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ESA 4 - Reproductive System > Fetal Growth and Development > Flashcards

Fetal Growth and Development Flashcards

1
Q

What is happening in the pre-embryonic period?

A

Lots of cell division

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2
Q

When is the pre-embryonic period?

A

Weeks 1-2

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3
Q

What happens in the embryonic period?

A

Growth and physiological maturation of the structures created during the embryonic period

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4
Q

When is the embryonic period?

A

Weeks 3-8

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5
Q

What is the embryonic period the stage of?

A

Greatest morphological change

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6
Q

What is the embryonic period characterised by?

A

Intense activity, as it is the organogenic period

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7
Q

What is meant by the organogenic period?

A

Building detailed stuctures from a few cells

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8
Q

How much absoloute growth is there in the embryonic period?

A

Very little

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9
Q

What is the fetal period?

A

The period involving preperation for the transition to independant life after birth

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10
Q

When is the fetal period?

A

Weeks 9-38

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11
Q

What is being grown towards in the fetal period?

A

The ability to survive after delivery

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12
Q

What happens to the rate of growth and weight gain in the fetal period?

A

They accelerate

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13
Q

How do the body proportions change in the fetal period?

A

At 9 weeks, the head is approx half of the crown-rump length, but thereafter the body length and limb growth accelerate, becasue development is in a head-to-tail fashion

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14
Q

When does crown-rump length increase rapidly?

A

In the pre-embryonic, embryonic, and early fetal period

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15
Q

What happens to weight gain throughout gestation?

A

It is slow at first, and then increases rapidly in the mid- and late-fetal periods

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16
Q

How much weight gain is there in the embryo?

A

Little weight gain, placental growth is most significant, and constitutes a large % of the weight gain

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17
Q

What is responsible for the weight gain in the early fetus?

A

Protein deposition to build the growing muscles

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18
Q

What is responsible for the weight gain in the late fetus?

A

Adipose deposition

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19
Q

What is the importance of adipose deposition in the late fetus?

A

Prepares it for life after the uterus

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20
Q
A
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21
Q

Why is adipose deposition required for life after the uterus?

A

Helps manage body temperature

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22
Q

What happens in an ante-natal assessment of fetal wellbeing?

A
  • Mother asked about fetal movements
  • Regular measurements of uterine expansion
  • Ultrasound scans
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23
Q

Why is it useful to ask the mother about fetal movements?

A

Mother will come to know the rhythm of the movements that the baby takes, and so can detect if their is a change

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24
Q

How is uterine expansion measured?

A

Symphysis-fundal height measured by palpation of pubic symphysis and fundus of uterus

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25
Q

Why are ultrasounds used in pregnancy rather than x-rays?

A

Because they are safe, and we don’t want to do anything that can damage the vulnerable fetus

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26
Q

What can ultrasound scans be used for in early pregnancy?

A
  • Calculate age
  • Rule out ectopic pregnancies
  • Check number of fetuses
  • Check fetal heart rate
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27
Q

Why is it important to check the fetal heart rate in early pregnancy?

A

Because fetal bradycardia can be a sign of impending fetal demise

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28
Q

When are ante-natal ultrasounds routinely performed?

A

20 weeks

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29
Q

What is being looked for at the 20 week ultrasound?

A

Fetal anomalies

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30
Q

Why can fetal anomalies be assessed at a 20 week ultrasound?

A

All major body systems have grown, so there are no further structural changes

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31
Q

What systems can be assessed at the 20 week ultrasound?

A
  • Brain ventricles
  • Heart chambers
  • Spinal cord development
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32
Q

Why is it important to check for spinal cord development at the 20 week ultrasound?

A

Look for signs of spina bifida

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33
Q

How can fetal age be estimated?

A
  • LMP
  • Developmental criteria
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34
Q

How is fetal age calculated from LMP?

A

Find out date of 1st day of LMP. and estimate ovulation from normal cycle length

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35
Q

What is the problem with calculating fetal age from LMP?

A

Prone to inaccuracies

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36
Q

Why is the calculation of fetal age from LMP prone to inaccuracies?

