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Woman's Health > 7.4 foetal growth > Flashcards

7.4 foetal growth Flashcards

1
Q

Baby’s growth at weeks 11- 14 (average 12)

Length 7 – 9cm; weight 28g:
• Fingers and toes distinct 
• Complete placenta 
• Complete foetal circulation 
• Complete organ systems

Foetal changes

  • Eyelids close (only open at ____________)
  • Genitals appear _____________
  • RBCs produced in the liver
  • Face is well-formed
  • ___________ appear for baby teeth
A

~28 weeks;

well-differentiated;

Tooth buds

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2
Q

Baby’s growth at weeks 15 – 18 (16)

Length 10 – 17cm; weight 55 – 120g: 
• Sex is differentiated 
• Rudimentary kidneys secrete urine 
• \_\_\_\_\_\_\_\_\_ is present
• \_\_\_\_\_\_\_\_\_\_\_ close

Foetal changes

  • Skin is almost transparent
  • ____________ (first faeces) in GI tract
  • Foetus makes active movements
  • __________ hair develops on head
  • Liver, pancreas make fluid secretions
  • ____________ motions made with mouth
A

Heartbeat;

Nasal septum and palate;

Meconium;

Fine lanugo ;

Sucking

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3
Q

Baby’s growth at weeks 19 – 21 (20)

Length 25cm; weight 223g:
• _________ covers whole body
• Foetal movements felt
• Heart sounds auscultated

Foetal changes

  • Foetus can ________
  • Mother may feel ________________
  • Foetus makes more movements
A

Lanugo hair;

hear;

fluttering in abdomen

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4
Q

Baby’s development at 22nd week

  • Lanugo hair covers entire body
  • ___________ appear on fingers and toes
  • _________________ appear
  • Foetus more active with increased muscle development
A

Nails;

Eyebrows and lashes

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5
Q

Baby’s growth at weeks 23 – 25 (24)

Length 28 – 36cm; weight 680g:
• Skin appears __________
• ________________ (sebum, cell layer coating skin) appears
• Eyebrows & fingernails develop

Foetus changes

  • _________________ begins making blood cells
  • Lower airways of foetal lungs develop but still do not produce _________
  • Foetus begins to store ______
A

Vernix caseosa;

wrinkled;

Bone marrow;

surfactant;

fat

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6
Q

Baby’s growth at week 26

  • Eyebrows and lashes well-formed
  • Foetus has hands and _____________
  • _____________ form in the lungs
  • All eye parts are formed
  • Toe/fingerprints are forming
A

startle reflex ;

Air sacs

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7
Q

Baby’s growth at week 27 – 30 (28)

Length 35 – 38cm; weight 1200g:
• Skin is \_\_\_\_\_\_\_\_
• \_\_\_\_\_\_\_\_\_\_\_\_ disappear
• Excellent chance of survival 
• Eyes open and close
  • Rapid brain development occurs
  • Nervous system developed enough to control some body functions
  • Eyelids open and close
A

red

Pupillary membrane

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8
Q

Baby’s growth at week 31 – 34 (32)

Length 38 – 43cm; weight 1500 – 2500g: • Foetus is viable
• Eyelids open
• Fingerprints are set
• ___________ foetal movement

Foetal changes

  • Rapid increase in amount of body fat
  • _________ breathing movements (but lungs still not fully mature)
  • Bones fully developed (but still __________)
A

Vigorous;

Rhythmic;

soft and pliable

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9
Q

Baby’s growth at week 38 (36)

Length 42 – 49cm; weight 1900 – 2700g:
• Face and body have __________ appearance due to subcutaneous fat deposition
• Lanugo disappears
• _____________ decreases

Foetal changes

  • Lanugo hair begins to disappear
  • Fingernails reach the end of fingertips
  • Body fat increases
A

loose wrinkled ;

Amniotic fluid;

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10
Q

Baby’s growth at week 39 – 42 (40)

Length 48 – 52cm; weight 3000g:
• Skin is __________
• Eyes uniformly slate coloured
• Bones and skull are ossified and nearly together at the sutures

Foetal changes

  • Lanugo gone except on ____________
  • Fingernails extend beyond fingertips
  • Head hair now ________________
  • Small __________ present in both sexes
A

smooth;

upper arm and shoulders;

coarser and thicker;

breast buds

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11
Q

what is the pathway where blood flows in the foetus?

