18 - Fetal & Neonatal Phys Flashcards
________ development is defined as the growth of a fertilized egg between conception and birth.
Prenatal
Prenatal development has three stages, which are…
Germinal period
Embryonic period
Fetal period
Full term gestation is typically _______ days.
266
The neonatal period is from birth to _____ days.
28
_______ development is defined as the time from 9th week of gestation to birth. Birth ends this period.
Fetal
The fetal period is a 30-week period of development. There is continual cell growth and differentiation. The fetus length will grow from 10 cm to 53 cm in 20 weeks. Weighs only 1 pound at 23 weeks gestation, but gains significant weight in the last ______ months.
2
In the fetal period, organs are developed by _____ months gestation, but cellular maturity (function) is not complete until after birth.
4
The circulatory system is integrated with the placenta through the umbilical cord. The fetus received both ________ and ________ from the placenta.
Oxygen
Nutrients
The heart is 2 parallel tubes that will fuse together. At the point of fetus (7-9 weeks) tubes fold and form heart, differentiating into 4 chambers. It has _______, diverting blood flow to bypass immature organs such as lungs and liver until childbirth.
Shunts
Placental blood is preferentially delivered to the heart, upper torso, and brain. Lower _________ blood is shunted to the lower body.
Oxygenated
Fetal circulation runs in parallel – left ventricle provides _____ percent of cardiac output, right ventricle provides _____ percent. Total fetal cardiac output is a combination of the two.
35
65
_______ start beating before fusion of the heart tubes. The beats begin in the final region of the pacemaker. Ventricle also acts as pacemaker.
Myocytes
T/F. Eventually the fetal heart contractions will match the mothers.
True
At 5 weeks the heart beats ____ times per day.
3.3
At 9 weeks the heart beats _____ bpm. It keeps increasing to _____ bpm.
80-85
195
Resistance in the lungs is very high and it has limited metabolic needs because the lungs are not functioning. Blood just passes through. The same is true for the _______.
Liver
Umbilical arteries carry…
Low-oxygen blood
Fecal waste
Fetal circulation –
– Blood from placenta through umbilical vein bypasses the ______.
– Enters the ______ atrium.
– Goes through the foramen ovale to ______ atrium.
– Oxygenated blood pumped to brain and upper extremities.
– Blood from superior vena cava go into right atrium to right ventricle and pumped through _______ _______ to descending aorta.
Liver
Right
Left
Ductus arteriosus
Iron is concentrated in the mother’s endometrium. This iron is ingested into the embryo by _________ cells and used to form early RBCs.
Trophoblastic
The 3rd week after fertilization, iron is bound as ________. Later, iron accumulates rapidly in the fetus, most of it stored in the liver to be used after birth to make ________.
Hemoglobin
Hemoglobin
In the fetus, initially there is high resistance in ________ artery pressure. Pressure drops with increase in systemic vascular resistance.
Pulmonary
In the fetal respiratory system, this starts to be produced in the last 3 months of gestation. It is a category of compounds that reduce surface tension.
Surfactant
Surfactant is a lipoprotein complex with hydrophilic and hydrophobic regions produced by ______ ______ cells.
Type II alveolar
_________ increases pulmonary compliance, preventing collapse of alveoli at the end of expiration. It prevents build up of fluid in alveoli.
Surfactant
In fetal metabolism, the fetus predominantly uses ________.
Glucose
The fetus stores fat and protein, there are also vitamins stored in the _______.
Liver
These fetal vitamins are necessary for the formation of RBCs and the nervous system.
B12
Folic acid
This fetal vitamin is necessary for bone matrix and connective tissue.
Vitamin C
This fetal vitamin is for normal bone growth.
Vitamin D
The mother needs adequate vitamin _____ to absorb calcium from the GI tract.
D
This fetal vitamin is needed for early embryonic development.
Vitamin E
This fetal vitamin is used by fetal liver to create normal clotting factors.
Vitamin K
At week 10 the ______ is present, but at the beginning of development.
