FETAL MATURATION AND GROWTH

Trudnoća (lat. gestatio) rezultat je implantacije oplođene jajne stanice u endometrij maternice. Oplodnja se najčešće događa u ampularnom dijelu jajovoda unutar 24 sata od ovulacije. Tijekom trudnoće oplođena jajna stanica svoju veličinu poveća za oko 6 milijardi puta. Njen razvitak od dvostaničnog zametka do nove jedinke dijelimo na embrionalni i fetalni stadij. Embrionalni stadij označavaju procesi gastrulacije, neurulacije i organogeneze. Navedeni procesi su jako podložni teratogenim učincima zbog čega se smatraju kritičnim za daljnji razvoj fetusa. Kardiovaskularni sustav se razvija među prvima obzirom na nutritivne potrebe rastućeg fetusa. Razvitak respiratornog sustava dijeli se u nekoliko faza, a počinje već u embrionalnom razdoblju a svoju ulogu preuzima nakon rođenja. Razvijanjem gastrointestinalnog sustava želudac počinje obavljati svoju funkciju, te se usklađuje rad živčanog i mišićnog sustava. Također, u ranom embrionalnom razdoblju započinje proces spolne diferencijacije fetusa i razvitak spolnog sustava koji će ostati neaktivan do razdoblja puberteta. Po završetku prvih osam tjedana gestacije embrij postaje fetus, te se taj period naziva fetalnim. Ostatak trudnće novonastali organi sazrijevaju da bi bili sposobni preuzeti svoju ulogu nakon rođenja. Fetalni je rast rezultat međudjelovanja različitih čimbenika. Osnovni čimbenici fetalnog rasta zasnivaju se na genetskom potencijalu fetusa, funkcioniranju organizma majke, funcionalnosti posteljice, te utjecaju okoline. Zbog toga, kvalitetna antentalna skrb tokom trudnoće igra veliku ulogu i za rezultat ima rođenje zdravog, donošenog, eutrofičnog novorođenčeta. U daljnjem tijeku trudnoće antenatalni je nadzor ponajprije usmjeren na prepoznavanju simptoma intrauterinog zastoja ili ubrzanja rasta, gestacijske hipertenzije ili gestacijskog dijabetesa. Naravno, za pračenje urednog fetalnog rasta nužno je definirati gestacijsku dob fetusa što se vrši ultrazvučnom biometrijom. U današnje vrijeme primalje imaju važnu ulogu u životu trudnica i njihovih obitelji. Primalje pružaju njegu, osiguravaju ženama potrebne informacije i savjete na način kojim će poticati sudjelovanje i olakšati informirano donošenje odluke. Primalje svoju djelatnost provode na svim razinama zdravstvene zaštite i važna su karika zdravstvenog lanca. Nažalost, primalje u Hrvatskoj imaju drugačiju ulogu od primalja u većini zemalja Europe gdje žena svoju primalju upoznaje na početku trudnoće i skrbi se o njoj i nakon porođaja. Naravno, uvjet za provođenje primaljskog modela skrbi u Republici Hrvatskoj je dodatno obrazovanje primalja i omogućeno dodatno školovanje u vidu magisterija, čime bi se dobio kadar sposoban za vođenje timova, upravljanje odjelom ili pak cijelom ustanovom predodređenom samo za primaljsku skrb.Pregnancy (lat. gestatio) is a result of implantation of an fertilized egg cell inside the endometrial wall of the uterus. Fertilization usually occurs inside the ampullar section of the fallopian tube in between 24 hours after ovulation. During pregnancy, the fertilized egg cell will magnify it's size for approximately six million times. It's development can be divided into early embryonic stage and fetal stage of development. Embryogenesis continues with the process of gastrulation, the processes of neurulation and organogenesis that follow and, because of that, the early embryonic stage is often described as critical. Due to increased needs of the developing fetus the cardiovascular system is among the first ones to form. Development of the respiratory system is divided into several phases, and it begins during the embryonic stage. The lungs take over their role after birth. By developing the gastrointestinal system, the stomach begins to perform its function and the function between the nervous and muscular system harmonizes. Also, in the early embryonic period, the process of sexual differentiation of the fetus and the development of a sexual system, which remains inactive until puberty. At the end of the first eight weeks of gestation, an embryo becomes a fetus, and that period is termed as the fetal period. During the remainder of the pregnancy the newly formed organs mature so that they are able to function after the baby is born. Fetal growth is the result of interaction between many different factors. The main factors of fetal growth are based on the genetic potential of the fetus, functioning of the mother's organism, functioning of the placenta, and the influence of the environment. Quality antenatal care during pregnancy is of vital importance. It's important to identify all of the risc factors that could interfere with the developing fetus on time and educate the mother about the consequences. In the further course of pregnancy, antenatal monitoring is primarily aimed at detecting symptoms of intrauterine deceleration or acceleration of growth, gestational hypertension or gestational diabetes. Of course, in order to monitor fetal growth, it is necessary to define the gestational age of the fetus by ultrasound biometry. Nowadays, midwives play an significant role in the life of pregnant women and their families. Midwives provide women with the necessary information and advice in a way that will encourage participation and facilitate informed decision-making. Midwives carry out their activities on all levels of health care and are an important link in the healthcare chain. Unfortunately, midwives in Croatia have a different role from the midwives in most countries of Europe where a woman meets her midwife at the beginning of her pregnancy and she cares for her during pregnancy her and after childbirth. Of course, a higher form of education for midwifes in Croatia is an requirement for the implementation of that kind model of care. If we would enable a higher form of education for Croatian midwifes, we would gain health personell that would be able to lead midwifery teams and departments that are a foundation of midwife led care