A

The foetus receives oxygenated blood from the placenta instead of the lungs (bypassing the pulmonary circulation):
• Blood from the placenta (SaO2 ~80%) → umbilical vein → ductus venosus (bypass
liver circulation) → IVC → right atrium

Majority: Right atrium → foramen ovale → left atrium (mixes with some desaturated blood from lungs) → left ventricle → aorta* → umbilical arteries → placenta

Minority: Right atrium (mixes with desaturated blood from SVC) → right ventricle → pulmonary artery → ductus arteriosus (bypasses high resistance pulmonary circulation) → descending aorta → umbilical arteries (SaO2 ~58%)

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12
Q

what does the foramen ovale connect?

A

Connects the right and left atria → blood bypasses right ventricle

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13
Q

what does the ductus arteriosus connect?

A

Connects the pulmonary artery to the aorta → bypasses the high-pressure pulmonary circulation (in foetal life)

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14
Q

what does the ductus venosus connect?

A

Shunt passing oxygenated blood from the umbilical vein to the IVC → bypasses the hepatic circulation

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15
Q

The neural groove develops 18 days post-ovulation, and fuses to form the ____________ 4 weeks post-ovulation → forms the 3 primary vesicles:
• Development of primitive ventricular system: ___________ secretes CSF which fills the connection between the vesicles
• Neurones develop from ____________ → myelination of the brain and spinal cord continues until after birth

A

neural tube;

choroid plexus

neuroblast cells

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16
Q

what are derivatives of the prosencephalone (forebrain)

A
  • telencephalon: Cerebrum, basal ganglia, hippocampus, amygdala
  • diencephalon: Thalamus, hypothalamus
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17
Q

what are derivatives of the Mesencephalon (midbrain)

A

Tectum, tegmentum

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18
Q

what are derivatives of the Rhombencephalon (hindbrain)

A

Metencephalon: Pons, cerebellum
Myelencephalon: Medulla oblongata

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19
Q

what are the functions of the amniotic fluid?

A
  • Source of growth factors (for the foetus)
  • Antimicrobial protection to combat uterine infections (also protects foetus)
  • Mechanical protection of the foetus (absorbs shock)
  • Supports foetal musculoskeletal development
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20
Q

how does the amniotic fluid travel in early pregnancy?

A

Diffusion of amniotic fluid between foetal skin, amnion, umbilical cord → derived from maternal plasma and placenta

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21
Q

how does the amniotic fluid travel after 8 weeks?

A

Keratinisation of foetal skin stops free diffusion of fluid through skin:
• Foetal swallowing starts
• Foetal urination begins after the 2nd half of the pregnancy

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22
Q

what are the uses of ultrasound in o& g?

A
  • Uses in obstetrics: foetal growth and development, assessment of blood flow (speed and direction) with colour doppler function
  • Uses in gynaecology: assessment of pregnancies under 12 weeks of gestation, pelvic masses, and normality of pelvic organs
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23
Q

what are the potential risks of ultrasound

A

tissue heats up with absorption of ultrasound waves (potentially dangerous) → increased thermal index (TI) is potentially dangerous (esp. to developing embryo in early pregnancy)

  • TI = power used / power needed to raise tissue temp. by 1°C
  • Important to adhere to ALARA (As Low As Reasonably Achievable) principle → obtain best image needed to complete investigation while maintaining lowest amount of risk to the tissue
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24
Q

how is naegele’s rule used to estimate EDD?

A

Naegele’s rule: estimates the expected date of delivery (EDD) by the first day of the woman’s LMP + 1 year – 3 months + 7 days

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25
Q

how is physical examination used to estiate EDD?

A

Measurement of symphysis-fundal height (SFH) after 12 weeks of gestation (when the uterus is palpable in the abdomen):
• Detects only ~30% of small for gestational age foetuses

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26
Q

when will SFH > dates?

A

multiple gestation, polyhydramnios, macrosomia, wrong EDD

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27
Q

when will SFH < dates?

A

where SFH < dates: oligohydramnios, wrong EDD

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28
Q

what ultrasound scan measurements are used to estimate EDD?

