Belen Amparo E. Velasco, M.D.

The fetus has a recognizable human form

by the 12th week of development.
The vital organs are not sufficiently
developed to sustain life outside the uterus until
the seventh month. While in the womb, the
fetus is especially susceptible to the effects of
drugs, alcohol, and X rays.
"Human Fetus."Microsoft Encarta Encyclopedia 2001. 1993-2000 Microsoft
Corporation. All rights reserved.

CIRCULATORY SYSTEM
FETAL CIRCULATION

Presence of 3 shunts:

Patent foramen ovale

Patent ductus arteriosus

Patent ductus venosus


CIRCULATORY SYSTEM
FETAL CIRCULATION

OXYGENATED BLOOD FROM MATERNAL BLOOD:

PLACENTA (Clearing house)

Umbilical vein Ductus venosus liver
hepatic veins Inferior vena cava

Superior vena cava Right auricle foramen ovale
left auricle left ventricle
ascending aorta



CIRCULATORY SYSTEM
FETAL CIRCULATION

UNOXYGENATED BLOOD:

Right ventricle pulmonary artery lungs

ductus arteriosus descending aorta

CIRCULATORY SYSTEM
CHANGES AT BIRTH ADULT TYPE OF
CIRCULATION

Cessation of placental circulation

Physiologic closure of foramen ovale ( L atrial
pressure)

Functional closure of patent ductus arteriosus (O2
content)


RESPIRATORY SYSTEM
FETAL LUNGS

Filled with respiratory (filtrate of plasma) fluid

Metabolic functions;
Production of surfactant

Occasional gasps


RESPIRATORY SYSTEM
NEWBORN LUNGS

Possess all equipment necessary for respiration incl.
chemoreceptors and baroreceptors

High negative intrathoracic pressure (10-70cms H2O)

Clearance of respiratory fluid with replacement by air


RESPIRATORY SYSTEM
NEWBORN LUNGS

Establishment of FRC to permit gas exchange even
during expiration

Alveolar structure

Periodic breathing with apneic pauses in premies
GASTROINTESTINAL SYSTEM
FETAL GI SYSTEM

Swallowing as early as the 12
th
week of gestation

Absence of excretion via the GIT unless with sphincter
relaxation during hypoxic event.

Accumulation of epithelial debris and conjugated
bilirubin in small intestine
GASTROINTESTINAL SYSTEM
NEWBORN GI SYSTEM

Passage of meconium (mixture of epithelial debris &
mucopolysaccharide with conjugated sbilirubin) within the
1
st
24 hours transitional stools (greenish soft stools) in
the next 4 days milk stools (normal pasty consistency
and yellow color)

Adequate levels of pancreatic enzymes except for
amylase and lipase

RENAL SYSTEM
FETAL RENAL SYSTEM

Production of urine as early as 4
th
month

Renal function (GFR, tubular mass and RPF) not reach
adult levels till 2
nd
year of life

Glomerular filtration begins at about 9 weeks


RENAL SYSTEM
NEONATAL RENAL SYSTEM

Passage of dilute urine due to inability to concentrate
urine adequately

Transient metabolic acidosis due to inadequate removal
of acid ions, limited formation of NH3 for acid removal with
minimum loss of base and overproduction of lactic and
pyruvic acid.


RENAL SYSTEM
NEONATAL RENAL SYSTEM


6-10% physiologic weight loss (loss of body water)due to:
Diuresis
Expulsion of meconium
Withholding of water and calories
CENTRAL NERVOUS SYSTEM
FETAL CNS

Rapid growth of fetal brain during last half of
fetal life with peak near time of birth

Posture of late fetal flexion attitude

Generalized symmetric muscular activity

Simple & stereotyped response to various
environmental and internal stimuli

CENTRAL NERVOUS SYSTEM
NEONATAL BRAIN





Soft spots on a babys
head, called fontanels, are
areas that have not yet
hardened to bone.
The skull is subjected to
great pressure as it passes
through the birth canal. Were
it inflexible, the tight squeeze
might injure the brain.
Growth is complete by
one year of age, and lines
called sutures are visible
where the plates fuse.

SPECIFIC REACTIONS:
Moro reflex
Grasp reaction
Tonic and righting reflex
Rooting, sucking, tongue retrusion and
swallowing reflexes

CENTRAL NERVOUS SYSTEM

RESPONSE TO STIMULI: Simple and
stereotyped

SENSES:
Regards moving objects & changing light
intensity
Hears loud sound
CENTRAL NERVOUS SYSTEM
ENDOCRINE SYSTEM
FETAL ENDOCRINE SYSTEM

The pituitary adrenal axis and thyroid gland
function separately from that of the mother to ensure
adequate growth of infant.

