GROWING FETUS Flashcards
Month 1
-all systems in rudimentary form
-heart chambers formed
-heart is beating (14 days)
-begins formation of eyes, ears, nose
-with arms & leg buds
PRIMARY GERM LAYER
ECTODERM
-ECsternal
Skin, Epidermis, Sweat glands, hair follicles, Sense organs, tooth enamel, mucus membranes of the mouth, anus, and nose, pituitary glands, peripheral nervous system
CNS is developed in what germ layer?
ECTODERM
PRIMARY GERM LAYER
MESODERM <3
Reproductive system
Musculoskeletal system
Cardiovascular system
kidney, ureter
spleen, bone marrow, blood cells
connective tissues (bones, cartilage, muscle, ligaments, tendons)
lymph, vessels, walls of digestive tract
PRIMARY GERM LAYER
ENDODERM
“ay”
Respiratory tract (lungs)
pharynx, tongue, tonsils, thyroid, parathyroid,thymus, liver, pancreas, lining of GI tract.
Lower urinary system (urethra & urinary bladder)
MONTH 2
-head is large in proportion to the rest of the body
-rapid brain development
-neural tube (brain, spinal cord) is well formed
-external genitalia if formed
-sonogram shows gestational sac (6 weeks)
-by the end of 2nd month 8th week “ORGANOGENESIS” is complete.
-by the end of 2nd month: fetus is about 1 inch long & weighs 20g
AFP Alpha-Feto Protein studies through amniocentesis (16-20 weeks)
-Discard the first few drops
-AFP done with bloody tap = False High
-AFP done after 20 weeks= False High
Results:
↑AFP= Neural Tube defects
↓ AFP= down syndrome
**do not heck AFP after >20 weeks, should be 16-18 weeks
1st functional organ in fetus?
Fetal heart: can be heard as early as 14 days
when will the head and chest become equal in size?
10-12 months of infancy
when will chest become larger than head?
2 years old
GTK
All neural tube defects delivered in CS
Organogenesis starts by what week?
starts by 2nd weeks; ends by 8th weeks
3 MONTH
-Placenta is complete
-FHT is audible by Echo Doppler (8-12)
-sex is distinguishable by outward appearance
-fetus begins to swallow
-kidney begins to excrete urine
-liver produces bile
-all organs & limbs are present
-by the end of 3rd month
Fetus: 4 inches long
: 45 grams (weight)
4 MONTH
-Quickening: 1st fetal moth
(MULTIGRAVIDA)
(fluttering sensation)
-formed eyes, ears,nose
-scalp hair develops
-FHT is audible by fetoscope
-Lanugo begins to appear
*-Meconium in bowel
*-by the end of 4th month
fetus: 6 inches long
: 55-120 gram
GTK
-absence of meconium stools for 1st 24 hours of life
-imperforated anus: no hole= ↓ peristalsis
-Hirschsprung disease: Intestinal nerve cells (ganglion cells) don’t develop properly
-Cystic fibrosis: due to meconium/ ↓pancreatic enzyme trypsin
5 MONTHS
-Lanugo completely appears: protect fetal skin
-Lanugo: Transparent, Fine downy hair
-Quickening (Primigravida)
-FHT: stethoscope (bell)
-Bones Hardening
-Nipple appear over the mammary gland
-Fetus Actively swallow (600mL/ day)
-Age of viability “V”
-End of 5th month
Fetus: 25 cm (long)
435-465 g (Wt)
6 MONTHS
-Body well proportioned
-Skin is red & wrinkled
-Eyebrows & eyelashes are well defined
-Eyelids are open
*-The skin is covered by vernix caseosa (Thermoregulator)
*-Hearing is established
Fetus: 28-36 cm long
Weight: 780g
7 MONTH
-Surfactant can be demonstrated in the amniotic fluid
-body is less wrinkled
-hearing is fully developed
-testes begins to descend in scrotal sac
-blood vessels in the retina are thin
(be careful in O2 oxygenation)
-Fetus: 35-38 cm (long)
weight: 1200 grams
-Daily counting of fetal movement the “cardiff- count-to-ten” method starting on 27th week
*Normal count: 10 FMS in 10 hours
Report:
1.) if no Fetal movement in 10 hours
2.)<10 Fetal movement in 2 consecutive days
pre-term or post-term ?
