L16: Fetal Growth Flashcards by selcan icli

How many phases of fetal growth and development are there

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What are the 3 phases called

Cellular hyperplasia
Hyperplasia and commitent hypertrophy
Hypertrophy

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What occurs in the first phase cellular hyperplasia

Increase in fetal weight
Increase in protein content
DNA content

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What occurs in hyperplasia and concomitent hypertrophy

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

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What occurs in hypertrophy

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

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What does fetal growth restriction mean

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

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What does small for gestational age (SGA) mean

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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What is large for gestational age (FGA) mean

Babies weight above the 90th percentile

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What does low birth weight mean

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

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What are the neonatal indices

Skinfold thickness
Head circumference to abdominal circumference ratio
Ponder all index

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What is fetal growth restriction a significant cause of

Peri-natal morbidity and mortality

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What are the morbidity complications for fetal growth restriction

Hypoglycaemia
Hypothermia
Birth asphyxia

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

Adult disease

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

Barker hypothesis

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What type of adult disease can occur in FGR

Diabetes

Metabolic syndrome

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What does adult disease in fgr occur as a result of

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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What are mothers who are born small most likely to have

SGA babies

Increased perinatal mortality

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What are the mechanims responsible for inner-generational effects

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

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What Is macrosomia

Birth weight greater than 4.5kg

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What can LGA be caused by

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

What is the pathophysiology for diabetes causing microsomnia

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

What is the barker hypothesis for FGA babies

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

What is growth regulation controlled by

Genetic

Environmental; maternal, fetal, placental factors

What is required for successful placentation for growth regulation

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

What are the maternal factors that can affect grwoth

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

What are the fetal factors that are involved in growth

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

What are the 2 categories of placental factors for growth regulation

Primary placental factors | Secondary placental factors

What are the primary placental factors involved in growth regulation

Abnormal placenta structure or function e.g abnormal chord insertion

What are the secondary placental factors

``` maternal factors that affect the placenta: Hypertension Chronic renal disease Vasculitis Prothrombic disease ```

What occurs in pre-eclampsia

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

What does pre-eclampsia change

Doppler indices

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

Head circumference maintained | Abdominal circumference decreased

What does this assymetrical FGR represent

Fetal growth pathology

What does a symmetrical pattern of IUGR show as

Head circumfernce and abdominal circumference grow but at a slow speed

What does a symmetrical IUGR most likely to represent

``` Early growth insult Chromosomal disorder Viral infection Disrupted growth processed Or Normal growth ```

How is fetal growth assessment carried out

Symphysis-fundal height | Ultrasound - if the symphysio-fundal height is low

What is the symphysis fundal height

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

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

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

What are the risk factors for SGA

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

What is gestational diabetes defined as

Glucose intolerance with its onset during pregnancy

What are the pre-existing risks for gestational diabetes

Women with: - pancreatic B cell dysfunction - chronic insulin resistance

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

Week 16-18

When are woman screening in 24-26 weeks

``` 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 ```

When are woman screened urgently for gestational diabetes

If there is evidence of polyhyramnios, macrosomia or significant glycosuria

What are the screening methods for gestational diabetes

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

What are the maternal complications for gestational diabetes

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

What are the fetal compliations for gestationla diabetes

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

What are the medical management for gestational diabetes

Diet restriction Metformin Insulin

What is the obstetric management for gestational diabetes

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