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OB > fetal growth and development > Flashcards

fetal growth and development Flashcards

1
Q

role of the placenta

A

secretion of peptides
steroid secretion
helps protect the fetus from rejection

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2
Q

gestational age

A

dated from the last day of LMP

precedes conception (occurs 2 weeks later)

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3
Q

Nagle’s rule

A

+7 days to the LMP date, - 3 months = EDD

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4
Q

how many woman deliver on their due date

A

Only 4% of women deliver on their due date

37 weeks -42 weeks

more of a window

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5
Q

changes in the placenta over time

A

stops doing gas exchange as well

becomes more calcified

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6
Q

first trimester is how many weeks from conception

sxs of 1st trimester improve around

A

first trimester 1
10 weeks from conception

fatigue
nausea
low energy

improves by 12 weeks

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7
Q

Fertilization

A

Formation of zygote (fusion of female and male pronuclei)

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8
Q

Division of zygote into ____ cells, then 12 cell ______

A

Division of zygote into blastomere cells, then 12 cell morula

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9
Q

formation of a blastocyst leads to the..

A

Trophoblastic cell secretes hCG to maintain corpus luteum, which secretes estrogen/progesterone to prevent menstruation

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10
Q

implantation occurs at the day___ of the cycle and at this location

A

upper endometrial epithelium

day 8 or 9

can have light bleeding

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11
Q

on the 5th day of fertilization the morula becomes a

A

blastocyst

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12
Q

implantation and development

A

Embryonic laminar develop, start of amniotic cavity and yolk sac, the primitive respiratory/digestive system

b. 2 flat layers of cells
c. The first of 3 germ layers

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13
Q

embryonic period begins at the ____ week of gestation

A

week three

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14
Q

3 germ layers

A
  • Ectoderm
  • Mesoderm
  • Endoderm
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15
Q

ectoderm develops into

A
  • Skin of ext genitalia
  • Lower 1/3 of anal canal
  • Nervous system primitive streak->neural tube
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16
Q

Epithelium of gonads, ureters, reproductive duct develops from

A

• Mesoderm

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17
Q

•Lower 1/3 of anal canal develops from

A

ectoderm d

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18
Q

Most muscle tissue, all connective tissue develops from

A

• Mesoderm

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19
Q

GI tract, epithelium develops from

A

• Endoderm

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20
Q

Urinary bladder, anorectal canal develops from

A

• Endoderm

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21
Q

Skin of ext genitalia develops from

A

• Ectoderm

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22
Q

Nervous system primitive streak->neural tube develops from

A

• Ectoderm

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23
Q

Lymph tissue, spleen, blood cells develops from

A

• Mesoderm

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24
Q

Dermis of skin, teeth (except enamel) develops from

A

• Mesoderm

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25
Q

Epithelium of gonads, ureters, reproductive ducts develops from

A

• Mesoderm

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26
Q

CR length 4mm at ___ weeks gestation

A

v. 4 weeks gestation

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27
Q

4 weeks gestation 4 developmental milestones

A
  1. Heart starts beating, neural folds fusing
  2. Disc becomes cylindrical
  3. Buds of arms, ears, legs and facial/neck structures
  4. Otic pits form
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28
Q

Brain development, head large relative to truck

A

week fiver

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29
Q

Neck, eyelids, genital tubercle (not differentiated yet)

A

Week seven

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30
Q

Nose, mouth and palate, CR=1cm

A

week six

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31
Q

Distinctly human form by

A

week seven

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32
Q

primitive mouth seen at

A

week five

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33
Q

, fetal period begins at

characterized by

A

week 8

Has or male female characteristics

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34
Q

by end of first trimester, fetus

A

can make respiratory movements, urinate, swallow, move limbs, squint and frown and open mouth

Beginnings of all structures present

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35
Q

13-15 week land marks

A

rapid fetal growth, nails, limb movements, scalp hair pattern, head erect, eyes in position on face

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36
Q

CRL at 16-18 weeks

A

CRL 4.5-6 inches,

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37
Q

rapid fetal growth, nails, limb movements, scalp hair pattern, head erect, eyes in position on face

A

• 13-15 weeks

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38
Q

fetus heart sounds

A

20-25 weeks

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39
Q

vernix caseosa

A

• 16-18 weeks

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40
Q

lanugo, eyebrows, hair

A

20-25 weeks

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41
Q

testes beginning to descend

A

• 16-18 weeks

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42
Q

can hear sounds at

A

20-25 weeks

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43
Q

typical weight at 20-24weeks

A

600g

24 weeks in viability here

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44
Q

lungs secrete surfactant

A

22-24 weeks

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45
Q

Blink/startle responses

A

22-24 weeks

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46
Q

REM sleep begins at

A

20-25 weeks

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47
Q

demands of the pregnancy are highest during ___ and result in

A

3rd trimester

we see gestational DM here

48
Q

eyelashes, descent of testes

A

• 26-29 weeks

49
Q

26-29 weeks weight and length

A

weight 1050g, 37cm

50
Q

26-29 weeks we see lung development and survival here

A

lungs capable of breathing but surfactant low, survival 90% at 28 weeks.

