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Fetal Growth And Development Flashcards

1
Q

What generally happens during the fetal period?

A

Growth and physiological maturation of the structures created during the embryonic period
Involves preparation for the transition to independent life after birth

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2
Q

When does crown-rump length increase the most?

A

During the pre-embryonic, embryonic and early fetal period

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3
Q

When is the rate of weight gain at its highest?

A

Mid and late fetal periods

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4
Q

What is deposited in the early and late fetal periods?

A

Early - protein deposition

Late - adipose deposition

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5
Q

How much of the lungs does embryonic development produce?

A

Bronchopulmonary tree

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6
Q

What are the names of the stages of development of the lungs and and which weeks is each one?

A

Pseudoglandular stage - week 8-16
Canalicular stage - week 16-26
Terminal sac stage - week 26-term

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7
Q

What happens during the pseudoglandular stage? (Week 8-16)

A

Duct system of the lungs begins to form within the bronchopulmonary segments created during the embryonic period to form bronchioles

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8
Q

What happens in the canalicular stage of development of the lungs (week 16-26)

A

Formation of respiratory bronchioles

Budding from bronchioles formed during the pseudoglandular stage

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9
Q

What happens during the terminal sac stage of development of the lungs?

A

Terminal sacs begin to bud from respiratory bronchioles
Get differentiation of type I and II pneumocytes
Surfactant production

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10
Q

How are the lungs prepared for birth during T2 and T3

A

Breathing movements to condition respiratory musculature

Fluid-filled which is crucial for normal lung development

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11
Q

What is the threshold of viability and when is it?

A

Viability only possible once lungs have entered the terminal sac stage of development
So after 24 weeks

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12
Q

What is respiratory distress syndrome?

How can you increase fetal surfactant production?

A

When babies are born pre-maturely, can have insufficient surfactant production
If preterm delivery it is unavoidable, give glucocorticoids to mother to increase fetal surfactant production

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13
Q

What is fetal bradycardia associated with?

A

Fetal demise

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14
Q

When does fetal kidney function begin?

A

Week 10

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15
Q

What happens if there is fetal kidney dysfunction?

A

Oligohydraminos

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16
Q

What can cause oligohydraminos?

A

Placental insufficiency

Fetal renal impairment

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17
Q

What can cause polyhydraminos?

A

Fetal abnormality eg inability to swallow

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18
Q

Which system is the first to begin development and last to finish?

A

Nervous system

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19
Q

When do corticospinal tracts begin to develop and what are they necessary for?

A

4th month

Required for co-ordinated voluntary movement

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20
Q

When does myelination of the brain begin?

A

9th month

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21
Q

When is first movement seen?

A

Week 8

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22
Q

What movements develop during the fetal period?

A

Suckling

Breathing

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23
Q

Implications of fetal movement?

A

Noticed by mother from week 17 onwards
Low cost simple method of ante-partum fetal surveillance
Reveals fetuses requiring follow up

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24
Q

Describe the development of the kidneys during the fetal period

A

Function after ascent is finished in week 10
Renal pelvis and calyces present by week 23
Histological differentiation of cortex and medulla is almost complete by 8 months

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25
What helps in placental transport of carbon dioxide?
Low maternal pCO2 cause by hyperventilation of mother driven by progesterone
26
If the fetus had an adult's circulation, what issues would there be?
Loss of oxygen to the liver Mix with deoxygenated venous blood from the body in the IVC Mix with deoxygenated blood from the head in the right atrium Lose oxygen in the lungs leaving desaturated blood for the brain
27
Where is blood from the umbilical vein delivered to?
The fetal hepatic portal vein
28
What shunts are present in the fetal circulation?
Ductus venosus to bypass liver Foramen ovale from IVC directed selectively to left atrium Ductus arteriosus from pulmonary artery to aorta distal to the branch to the head
29
For now long does the fetus make breathing movements each day?
1-4 hours
30
What are lungs filled with in utero?
Amniotic fluid
31
What is the purpose of amniotic fluid?
Surrounds the fetus to give mechanical protection, provide a moist environment
32
How much amniotic fluid is there at the different stages of development?
10ml at 8 weeks 1L at 38 weeks 300 ml at 42 weeks
33
How is amniotic fluid formed?
From maternal fluids and fetal extracellular fluid by diffusion across non-keratinised early on
34
At 25 weeks and term, how much urine does the fetus produce?
Around 100ml of hypotonic urine a day | About 500ml at term
35
Cycle of amniotic fluid?
Swallowed by fetus where it absorbs water and electrolytes Debris accumulates in the fetal gut Weed out
36
What does amniotic fluid contain?
Cells from the fetus and amnion and a variety of proteins
37
What does the debris from the amniotic fluid and fetal gut form?
Meconium
38
How is bilirubin excreted by the fetus?
Fetus cannot conjugate it so it crosses the placenta and is excreted by the mother
39
What can an ultrasound scan be used to do?
Calculate age Rule out ectopic pregnancy Number of fetuses Assess fetal growth and abnormalities
40
When is the ultrasound scan done?
At around 20 weeks
41
How often does the bladder of the fetus fill and empty?
Every 40-60 mins
42
What are the factors that affect viability of the pre-term neonate?
Threshold of viability Brain development - viable only if brain is sufficiently mature to control body function such as breathing Respiratory distress syndrome
43
List the techniques used to assess fetal development
``` Ultrasound scan Doppler ultrasound Non-stress test Biophysical profiles Fetal movements kick chart ```
44
What is the non-stress test?
Measures heart rate changes associated with fetal movement
45
What classes a fetus as having growth restriction?
If weight is less than the tenth percentile for gestational age
46
What is the difference between symmetrical and asymmetrical growth restriction?
Symmetrical: generalised and proportional Asymmetrical: abdominal growth lags but relative sparing of head growth
47
What can cause asymmetrical growth restriction?
Deprivation of nutrition and oxygen supply to fetus
48
How can the fetal age be estimated?
Duration of pregnancy Development criteria Symphysis-fundal height
49
Which weeks make up the fetal period?
9-38
50
What are some issues with using the duration of pregnancy as an estimation for the fetal age?
Fertilisation age - use of calendar months may cause inaccuracies Age since mother's last menstrual cycle (LMP) - irregular cycles can cause confusion
51
What are some development criteria for estimating the fetal age and when are some of them used?
``` Crown-rump length (CRL) used in T1 Foot length Biparietal diameter of head used in T2/3 Weight after delivery Appearance after delivery ```
52
What is the symphysis-fundal height?
Can measure distance between pubic symphysis to top of the uterus (fundus) with a tape measure
53
What are problems with using the symphysis-fundal height?
Multiple fetuses can cause variation | So can volume of amniotic fluid and the lie of the fetus
54
What are the daily rhythms of the fetus?
Daily rhythms of heart rate, breathing and activity | HR variability is a good index of developing control systems
55
What are the classifications for birth weights?
4500g = macrosomia (maternal diabetes)
56
What are the effects of the fetus of poor nutrition in early and late pregnancy?
Early - neural tube defects eg DiGeorge syndrome In late pregnancy - asymmetrical GR and subsequent oligohydraminos
57
What is the fetal pO2?
4kPa at most | 13.3kPa in adults
58
Difference between structure of adult and fetal haemoglobin?
Fetal haemoglobin has no beta chains | Therefore does not readily bind 2,3 BPG
59
How does fetal blood adapt to the low pO2?
Has a higher affinity for oxygen (70% saturated at 4kPa) | Has more haemoglobin
60
What factors increase oxygen transfer across the placenta?
Low diffusion resistance Partial pressure gradient (about 9kPa) High affinity of fetal haemoglobin
61
What determines the oxygen transport rate across the placenta?
Umbilical arterial pO2
62
How long would fetal stores of oxygen last for?
2 mins

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