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impacted fetus

Fetus

[fee-tuhs]

A fetus (or foetus or fœtus) is a developing mammal or other viviparous vertebrate, after the embryonic stage and before birth. The plural is fetuses, or sometimes feti. The fetal stage of prenatal development starts when the major structures have formed, and lasts until birth.

In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age (the 9th week after fertilization).

Etymology and spelling variations

The word fetus is from the Latin fetus, meaning offspring, bringing forth, hatching of young. It has Indo-European roots related to sucking or suckling.

Fœtus is an English variation on the Latin spelling, and has been in use since at least 1594, according to the Oxford English Dictionary, which describes "fœtus" as "incorrectly written". The variant fœtus may have originated with an error by Saint Isidore of Seville, in AD 620. The preferred spelling in the United States is fetus, but the variants foetus and fœtus persist in other English-speaking countries and in some medical contexts, as well as in some other languages (e.g., French). In technical usage, fetus is now the standard spelling throughout the English-speaking world.

Human fetus

The fetal stage starts at the beginning of the 9th week following fertilization, after the zygote, blastocyst, and embryonic stages. The risk of miscarriage decreases sharply at the beginning of the fetal stage. The fetus is not as sensitive to damage from environmental exposures as the embryo was, though toxic exposures can often cause physiological abnormalities or minor congenital malformation. Fetal growth can be terminated by various factors, including miscarriage, feticide committed by a third party, or induced abortion.

Development

The following describes some of the specific changes in fetal anatomy and physiology by fertilization age (i.e. the time elapsed since fertilization). Obstetricians often use "gestational age" which, by convention, is measured from 2 weeks earlier than fertilization. For purposes of this article, age is measured from gestation rather than from fertilization, except as noted.

Weeks 11-17

The fetal stage commences at the beginning of the 11th week. At the start of the fetal stage, the fetus is typically about 30 mm (1.2 inches) in length from crown to rump, and weighs about 8 grams. The head makes up nearly half of the fetus' size. Breathing-like movement of the fetus is necessary for stimulation of lung development, rather than for obtaining oxygen.The heart, hands, feet, brain and other organs are present, but are only at the beginning of development and have minimal operation.

Fetuses are not capable of feeling pain at the beginning of the fetal stage, and will not be able to feel pain until the third trimester. At this point in development, uncontrolled movements and twitches occur as muscles, the brain and pathways begin to develop.

From weeks 11 to 14, the fetal eyelids close and remain closed for several months, and the fetus' sex may be apparent. Tooth buds appear, the limbs are long and thin, and red blood cells are produced in the liver, however the majority of red blood cells will be made later in gestation (at 21 weeks) by bone marrow. A fine hair called lanugo develops on the head. The gastrointestinal tract, still forming, starts to collect sloughed skin and lanugo, as well as hepatic products, forming meconium (stool). Fetal skin is almost transparent. The first measurable signs of EEG movement occur in the 12th week.

Weeks 18-27

The lanugo covers the entire body. Eyebrows, eyelashes, fingernails, and toenails appear. The fetus has increased muscle development. Alveoli (air sacs) are forming in lungs. The nervous system develops enough to control some body functions. The cochlea are now developed, though the myelin sheaths in the neural portion of the auditory system will continue to develop until 18 months after birth. The respiratory system has developed to the point where gas exchange is possible. A woman pregnant for the first time (i.e. a primiparous woman) typically feels fetal movements at about 20-21 weeks, whereas a woman who has already given birth at least two times (i.e. a multiparous woman) will typically feel movements around 16 weeks. By the end of the fifth month, the fetus is about 20 cm (8 inches).

Weeks 28-40

The amount of body fat rapidly increases. Lungs are not fully mature. Thalamic brain connections, which mediate sensory input, form. Bones are fully developed, but are still soft and pliable. Iron, calcium, and phosphorus become more abundant. Fingernails reach the end of the fingertips. The lanugo begins to disappear, until it is gone except on the upper arms and shoulders. Small breast buds are present on both sexes. Head hair becomes coarse and thicker. Birth is imminent and occurs around the 38th week. The fetus is considered full-term between weeks 35 and 40, which means that the fetus is considered sufficiently developed for life outside the uterus. It may be 48 to 53 cm (19 to 21 inches) in length, when born.

Variation in growth

There is much variation in the growth of the fetus. When fetal size is less than expected, that condition is known as intrauterine growth restriction (IUGR) also called fetal growth restriction (FGR); factors affecting fetal growth can be maternal, placental, or fetal.

