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RED > L16: Fetal Growth > Flashcards

L16: Fetal Growth Flashcards

1
Q

How many phases of fetal growth and development are there

A

3

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2
Q

What are the 3 phases called

A

Cellular hyperplasia
Hyperplasia and commitent hypertrophy
Hypertrophy

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3
Q

What occurs in the first phase cellular hyperplasia

A

Increase in fetal weight
Increase in protein content
DNA content

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4
Q

What occurs in hyperplasia and concomitent hypertrophy

A

Increase in protein
Increase in fetal weight
Lesser increase in fetal DNA

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5
Q

What occurs in hypertrophy

A

Increase in fetal protein
Increase in fetal weight
No increase in DNA

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6
Q

What does fetal growth restriction mean

A

A failure of a fetus to achieve his/her growth potential

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7
Q

What does small for gestational age (SGA) mean

A

Babies that are less than the 10th percentile but baby is healthy i.e has no pathological processes that made him small

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8
Q

What is large for gestational age (FGA) mean

A

Babies weight above the 90th percentile

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9
Q

What does low birth weight mean

A

Birth weight less than a certain threshold e.g 2.5kg

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10
Q

What are the neonatal indices

A

Skinfold thickness
Head circumference to abdominal circumference ratio
Ponder all index

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11
Q

What is fetal growth restriction a significant cause of

A

Peri-natal morbidity and mortality

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12
Q

What are the morbidity complications for fetal growth restriction

A

Hypoglycaemia
Hypothermia
Birth asphyxia

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13
Q

What can being born with fetal growth restriction cause in the future

A

Adult disease

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14
Q

What is the hypothesis known as that suggests being born with fetal growth restriction results in adult disease

A

Barker hypothesis

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15
Q

What type of adult disease can occur in FGR

A

Diabetes

Metabolic syndrome

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16
Q

What does adult disease in fgr occur as a result of

A

Secondary changes in growth, metabolism, vasculature i.e thrift phenotype whereby they adapt to cope with reduced nutrient supply but this adaption remains in adulthood

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17
Q

What are mothers who are born small most likely to have

A

SGA babies

Increased perinatal mortality

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18
Q

What are the mechanims responsible for inner-generational effects

A 
Epigenetics mechanims e.g
DNA methylation 
Histone modification 
Micro RNA 
Or maternal mitochondrial inheritance
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19
Q

What Is macrosomia

A

Birth weight greater than 4.5kg

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20
Q

What can LGA be caused by

A

Pregnancy above 40 weeks
Male infants tend to weigh more
Excessive maternal weight gain
Obesity in the mother
Genetic disorders e.g beckwith weidemann
Maternal gestational diabetes or pre-existing diabetes

21
Q

What is the pathophysiology for diabetes causing microsomnia

A

Increased maternal glucose which crosses the placenta
Increased fetal insulin conc
Increased fetal growth factors

22
Q

What is the barker hypothesis for FGA babies

A

Babies that have an increase risk of diabetes and metabolic syndrome in adult hood

23
Q

What is growth regulation controlled by

A

Genetic

Environmental; maternal, fetal, placental factors

24
Q

What is required for successful placentation for growth regulation

A

Substrate availability
Endocrine/paracrine signalling
IGF1 and IGF2 (major stimulus)

25
Q

What are the maternal factors that can affect grwoth

A

Ethnicity
Maternal BMI: obesity increased risk for FGA, malnutrition increases risk for FGR
Drugs: drugs of abuse
Nutrition: vitamin d, folic acid and balanced diet
Maternal hypoxia: cyanotic heart disease, chronic respiratory disease, high altitude

26
Q

What are the fetal factors that are involved in growth

A

Genome- chromosomal disorders
Growth factors- insulin like growth factors
Congenital infection: rubella

27
Q

What are the 2 categories of placental factors for growth regulation

A

Primary placental factors

Secondary placental factors

28
Q

What are the primary placental factors involved in growth regulation

A

Abnormal placenta structure or function e.g abnormal chord insertion

29
Q

What are the secondary placental factors

A 
maternal factors that affect the placenta:
Hypertension 
Chronic renal disease
Vasculitis 
Prothrombic disease
30
Q

What occurs in pre-eclampsia

A

1) There is insufficient invasion of EVT into the decidua and remodelling
2) this gives high resistance and low blood flow to the placenta

31
Q

What does pre-eclampsia change

A

Doppler indices

32
Q

When there is uteroplacental insufficiency what is the head circumference and abdominal circumference like

A

Head circumference maintained

Abdominal circumference decreased

33
Q

What does this assymetrical FGR represent

A

Fetal growth pathology

34
Q

What does a symmetrical pattern of IUGR show as

A

Head circumfernce and abdominal circumference grow but at a slow speed

35
Q

What does a symmetrical IUGR most likely to represent

A 
Early growth insult 
Chromosomal disorder 
Viral infection 
Disrupted growth processed 
Or 
Normal growth
36
Q

How is fetal growth assessment carried out

A

Symphysis-fundal height

Ultrasound - if the symphysio-fundal height is low

37
Q

What is the symphysis fundal height

A

A measurement from the pubic symphysis to the top of the fundus measured in cm

38
Q

Once a fetus is assessed as SGA how do we monitor fetal well being

A

Cardiotocograph: measured fetal heart rate and metal urine activity
Umbilical artery doppler

39
Q

What are the risk factors for SGA

A 
Maternal age 40+
Previous eclampsia 
Lowe maternal weight gain 
Previous SGA baby 
Previous still birth
40
Q

What is gestational diabetes defined as

A

Glucose intolerance with its onset during pregnancy

41
Q

What are the pre-existing risks for gestational diabetes

A

Women with:

  • pancreatic B cell dysfunction
  • chronic insulin resistance
42
Q

When are women screened for gestational diabetes if there is a past history of GDM or glucose intolerance

A

Week 16-18

43
Q

When are woman screening in 24-26 weeks

A 
If there is:
Family history of diabetes 
PCOS 
BMI greater than 30 
Asian, black or Middle Eastern ethnicity 
Previous macrosomia 
Previous unexplained still birth 
On steroids
44
Q

When are woman screened urgently for gestational diabetes

A

If there is evidence of polyhyramnios, macrosomia or significant glycosuria

45
Q

What are the screening methods for gestational diabetes

A
  • Oral glucose tolerance test: overnight fast then 75g glucose load, test 2 hours later
  • Random blood glucose testing after 36+ weeks
46
Q

What are the maternal complications for gestational diabetes

A

Pre-eclampsia
Caesarean section
Diabetes in later life
Pre term labour

47
Q

What are the fetal compliations for gestationla diabetes

A 
Macrosomia 
Shoulder dystocia (shoulders become stuck under the pubic symphysis)
Polyhydroaminos 
Jaundice 
Hypocalcemia 
Neonatal hypoglycaemia 
Polycythemia
48
Q

What are the medical management for gestational diabetes

A

Diet restriction
Metformin
Insulin

49
Q

What is the obstetric management for gestational diabetes

A

Regular growth scans
Regular bone marrow monitoring
Deliver around 38 weeks
Offer glucose intolerance test 6 weeks post natal to identify T2M

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