51
Q

30-34 weeks development

A

pupils respond to light, skin smooth and pink. 1700g at 32 weeks

52
Q

35-38 weeks last things to develop

A

fetus orients to light, and has a firm grasp. 36 weeks – lungs mature, skin loses wrinkled appearance,

53
Q

head and abdomen circumference around 35-38 weeks

A

head/abdomen circumferences equal, fetus start to get “plump”

54
Q

BPD stands for

A

bi parietal diameter

usually in newborns at term BPD 9.5 cm (hence the need for cervical dilation to 10 cm)

55
Q

normal growth is dependent on

A

genetically predetermined

modulation by
the health of the fetus, placenta and
mother

56
Q

first 16 weeks growth is mainly

A

Cellular hyperplasia (first 16 weeks)

57
Q

weeks 16-32 growth looks like

A

Concomitant hyperplasia and hypertrophy (weeks 16-32)

58
Q

32 weeks to term growth looks like

A

Cellular hypertrophy

59
Q

7 factors that directly influence growth

A
  1. Poverty
  2. Maternal age
  3. Substances – drugs, EtoH, nicotine
  4. Maternal nutrition
  5. Disease
  6. Psychological effects on pregnancy
  7. Environmental toxins
60
Q

how can you determin

A

• Using hx, LMP, early US

(CRL more accurate than gestational sac diameter, yolk sac visible at 5 weeks

61
Q

Cardiac activity establishes GA of _____

A

Cardiac activity establishes GA of 5.5-6 weeks

62
Q

how do we measure fetal growth

A

• Head circumference, femur length, abd circumference

63
Q

naval height of fundus

A

20 weeks

grows about a cm a week

64
Q

after 20 weeks ow do we monitor growth

A
  • Monitor weight gain
  • Measure uterine size/fundal height at each visit
  • Serial US as needed
65
Q

reasons for the size being bigger than the date

A

Inaccurate dating

Large for gestational age (LGA)

Multiple gestation

Polyhydramnios – too much amniotic fluid

Molar pregnancy (1st tri)

Uterine anomaly (fibroid)

Congenital anomaly

66
Q

if the size is smaller than the date (6)

A

Inaccurate dating

Intrauterine growth restriction (IUGR)

Oligohydramnios – not enough amniotic fluid

Congenital anomaly

Chronic maternal disease

Viral infection- think TORCH

67
Q

Birth weight >90th percentile

A

over 4000g (8lbs 13oz)

ACOG suggests >4500g

68
Q

Macrosomia

A

grades 1-3

(birth weight >4000g)

this usually means a edematous

69
Q

incidence of macrosomia

A

iii. Incidence – about 7% American babies (2008)

70
Q

RF for macrosomia

A
  1. Mothers who were LGA/obese/excessive wt gain
  2. GDM
  3. Postdates
  4. H/o large babies/previous macrosomic infant
  5. Male sex
  6. Race (Hispanic/African American)
  7. Genetic abnormalities/syndromes (Beckwith-Wiedermann)
71
Q

CPD complications

A

Cephalopelvic disproportion (CPD)

Labor dystocia/prolonged labor

Shoulder dystocia, birth injuries

Maternal soft tissue damage/lacerations

Increased C/S

72
Q

LGA complications other than CPD

A
  1. Postpartum hemorrhage
  2. Stillbirth, esp with grade 3 macrosomia (5000g)
  3. Neonatal complications
73
Q

Neonatal complication

A

a. Low Apgar, need for mechanical ventilation, RDS
b. Hypoglycemia, perinatal asphyxia
c. Hematologic abnormalities/polycythemia

