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Fetal physiology Flashcards

0
Q

How often are breathing movements in the last trimester?

A

1-4 hours

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1
Q

By the 8th week, what is developed in terms of lung tissue?

A

The bronchial tree

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2
Q

What is the function of breathing movements in the neonate?

A

To bring amniotic fluid in
For mechanical
For washing out the lungs

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3
Q

When do fetal lungs start to produce surfacant?

A

20-30 weeks

more after 30 weeks

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4
Q

What happens if there is a lack of surfacant in the neonate, which is a common problem in premature babies?

A

respiratory distress syndrome

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5
Q

What do you need to give the mother if the baby is going to be born premature and why?

A

steroids to encourage surfacant production

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6
Q

Why does amniotic fluid surround the fetus?

A

Mechanical protection
To allow the baby to keep in its fluids - else it would just diffuse out
Nutrients
Moist environment

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7
Q

At the start of pregnancy, up until week 8 what produces amniotic fluid?

A

The mother and it diffuses across the placenta

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8
Q

In the fetal period of pregnancy, what produces amniotic fluid?

A

The fetus, it swallows it, puts it through the gut and then is excreted via the kidneys, and the process starts again

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9
Q

How much amniotic fluid is produced at:
week 8
week 38
week 42

A

10ml
1 litre
300 ml

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10
Q

What is the remnants of amniotic fluid in the gut called?

A

Meconium

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11
Q

What is amniocentesis?

A

The using of amniotic fluid to assess fetal wellbeing
cytological and biochemical studies
neural tube defects and chromosomal abnormalities

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12
Q

What is bilirubin?

A

Breakdown of rbc

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13
Q

Why can a fetus not conjugate billirubin?

A

Because the liver is not functioning properly

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14
Q

If the fetus turns Jaundice when they are born, what can you do to encourage conjugation of bilirubin?

A

expose the baby to light

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15
Q

What is polyhydraminos?

A

This is too much amniotic fluid

Due to oesophogeal or duodenal atresia and can lead to CNS abnormalities

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16
Q

What is oligohydraminos?

A

This is too little amniotic fluid
Due to poor or absent kidney function
Due to small placenta

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17
Q

What can oligohydraminos cause?

A

pre-eclampsia

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18
Q

What is pre-eclampsia?

A

Hypertension and protein in the urine

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19
Q

What is eclampsia?

A

Seizures

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20
Q

How do you treat eclampsia?

A

See out the fit, so put patient on their side, relax them and give magnesium
Then birth

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21
Q

Where does the fetus get its glucose?

A

From the mother via facilitated diffusion

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22
Q

What can you measure to see that the fetus is storing glycogen correctly?

A

abdominal circumference which gives you an estimation of the liver

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23
Q

When do fetal movements occur?

A

8 weeks

but not felt until about the 15-17th week by the mother

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24
Q

When does myelination complete?

A

Not until after birth

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25
Q

How much o2 storage does the fetus have?

A

2 minutes - can become a problem in labour

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26
Q

What does progesterone do to the body in terms of smooth muscle?

A

Relaxes it

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27
Q

What does progesterone encourage the fetal endocrine system to produce?

A

Corticosteroids - such as thyroid hormones which are neccessary for growth, nervous system and the cardiovascular system

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28
Q

When is the fetal endocrine system active from?

A

Week 12

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29
Q

What is a good indication that the fetus is ready to birth?

A

Regular bodily rhythms such as heart rate and breathing

30
Q

What is fetal heart rate?

A

160-180bpm

31
Q

What causes the neonate to take its first breath?

A

Trauma and cold air

32
Q

What does the first breath of neonate cause?

A

Decreased pulmonary resistance and an increase in arterial pressure which closes the foramen ovale

33
Q

What closes the ductus arteriosus?

A

Smooth muscle in the wall is sensitive to high pO2 which closes it - contracts

34
Q

What happens to the ductus venosus?

A

It stays open for several days after birth
closes within 2-3 months
but there is a spinchter which contracts and directs blood flow through the liver

35
Q

What happens to fetal CO2?

A

Fetus cannot get rid of it, so it diffuses into mothers circulation
Mother then has a degree of hyperventillation which causes respiratory alkalosis

36
Q

Why can the fetus not excrete CO2?

A

acid base problems

not a functioning kidney in terms of this respect

37
Q

What is the function of the ductus venosus?

