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UMBILICAL CORD
Dr. Sherif Fahmy
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Morphology of Umbilical CordIt is the connection between placenta and fetus.• Length: 50 – 60 cm• Diameter: 2 cm.• Shape: Tortous, showing false notes.• Contents: 2 umbilical arteries, one umbilical vein
embedded in wharton’s jelly and surrounded by amniotic membrane.
• Attachments: It is attached to fetal surface of placenta near its center, the other attachment is to ventral aspect of fetal abdominal wall.
• Functions:– It contains umbilical vessels that connect the fetus to the
placenta.– Allows free mobility of the fetus.
Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Development of the Cord• Primitive umbilical ring: - Expansion of amniotic cavity, leads to folding with
ventral shifting of amnio-ectodermal junction and formation of primitive umbilical ring
- Contents: -Connecting stalk containing allantois and umbilical vessels.-Vitelline duct and vitelline vessels.-Connection between intraembryonic and extra-embryonic coelom.
Dr. Sherif Fahmy
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Primitive umbilical cord:- Expansion of amniotic cavity, leads to elongation of umbilical cord.Contents:1- Yolk sac and vitelline duct.2- Connecting stalk with remnant of allantois.3- Intestinal loop in its proximal part.4- Umbilical and vitelline vessels.
Dr. Sherif Fahmy
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Definitive umbilical cord:- Return of intestinal loop to abdominal cavity at 3rd month.-Obliteration of vitelline duct, allantois, extra-embryonic part of vitelline vessels.-Degeneration of one umbilical vein with persistence of other vein and 2 umbilical arteries.-Transformation of mesoderm of connecting stalk into wharton’s jelly.
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Development
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Embryonic disc with removed ectoderm
Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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• Abnormalities of Umbilical Cord• 1- Short cord: leads to premature separation
of placenta.• 2- Long cord: It may encircle neck of fetus and
may form true knots.• 3- Congenital umbilical hernia
(omphalocele): the cord contains coils of intestine.
• 4- Presence of one umbilical artery.• 5- Abnormal attachment of the cord:
– Marginal attachment (battledore)– Through membranes (velamentous).
Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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Dr. Sherif Fahmy
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TwinsDr. Sherif Fahmy
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Types of TWINSDizygotic (Fraternal) twins:- It is the commonest type as it represent 2/3 of
twins and 7 – 11 / 1000 births.- Fertilization of 2 separate ova.- Each embryo has its own placenta, chorion
and amniotic cavity.- Twins are non-identical and may of same sex
or different.
Dr. Sherif Fahmy
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Monozygotic (Identical) twins:Developed from division of a fertilized ovum. Twins of this type are identical and of same sex. Its incidence is 0.3 – 0.4 %
Division may occure at 3 different stages:
1- At morula stage: Twins has separate amnion, chorion and placentae (as in dizygotic).
2- At blastocyst stage: due to division of inner cell mass. Twins has separate amniotic cavity but single chorion and placenta.
3- At embryonic disc: Midline division of the embryonic disc. Twins has common amniotic cavity, common chorion and common placenta .
Dr. Sherif Fahmy
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Morula
stageEmbryonic Disc StageEarly
blastcyste
Dr. Sherif Fahmy
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SIAMESE (CONJOINED) TWINS• Fused monozygotic twins that occurs
due to incomplete separation of emberyonic disc. They could be either:Craniopagus: Fusion between 2 heads.Thoracopagus: Fusion at thoracic region.Pygopagus: Fusion at the pelvic region.
Dr. Sherif Fahmy
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Conjoined Twines
Dr. Sherif Fahmy
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Birth DefectsDr. Sherif Fahmy
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Dr. Sherif Fahmy
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1- Enviromental Factors• Infectious Agents: Viruses, Bacteria and
parasites.• Radiations: X-ray, Gamma and atomic
radiation.• Drugs & chemicals: e.g. antiepileptic drugs,
vit. A, Alcohol• Maternal diabetes:
Dr. Sherif Fahmy
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Chromosomal
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1- Numerical Chromosomal AnomaliesA-Autosomal:• A- Triosomy 21 (Down or Mongolism).• Each cell contains 47 chomosomes (45 + XX or
XY).• B- Triosomy 13, 15, 17 & 18.
Dr. Sherif Fahmy
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B- Sex Numerical Chromosomal Anomalies
• 1- Klinefelter syndrome: (44 + XXy)Due to non-disjunction of X chromosome. Male
case suffers from infertility and gynecomastia. • 2- Turner syndrome: (44 + X0)Due to non-disjunction of X chromosome.
Female case suffers from gonadal dysgenesis, short staure and neck skin fold
Dr. Sherif Fahmy
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2- Structural Chromosomal Anomaly• A- Cri-du-Chat Syndrome.Due to partial deletion of short arm of
chromosome 5 (cat-like cry, microcephaly and mental retardation).
• B- Angelman Syndrome.Partial deletion of long arm of chromosome 15
(mental retardation, poor motor development and prolonged period of laughter.
Dr. Sherif Fahmy
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Down Syndrome
Dr. Sherif Fahmy
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Cri du Chat Syndrome
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Turner Syndrome
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Achondroplasia
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A Child of Alcoholic Mother
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A Child of A Mother Treated by Antiepileptic drug
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A Child of A Mother Treated with Antithyroid drug
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A Child of A mother Exposed to Rubella Infection
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External Appearance of the Embryo (4th – 8th week)
At the embryonic period (4th – 8th week), human shape becomes easily identified.-Head, body and limb buds are easily identified.-Eyes, nose and ears are seen.
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C-R length in mms Age of embryo in weeks
5 – 8 5
10 – 14 6
17 – 22 7
28 – 30 8
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Fetal Period
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C-R length in cm Age of embryo in months
5 – 8 cm 3rd month
18 cm 5th month
36 cm Full term fetus at birth
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Relative size of head to body:-At the beginning of the 3rd month, the head is ½ the CR length.-At the beginning of the 5th month, the head is 1/3 the CH length.-At birth, the head is ¼ of CH length.
Weight growth:-At the end of 5th month, the weight is ½ kg.-At the 7th month, the weight is 1.75 kg.-At full term, the weight is 3.5 kg.
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Changes in external features:-Face becomes human looking.-Limbs become longer.-External genitalia are differentiated at 12th week.-Lanugo hair covers the fetus since the 4th month.-The skin is wrinkled till the end of 6th month.-Testes descend to scrotum just before birth.-Skin is covered by fatty substance called vernix caesosa.
Fetal movement:It is clearly recognized since the 5th month.
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The End & Beginning
With my best wishes Dr. Sherif
Fahmy