74
Q

prenatal management of LGA

A
  1. Screen for GDM if not already done
  2. US to r/o polyhydramnios, molar pregnancy, fibroids
  3. Serial US to monitor growth
  4. Anticipate cephalopelvic disproportion (CPD) and sequelae
  5. Anticipate shoulder dystocia
  6. Anticipate postpartum hemorrhage
  7. Offer delivery at 38 wks if possible macrosomia
  8. Offer elective C/S
  9. Alert peds at delivery
75
Q

PROGNOSIS of LGA

A
  1. Risk of subsequent LGA baby
  2. Increased risk of diabetes eventually in child
  3. Neonatal complications and sequelae
  4. Increased risk of obesity, insulin resistance, hyperlipidemia, CV disease? in child
76
Q

IUGR

what is it and why is it significant

A

Intrauterine Growth Restriction/FGR (Fetal Growth Restriction)

i. Impaired or restricted intrauterine growth
ii. Significant because there is an inverse relationship between fetal/neonatal weight percentile and perinatal mortality

77
Q

how os SGA different

A

SGA is

Neonatal diagnosis of size below the 10th percentile

Usually genetic or due to inadequate nutrition

Baby that is around a 1000g has much less risk of mortality

78
Q

IUGR RF

A
  • Poor nutrition/weight gain
  • Vascular disease/HTN
  • Renal disease
  • Infection
  • Genetic abnormality
  • Multiple gestation
  • Placental problems • Pregestational diabetic
  • Drug use/smoking/EtoH
  • Hypoxemia/anemia
  • Late onset prenatal care
  • Low SES
  • Prothrombotic disorders
  • ART (in vitro)
79
Q

types of IUGR and which is more serious, which is more common

A

symmetric and asymmetrical

symmetric is more serious but less common

80
Q

picture os symmetric IUGR

A

20-25% . of IUGR

  1. Compromised growth in length, head circumference and weight
  2. More likely to have permanent neuro sequelae
  3. Often d/t TORCH infections
  4. D/t Chromosomal abnormalities
  5. Substance abuse
81
Q

asymmetrical IUGR picture

A

MORE COMMON b/c head size is preserved but body can be small

  1. Decreased length and weight, but normal head circumference aka head-sparing (lack of fat, normal growth first 2 trimesters)
    a. D/t reduction in nutrients
  2. HTN, malnutrition, Pre-eclampsia
82
Q

complications with IUGR

A
  1. Increased risk fetal distress
  2. Meconium staining
  3. Increased perinatal morbidity and mortality
83
Q

complications specifically with meconium staining

A

a. When baby is stressed, they let go of their bowel

b. The sticky bowel doesn’t let the lung inflate and causes respiratory distress

84
Q

maternal causes of IUGR

A

Poor weight gain, anemia, drugs/EtoH, smoking, HTN, GD, celiac disease, poor nutrition

a. Mom should be gaining about 1 lb per week

85
Q

Uteroplacental causes of IUGR

A

Pre-eclampsia, multiple gestation/Twin to twin transfusion syndrome, uterine malformations,

placental insufficiency (abruption life threatening)
anemia
SSD
toxins 
single uterine atery
86
Q

fetal etiology of IUGR

A

vertically transmitted infections, chromosomal abnormalities

87
Q

DX IUGR

A
  1. Careful menstrual/medical/OB hx
  2. Accurate dating/early ultrasound
  3. Monitor for adequate weight gain
  4. Carefully evaluate fundal height changes
  5. 2 U/S 4 wks apart to confirm
88
Q

Carefully evaluate fundal height changes involves

what is suspiciously slow growth look like

A

a. Watch for “progressive” growth

b <2cm in 4 wks is suspicious

c. If possible, single, consistent examiner

89
Q

ULS tracking of IUGR

A

a. Esp head and abdominal circumference

b. AFI check to r/o oligohydramnios (not enough fluid)

90
Q

oligohydramnios causes

A

most fluid is from the fetal kidneys

renal issues can cause low fluid levels

91
Q

management of IUGR in mom

A
  1. Limit activity/bed rest so that the mom is not using extra calories and it can go to the baby for growth
  2. Nutrition
  3. Cessation of smoking
  4. Fetal surveillance
  5. Delivery of compromised fetus
92
Q

Fetal surveillance looks like

A

a. Repeat U/S q 4-6 wks
b. Non Stress Tests (NST) weekly – monitor of fetal well being

c. Biophysical Profiles (BPP) prn
d. Amniocentesis for lung maturity if felt induction is necessary

93
Q

etiology of birth defects

A

Unknown causes (65-75%)

Genetic

  1. Single gene disorders (15-20%)
  2. Chromosomal abnormalities (5%)

Environmental exposures (10%)