Brain
Activity-________ mechanisms are genetically programmed to differentiate from stem cells, migrate and create axons that reach the target.
Independent
Activity-________ mechanisms are after reaching target, synapse formation is dependent on activity, modifications of synapses.
Dependent
The fetus moves, but movements are jerky and not controlled. Weeks 16-20 limb movement is more powerful and mother may feel fetal movements. Mostly arms are crossed and legs bent at knees. Most movement is ________.
Reflexive
At week 16, the fetus is able to swallow several ounces of _______ _______ per day.
Amniotic fluid
At week 18, the nerves become covered with _______ (not complete until year 1).
Myelin
At week 24, the fetus can _______ (eyes).
Blink
At week 26, the brain develops rapidly. Nervous system develops some control of organs. Cochleae developed. Brain forms smooth surface with grooves and indentations, and the _________ is developing very fast.
Cerebellum
At week 31, the ________ brain connections develop.
Thalamic
Overview of weeks _____:
- Ossification of bone
- Fingers and toes develop
- Eyelashes appear
- Amniotic fluid is swallowed and urinated
- In males testes descend
- Intestines accumulate tarry, greenish black meconium (sterile)
9-12
Overview of weeks ______:
- Sensory organ development
- Eyes move closer together
- Mouth makes sucking motions
- Ears move upward
- Scalp begins to grow hair
- Kidneys are formed
13-16
In weeks 16-20, the skin is coated with a waxy protective substance called _______ _______ and silky hair covers all skin as lubricant.
Vernix caseosa
Overview of weeks ______:
- Eyelids are no longer fused
- Bone marrow synthesizes erythrocytes
- Eyelashes appear
- Lungs produce surfactant (reduces tension in lungs)
- Finger and toe nails begin to develop
21-31
The invasive methods of prenatal screenings are used for ________ assessment.
Genetic
This invasive prenatal screening method is done only between 14-20 weeks gestation.
Amniocentesis
This invasive prenatal screening method is done between 9.5 to 12.5 weeks gestation. It is associated with more risk to the fetus.
Chorionic villus sampling (Placenta sample)
This non-invasive prenatal screening method is used to look at the fetus anatomy.
Ultrasound
A non-invasive prenatal screening method is getting a blood test of the maternal blood. Some _______ can be picked up by detecting fetal DNA in maternal blood. If abnormalities are picked up, then invasive procedures are used to confirm.
Trisomies
This is a compound that can permanently deform the function or structure of a developing embryo or fetus. An example was Thalidomide, an anti-nausea sedative. It caused severe limb defects in babies born in the 1960s.
Teratogens
The most common teratogen is due to _______, which causes growth retardation and abruption of placenta.
Smoking
This teratogen causes a flattened and thin upper lip, epicanthal folds, flattened nasal bridge, and short nose. They can also have microcephaly, mental retardation and learning disabilities. 1 percent of all births have this.
Fetal alcohol syndrome (FAS)
_______ produces growth restriction, preterm delivery, microcephaly, limb anomalies, and CNS abnormalities.
Cocaine
________ can cause fetal renal failure and pulmonary hypoplasia.
ACE inhibitors
This is the term for 37-42 weeks gestation.
Full gestation
This is the term for a fetus born before 37 weeks gestation.
Premature
This is the term for the first 28 days of life.
Neonate
This is the term when a fetus weighs less than 1000 grams at birth.
Low birth rate
T/F. Low birth rate can lead to hypothermia, respiratory distress, hyperbilirubinemia, electrolyte imbalance, infections and feeding problems.
True
The ______ ______ with development of the respiratory system is the single most important event immediately after birth. The stimulus in normal delivery is hypoxia, cold air, and with delayed breath there is greater hypoxia and hypercapnia.
First breath
At birth, the walls of the _______ are collapsed. First breaths by neonate must be very strong to open them for the first time.
Alveoli
________ is made in lungs at 24 weeks gestation.
Surfactant
Drugs can be given to the mother to improve neonatal lung function. Alveolar development continues through age _____.