A

Before 13+6 weeks: crown-rump length (CRL) is most accurate
After 13+6 weeks: biparietal diameter (BPD) → head circumference
*Allows for identification of foetal anomalies as well

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29
Q

1st trimester screening

  • when is it done
  • what does it consist of
A

Done from 11 – 13+6 weeks of gestation → consists of maternal age, serum biochemistry (β-hCG and PAPP-A) and foetal nuchal translucency:
• Trisomies: trisomy 21 (Down syndrome), trisomy 18 (Edward’s syndrome), trisomy 13 (Patau syndrome)
• Thickened nuchal translucency (on ultrasound): marker for cardiac anomalies and other chromosomal anomalies

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30
Q

foetal abnormality ultrasound scan

  • when is it done
  • what does it consist of
A

Done from 18 – 20+6 weeks of gestation for the following:
• Identify serious foetal abnormalities (incompatible with life and associated with morbidity)
• Offers couple choices about screening options and pregnancy management
• Identify abnormalities that may benefit from antenatal intervention
• Identify abnormalities requiring early intervention after delivery

31
Q

what is the definition of oligohydramnios?

A

deepest vertical pool (DVP) < 2cm OR amniotic fluid index (AFI) < 5th centile (summation of all DVPs from all 4 corners of the uterus)

32
Q

what are the common causes of oligohydramnios?

A

placental insufficiency, foetal anomalies (renal agenesis, urethral obstruction, renal dysplasia), preterm premature rupture of membranes (PPROM)

33
Q

what are the complications of oligohydramnios?

A

from underlying cause, foetal lung hypoplasia, foetal limb contractures

34
Q

what is the definition of polyhydramnios?

A

fluid): DVP > 8cm OR AFI > 95th centile

35
Q

what are the common causes of polyhydramnios?

A

idiopathic, diabetic mellitus (foetal hyperglycaemia → polyuria → polyhydramnios), intestinal obstruction (duodenal or oesophageal atresia), impaired foetal swallowing (muscular dystrophy), foetal polyuria (twin-to-twin transfusion syndrome), cardiac failure (sacrococcygeal teratoma, foetal anaemia from maternal alloimmunisation or infections), foetal infections

36
Q

what are the complications of polyhydramnios?

A

preterm labour, PPROM, foetal malposition

37
Q

what are the causes of small for gestational age (SGA) foetuses?

A

SGA is defined as a foetus with estimated foetal weight < 10th centile on ultrasound: • Normal (constitutionally) small (50 – 70% of SGA foetuses)
• Non-placenta-mediated growth restriction: structural/chromosomal anomalies, inborn errors of metabolism, foetal infections
• Placenta-mediated growth restriction: maternal factors, medical conditions

38
Q

what is the definition of intrauterine growth restriction (IUGR)?

A

IUGR is defined as a foetus with estimated foetal weight < 10th centile on ultrasound that has not attained its predetermined growth potential due to pathologic process:

39
Q

what are the risk factors for IUGR?

A

age > 40 (3.2x), nulliparity (1.89x), smoking > 11 cigarettes/day (2.21x), drugs like cocaine (3.23x), vigorous exercise (3.3x), previous history of SGA baby (3.9x), previous stillbirth (6.4x), maternal history of small for dates (2.64x), hypertension (2.5x), diabetes (6x), renal disease (5.3x)

40
Q

symmetric IUGR: Restriction affects all growth parameters → foetus is symmetrically small:
• Normal head : abdomen & femur : abdomen ratios
• Possible causes: ______________, ___________________, maternal alcohol use
• Complicated neonatal course with poor prognosis (pathology)

A

genetic/chromosomal causes;

early gestational intrauterine infections (TORCH),

41
Q

asymmetric IUGR: Occurs due to utero-placental insufficiency:
• Elevated ______________ ratios (relative brain sparing effect)
• More commonly due to extrinsic influences which affect the foetus later in gestation (usually after 28 weeks) like ______, ________, _________
• Usually unexpectedly benign neonatal course and typically do well if complications are prevented/adequately treated

A

head : abdomen & femur : abdomen;

pre-eclampsia, chronic hypertension, renal disease;

42
Q

what is the definition for foetal macrosmia?

A

Foetal macrosomia (large for gestational age/LGA) is defined as a foetus with estimated foetal weight > 90th centile on ultrasound:

43
Q

what are the risk factors for foetal macrosomia?

A

pre-existing diabetes, gestational diabetes, excessive maternal weight gain in pregnancy

44
Q

what are the associated complaints for foetal macrosomia?

A

labour problems, genital tract lacerations during delivery, PPH, uterine rupture, neonatal hypoglycaemia, childhood obesity

45
Q

what are examples of genetic abnormalities in foetus?

A

Trisomy 21 (Down syndrome), trisomy 18 (Edward’s syndrome), trisomy 13 (Patau syndrome), sex chromosome abnormalities (XXX, XYY, XXY, XO), single gene disorders

46
Q

what are examples of structural abnormalities in foetus?