94
Q

Single gene disorders

A
  1. Autosomal dominant/recessive, X-linked
95
Q

vi. Non-Mendelian patterns of inheritance

A
  1. Unstable DNA, fragile X syndrome, imprinting, mitochondrial inheritance, etc.
96
Q

all or none period

A

First two weeks after conception known as

97
Q

Organogenesis occurs at

this period is important because

A

menstrual weeks 5-10

tissues are differentiating, susceptible to teratogenic effects

98
Q

Pregestational diabetes causes increase in

A

2-3 fold increase in congenital anomalies (esp heart disease, spina bifida)

  1. Abnormal fetal growth
  2. Newborn hypoglycemia
  3. Stillbirth
99
Q

complications of mom with PKU

A
  1. Microcephaly, MR, congenital heart disease
100
Q

Androgen producing tumors in mother

A

Virilization of female fetuses

101
Q

SLE can lead to

A

SLE – fetal, not maternal heart block

Treatment of mother does not always reduce effects on fetus

102
Q

influenza in mother can lead to

A

– 2nd trimester assoc. w/cleft lip, NTD, congenital heart defects, hydrocephaly

103
Q

Infections (TORCH) can cause malformations/congenital infections, disability and deat

A
  1. Toxoplasmosis
  2. Other (syphilis and parvovirus)
  3. Rubella
  4. Cytomegalovirus (CMV)
  5. Herpes/varicella
104
Q

slap cheek disease caused by the

A

parvovirus

105
Q

hutchinson’s teeth

A

syphilis

106
Q

saddle nose, short maxilla, protuberant mandible.

A

syphilis

107
Q

Non specific sonographic signs suggestive of fetal infection seen on ULS (6)

A
  1. Microcephaly
  2. Cerebral or hepatic calcifications
  3. IUGR
  4. HSM
  5. Cardiac malformations, limb hypoplasia, hydrocephalus
  6. Hydrops
108
Q

hydrops fetalis

A

hydrops fetalis refers to abnormal fluid collections in fetal soft tissues and serous cavities.

109
Q

common teratogenic Rx

A

ACE inhibitors, chloramphenicol, warfarin/anticoags, DES, toluene, iodides, lithium, accutane/iso-retinoin, tetracycline, thalidomide, valproate, lead, rubella vaccine, anticonvulsants, antineoplastics

SSRIs

ibuprofen, ASA, sulfa drugs at term, trimethoprim

110
Q

fetal BAL reach maternal levels within

A

Fetal BAL approach maternal levels within two hours of maternal intake

Elimination relies on maternal metabolic capacity, which varies – this explains why similar amounts of EtoH result in wildly varying phenotypic presentations in infants

111
Q

4 classification for pregnancy

A

evidence of CNS impairment
growth deficiency
typical features
hx of alcohol exposure in prengnacy

112
Q

]The most important modifiable risk factor associated with adverse outcomes

A

tobacco

113
Q

cessation could prevent

A

a. 10% of perinatal deaths
b. 35% of low birth weight infants
c. 15% of preterm deliveries

114
Q

Pathophysiology for tobacco

A

a. Impaired fetal oxygen delivery
b. Carbon monoxide exposure
c. Direct damage to fetal genetic material, genetic susceptibility varies
d. Direct toxicity form more than 2500 substances found in cigarettes, up to 100,000 compounds in tobacco smoke!
e. Directly impairs lung development
f. Sympathetic activation leads to accelerated heart rate/ reduction in fetal breathing movement

115
Q

Adverse effects of tobacco use in pregnancy

A

a. Infertility (maternal)
b. Low birth weight (LBW) <2500g
c. Miscarriage
d. Stillbirth, including from second hand smoke
e. Preterm premature rupture of membranes
f. Placental abruption/previa
g. Preterm delivery (1.3-2.5 times more likely)
h. Congenital malformations, likely
i. Postnatal morbidity
j. Preeclampsia
k. Decreased milk volume production, postnatal morbidities (SIDS, respiratory infections, asthma, atopy…)
l. ?Long term implications for offspring: DMII, reduced sperm concentration, dyslipidemia, cancer

116
Q

5 A’s

A

Ask, Advise, Assess, Assist, Arrange

117
Q

Pharmacotherapy

A

women who are otherwise unable to quit or heavy smokers (>10day) – In this population, the benefits of quitting with pharmacotherapy outweigh the potential risks of pharmacotherapy and continued smoking.

OB (14 decks)

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