Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics > Fetal Growth & Development > Flashcards

Fetal Growth & Development Flashcards

1
Q

Gestational Age

A
  • from first day of LMP
  • Precedes conception (happens 2wks later)
  • approx. 280days/10lunar months/40wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Naegel’s Rule

A

LMP + 7days - 3months + 1year = EDD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First 2 Weeks

A
  1. ovulation
  2. fertilization (12cell morula)
  3. Blastocyst (fluid filled sphere)
    - Trophoblastic cell secretes HcG to maintain corpus luteum
    - Corpus luteum secretes estrogen/progesterone to prevent menstruation
  4. Implantation
    • 2 flat layers of cells ——> First 3 germ layers
    • Amniotic cavity, yolk sac & primitive Resp/GI system forms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

First thing that secretes HcG

A

Trophoblastic cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Day #5

A

Early blastocyst w/ ICM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does implantation of the blastocyst occur?

A

Day 8-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Embryonic Period = 3rd week

A
  • All major internal/external structures established
  • First missed day of period (Day#15)
  • Trilaminar disc w/ 3 germ layers
  • Ectoderm, Mesoderm & Endoderm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does the Etcoderm form?

A
  • skin of ext genitalia
  • Lower 1/3 of anal canal
  • Nervous system primitive streak—-> Neural tube (spinal cord)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Endoderm

A
  • GI tract, epithelium
  • bladder
  • anorectal canal
  • male/female urethra
  • Vaginal epithelium/vestibule
  • prostate gland
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mesoderm

A
  • gonads, ureters, reproductive ducts
  • most muscle tissue & all connective tissue
  • lymph tissue, spleen, blood cells
  • Dermis of skin & teeth (except enamel=ectoderm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

4weeks gestation

A 
Heart starts beating 
Neural folds fuse into spinal cord
Arm, Ears, & leg Buds form 
Facial & neck structures
Otic pits = eye
CR length 4mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Week 5

A

Brain development

Primitive mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Week 6

A

Nose, mouth, palate

CR = 1cm (doubled)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Week 7

A

Distinctly human form

But genital tubercle not formed yet = not a boy or girl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Week 8

A

End of embryonic period & Beginning of Fetal period

—Boy or girl

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When can the fetus make respiratory Mets, urinate, swallow, move limbs, squint/frown & open mouth?

A

8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What happens during week 13-15?

A

Rapid fetal growth

- nails/scalp hair pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When does

  • brown fat form
  • skeleton ossifies
  • vernix caseosa cover the skin
  • uterus/primordial follicles
  • testes descend
A

16-18wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When?

  • lanugo
  • fetus can hear sound
  • REM
A

20-25wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When can fetus blink/startle

- Lungs secrete surfactant?

A

22-24wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is Viability?

A

End of 24th week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do lungs mature?

A

Third trimester: 36 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 3 phases of normal growth?

A
  1. Cellular hyperplasia - first 16wks
  2. concomitant hyperplasia & hypertrophy - wks 16-32
  3. Cellular hypertrophy - 32wks-term
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Factors influencing growth rate

A
  • poverty
  • maternal age
  • substances: drugs, EtoH, Nicotine
  • Maternal nutrition
  • Disease
  • Psychological effects on pregnancy
  • environmental toxins (metals/meds)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cardiac activity establishes a GA of?

A

5.5-6wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How to evaluate fetal growth after 20wks

A
  • monitor weight gain
  • measure uterine size/fundal ht @ each visit
  • serial U/S
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Ways to establish GA

A
  • hx, LMP, early U/S, CRL
  • cardiac activity
  • head & ABD circumference
  • femur length
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Fundal height of navel

A

20wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What can cause Size being larger than Date?

A
  • Inaccurate dating
  • Large for gestational age (LGA)
  • Multiple gestation
  • Polyhydraminos (too much fluid)
  • Molar pregnancy
  • Uterine anomaly (fibroid)
  • Congenital anomaly (hydrocephalus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What could explain Dates> Size?

A
  • Intrauterine growth restriction
  • Oligohydraminos (not enough fluid)
  • Congenital anomaly
  • Chronic maternal disease
  • Viral Infection
  • Inaccurate dating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

LGA

A

Birth weight >90th percentile

> 4000g or8lbs.13oz

Macrosomia grades 1-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which infants are at greatest risk of Perinatal morbidity/mortality?

A

LGA

33
Q

What are the risk factors for LGA baby?

A
  1. Moms who were LGA/obese/excessive wt gain
  2. GDM
  3. Post dates
  4. h/o Large babies/previous macroscopic baby
  5. Male sex
  6. African American/Hispanic
  7. Genetic ABNLs/syndromes
    Beckwith-Wiedemann
34
Q

LGA complications

A
  1. Cephalopelvic disproportion (CPD)
  2. Postpartum Hemorrhage
  3. Stillbirth esp w/ grade 3 macrosomia
  4. Neonatal complications
35
Q

CPD = cephalopelvic disproportion

A
  • labor/shoulder dystocia
  • prolonged labor
  • birth injuries
  • Maternal soft tissue damage/lacerations
  • Increased risk of C-section
36
Q

What are neonatal LGA complications ?