-Abundant hair in scalp= Post-term
-Lots of lanugo= Pre-term
-Little lanugo= Term
-Absent Lanugo = Post-Term
GTK
-Meconium staining early excretion of meconium
-Meconium staining is sign of fetal distress except for “breech presentation” which is normal, other presentation is reportable.
Signs of fetal distress
-Fetal tachycardia: FHB >160bpm
-↑ peristalsis; ↓sphincter = release of meconium
-Meconium stained + Pink Skin = acute hypoxia
Fetal distress
FETAL DISTRESS
↓
↑FETAL HEART RATE (FETAL TACHYCARDIA 160 bpm)
↓
↑PERISTALSIS
↓
RELAXATION OF ANAL SPHINCTER
↓
RELEASE OF MECONIUM
↓
MECONIUM STAINING
Exposure of fetus to meconium strained amniotic fluid for >4 hours would lead to?
Green fetal skin
↓
CHRONIC HYPOXIA
*can be seen to post-term babies
*Placental insufficiency is seen in post-term
“wear and tear theory” ↓36 weeks
*After several days the meconium turns into Yellow
GTK
No meconium by 24 hours after delivery would mean imperforated anus
(+) reportable is wink reflex is absent
(+) imperforated anus
Common: Boys
Nursing Assessment:
-Check genitals if green urine excretion; (+) Fistula.
**Imperforated anus/ Hirschprungs dse
Aganglionic Megacolon
Cystic Fibrosis
↓peristalsis
8 MONTH
-Subcutaneous fats begins to deposit
-Fetal storage: Iron deposit; calcium deposit
-Skin is smooth & Pink
-Fingernails grow
-Birth position assumes
-CNS has matured enough (29-32 weeks)
-Active Moro reflex is present (Embracing Motion)
-Fetus: 38cm long
weight: 1600 grams
In Giving Iron Supplement
-Baby’s delivered > 1 month early, starts iron at “6weeks until 6 months”
-Baby’s delivered >2 months early, starts iron at 2 weeks-6months
Manuever/ method to used to check fetal position
Leopold’s Maneuver: To check for position
F-U-P-P
1st: FUNDAL GRIP: Presentation
2nd: UMBILICAL/LATERAL GRIP: Fetal back
3rd: PAWLIK’S GRIP: Engagement
4th: PELVIC GRIP: Flexion or extension
/Attitude/ location
of cephalic prominence
*4th grip is only applicable to cephalic presentation
9 MONTH
-Nails are firm
-with definite sleep & wake pattern
-lanugo disappearing
-95% most babies turns into vertex position
-Fetus: 42-48 cm long; 2700 grams
*-Lung maturity:
a) Lecithin & Sphingomyelin Ratio (L&S Ratio)
2:1 at 35 weeks
DM Mother: 3:1 or 5:1 L&S ratio
b) Presence of phosphatidylglycerol at 36 weeks
DM mother: appears at 38 weeks: hypersecretion of insulin delays insulin
Best indicator of lung maturity
Phosphatidylglycerol
what to focus on 3rd trimester?