Peculiarities in the fetus:
Maternal estrogenic effects
urinary 17-ketosteroids


PITUITARY GLAND



ENDOCRINE SYSTEM
NEONATAL ENDOCRINE SYSTEM

MATERNAL ESTROGENIC EFFECTS

Hypertrophied mammary glands

Witch milk

Mucoid to bloody vaginal discharge
ENDOCRINE SYSTEM
NEONATAL ENDOCRINE SYSTEM

NEONATAL OUTCOME IN MATERNAL DIABETES

Immaturity of lungs Hyaline membrane disease

Hypoglycemia

Hypocalcemia

Anomalies: Ventricular septal hypertrophy
Microcolon
HEMATOLOGIC SYSTEM
FETAL HEMATOPOIETIC SYSTEM

Erythropoietin: hormone produced in the glomerular
tuft responsible for the production of RBC

Due to relative hypoxia of the fetus stimulating the bone
marrow, the fetal hemoglobin is as high as 20g/dl

Blood formation as early as 3
rd
wk after conception:
Mesodermal tissue in the 1
st
month
Liver in the 2
nd
month
Medullary spaces from the 6
th
month onward

HEMATOLOGIC SYSTEM
NEOWBORN HEMATOPOIETIC SYSTEM

At birth, still with high hgb. Starts to drop on the 3
rd
day
of life until a minimum of 10-12g/dl on the 2
nd
-3
rd
month of
life PHYSI OLOGI C ANEMI A - a result of the following:
in bone marrow activity
in rate of hemolysis
hemodilution due to rapid expansion of blood volume

Normal blood volume ranging from 80-90ml/kg

WBC ranging from 10,000-30,000/mm
3
with PMN
predominance
IMMUNOLOGIC SYSTEM
FETAL IMMUNE SYSTEM

Liver serves as the repository for lymphoid precursor
cells during early intrauterine life.

T cell functions begin as early as 7 weeks

Circulating B cells are seen as early as 13 weeks. IgM
antibodies are first to develop


IMMUNOLOGIC SYSTEM
NEWBORN IMMUNE SYSTEM

Considered completely developed immunological system
but with inadequate antigenic stimulus


IMMUNOLOGIC SYSTEM
NEWBORN IMMUNE SYSTEM

Antibodies (maternal in origin) present 7s or IgG
antibodies
Tetanus antitoxin
Diphtheria antitoxin
Smallpox agglutinins
Antistreptolysin
Toxoplasma antibodies
Salmonella H antibodies
Rh blocking antibodies
IMMUNOLOGIC SYSTEM
NEWBORN IMMUNE SYSTEM

Antibodies absent 19s gammaglobulins
Streptococcus agglutinins
H. influenza antibodies
Blood group isoagglutinins
Shigella antibodies
Poliomyelitis antibodies
Salmonella O antibodies
E. coli H and O antibodies

Less capacity to produce antibodies and lower ameboid
and phagocytic activities of neonatal leukocytes
susceptibility to infection esp of the preterm
T lymphocytes are specialized white blood cells
that identify and destroy invading organisms such as
bacteria and viruses. Some T lymphocytes directly
destroy invading organisms, whereas other T
lymphocytes regulate the immune system by
directing immune responses.

Antibodies absent in the newborna.m EXCEPT:
A. Streptococcus agglutinins
B. H. influenza antibodies
C. Poliomyelitis antibodies
D. E. coli H and O antibodies
E. Tetanus antitoxin



Physiologic anemia:
A. Increased RBC turnover due to hemolysis
B. Decreased RBC turnover due to hyperoxia
C. Decreased blood volume expansion
D. Increased erythropoietic activity
E. Depressed bone marrow activity due to
hyperoxia
True of fetal circulation, EXCEPT:
A. Ductus arteriosus shunts blood from pulmonary
artery to aorta
B. Foramen ovale shunts blood from right to left
auricle
C. Ductus arteriosus shunts blood from right to left
side of heart
D. Foramen ovale shunts blood from left to right
auricle
E. Oxygenated blood from placenta supplies upper
half of body

Physiologic weight loss due to:
A. Polyuria
B. Diuresis
C. Adequate caloric intake
D. Retention of meconium
E. Transient metabolic acidosis