A
  • low APGAR score
  • Hypoglycemia
  • perinatal asphyxia
  • Heme problems, polycythemia
  • need mechanical ventilation
  • respiratory distress syndrome (RDS)
37
Q

Prenatal Mgt for LGA moms

A
  • Screen for GDM
  • US to r/o polyhydramnios/molar preg/fibroids
  • Serial US to monitor growth
  • Anticipate CPD & postpartum hemorrhage
  • Offer delivery at 38wks if macrosomia
  • Offer elective C/S
  • Alert peds at delivery
38
Q

Prognosis of LGA mom/baby

A
  • increased risk of DM in kids
  • risk of more LGA babies
  • increased risk of obesity, insulin resistance, Hyperlipidemia, CV dz in kid
39
Q

IUGR
Intrauterine growth restriction
Fetal growth restriction

A

Baby below 10th percentile

Usually caused by genetics or lack of nutrition
NOT SGA- small for gestational age

  • Twin to twin transfer syndrome
40
Q

IUGR Risk Factors

A
  1. Poor nutrition/wt gains
  2. Vascular dz/HTN
  3. Renal dz
  4. Infxn
  5. Multiple gestation
  6. Placental problems
  7. Pregestational DM
  8. Drugs/EtoH
  9. Hypoxemia/Anemia
  10. Late prenatal care
  11. Low SES
  12. ART
  13. Prothrombin disorders (protein S, C, Factor V Leiden)
  14. Genetic ABNL
41
Q

Symmetrical IUGR = Global growth restriction

A

25%

Growth restricted in
- length, head circumference & weight

Caused by Torch Infxns, chromosomal ABLs or substance abuse

  • higher risk of Permanent Neuro sequalae
42
Q

Asymmetrical IUGR

A

70% of cases

  • Decreased length & Weight BUT normal Head (Head sparing)
  • Lack of fat
  • Caused by HTN, Pre-eclampsia, Malnutrition

Normal growth in first 2 trimesters

43
Q

Complications of IUGR

A
  • fetal demise
  • Meconium staining
  • Perinatal morbidity/mortality
44
Q

Causes of IUGR

A
  1. Maternal
    - Anemia
    - Drugs/alcohol/smoking
    - malnutrition/poor wt gain
    - HTN
    - GDM
    - Celiac dz
  2. Uteroplacental
    - pre-eclampsia
    - multiple gestation
    - TTS: tein to twin transfer syndrome
    - uterine malformations
    - placental insufficiency
  3. Fetal
    - vertically transmitted infxns
    - chromosomal ABNLS
45
Q

IUGR Diagnosis

A

<2cm in 4wks = Suspicious (Should be 4cm)

2 US 4wks apart to confirm
- head & ABD circumference
AFI check to r//o Oligohydraminos

46
Q

IUGR Management

A
  1. Bed rest, limit activity
  2. Nutrition
  3. Stop smoking
  4. Fetal surveillance
    - repeat U/S every 4-6wks
    - NST weekly
    - BPP PRN
    - Amniocentesis for lung maturity
  5. Delivery the baby
47
Q

Substrate deprivation/Uteroplacental insufficiency

A

Variable/asymmetric growth pattern

Normal anatomy

Low amniotic fluid

Fetal lung maturity testing
BPP score decreases
UAV shows vascular resistance

BPP & UAV

48
Q

Fetus w/ structural and/or chromosomal ABNL or fetal infxn

A

Growth pattern markedly Below normal/symmetric

Anatomy usually ABNL

Hydramnios (too much fluid). Decrease w/ renal agenesis or urethral obstruction

Test for viral DNA/karyotype

BPP variable/normal UAV

49
Q

Birth defects

A
  • of medical, surgical or cosmetic
genetic &amp; environmental factors
Maternal age >35yo
Illness
Drug use
Physical features of uterine involvement
50
Q

Major congenital malformations

A
  1. Skull
  2. Eyes
  3. Ears
  4. Mouth/throat
  5. Neck
  6. Chest
  7. Back
  8. Abdomen
  9. Genitalia
  10. Extremities
    - Hands & feet
  11. Cardiovascular & great vessels
51
Q

Birth Defect Etiology

A

65-75% unknown causes

Genetic

  • single gene disorders-15-20% = mitochondrial/autosomal rec/dom
  • chromosomal ABNLs -5%

Environmental disorders-10%

  • maternal illness
  • substance use
  • infxn
  • Drugs
  • chemicals
  • radiation
  • Hyperthermia (fever)
  • mechanical/physical constraints
52
Q

Genetic disorders

A

> 90% don’t survive to term, very early preg loss

Fragile X: long face big ears

Klinefelters

Trisomy 18/21

53
Q

All or none period

Not susceptible to teratogens

A

First 2 wks after conception

54
Q

Organogenesis (menstrual weeks 5-10)

A

Tissues differentiating

Susceptible to teratogens

55
Q

When is the fetus susceptible to teratogens?

A

Menstrual weeks 5-10

56
Q

Which factors of teratogens influence effect on fetus?