Fetal weight gaining
WHAT TO FOCUS ON 1st TRIMESTER
ORGANOGENESIS
WHAT TO FOCUS ON 2ND TRIMESTER
FETAL LENGTH
GTK about brown fat
Brown fat Metabolism: Heat production
Fat utilization: ketones
↓
ACIDOSIS
COLD STRESS
BROWN FAT METABOLSIM
↓
↑O2 consumption
↓
RDS
BROWN FAT METABOLSIM
↓
↑ Glucose utilization
↓
HYPOGLYCEMIA
**By product of ketones: Acidosis
temperature in DR
25-28 DEGREES CELSIUS
LOTS OF VERNIX CASEOSA
Pre-term
ABSENT VERNIX CASEOSA
Post-term
VERNIX CASEOSA
-do not remove vernix earlier <6 hours
-bathe; 6-8 hours
-we don’t bathe LBW & VLBW
-we only clean with dump cloth after 24 hours
How to check Fetal movement
-day time hours
-Stimulate by sounds/noise (6 months)
-Eating (glucose) stimulates movement
-Activity
-Massage: Daytime Hours
THE UMBILICUS
Below 95% CEPHALIC
Above 4% BREECH
Near 1% Shoulder/ Transverse
*Point of maximum impulse: Fetal Back
memorize pls!!!!
LOA: Left Occiput Anterior
PMI: Below Umbilicus Left sid e
RSA: Right Sacral(breech) Anterior
PMI: Above Umbilicus Right Side
Occuput: Cephalic
Sacral: Breech
10 MONTHS
-little lanugo
-testes have descended
*-with good muscle tone & reflexes
-fetal kicks active
-fingernails extended over the fingertips
-creases on the soles of the feet covering at least 2/3 of the surface
*-lightening occurs 2 weeks before labor Primigravida
(1 day before labor: Multigravida)
-FETUS: 48-52 cm long
Weight: 3000 grams
AMNIOTIC FLUIDS
-Alkaline
-Ph: 7-7.25
-Color: Clear/ Lightest yellow/ Amber
-Abnormal color: Green (except post-term)
NORMAL VOLUME:
10 weeks: 30 ml
20 weeks: 350 ml
after 20 weeks: 500-1000 ml
<500 ml= Amniotic fluid after 20 weeks
<500 ml= Amniotic fluid after 20 weeks
(Oligohydramnios)
INDICATIONS:
=Fetal Kidney Malfunction (Renal Agenesis)
> 1500 ml amniotic fluid after 20 weeks
Polyhydramnios: Risk for preterm birth
INDICATIONS:
-TreachoEsophageal Atresia Fistula (TEF):
3C’S OF TEF: Coughing, Choking, Cyanotic
-Multifetal pregnancy
-DM during pregnancy
3C’S of Esophageal Atresia Fistula (TEF):
Coughing, Choking, Cyanotic
GIVING OF RHOGAM
Prevents antibody function; Temporary
-28 weeks
-within 72 hours after delivery
-if abortion occurs. give rhogam after evacuation
-if Chorionic Vili Sampling+Amniocentesis are done, give Rhogam
Indirect Coomb’s test
(-) result: No antibody formation yet
Give Rhogram
(+) result: with antibody formation
Dont give, too late
***Indirect’s coombs test after delivery to protect the next fetus.
FUNCTIONS OF AMNIOTIC FLUID
-shield against pressure or blow the maternal abdomen
-maintain temperature
-muscular development
-protect umbilical cord pressure
-helps in delivery
external version
-Term bby
-Floating not engaged
-We need consent because there is risk
-Breech to Cephalic
Pre-term babies
-Lack reflexes
-Smooth nails
-Lots of lanugo
-Lots of vernix caseosa
TOCOLYTICS
-Muscle Relaxants/ Relaxes Contractions
Contraindicated to:
-Fetal distress
-Maternal tachycardia/ Cardiac Dse
-Abruptio Placenta
-Cervical Dilatation
-PROM
-Chorioamnionitis
TYPES OF TOCOLYTICS
Its-Not-Yet-My-Time
-Indomethacin: Least used
-Nifedipine (Procardia)
-Yutopar (Ritodrine)
-MgSO4
-Terbutaline (Brethine)
Fetal risk:
Closes Ductus Arteriosus
POSITION OF CHOICE FOR PREMATURE RUPTURE OF MEMBRANE
-Knee chest
-Trendelenburg
-Put Pillow at back
What causes Pathologic Jaundice
Erythroblastocyst Fetalis
-Occurs due to RH incompatibility between mother and fetus, resulting in severe anemia and sometimes death of fetus.
