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Pelvis, Perineum, + Lower Limb > 11/30 Fetal Growth > Flashcards

11/30 Fetal Growth Flashcards

1
Q

When is the fetal period?

A

Weeks 9-38 (birth)

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2
Q

What happens in the fetal period

A

Differentiation and growth of tissues/organs, rate of body growth increases

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3
Q

When is the time of greatest vulnerability to death?

A

Weeks 1-2

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4
Q

When is the time of greatest vulnerability to congenital anomalies?

A

Weeks 3-8

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5
Q

What is a teratogen?

A

any agent that causes an abnormality after exposure during development

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6
Q

What can teratogens increase the risk for?

A

Miscarriage, preterm labor, stillbirth

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7
Q

What does the danger of a teratogen depend on?

A

teratogen, timing (when and how long), quantity, genotype

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8
Q

What is another name for a teratogen?

A

Reproductive toxicant

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9
Q

What does the term reproductive toxicant emphasize?

A

That timing and dose matter

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10
Q

What are the outcomes (congenital anomalies) of common medications with known reproductive toxicants?

A

CHDs, cleft palate, spina bifida

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11
Q

What are the actions of caffeine

A

Stimulant and diuretic

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12
Q

What side effects can caffeine have?

A

Vasoconstriction = Increases HR, BP
Increases urination and metabolism = dehydration, diarrhea
Stimulates CNS = jittery feelings, anxiety, irritability, insomnia

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13
Q

Does caffeine cross placenta/into breast milk?

A

Caffeine does cross placenta and is transferred via breastmilk

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14
Q

What are the current recommendations for pregnancy and those TTC for caffeine?

A

pregnant people: <200 mg caffeine/day (less is better)
TTC: both partners should abstain or decrease caffeine intake

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15
Q

What was thalidomide initially created for?

A

As a sedative

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16
Q

What was thalidomide found to be useful for?

A

Anti-emetic (helped morning sickness)

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17
Q

What can thalidomide cause?

A

Unusually high numbers of congenital anomalies - thalidomide embryopathy
Severe limb, eye, urinary tract, and heart defects

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18
Q

What is thalidomide embryopathy, what property causes this?

A

Severe limb defects: amelia, meromelia, phocomelia
Due to anti-angiogenic properties of thalidomide

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19
Q

What is the difference when thalidomide is introduced on day 24 versus 28?

A

Day 24 = upper limb damage
Day 28 = lower limb damage

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20
Q

What is thalidomide used for today?

A

immunomodulatory, anti-inflammatory, and anti-angiogenic causes
used to treat multiple myeloma, Hansen’s disease (aka, leprosy), certain conditions caused by cancer or HIV infection

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21
Q

What happens to development after weeks 17-20 in the fetal period

A

Growth slows quite a bit

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22
Q

What is quickening, when is it more common?

A

The first fetal movements felt by pregnant woman
Often stronger and/or more noticeable in evening or night

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23
Q

What is lanugo?

A

Fine, soft hair covering body and limbs of neonate

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24
Q

When does lanugo disappear and what replaces?

A

Disappears soon after birth and is replaced by vellus hair

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25
Q

What is lanugo often found in?

A

Teratomas

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26
Q

What is vernix caseosa, what does it do?

A

Waxy substance covering skin of neonate
Functions to keep skin moisturized, retain heat, protect, lubricate

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27
Q

What is used to estimate the size of fetal growth

A

Crown-to-rump length

28
Q

What is used to estimate age of fetal growth?

A

Biparietal diameter, head/abdominal circumference, femur length

29
Q

What is not a reliable measurement for estimation of age?

A

Neonatal weight

30
Q

When does gestational diabetes affect pregancy? How is this detected?

A

Typically affects late pregnancy
Often detected during OGTT (oral glucose tolerance test)

31
Q

Can insulin cross the placenta?

A

No

32
Q

What is the mechanism of gestational diabetes?

A

Placental hormones block action of maternal insulin
High blood glucose passes from mother to fetus
Fetal pancreas works overtime making insulin
Extra energy in fetus is stored as fat

33
Q

What are possible results for gestational diabetes in the fetus?

A

macrosomia, hypoglycemia, breathing problems,
increased risk of childhood obesity, increased risk of type 2 diabetes

34
Q

What are possible results for gestational diabetes in the carrier/mother?