A

Congenital heart disease, neural tube defects (spina bifida, anencephaly), abdominal wall defects (gastroschisis, exomphalos), lung disorders (diaphragmatic hernia), genitourinary anomalies (Potter’s syndrome)

47
Q

how is chorionic villus sampling conducted and when is it done?

A

Sampling of placental tissue with needle under ultrasound guidance (testing for chromosomal abnormalities): • Performed usually between 11 – 15 weeks gestation
• Risk of miscarriage: 1%

48
Q

how is amniocentesis conducted and when is it done?

A

Small amount of amniotic fluid (containing foetal tissues) sampled from amnion/amniotic sac surrounding foetus under ultrasound guidance (foetal DNA examined for genetic abnormalities):
• Performed usually after 15 weeks gestation
• Risk of miscarriage: 1%

49
Q

what are the mechanisms that cause down syndrome?

A

1) Meiotic non-disjunction: Trisomy 21 [47,XX, +21] → gamete is produced with extra copy of chromosome 21 and combines with normal gamete from other parent to form an embryo with 47 chromosomes
2) Robertsonian translocation: Long arm of chromosome 21 attached to another chromosome → often 14 [45,XX,t(14;21)] or itself [45,XX,t(21;21)(q10;q10)] → may be de novo or inherited from a parent with a balanced translocation

3) Mosaicism: Some cells are normal, and some cells have trisomy 21 [46,XX/47,XX, +21]
• Non-disjunction event during early cell division leads to a fraction of cells with trisomy 21
• Anaphase lag of a chromosome 21 in a Down syndrome embryo leading to a fraction of euploid cells (aneuploidy rescue)

50
Q

what are the serum biochemistry results for patients with down syndrome

  • Pregnancy-associated plasma protein A (PAPP-A)
  • β-hCG
  • AFP
  • Unconjugated oestriol (uE3)
  • Inhibin-A
A
  • decreased
  • increased
  • decreasaed
  • decreased
  • increased
51
Q

what are the serum biochemistry results for patients with normal patients

  • Pregnancy-associated plasma protein A (PAPP-A)
  • β-hCG
  • AFP
  • Unconjugated oestriol (uE3)
  • Inhibin-A
A
  • increased
  • decreased
  • increased
  • increased
  • decreased (until 17 weeks)
52
Q

what are the features of turner’s syndrome?

A

short stature, low hairline, shield shaped thorax, widely spaced nipples, shorter finger nails, fold of skin at neck, constriction of aorta, nevi, poor breast development, underdeveloped gonodal features, no menstruation

53
Q 
Klinefelter syndrome (47,XXY) is a genetic disorder in which there is at least one extra X chromosome to a standard human male karyotype (total of 47 chromosomes):
• Exists in ~1 : 500 – 1 : 1000 live male births (but many are asymptomatic → associated physical traits typically become apparent after onset of puberty, if at all)
• Genetic mechanism: extra X chromosome retained due to \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (X and Y sex chromosomes fail to separate → produces a sperm with an X and a Y chromosome)
A

non-disjunction event during meiosis I

54
Q

what are examples of disease with an autosomal dominant pattern?

A

Myotonic dystrophy
Huntington’s disease
Osteogenesis imperfecta

55
Q

what are examples of disease with an autosomal recessive pattern?

A

Cystic fibrosis
Beta-thalassaemia
Tay-Sachs disease
Rh isoimmunisation

56
Q

what are examples of disease with an x linked pattern?

A

Haemophilia
Duchenne’s and Becker’s muscular dystrophy
Fragile X syndrome
Retinitis pigmentosa

57
Q

what are examples of diseases with parents of origin effect

A
  • Example: genetic imprinting (gene expression occurs from only 1 allele) (e.g. Prader-Willi syndrome/Angelman syndrome associated with loss of chromosomal region 15q11-13)
  • Paternal inheritance of deletion: Prader-Willi syndrome (language, motor, developmental delays, excessive weight gain)
  • Maternal inheritance of deletion: Angelman syndrome (severe mental retardation, happy demeanour, non-verbal)
58
Q

what is anencephaly caused by?

A

Failed closure of the rostral end of the neural tube → incomplete formation of the brain and skull → incompatible with life

59
Q

what is myeleminongocoele caused by?

A

Failed closure of the caudal end of the neural tube → open lesion or sac containing dysplastic spinal cord, nerve roots, meninges, vertebral bodies, and skin:
• Anatomic level of myelomeningocoele roughly correlates with patient’s neurologic, motor, and sensory deficits

60
Q

what do the TORCH Infections stands for?

A

Toxoplasmosis, Others, Rubella, Cytomegalovirus (CMV), Herpes simplex virus (HSV).

61
Q

Toxoplasmosis is caused by Toxoplasma gondii which is transmitted to humans from uncooked meats and inadvertent ingestion of oocytes in cat faeces:
• Transmission: transplacental spread, direct contact in birth canal
• Severity: depending on gestational period at which transmission occurs (more severe in the 1st trimester; higher risk of infection but milder in 3rd trimester)
• Effects: __________, ________, _________, ___________, ____________

A

encephalomyelitis, chorioretinitis, microcephaly, hydrocephaly, mental retardation

62
Q

what are the effects of primary vzv infection < 20 weeks?

A

Foetal varicella syndrome (2% risk): skin scarring (dermatomal distribution), eye defects (cataracts, chorioretinitis, micro-ophthalmia), limb hypoplasia, brain defects (microcephaly, cortical atrophy/mental retardation)

63
Q

what are the effects of primary vzv infection 20 - 36 weeks?

A

Not associated with adverse foetal outcomes → shingles may occur in the first few years of life

64
Q

what are the effects of primary vzv infection > 36 weeks?

A

Main risk in foetuses born between 2 days prior and 5 days after maternal rash develops → varicella of newborn (in up to 50%)
• Avoid elective delivery until 5 – 7 days after onset of maternal rash to allow passive transfer of maternal antibodies to child

65
Q

what are the effects of congenital rubella syndrome?

A

o Brain: Microcephaly, mental retardation
o Ears: Sensorineural deafness
o Eyes: Cataracts, glaucoma, chorioretinitis
o Heart: Patent ductus arteriosus, ASD and/or VSD
o Blood: Hepatosplenomegaly, thrombocytopenia, bone defects
o Skin: “Blueberry muffin” appearance of the skin

66
Q

whaat is the consequences of CMV?

A

CMV is the most common cause of congenital infection and non-hereditary deafness:
• Manifestations: hepatosplenomegaly, microcephaly, hyperbilirubinaemia, foetal growth restriction, thrombocytopenia
• Long-term sequelae: mental retardation, hearing difficulties, motor retardation

67
Q

what are the manifestations of foetal alcohol syndrome?

A

growth restriction, distinctive facial stigmata, permanent CNS damage, psychological/behavioural problems, primary cognitive and functional disabilities (poor memory, attention deficits, impulsive behaviour, poor cause-effect reasoning), secondary disabilities (predispose to mental health issues, drug addiction)

68
Q

what is the diagnostic criteria for level 1 foetal alcohol syndrome?

A

Confirmed maternal alcohol exposure

69
Q

what is the diagnostic criteria for level 2 foetal alcohol syndrome?

A

Dysmorphic features: short palpebral fissure, flattened upper lip, philtrum, midface

70
Q

what is the diagnostic criteria for level 3 foetal alcohol syndrome?

A

Foetal growth restriction (low birth weight for gestational age)

71
Q

what is the diagnostic criteria for level 4 foetal alcohol syndrome?

A

CNS involvement (structural brain abnormalities: microcephaly, corpus callosum agenesis, cerebellar hypoplasia)

72
Q

AEDs (e.g. phenytoin) increases the risk of _____________ and other problems:
• Increased risk with prenatal exposure, poly-therapy and higher doses • Principle of use: single agent at lowest possible dose to control epileptic patients

A

folic acid deficiency

73
Q

how to minimise risk to pregnancy?

A
  • Pre-conception folic acid 400μg/day till first 12 weeks of pregnancy → reduces the risk of neural tube defects
  • Avoid smoking → reduces risk of subfertility and obstetric complications (e.g. miscarriage, premature labour, low birth weight)
  • Avoid alcohol → reduces risk of foetal alcohol syndrome
  • Underweight: higher risk of subfertility, miscarriage, IUGR, children having long-term health issues (e.g. CVD, diabetes)
  • Overweight: higher risk of miscarriage, obstetric complications (e.g. gestational diabetes, pregnancy-induced hypotension, pre-eclampsia)
  • Consider the effect of pregnancy on the medical condition and vice versa → optimise medical condition prior to pregnancy to reduce risks

Woman's Health (29 decks)

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