-Rh incompatibility
-ABO incompatibility
-Subgroup Incompatibility
Umbilicus cord/ Funis
Average Length: 50-55 cm
<35 cm= at risk for abruptio
>70cm = cord proplaprse, Cord Coil, Knot, Compression
-AVA
-No nerve supply
-Wharton’s jelly
<35 cm of umbilical cord risk for?
at risk for abruptio
> 70 cm of umbilical cord risk for?
cord proplaprse, Cord Coil, Knot, Compression
GTK
we dont do I.E. in placenta previa pregnant woman
What protects the vessels in umbilical cord
Wharton’s jelly
FETAL CIRCULATION
OXYGENATED BLOOD FROM PLACENTA
↓
UMBILICAL VEIN
↓
DUCTUS VENOSUS
↓
INFERIOR VENA CAVA
↓
RIGHT ATRIUM
↓
FORAMEN OVALE
↓
LEFT ATRIUM
↓
LEFT VENTRICLE
↓
ASCENDING AORTA
↓
UPPER AND LOWER PARTS OF THE BABY
BLOOD RETURNING TO HEART
RIGHT ATRIUM
↓
RIGHT VENTRICLE
↓
PULMONARY ARTERY
↓
DUCTUS ARTERIOSUS
↓
DESCENDING AORTA
↓
UMBILICAL ARTERIES
↓
PLACENTA
↓
MATERNAL CIRCULATION
failure of foramen ovale to close
Arterial Septal Defect (ASD)
Acyanotic: Left-To-Right Shunt
Failure of ductus arteriosus to close
Patent Ductus Arteriosus
Acyanotic: Left-right- shunt
DOC:
PATENT DUCTUS ARTERIOSUS
- DOC: Indomethacin
-Prostaglandin inhibitor
-closes PDA - Ibuprofen (NSAID)
In fetal circulation what is powerful side?
Right side is powerful than left side.
No.1/ common cause of heart defect?
PREMATURITY
PLACENTA
Weight at term: 500-600 grams
↑ blood supply: 500-600 ml/min at term
PLACENTAL HORMONES
- HCG
- HPL/HCS (human chorionic somatomammotropin)
- Lactogenic hormones
- estrogen
- progesterone
-anti-insulin hormone
-effect: diabetogenic
-begins to produce at 6 weeks at peak after 20 weeks
-screening for GDM = Between 24-28 weeks
HPL/HCS (human chorionic somatomammotropin)
HORMONE THAT CAUSES:
A.) Vascularization: chadwicks sign
B) ↑ Blood volume
C) Enlargement of uterus
estrogen
Chadwick’s sign
-6th week
-Probable sign
-↑ estrogen
-Nasal congestion
-softening of gums
-palmar erythema
enlargement of uterus
Non-Pregnancy shape: Pear
Non preg weight: 50-60 g
Pregnancy shape: Ovoid
preg weight:1000-1100 g
after delivery: 1000-1100 g
after 2 weeks: 500 g
3-4 week: 300g
5-6 weeks: 50-60 g
Return of uterus to non-pregnancy state for 6 weeks
Uterine Involution
Incomplete return of uterus at 6 weeks
cause: Uterine Infection
Sub-Involution
Secretions
-leukorrhea
-operculum (mucus plug): Bacteriostatic affect
-Ptyalism: ↑ excessive salivation
Management: mouth wash
Hormone that is:
-Muscle relaxant
-↓ peristalsis
-Fluid retaining hormone
-↑ BBT
-Mammary Gland-Lactation
PROGESTERONE
Colostrum production starts at what month?
-4th month of pregnancy
estrogen & progesterone level during pregnancy
1st trimester: ↑E↑P
2nd trimester: ↑E↑P
3rd trimester: ↑E↓P - decrease slowly in prep for labor
TYPE OF C.S.
Classical: Fundus; for E.R.
Transverse: Isthmus; “Bikini Line”
VBAC (Vaginal birth after cesarean section )
Allowed only for transverse CS after 2 years
hormone that initiate labor
ESTROGEN
