Inheritance (page 1163) Genetics is the study of heredity and how traits are passed from generation to generation. It is for example the male gamete that determines sex of the offspring. A female has a pair of X chromosomes and will donate one X chromosome to the new offspring. A male has an X chromosome and a Y chromosome, and he will donate one to the new offspring. If he donates an X chromosome, the infant will be female. If he donates a Y chromosome, the infant will be male.
X Y X XX XY X XX XY

Some genes are dominant over other genes. For example, brown eyes are dominant over blue eyes. The genes that carry a trait are called the genotype; the way the trait is expressed is called a phenotype. Capital letters are used for the dominant trait, lower-case letters for recessive or non-dominant trait. In order for a nondominant or recessive trait to be expressed, both genes (one from the mother, one from the father, must be lower case or recessive. When the genotype contains the same letter (both upper case, and both lower case) it is said to be homozygous. If there is one upper case, and one lower case, it is said to be heterozygous. Those with heterozygous genotypes, exhibit the dominant phenotype. Ex. Let B be the gene for brown eyes, so BB or Bb is the genotype for brown eyes. Let b be the gene for blue eyes, so the genotype would be bb. If a brown eyed man and a blue eyed woman have a child, the Punnett square could be like this
b b B Bb Bb B Bb Bb

In this case, all offspring would have heterozygous genotype, and have a phenotype of brown eyes. Should the brown-eyed parent have a trait for blue eyes (Bb) the results would be different, as you can see.
b b B Bb Bb b bb bb

In this case, every time this couple has a child, there is a 50% chance that the child will have brown eyes (Bb) and a 50% chance of blue eyes (bb) In the case of sickle cell anemia, which we discussed in the blood chapter, there is a bit of a different scenario. Sickle cell anemia is a condition in which hemoglobin has a point mutation that causes the shape of erythrocytes to be sickle or comma shaped, rather than biconcave disks. The genotype for normal hemoglobin is HbA, HbA, with one gene coming from each parent. Those who suffer from sickle cell have the homozygous recessive trait of HbS, HbS. (It is the same as calling it Hba, Hba. In order for an offspring to have sickle cell anemia, he or she must acquire one gene for sickle cell anemia from each parent. If parents are heterozygous for sickle cell disease (HbA, HbS) this is called sickle cell trait. Those with sickle cell trait do not suffer the side effects that those with sickle cell disease do, unless they are in high

altitudes, with low partial pressures of oxygen. Those with sickle cell trait, are also immune to malaria, for reasons unknown.
HbA HbS HbA HbA,HbA HbA,HbS HbS HbA,HbS HbS,HbS

Sex-linked traits (page 1167) are traits carried on the X chromosome. They are always recessive. Two wellknown sex linked traits are color blindness, and hemophilia, both homozygous recessive traits, that generally effect males only. If a woman has a gene for normal vision, and a gene for color blindness, the will have normal vision, and is called a carrier. (XC,Xc) with C being the gene for normal vision, and c being the gene for color blindness, both of which are carried on the X chromosome. A woman will donate either the XC gene for normal vision to the baby, or she will donate the Xc gene for color blindness to the baby. If the father has normal vision, he will donate XC to a female child, and Y to a male child. If the mother donates the gene for color blindness (Xc) and the child is female, then the father will have donated the gene for normal vision (XC) and the child will be like the mother XC,Xc. However, if the child is male, and the father donates the Y chromosome and the mother has donated the Xc color-blind gene, the male infant will be XcY and will be color blind. Sex linked traits will effect only males,

unless of course, the father happens to be color-blind as well (XcY) In this scenario, if the father donates his Xc chromosome to the female infant, and the mother also donates Xc chromosome, then the baby girl will be XcXc, and color-blind. Color blind females are very, very rare.
XC Y XC XCXC XCY Xc XCXc XcY