A

difficult birth, hypertension, preeclampsia, increased risk of type 2 diabetes (~25% higher than non-GD population)

35
Q

What is the purpose of sonography/ultrasonography?

A

Uses sound waves to visualize tissues based on information about density

36
Q

When can sonography/ultrasonography be performed?

A

Anytime

37
Q

What is the procedure for Sonography/Ultrasonography?

A

Transvaginal or Abdominal
2D, 3D, 4D
Fetal echocardiography

38
Q

What is the risk level for Sonography/Ultrasonography?

A

Little to none

39
Q

When is the anatomy scan performed?

A

Around weeks 18-22

40
Q

Does the sonographer discuss anatomy scan with patient?

A

Sonographer may discuss with patient throughout, but obstetrician/perinatologist reviews and follows up

41
Q

What is the purpose of the anatomy scan?

A

Check development of fetal organs (including sex of fetus), placenta and fetal membranes, amniotic fluid, pelvic tissues
Screen for structural issues (can indicate further testing for congenital anomalies or syndromes)

42
Q

What is the purpose of amniocentesis?

A

Collect sample of amniotic fluid to analyze fetal genotype, amount of alpha fetoprotein, respiratory secretions

43
Q

When is amniocentesis performed?

A

> 15 weeks

44
Q

What is the risk level for amniocentesis?

A

Moderate
Postprocedural rate of fetal loss = 1.4%

45
Q

What information can alpha fetoprotein provide?

A

If too high = possible body wall defects or NTDs
If too low = possible syndromes

46
Q

What information can respiratory secretions provide?

A

Status of lung maturity (surfactant production)

47
Q

If maternal Rh- blood mixes with fetal Rh+ blood, what is a possible consequence?

A

If the first meeting, possibly no issue for current pregnancy
If second (or more) meeting, then potential Rh incompatibility sequelae

48
Q

What is the purpose of Chorionic villus sampling (CVS)?

A

Collect sample of chorionic villus to analyze fetal genotype

49
Q

When is Chorionic villus sampling (CVS) performed?

A

> 10 weeks (earlier than amniocentesis)

50
Q

What is the risk level for Chorionic villus sampling (CVS)?

A

High
Postprocedural rate of fetal loss = 1.9%

51
Q

What is the purpose of cordocentesis (Percutaneous umbilical cord blood sampling (PUBS))? Why is this performed?

A

Collect sample of fetal blood to analyze fetal genotype
• Only if amniocentesis/CVS are inconclusive or inadequate

52
Q

When is cordocentesis (Percutaneous umbilical cord blood sampling (PUBS)) performed?

A

> 17 weeks

53
Q

What is the risk level of cordocentesis (Percutaneous umbilical cord blood sampling (PUBS))?

A

Very high
Postprocedural rate of fetal loss = 1-4%

54
Q

Is Rh incompatibility a potential issue with Cordocentesis (Percutaneous umbilical cord blood sampling (PUBS))?

A

Yes

55
Q

What is fetal viability?

A

50/50 potential ability of fetus to survive in extrauterine environment with modern medical care

56
Q

What is the gestational age and embryological age for fetal viability?

A

Gestational: ~24 weeks
Embryological: ~22 weeks

57
Q

What is lung development like in week 22?

A

Canalicular stage, there are a few young alveoli and surfactant production just began ~week 20

58
Q

What is abortion?

A

premature stoppage of development and expulsion of conceptus/embryo/fetus before it is viable

59
Q

What is a threatened abortion?

A

bleeding with the possibility of abortion

60
Q

What is spontaneous abortion?

A

Aka miscarriage
pregnancy loss that occurs naturally before week 20

61
Q

When is spontaneous abortion considered habitual?

A

If it occurs > 3 times

62
Q

What is fetal demise?

A

Spontaneous abortion after week 20

63
Q

What is (medically) induced abortion?

A

birth that is medically induced before fetal viability is reached

64
Q

How many clinically recognized pregnancies end in miscarriage?

A

1/4

65
Q

How many babies in the US are born with congenital anomalies?

A

1/33

66
Q

What can congenital anomalies necessitate?

A

surgeries and therapies, lifelong monitoring, specialist care, and may result in developmental delays and chronic disability

Pelvis, Perineum, + Lower Limb (12 decks)

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