Endo-Repro L26 The Fetus and its Preparations for birth:

Question 1

Pattern of fetal growth is: Determined by

Answer 1

Genome of fetus

Question 2

Pattern of fetal growth is: Modulated by

Answer 2

Placenta
Hormones
Environment
•	Nutrition
•	Health
Metabolic

Question 3

Pattern of fetal growth is: Hormones

Answer 3

Glucocorticoids, insulin
Insulin-like growth factors (IGFs or sometomedins)
Thyroid hormones
Human placental lactogen

Question 4

Growth Retardation → IUGR

Answer 4

Defined as birth weight that is more than two standard

Question 5

Types of IUGR

Answer 5

Type 1 → symmetric
Type II → Asymmetric
Intermediate IUGR

Question 6

Type 1 (symmetric IUGR )

Answer 6

Decreased growth potential ~20%

Question 7

Type II (asymmetric) IUGR

Answer 7

Restricted growth ~ 70% cases

Question 8

Intermediate IUGR

Answer 8

Combination of types I and II

Question 9

The human placental interface →

Answer 9

Maternal and fetal circulations pass close to each other, but do not mingle, to facilitate the exchange of materials.

Question 10

Transport Across the placenta types:

Answer 10

1. Transported intact
2. Partially consumed
3. Metabolised
4. Not Transported

Question 11

The Oxyhaemoglobin Dissociation Curve and the Bohr Effect →

Answer 11

The oxygen–hemoglobin dissociation curve plots the proportion of haemoglobin in its saturated form on the vertical axis against the prevailing oxygen tension on the horizontal axis.

Question 12

Rightward shift → decreased affinity

Answer 12

• This makes it more difficult for haemoglobin to bind to oxygen (requiring a higher partial pressure of oxygen to achieve the same oxygen saturation)
• It makes it easier for the haemoglobin to release oxygen bound to it.
• The effect of this rightward shift of the curve increases the partial pressure of oxygen in the tissues when it is most needed, such as during exercise, or haemorrhagic shock.

Question 13

The Double Bohr Effect:

Answer 13

• Fetal demand for oxygen regulates fetal oxygenation.

* Increased ph leads to a left shift of curve and an increased affinity for oxygen uptake.

Question 14

Fetus capacity for gluconeogenesis

Answer 14

Little

Question 15

Glucose supply

Answer 15

Maternal

Question 16

Maternal glucose levels depend on

Answer 16

Nutrition

Endocrine control mechanisms

Question 17

Early pregnancy Glucose and Carbohydrates:

Answer 17

Progesterone:

1. Increases maternal appetite
2. Builds fat stores

Question 18

Late pregnancy Glucose and Carbohydrates:

Answer 18

Maternal tissues insulin insensitive:

1. More glucose available to fetus
2. Diabetes mellitus may develop in mother

Question 19

Glucose storage provides for

Answer 19

The metabolic neds of the newborn baby until feeding begins

Question 20

Glycogen is stored

Answer 20

In the liver and cardiac muscle

Question 21

Glycogen and Fat: Regulated by

Answer 21

Fetal adrenal cortex

Question 22

Which organ has no glycogen stores

Answer 22

The brain

Question 23

What regulates fetal fat stores

Answer 23

Insulin

Question 24

White fat stores

Answer 24

Fatty acids

Question 25

Brown fat

Answer 25

Heat generation (Nonshivering thermogenesis)

Question 26

Brown fat plays a crucial role in

Answer 26

Maintaining body temperature of the newborn baby after birth

Question 27

Brown fat location

Answer 27

Head, neck, back and chest

Question 28

White fat location

Answer 28

Lower back and buttocks

Question 29

Amino acids

Answer 29

No increase in materal protein intake | Progesterone increases maternal metabolism efficiency

Question 30

Fatty acids

Answer 30

Mother accumulates lipids in early pregnancy | Placental transfer and fetal synthesis meet fetal demands

Question 31

Salt and water

Answer 31

Oestrogen and progesterone stimulate maternal retention | Water exchanges at placenta and non-placental chorion

Question 32

Iron

Answer 32

Fetal blood has a 2-3 times higher concentration of iron | Maternal iron absorption is enhance

Question 33

Calcium

Answer 33

Fetal ossification demands much calcium from mother | Maternal absorption of calcium is more efficient

Question 34

Fetal development requires

Answer 34

Folic acid and vitamin B12

Question 35

Folic acid

Answer 35

Amino acid metabolism

Question 36

Vitamin B12 Made by Provided by

Answer 36

Fatty acid and amino acid metabolism | Provided at expense of maternal stores

Question 37

Recommended weight gain

Answer 37

11.5-16 kg

Question 38

Weight gain from Intrauterine contents:

Answer 38

Fetus → 3.3 kg Placenta → 0.7 kg Amniotic fluid → 1.0kg

Question 39

Weight gain maternal contribution

Answer 39

Uterus → 0.7 kg Blood → 1.3 kg Breasts →2.0 kg Adipose tissue and interstitial fluid → 5.0 kg

Question 40

Response of the Mother to Pregnancy: Cardiovascular changes

Answer 40

Blood volume expands | Cardiac output increases

Question 41

Response of the Mother to Pregnancy: Respiratory system

Answer 41

Alveolar ventilation increases

Question 42

Response of the Mother to Pregnancy: Nutrition

Answer 42

Maternal diet should be supplemented with iron and folic acid