A

Timing of exposure, dose & duration

57
Q

Pregestational Diabetes

A

2-3 fold increase in congenital anomalies
*Esp Heart dz & spina bifida

  • ABNL fetal growth
  • newborn hypoglycemia
  • still birth
58
Q

Phenylketonuria

A
  • microcephalic, MR, congenital heart dz
59
Q

Androgen producing tumor

A

Virilization of girls

60
Q

Autoimmune disease

A

SLE- fetal heart block

To of mom doesn’t always reduce effect on baby

61
Q

Influenza

A

Cleft lip assoc w/ 2nd trimester

Congenital heart defects

Hydrocephalus

NTD

62
Q

TORCH Infxns

A

Toxoplasmosis

Other-Syphilis & Parvovirus (slap cheek)

Rubella

CMV

Herpes/varicella (direct exposure at time of delivery

63
Q

Toxoplasmosis

Syphilis

Rubella

A
  1. Intracranial calcification
  2. Hutchison teeth & Snuffles
  3. Blueberry muffin baby
64
Q

Non-specific signs on US that suggest fetal infection

A
  • microcephaly
  • cerebral or hepatic calcification
  • IUGR
  • HSM
  • cardiac malformations, limb hypoplasia, hydrocephalus
  • hydrops
65
Q

Examples of Teratogens

A
  • ionizing radiation
  • SSRIs
  • Ibuprofen, ASA, sulfa drugs at term, trimethoprim (bactrim)
  • EtoH, tobacco, recreational drugs
  • others: ACEI, iodine’s, lithium, accutane/isoretinoin, tetracycline, thalidomide, valproate, lead, rubella vaccine, anticonvulsants, antineoplastics
66
Q

Factors that increase risk of fetal alcohol syndrome (FASD)

A
  • maternal age
  • high parity
  • AA or Native American
  • Genetics
67
Q

FASD Exposure risk factors

A
  • low SES
  • smoking
  • unmarried
  • unemployed
  • illicit drugs
  • h/o sexual/physical abuse
  • h/o incarceration
  • fam member who drinks heavily
  • Socially transient
  • Psych stress/mental health disorder
68
Q

FASD spectrum

A
  • no effect/normal
  • FAE, fetal alcohol effects
  • ARBD, alcohol related birth defects
  • FAS, fetal alcohol syndrome
69
Q

Physical features of FASD

A

small eye opening
Smooth philtrum
Thin upper lip

70
Q

The most important modifiable risk factor assoc with adverse outcomes

A

Smoking

71
Q

Smoking

A

Directly impairs lung dev
Increased HR
Reduction of fetal breathing
ABNL gas exchange via placenta

72
Q

Adverse effects of tobacco use

A
  • infertility
  • Low birth weight <2500g
  • miscarriage
  • stillbirth even 2nd hand smoke
  • preterm premature rupture of membranes
  • placental abruption/previa
  • Preterm delivery
  • Congenital malformations
  • postnatal morbidity
  • preeclampsia
  • decreased milk production, postnatal morbidities

——> long term complications for baby: DMII, reduced sperm concentration, dyslipidemia, cancer

73
Q

Smoking cessation in pregnancy

A

Ask, Advise, Assess, Assist, Arrange

Pharmacotherapy - lowest dose necessary—> NOT in first trimester (organogenesis)

CBT, hypnotherapy, acupuncture

Nicotine replacement: Wellbutrin
- Category C but benefits outweighs risks

74
Q

Sxs of high risk chemical abuse

Opiates

A

Late to prenatal care

Multiple missed appts

Impaired school/work performance

Past OB h/o SAB, IUGR, premature birth, placental abruption, stillbrth, precipitous delivery

Children w/neuro-dev problems

H/o drug ETOH problems

75
Q

Opiate OB complications

A

Pre-eclampsia

Placental abruption

Premature labor/delivery

Placental insuff

3rd trimester bleeding

Malpresentation

Non reassuring fetal status

Meconium passage

Low birth weight

Perinatal mortality

Puerperal morbidity

76
Q

OPiate Neonatal outcomes

A

Premature birth

Neonatal opiate withdrawal

Postnatal growth deficiency
Microcephaly

Neurobehavioral deficits - tremors, high pitched cry, excessive suck, hyper alertness, irritability

SIDS

77
Q

Cocaine

A

Readily crosses the placenta

Vasoconstriction = major mechanism of fetal & placental damage

Shows up in baby pee 2days after delivery, Meconium positive for 3days, hair-months

78
Q

Methamphetamine

A
  • neurotoxic agent: damages brain cells w/ dopamine

- SGA

79
Q

Mgt of pregnant substance abuser

A

Screen for ETOH & drugs
Counsel about risks
Use behavioral therapy & pharmacotherapy
Assemble a team
Test for STIs
Schedule freq visits
Get an early US to confirm GA & get a baseline for growth
Begi antepartum fetal surveillance
Inform peds -may be withdrawal
No breastfeeding
Address incarceration, homelessness & malnutrition
Educate about nutrition & wt gain
Referrals- transportation, prenatal MVI, shelters, food assistance
Consult Anesthesia for pain mgt

Obstetrics (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions