Embryology and Pregnancy Flashcards by Luke Cielonko

Finding of Low Alpha Fetoprotein in amniotic fluid

Down syndrome

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What is derived from the 3rd and 4th laryngeal pouches

1) Thymus

2) Parathyroid glands

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What is derived from Ratchkes pouch

Adenohypophysis

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Component of pulomonary surfactant

Phosphatidylcholine (lecithin)

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Used to measure the fetal lung maturity

Lecithin/sphingomyelin ration (L/S)

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At what week should the L/S ratio be 2:1

35th week

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What component from the mother exerts the greatest effect on the L/S ratio?

1) Cortisol

2) Cortisol has the greatest effect on increasing surfactant production

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What is the processus vaginalis?

It is the invagination of the peritoneum that takes place when the testicles descend

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What occurs when the processus vaginalis remains?

1) Persistent connection between scrotum and peritoneal cavity

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What occurs in week 2 of early development of the fetus?

1) Development of the bilaminar disc

2) Consists of 2 layers (hypoblast and epiblast)

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What occurs in week 3 of early development of the fetus?

1) Development of the trilaminar disc
2) Consists of 3 layers (Ectoderm, Mesoderm, and endoderm)
3) Gastrulation

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Process that forms the trilaminar embryonic disc. Establishes the ectoderm, mesoderm, and endoderm germ layers

Gastrulation

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How does gastrulation begin?

1) Invagination of the epiblast

2) Forms the primitive streak

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What does the ectoderm consist of?

1) Surface ectoderm
2) Neuroectoderm (CNS)
3) Neural crest cells (PNS)

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What does the mesoderm consist of?

1) Muscle
2) Bone
3) Cardiac
4) Renal
5) Vasculature
6) Adrenal cortex
7) Dermis

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What does the endoderm consist of?

1) Gut tube epithelium

2) Luminal epithelium

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What are the pharyngeal clefts derived from? Archs? Pouches?

1) Clefts = ectoderm
2) Arches = mesoderm
3) Pouches = endodermd

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When does the heart begin to beat in the fetus?

Week 4

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What does the first pharyngeal cleft develop into?

External auditory meatus

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What does the 1st pharyngeal arch become?

Chew

1) Muscles for mastifiction
2) CN V2 and V3
3) Meckles cartilage (manible, malleus, incus, sphenomandibular ligament

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What does the 2nd pharyngeal arch become?

Smile

1) Reichert’s cartilage: stapes, styloid process
2) CNVII
3) Muscles: muscles of facial expression

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What does the 3rd pharyngeal arch become?

Stylishly swallow

1) Muscles: Stylopharyngeus
2) CN IX (glossopharyngeal nerve)

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What does the 4th-6th pharyngeal arches become?

Simply swallow and speak

1) Cartilages: thyroid, cricoid, arytenoids
2) 4th = pharyngeal constrictors; 6th = intrinsic muscles of larynx
3) 4th = CN X, 6th = CN X

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What do the pharyngeal pouches develop into?

Ear, Tonsil, Bottom to Top
1st pouch = middle ear cavity and eustachian tube
2nd pouch = epithelial lining of palatine tonsil
3rd pouch = inferior parathyroids and thymus
4th pouch = superior parathyroids

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Agenesis of 3rd and 4th pharyngeal pouches?

Di George syndrome 1) Hypocalcemia 2) Immunosuppressed 3) Cardiac defects

What embryological structure develops into the female reproductive structures?

Paramesonephric (Mullerian) duct

How does male development occur in fetus?

1) Y chromosome carries the SRY gene which produces testis-determining factor 2) Sertoli cell secrete Mullerian inhibitory factor (MIF) that suppress the development of the paramesonephric duct

What secretes androgens to stimulate development of the mesonephric duct?

Leydig cells

What do Sertoli cells produce early on in development of a fetus sex?

Mullerian inhibitory factor

Describe the early development of the fetus from week 1 to 10

1) Week 1 = hCG secretion after implantation 2) Week 2 = bilaminar disc development 3) Week 3 = trilaminar disc development/gastrulation 4) Week 3-8 = Organogenesis; susceptible to teratogens 5) Week 4 = heart beats and limbs develop 6) Week 8 = fetal movment 7. Week 10 = genitalia have characteristics

When is the fetus most susceptible to teratogens?

3rd-8th week

What do the following teratogens do to the fetus? 1) ACE inhibitor 2) Alkylating agents 3) Aminoglycosides 4) Carbamazepine (anti-convulsant) 5) Diethylstilbestrol 6) Warfarin 7) Heparin

1) Renal damage 2) Absence of digits, multiple anomalies 3) CN VIII toxicity 4) Neural tube defects (spina bifida) 5) Vaginal Clear cell adenocarcinoma and T shaped uterine cavity 6) Stippled epiphyses and nasal hypoplasia 7) Prematurity and fetal demise

What do the following teratogens do to the fetus? 1) Folate antagonists 2) Lithium 3) Phenytoin and Diphenylhydantoin 4) Tetracylcine 5) Thalidomide 6) Lisinopril 7) Valproic acid 8) Retinoids (Isotretinoin or Etritinate)

1) Neural tube defect 2) Ebstein's anomaly (atrialized right ventricle) 3) Fetal hydantoin syndrome 4) Discolored teeth 5) Limb defect (flippers) 6) Fetal mortality 7) Neural tube defect, cardiac, and skeletal abnormalities 8) Ear defects, blindness

What do the 1-4,6 aortic arch derivatives become?

1) 1= maxillary artery 2) 2 = Stapedial 3) 3 = Common Carotid and part of internal carotid 4) 4 = Right subclavian and Left part of aortic arch 5) 6 = Proximal part of pulmonary arteries and ductus arteriosus

What does the Wolffian duct make up?

SEED 1) Seminal vesicles 2) Epididymis 3) Ejaculatory duct 4) Ductus deferens

What is the triple marker screen?

1) alpha fetoprotein 2) hCG 3) Uncongugated estriol

External intestines with no peritoneal lining

Gastrochisis

External intestines with peritoneal lining

Omphalocele

Low triple marker screen

Edward's syndrome (trisomy 18)

Craniofacial defects, mitral regurgitation, other cardiac problems

Fetal Alcohol syndrome

Rupture without signs of labor

Premature rupture of membranes (PROM)

Death of fetus past 20 weeks of gestation

Intrauterine Fetal demise

What are women with intrauterine fetal demise at an increased risk for?

DIC

Difficult delivery of the shoulder lasting at least 60 seconds from when the head delivers

Shoulder Dystocia

Number of times a pt. has been pregnant

Gravida

Number of times a person has delivered

Para

Greater than 37 week delivery

Term

Delivery between 20-36.6 weeks

Preterm

Pregnancy ending prior to 20 weeks

Abortions

What are the numbers after Para?

Texas Power And Light1) Term2) Preterm3) Abortion4) Living

How do you determine due date?

9 months plus 7 days

What are uterine factors for spontaneous abortion?

1) Cervical incompetence2) Congenital Abnormal Uterus3) Fibroids4) Intrauterine adhesions (Ashermann syndrome)

What do these disease have in common? (Sickle cell anemia, CF, Tay-Sach, Thallasemia

Autosomal recessive

What do these diseases have in common? (Tuberous sclerosis, neurofibromatosis, achondroplasia, craniofacial synostosis, adult onset polycystic kidney disease)

Autosomal dominant

Premature separation of the implanted placenta

Abruptio Placentae

What are the clinical findings of Abruptio placentae?

1) Painful vaginal bleeding 2) Uterine tenderness 3) Hyperactivity 4) Increased uterine tone

How is Abruptio placentae diagnosed?

Diagnosed based on clinical findings

What are complications of Abruptio placentae?

1) Hypoxia and fetal death 2) DIC 3) Hypovolemic shock 4) Acute renal failure 5) Sheehan's syndrome

Complete separation of the uterine musculature through all of its layers leading to fetus being extruded from the uterine cavity; sudden onset of abdominal pain, abnormal fetal heart pattern

Uterine rupture

Describe the Apt Test?

1) Test used to determine origin of blood 2) Blood is obtained from the vagina and placed in tap water 3) KOH is added 4) Brown = mom; Red = fetus

Loss of 500 mL after vaginal delivery or 1000 mL after Cesarean delivery

Postpartum Hemorrhage

Most common cause of postpartum hemorrhage

Uterine Atony

Differential for Postpartum Hemorrhage

1) Uterine atony 2) Genital tract trauma 3) Retained placental tissue 4) Uterine inversion 5) Low placental implantation 6) Coagulation disorder 7) Abruptio placentae

Differential for Antepartum Hemorrhage

1) Placenta previa 2) Abruptio placentae 3) Uterine rupture 4) Fetal vessel rupture

What is the most common cause of Abruptio placentae?

Maternal Hypertension

painful vaginal bleeding in associate with uterine tenderness, hyperactivity and increased tone

Abruptio placentae

Treatment for uterine rupture

Total abdominal hysterectomy

Fever and increasing uterine tenderness after postpartum day 2-3

Puerperal sepsis

What is the management for preterm labor?

1) Culture 2) Steroids (used for fetal lung maturity) 3) Tocolysis

What is a tocolytic?

1) Magnesium sulfate- competes Ca

What are post-term pregnacies at risk for?

1) Fetal mortality | 2) Meconium is more common

How much weight should a woman gain during pregnancy?

10-40lbs

What is placenta accreta? increta? percreta?

1) attachment to myometirum 2) Invading the myometrium 3) attchement through the myometrium to the serosa

What is the most common cause of DIC in pregnancy?

Abruptio Placentae

When unprotected vessels pass over the cervical os

Vasa previa

Pulmonary hypoplasia, limb deformaties, and characteristic facies due to oligohydramnios; occurs with renal agenesis

Potter syndrome

New onset of hypertension prior to 20 weeks gestational age; >140/90

Gestational hypertension

What are cystic hygromas associated with?

Turner syndrome

Mass composed of cystic spaces of connective tissue rich in lymphoid aggregates associated with turner syndrome

Cystic hygroma

What are the complications of Turner syndrome?

1) Webbed neck 2) Primary amenorrhea 3) Low hair line 4) Cystic hygroma 5) Lymphedema 6) Shield chest 7) Short stature

What do neural crests become?

1) Enteric nervous system 2) Adrenal medulla chromaffin cells 3) C cells of thyroid 4) Atrioventricular and aorticpulmonary septae 5) CN

What is the FGF gene important for?

Limb lengthening | 1) Defect observed in achondroplasia

What is the sonic hedgehog gene important for?

CNS development

What is the Wnt-7 gene important for?

Organization along dorsal-ventral axis

What is the result of a defective Hox gene

appendages in wrong locations

What defect has occured if pt. has primary ammenorrhea but secondary sex characteristics?

Failure of Mullerian ducts to fully develop

21 day old boy has palpable swelling in neck, feeds well, Favors looking toward right, firm swelling on the left side of neck that does not move when swallowed; no other findings

Torticollis

Cause of torticollis

Intrauterine malposition

Failure of the maxillary prominence and medial nasal prominence to fuse

Cleft lip

Failure of the intermaxillary segment and maxillary prominences to fuse

Cleft palate