A

To shunt blood around the liver

38
Q

What is the function of the ductus arteriosus?

A

To shunt blood from the pulmonary artery to the aorta

39
Q

What is the function of the foramen ovale

A

To shunt blood from the right atrium to the left atrium

40
Q

What is the fetal O2 saturation?

A

60%

41
Q

What is fetal O2 kPa?

A

4

42
Q

Explain the fetal circulation of blood

A

Blood arrives at umbilican vein, shunts around liver, into ivc, into right atria -> FO -> LA -> LV -> aorta -> carotids and brain -> RA -> RV -> PT -> aorta -> back around the body to the umbilical arteries where it picks up O2 again

43
Q

What are the stages of pregnancy in terms of the fetus?

A

Pre-embryonic - 1-2 weeks
Embryonic - 3-8 weeks
Fetal - 9-40 weeks

44
Q

What happens in the embryonic period?

A

Growth of all systems
They just need to mature
Placental growth

45
Q

What growth deposition is in early fetal period?

A

Protein deposition

46
Q

What growth deposition is in the late fetal?

A

Adipose deposition

47
Q

How can you measure fetal growth?

A

Symphysis - fundal height
Crown - rump length
Abdominal circumference and femur length
Biparietal diameter

48
Q

What is good about the symphysis - fundal height?

A

That it is not invasive

It is proportional to the number of weeks the fetus is

49
Q

What lag in growth is indicative of a growth restriction?

A

Over 4cm

  • lie of fetus
  • amniotic fluid
  • number of fetus
  • extent of engorgement of head
50
Q

When is CRL measured?

A

between weeks 7-12

51
Q

Why is US done at 20 weeks - known as the anomalies scan?

A 
Predicts anomalies
Growth of fetus
Number of fetus 
Gender of fetus
All systems are developed
52
Q

What does abdominal circumference measure?

A

Growth of the liver

Glycogen storage

53
Q

Why is anatomy ideal for fetal investigation?

A

Its safe, non invasive, doesnt affect brain growth

54
Q

Why might a transvaginal US be performed on someone who has miscarried a lot?

A

Because it ensures baby has implanted in the correct place and that its developing well during the embryonic and early fetal period

55
Q 
What is:
the average
the growth restricted
and the macrosomic 
birth weight?
A

3500g
2500g
4500g

56
Q

Why might a baby be macrosomic?

A

Gestational diabetes

57
Q

Why might a fetus be too light?

A

Premature
Small mother
Growth restriction

58
Q

What are the 4 stages of lung development?

A

Pseudoglandular
Canalicular
Terminal sac
Alveolar

59
Q

What happens in the pseudoglandular stage and when is it?

A

Differentiation into terminal bronchioles

8-16

60
Q

What happens in the canalicular stage and when is it?

A

Respiratory bronchioles

16-26

61
Q

What happens in the terminal sac stage and when is it?

A 
Development of terminal sacs 
Some primitive alveoli
Alveolar type II pneumocytes 
Surfacant 
27- term
62
Q

What happens in the alveolar stage and when is it?

A

Alveolar develop

From birth until 8 years of agee

63
Q

What happens to the amniotic fluid that is in the lungs after birth?

A

Expelled at birth and reabsorpbed

64
Q

When are the lungs viable from?

A

Week 24 onwards due to some production of surfacant

65
Q

When is the heart rate felt by a stethescope?

A

About 16-18 weeks

66
Q

When can fetal heart rate be felt with a doppler stethescope?

A

10 weeks

67
Q

When does fetal kidney function begin?

A

week 10

68
Q

When does myelination of the brain begin?

A

In the 9th month

69
Q

What senses work first?

A

Hearing and taste

Retina is immature at birth and the eyelids are fused until the 9th month

70
Q

What is an asymmetrical restriction?

A

Where the abdominal growth lags behind and there is relative sparing of head growth
Occurs in the last part of pregnancy

71
Q

What is symmetrical growth restriction?

A

This is where the restriction affects the head as well as the body

72
Q

What clinical tests can you use for growth and development?

A 
US 
Doppler
non stress test 
biophysical profiles 
vibroacoustic stimulation 
contraction stress test
fetal movements kick chart
73
Q

what is a non stress test?

A

Monitor fetals heart rate with changes in fetal movement

Reproduction (14 decks)

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