Maternal factors include maternal weight, body mass index, nutritional state, emotional stress, toxin exposure (including tobacco, alcohol, heroin, and other drugs which can also harm the fetus in other ways), and uterine blood flow.

Placental factors include size, microstructure (densities and architecture), umbilical blood flow, transporters and binding proteins, nutrient utilization and nutrient production.

Fetal factors include the fetus genome, nutrient production, and hormone output. Also, female fetuses tend to weigh less than males, at full term.

Fetal growth is often classified as follows: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). SGA can result in low birth weight, although premature birth can also result in low birth weight. Low birth weight increases risk for perinatal mortality (death shortly after birth), asphyxia, hypothermia, polycythemia, hypocalcemia, immune dysfunction, neurologic abnormalities, and other long-term health problems. SGA may be associated with growth delay, or it may instead be associated with absolute stunting of growth.

Viability

The lower limit of viability is approximately five months gestational age, and usually later. According to The Developing Human:

Viability is defined as the ability of fetuses to survive in the extrauterine environment... There is no sharp limit of development, age, or weight at which a fetus automatically becomes viable or beyond which survival is assured, but experience has shown that it is rare for a baby to survive whose weight is less than 500 gm or whose fertilization age is less than 22 weeks. Even fetuses born between 26 and 28 weeks have difficulty surviving, mainly because the respiratory system and the central nervous system are not completely differentiated... If given expert postnatal care, some fetuses weighing less than 500 gm may survive; they are referred to as extremely low birth weight or immature infants.... Prematurity is one of the most common causes of morbidity and prenatal death.

During the past several decades, neonatal care has improved with advances in medical science, and therefore the point of viability may have moved earlier. As of 2006, the two youngest children to survive premature birth are thought to be James Elgin Gill (born on 20 May 1987 in Ottawa, Canada, at 21 weeks and 5 days gestational age), and Amillia Taylor (born on 24 October 2006 in Miami, Florida, at 21 weeks and 6 days gestational age). Both children were born just under 20 weeks from fertilization, or a few days past the midpoint of an average full-term pregnancy. Despite their premature births, both developed into healthy children.

Fetal pain

Fetal pain, its existence, and its implications are debated politically and academically. According to the conclusions of a review published in 2005, "Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester." However, there may be an emerging consensus among developmental neurobiologists that the establishment of thalamocortical connections" (at about 26 weeks) is a critical event with regard to fetal perception of pain. Nevertheless, because pain can involve sensory, emotional and cognitive factors, it is "impossible to know" when painful experiences may become possible, even if it is known when thalamocortical connections are established.

Whether a fetus has the ability to feel pain and to suffer is part of the abortion debate. For example, in the USA legislation has been proposed by pro-life advocates requiring abortion providers to tell a woman that the fetus may feel pain during the abortion procedure, and that require her to accept or decline anesthesia for the fetus.

Fetal movement

Quickening is the first maternally discernible fetal movement, which is often felt around the middle of pregnancy. Women who have already given birth have more relaxed uterine muscles that are consequently more sensitive to fetal motion, and for them fetal motion may be felt as early as 18 weeks. Mothers can begin to feel quickening anywhere between 18 and 24 weeks of gestation.

The parts of the fetal brain that control movement will not fully form until late in the second trimester, and the first part of the third trimester. Control of movement is limited at birth, and purposeful voluntary movements develop in the first year after birth. However, locomotor activity begins during the late embryonic stage, and changes in nature throughout development. Muscles begin to move as soon as they are innervated. These first movements are not reflexive, but arise from nerve impulses originating in the spinal cord. As the nervous system matures, muscles can move in response to stimuli, though this is not a voluntary movement.

Circulatory system

The circulatory system of a human fetus works differently from that of born humans, mainly because the lungs are not in use: the fetus obtains oxygen and nutrients from the mother through the placenta and the umbilical cord.

Postnatal development

With the first breath after birth, the system changes suddenly. The pulmonary resistance is dramatically reduced ("pulmo" is from the Latin for "lung"). More blood moves from the right atrium to the right ventricle and into the pulmonary arteries, and less flows through the foramen ovale to the left atrium. The blood from the lungs travels through the pulmonary veins to the left atrium, increasing the pressure there. The decreased right atrial pressure and the increased left atrial pressure pushes the septum primum against the septum secundum, closing the foramen ovale, which now becomes the fossa ovalis. This completes the separation of the circulatory system into two halves, the left and the right.

The ductus arteriosus normally closes off within one or two days of birth, leaving behind the ligamentum arteriosum. The umbilical vein and the ductus venosus closes off within two to five days after birth, leaving behind the ligamentum teres and the ligamentum venosus of the liver respectively.

Blood from the placenta is carried to the fetus by the umbilical vein. About half of this enters the fetal ductus venosus and is carried to the inferior vena cava, while the other half enters the liver proper from the inferior border of the liver. The branch of the umbilical vein that supplies the right lobe of the liver first joins with the portal vein. The blood then moves to the right atrium of the heart. In the fetus, there is an opening between the right and left atrium (the foramen ovale), and most of the blood flows through this hole directly into the left atrium from the right atrium, thus bypassing pulmonary circulation. The continuation of this blood flow is into the left ventricle, and from there it is pumped through the aorta into the body. Some of the blood moves from the aorta through the internal iliac arteries to the umbilical arteries, and re-enters the placenta, where carbon dioxide and other waste products from the fetus are taken up and enter the woman's circulation.

Some of the blood entering the right atrium does not pass directly to the left atrium through the foramen ovale, but enters the right ventricle and is pumped into the pulmonary artery. In the fetus, there is a special connection between the pulmonary artery and the aorta, called the ductus arteriosus, which directs most of this blood away from the lungs (which aren't being used for respiration at this point as the fetus is suspended in amniotic fluid).

Differences from the adult circulatory system

Remnants of the fetal circulation can be found in adults:

Fetal Adult
foramen ovale fossa ovalis
ductus arteriosus ligamentum arteriosum
extra-hepatic portion of the fetal left umbilical vein ligamentum teres hepatis (the "round ligament of the liver").
intra-hepatic portion of the fetal left umbilical vein (the ductus venosus) ligamentum venosum
proximal portions of the fetal left and right umbilical arteries umbilical branches of the internal iliac arteries
distal portions of the fetal left and right umbilical arteries medial umbilical ligaments (urachus)

In addition to differences in circulation, the developing fetus also employs a different type of oxygen transport molecule than adults (adults use adult hemoglobin). Fetal hemoglobin enhances the fetus' ability to draw oxygen from the placenta. Its association curve to oxygen is shifted to the left, meaning that it will take up oxygen at a lower concentration than adult hemoglobin will. This enables fetal hemoglobin to absorb oxygen from adult hemoglobin in the placenta, which has a lower pressure of oxygen than at the lungs.

Developmental problems

Congenital anomalies are anomalies that are acquired before birth. Infants with certain congenital anomalies of the heart can survive only as long as the ductus remains open: in such cases the closure of the ductus can be delayed by the administration of prostaglandins to permit sufficient time for the surgical correction of the anomalies. Conversely, in cases of patent ductus arteriosus, where the ductus does not properly close, drugs that inhibit prostaglandin synthesis can be used to encourage its closure, so that surgery can be avoided.

A developing fetus is highly susceptible to anomalies in its growth and metabolism, increasing the risk of birth defects. One area of concern is the pregnant woman's lifestyle choices made during pregnancy Diet is especially important in the early stages of development. Studies show that supplementation of the woman's diet with folic acid reduces the risk of spina bifida and other neural tube defects. Another dietary concern is whether the woman eats breakfast. Skipping breakfast could lead to extended periods of lower than normal nutrients in the woman's blood, leading to a higher risk of prematurity, or other birth defects in the fetus. During this time alcohol consumption may increase the risk of the development of Fetal alcohol syndrome, a condition leading to mental retardation in some infants. Smoking during pregnancy may also lead to reduced birth weight. Low birth weight is defined as 2500 grams (5.5 lb). Low birth weight is a concern for medical providers due to the tendency of these infants, described as premature by weight, to have a higher risk of secondary medical problems.

Legal issues

In the United States, some states have laws that impose strict punishments for those who inflict violence that results in damage to a fetus or the unwanted termination of a pregnancy. The severity of the punishment, and the stage of fetal development where laws start to apply vary from state to state.

Abortion of a fetus is legal in many countries such as Australia, Canada, Mexico, UK and USA. Many of those countries that allow abortion during the fetal stage have gestational time limits, so that late-term abortions are not normally allowed.

Non-human fetuses

The fetus of most mammals develops similarly to the Homo sapiens fetus. After the first stages of development, the human embryo reaches a stage very similar to all other vertebrates. The anatomy of the area surrounding a fetus is different in litter-bearing animals compared to humans: each fetus is surrounded by placental tissue and is lodged along one of two long uteri instead of the single uterus found in a human female. Development at birth is similar, with animals also having a poorly developed sense of vision and other senses.

See also

References

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