A
  • Cycle length can vary
  • Implantation bleeding happens at 14 days
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37
Q

What is the advantage of fetal aging using developmental criteria?

A

Allows accurate estimation of fetal age

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38
Q

What developmental criteria can be used to measure fetal age?

A
  • Crown-rump length
  • Bi-parietal diameter
  • Abdominal circumference and femur length
  • 3- or 4-D USS
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39
Q

When is crown-rump length used to estimate fetal age?

A

Betwen 7 and 13 weeks

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40
Q

What happens after 13 weeks, regarding using crown-rump length to estimate fetal age?

A

The relationship is less predicatble

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41
Q

What is the bi-parietal diameter?

A

The distance between parietal bones of the fetal skull

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42
Q

How is the measurement of bi-parietal diameter used?

A

In combination with other measurements to date pregnancies in T2 and Y3

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43
Q

Other than fetal aging, what is the use of bi-parietal diameter?

A

Can see ventricular system of the brain, therefore can look for any malformations

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44
Q

How is abdominal circumference and fermur length used?

A
  • In combination with BPD for dating and growth monitoring
  • Anomaly detection
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45
Q

What is the difference between 3D and 4D USS?

A

4D includes movement

46
Q

How is 3D and 4D USS used?

A

As a complimentary tool, not likely to replace standard USS

47
Q

What abnormality can be seen on 3D and 4D USS?

A

Can see cleft lip and palate

48
Q

What birth weight is considered to be average?

A

3500g

49
Q

What birth weight suggests growth restriction?

A

<2500g

50
Q

What birth weight is considered to be macrosomia?

A

>4500g

51
Q

What is the most common cause of macrosomia?

A

Poorly controlled maternal diabetes

52
Q

Are all factors that influence birth weight pathological?

A

No

53
Q

Why may babies have a low birth rate?

A
  • Premature, and they are the normal weight for their gestational age
  • Constitutionally small
  • Suffered growth restriction
54
Q

Why may a baby be constitutionally small?

A

Small mothers tend to have small babies

55
Q

Why do we want to try and identify babies that have suffered growth restriction during antenatal screening?

A

Because it is associated with neonatal morbidity and mortality

56
Q

Why do the lungs develop relatively late?

A

Beause they have no function during embryonic life

57
Q

What does embryonic development create, regarding the lungs?

A

Only the bronchopulmonary tree

58
Q

What is the respiratory diverticulum made of?

A

Endoderm tissue that buds off from the primitive gut tube

59
Q

How is the respiratory diverticulum and the gut tube seperated?

A

Tracheoesophageal septum is formed to seperate the tracts

60
Q

When does functional specialisation of the respiratory system occur?

A

In the fetal period

61
Q

What are the stages of functional specialisation of the lungs?

A
  • Pseudoglandular stage
  • Canalicular stage
  • Terminal sac stage
62
Q

When is the pseudoglandular stage?

A

Weeks 8-16

63
Q

What happens in the pseudoglandular stage?

A

Begin to develop a series of primitive ducts within the broncopulmonary segments created during the embryonic periods, getting down to the formation of bronchioles

64
Q

When is the canalicular stage?

A

Weeks 16-26

65
Q

What happens in the canalicular stage?

A

Formation of respiratory bronchioles

66
Q

How are respiratory bronchioles formed in the canalicular stage?

A

Bud off from the bronchioles formed during the pseudoglandular stage

67
Q

When is the terminal sac stage?

A

Week 26-term

68
Q

What happens in the terminal sac stage?

A

Terminal sacs begin to bud off from the respiratory bronchioles, and differentiation of type I and II pneumocytes

69
Q

What do type II pneumocytes produce?

A

Surfactant

70
Q

What does the terminal sac stage allow?

A

The respiratory system to function as a gas exchange membrane

71
Q

What does the fetal development of the lungs have major implications for?

A

Pre-term survival

72
Q

Why does the development of the lungs have major implications for pre-term survival?

A

Because the baby cannot surviva without a membrane for exchanging gas

73
Q

Why can’t the threshold of viability be continuously pushed back?

A

Since there is a limit beyond which the lungs will not be sufficiently developed to sustain life

74
Q

When is a fetus viable?