5
First breath starts at 0 pressure and builds. Volume in lungs does not change until -40 cm H2O, only then does air enter lungs. To expel air, excessive force must be applied. The next breath requires much (MORE/LESS) force.
Less
Neonates have periodic breathing pattern. It goes from ______ (less than 5 sec) followed by _______. This can correlate with changes in heart rate and is related to the low functional residual capacity.
Apnea
Tachypnea
Neonate periodic breathing pattern causes excessive variation in blood gas concentrations when respiration slows. This pattern may persist up to ______ weeks gestation.
60
If the mother is given general anesthesia, fetal respiration is likely to be _______.
Delayed
Intracranial hemorrhage or brain trauma during birth can cause depressed ________ center.
Respiratory
Prolonged hypoxia during delivery can severely depress respiratory center. This can happen from compression of the _______ _______, premature separation of the ________, excessive contraction of the uterus, and anesthesia to the mother.
Umbilical cord
Placenta
If the neonate fails to breathe for _____ minutes or greater, then it is dead.
4
If the neonate survives after not breathing for 4 minutes or more, then they will have serious and permanent brain damage. This includes ______ ______, the portion of the brain that appears to be most affected is the ________, and loss of motor control.
Cerebral palsy
Thalamus
Respiratory distress is most common in prematurity and mothers with ________. It develops in first hours to days after birth. There is a failure to produce enough ________ and alveoli fill with high protein fluid.
Diabetes
Surfactant
Prior to birth, the ______ had little blood flow, but immediately after birth blood flow increases.
Liver
Pulmonary vascular resistance (INCREASES/DECREASES) associated with taking the first breath. Subsequently there is (INCREASED/DECREASED) pulmonary arterial pressure, right ventricular pressure and right atrial pressure.
Decreases
Decreased
There are changes in pressure between left and right atria that causes blood to flow backward through the _______ _______ (left to right). The valve associated with this now closes. _____ of people will have permanent closure within months to years.
Foramen ovale
2/3
1/3 of people have patent foramen ovale, but ______ should function to stop back flow.
Valve
Increased aortic pressure with decreased pulmonary resistance causes backward flow through the _______ _______. Over 8 day period, muscle wall contracts and closes hole. Over next 4 months, fibrous tissue overgrows.
Ductus arteriosus
After birth blood still passes through ______ ______ and bypasses the liver. Within 1-3 hours, muscle wall contracts and closes the hole. Portal venous pressure rises from _____ to _____ mmHg. Systemic blood pressure is 70/50 mmHg, over months it increases to 90/60.
Ductus venosus
0
10
Bilirubin formed by the fetus passes the placenta into the mother to be excreted through the mother’s liver. After birth, neonates own liver must work. Plasma bilirubin rises 5 times the first 3 days of life and slowly return to normal as liver functions. Typically treated with ________.
Sunlight
There can be intrinsic causes of excessive bilirubin (hyperbilirubinemia), which can be _______ conditions or _______ _______ disease.
Enzyme
Sickle cell
There can extrinsic causes of excessive bilirubin (hyperbilirubinemia), which can be ________ and _____ compatibility.
Sepsis
Rh
In the most severe cases of hyperbilirubinemia, _________ occurs which is a severe CNS injury.
Kernicterus
Before birth glucose comes from the mother. Stored glucose lasts only a few hours. The liver is still too immature for ___________. Mother’s milk is not fully developed. Blood glucose falls to 30-40 mg/dL. Begins using stored ______ and ______ for next few days. Body weight will drop by up to ______.
Gluconeogenesis
Protein
Fat
20 percent
What does an apgar score consist of?
Appearance Pulse Grimace Activity Respiratory
An apgar score is given at 1 and 5 min after birth. A score of ______ is low, ______ and below are critical.
4-5
3
An apgar score below 3 at 10-30 minutes is associated with long-term _________ damage.
Neurological
An apgar score of ______ is almost never seen, due to normal early cyanosis.
10
