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RDA > Normal Fetal Growth > Flashcards

Normal Fetal Growth Flashcards

1
Q

When is fetal growth the fastest?

A

Before term

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2
Q

When does the baby gain the most weight?

A

Mid/late trimester

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3
Q

Define fetal growth

A

The increase in mass that occurs between the end of the embryonic period and birth

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4
Q

What are the two components which determine normal fetal growth?

A

Genetic potential

Substrate supply

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5
Q

What is substrate supply dependent upon?

A

Uterine and placental vascularity

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6
Q

What is genetic potential mediated via?

A

Growth factors e.g. IGF

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7
Q

What are the three phases of normal fetal growth and when do they take place?

A
  1. Cellular hyperplasia (4th-20th week)
  2. Hyperplasia and hypertrophy (20-28th week)
  3. Hypertrophy alone (28th-40th week)

In the alphabet: p>t

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8
Q

Distinguish between hypertrophy and hyperplasia

A

Hypertrophy - increase in cell SIZE

Hyperplasia - increase in NUMBER of cells

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9
Q

Besides increase in cell size, what happens during hypertrophy in the last phase of foetal growth?

A

Rapid accumulation of fat, muscle and connective tissue

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10
Q

Which four fetal organs grow rapidly in size during pregnancy?

A

LARGE:
Brain
Liver

SMALL:
Kidney
Heart

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11
Q

How do foetal organs compare to baby organs?

A

They contain 20% less cells, therefore must growth after birth

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12
Q

What is the average weight gain between 14 and 15 weeks?

A

5g/day

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13
Q

What is the average weight gain at 20 weeks?

A

10g/day

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14
Q

What is the average weight gain between 32 and 34 weeks?

A

30-35g/day (triples)

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15
Q

What happens to the weight gain after 34 weeks?

A

Growth rate decreases

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16
Q

Name and describe a bedside technique used to determine the health and growth of the baby

A

Symphysis fundal height (SFH)

Measure the distance from the pubic symphysis to the top of the uterus

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17
Q

At which week is the SFH at:

i) the pubic symphysis
ii) the umbilicus

A

PS - 12 weeks

U - 20 weeks

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18
Q

Between 20 and 34 weeks, what would the SFH be?

A

Gestational age plus or minus 2 cm

e.g. at 25w, it could be between 23 or 27cm

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19
Q

Between 36 and 38 weeks, what would the SFH be?

A

Gestational age plus or minus 3 cm

20
Q

After 38 weeks, what would the SFH be?

A

Gestational age plus or minus 4 cm

21
Q

State four reasons for why the SFH may be smaller than expected

A

Baby may be small for its gestational age
Oligohydramnios (reduced amniotic fluid)
Transverse lie (baby may be lying in different position)
We may have the wrong dates

22
Q

State seven reasons for why the SFH may be larger than expected

A 
We may have the wrong dates
Multiple gestation 
Large for gestational age 
Polyhydramnios 
Maternal obesity
Fibroids
Molar pregnancy
23
Q

What are the pros of SFH?

A

Simple

Inexpensive

24
Q

What are the cons of SFH?

A

Low detection rate
Great inter-operator variability
Influenced by many factors (BMI, fetal lie, amniotic fluid, fibroids)

25
Q

What is molar pregnancy?

A

When an unviable fertilised egg implants in the uterus and fails to come to term

Unviable because of abnormal number of chromosomes (e.g. fertilised by two sperm, or the egg doesn’t have any nuclei inside)

26
Q

How else can the age of the fetus be estimated?

A

Dating by last menstrual cycle

27
Q

Give four reasons why dating by LMP may be inaccuate

A

Irregular periods
Abnormal bleeding
Oral contraceptives
Breastfeeding ??

28
Q

State three reasons why determining the baby’s date is important

A

To avoid small/large gestational age confusion
To ensure that inductions are given at the right time if the baby is due
To ensure that steroids can be given at the right time in preterm delivery, to promote lung surfactant in the fetus

29
Q

In the modern day, how are babies dated?

A

Crown-rump length (length of baby sagitally)

30
Q

Which group of babies are not dated by crown rump length?

A

IVF babies

31
Q

What is used to date the pregnancy if the first scan is done after 14 weeks?

A

Head circumference

32
Q

Give two situations when head circumference is used to date the baby

A

If first scan is done after 14w

If CRL is above 84mm

33
Q

Which four parameters are used to estimate fetal weight (EFW)?

A 
Biparietal diameter (BPD)
Head circumference (HC)
Abdominal circumference (AC)
Femur length (FL)
34
Q

What is done with these measurements?

A

Plotted on a centile graph to see growth curve to assess neonatal/obstetric complications

35
Q

Give nine maternal factors influencing fetal growth

A 
Age (e.g. older woman vs younger woman)
Weight
Diet
Alcohol, drugs and smoking
Disease 
Environmental toxins
Poverty
36
Q

Give four maternal diseases/conditions which could affect fetal growth

A

Hypertension
Diabetes
Coagulopathy
Prenatal depression

37
Q

Give four feto-placental factors influencing fetal growth

A

Genotype (genetic potential)
Gender B>G
Fetal hormones
Previous pregnancy

38
Q

Give five fetal hormones influcing fetal-placental growth

A 
Somatotrophin (GH)
FSH/LH
Insulin
Androgens
Iodothyronines (by third trimester)
39
Q

Which hormone is not produced by the fetus but is involved in pregnancy?

A

Prolactin

40
Q

Which two organs produce androgens in the fetus?

A

Adrenals and gonads

41
Q

How is a customised growth chart made to be as accurate as possible?

A

Based on fetal weight curves derived from normal pregnancies
Adjusted to reflect maternal factors e.g. height, weight, ethnicity, parity (previous successful pregnancies)
Optimised by excluding pathological factors ?

42
Q

Give the advantages of obstetric ultrasound examination

A 
Assesses fetal wellness + size
Looks at trends in growth 
Predicts fetal metabolic compromise 
Anticipates need for premature delivery 
Gives a chance to liase with neonatal services for them to be present at birth
43
Q

What is parity in a medical sense?

A

Number of previous successful pregnancies

44
Q

Give an example of a condition causing a larger than average baby

A

Gestational diabetes - causes macrosomia (large baby)

45
Q

Give two fetal abnormalities

A

Neonatal hydrocephalus

Achondroplasia

RDA (13 decks)

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