A

Only once the lungs have entered the terminal sac stage of development, at 24 weeks

75
Q

What often affects infants born prematurely?

A

Respiratory distress syndrome

76
Q

What causes respiratory distress syndrome?

A

Insufficient surfactant production due to there not being enough type II pneumocytes

77
Q

What can be done if a pre-term delivery is unavoidable or inevitable?

A

Give glucocorticoids treatment to mother

78
Q

How does giving glucocorticoid treatment to the mother help prevent respiratory distress syndrome?

A

Pushes fetal type II pneumocytes to produce more surfactants, allowing for mitigation of some of the consequences of pre-term delivery

79
Q

How is gas exchange conducted during T2 and T3?

A

At the placenta

80
Q

When must the lungs be prepared to assume the full burden of gas exchange?

A

At birth

81
Q

How are the lungs prepared to take the full burden of gas exchange at birth?

A

Breathing movements

82
Q

What is the importance of breathing movements of the fetus?

A

Conditions the respiratory musculature- the diaphragm and intercostals

83
Q

What does the fluid filling the lungs contain?

A

Growth factors

84
Q

What is the fluid filling the lungs crucial for?

A

Normal lung development

85
Q

What is the fetal cardiovascular system arranged to do?

A

Ensure that oxygenated blood collected by the umbilical vein at the placenta is circulated around the fetus

86
Q

When is the definitive fetal heart rate reached?

A

Around 15 weeks

87
Q

What is the definitive fetal heart rate?

A

110-140BPM

88
Q

What is fetal bradycardia associated with?

A

Fetal demise

89
Q

When does fetal kidney function begin?

A

In week 10

90
Q

What is the importance of fetal urine?

A

It is a major contributor to amniotic fluid volume

91
Q

Theorectically, what would happen if a fetus had no kidney function?

A

Fetal kidney function is not necessary for survival in utero, but without it there is oligohydramnios

92
Q

Why is fetal kidney function not necessary for survival in utero?

A

Because placenta is doing the renal function

93
Q

What is oligohydramnios?

A

Too little amniotic fluid

94
Q

What could oligohydramnios be due to?

A

Placental insufficiency

95
Q

Why can placental insufficiency cause oliohydramnios?

A

Because very early in pregnancy, placental membranes are responsbile for AF production

96
Q

Give an example of a condition that would give fetal renal impairment?

A

Bilateral renal agenesis, which is incomptaible with life

97
Q

What is polyhydramnios?

A

Too much amniotic fluid

98
Q

What can cause polyhydramnios?

A
  • Sometimes idiopathic
  • Fetal abnormality, e.g, inability to swallow
99
Q

How does the timing of nervous system development compare to the other systems?

A

First to begin development, last to finish

100
Q

When does fetal movement begin?

A

8th week

101
Q

What happens, regarding fetal movements, from the 8th week onwards?

A

A large repertoire of movements development

102
Q

What is the importance of the development of a large repertoire of movements in fetal life?

A

Practicing for post-natal life

103
Q

Give two examples of movements a fetus might perform to practice for post-natal life

A
  • Suckling
  • Breathing
104
Q

When does corticospinal tract development begin to form?

A

In the 4th month

105
Q

What are corticospinal tracts required for?

A

Coordinated voluntary movements

106
Q

When does myelination of the brain begin?

A

In the 9th month

107
Q

What evidence is there for corticospinla tract myelination being incomplete at birth?

A

Increasing infant mobility in the 1st year, with babies not being able to walk until a year old

108
Q

What is the implication of development of the fetal nervous tract?

A

‘Quickening’

109
Q

What is quickening?

A

Maternal awareness of fetal movements

110
Q

When does maternal awareness of fetal movements begin?

A

17 weeks onwards, but later in first pregnancy, earlier in later pregnancies

111
Q

How can quickening be used clinically?

A

It is a low cost, simple method of ante-partum fetal surveillance

112
Q

How can quickening be used in fetal surveillance?

A

Can report changes in pattern of movement, and reveal fetuses requiring follow up

ESA 4 - Reproductive System (31 decks)

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