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Semester 4 > Repro Session 9 > Flashcards

Repro Session 9 Flashcards

1
Q

What is the organogenetic period of human development?

A

Embryonic period

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2
Q

Describe growth in the embryonic period.

A

Foetal growth is very small but placental growth is large

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3
Q

Broadly describe the foetal period.

A

Growth and physiological maturation of structures established in the embryonic period

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4
Q

When is the embryonic period?

A

3-9 weeks after fertilisation

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5
Q

When is the foetal period?

A

9-38 weeks post fertilisation

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6
Q

Why is human pregnancy considered to be 40 weeks when human gestation is 38 weeks?

A

Can be +/- 2 weeks due to natural variation but this is masked by using the date of the LMP to calculate pregnancy weeks

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7
Q

Why is using LMP to date pregnancy prone to inaccuracy?

A

Irregularity of menstrual cycles and confusion with implantation bleeding

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8
Q

During which periods does CRL increase rapidly?

A

Pre-embryonic, embryonic and early foetal

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9
Q

When is increase in CRL most striking?

A

Months 3-5

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10
Q

Describe how the body proportions of the foetus changes during development.

A

At 9 weeks head = 0.5 CRL, reducing to 0.3 around 20 weeks and reaching 0.25 at term

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11
Q

What happens after week 9 that allows the body proportions of the foetus to near those seen in the adult?

A

Acceleration of body and lower limb growth

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12
Q

What CRL would be expected at 9 weeks?

A

5 cm

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13
Q

What CRL would be expected at 9, 12, 16 and 38 weeks respectively?

A

5, 8.5, 16 and 36 cm

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14
Q

Around what time does the face become more distinguished and the limbs reach their relative lengths?

A

Week 12

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15
Q

Briefly describe the 16 week old foetus.

A

Weighs less than 500 g and is covered in lanugo with head and eyebrow hair visible

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16
Q

When does weight gain increase rapidly in utero?

A

2nd half of intrauterine life, especially during mid- and later foetal periods

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17
Q

When is 50% of full term weight added to the foetus?

A

Mid and late foetal periods

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18
Q

What deposition dominates in weight gain of the early foetus?

A

Protein

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19
Q

Does protein deposition always dominate in weight gain of the foetus?

A

No, adipose deposition takes over in late foetal stages

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20
Q

Why might a pre-term baby be unable to maintain a constant body temperature?

A

Lack of brown adipose tissue for thermoregulation due

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21
Q

What are non-pathological causes of low birth weight?

A

Prematurity or constitutionally small

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22
Q

How is a SFD differentiated from IUGR?

A

By doppler- abnormal in IUGR

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23
Q

What happens if a foetus is SFD and has an abnormal Doppler scan at >36 weeks?

A

Labour is induced or C-section performed

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24
Q

How is IUGR identified preterm managed?

A

Regular review

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25
Q

Why is obstetric USS performed in early pregnancy?

A

Confirm gestation, pregnancy site, number of foetuses, age and rule out ectopics

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26
Q

When is USS in early pregnancy usually performed?

A

9-12 weeks

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27
Q

What allows a more accurate ageing of a foetus than calculation of pregnancy from LMP?

A

CRL between weeks 7-13

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28
Q

What method can be used for early obstetric USS if there are concerns?

A

Transvaginal

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29
Q

When is obstetric USS routinely performed?

A

20 weeks

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30
Q

What is the 20-week obstetric USS also known as?

A

Anomaly scan

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31
Q

Why is an obstetric USS performed at 20 weeks?

A

To assess foetal growth and identify congenital malformations as all are detectable at this stage

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32
Q

How does a 4D USS scan differ from a 3D scan?

A

Includes time dimension, gives better resolution image

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33
Q

What measurements of the foetus are used in pregnancy?

A

Biparietal diameter, abdominal circumference, femur length, foot length

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34
Q

Why are biparietal diameter, abdominal circumference and femur length used together when assessing foetal growth?

A

Used for dating and to identify asymmetrical growth restriction

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35
Q

What does asymmetrical growth restriction usually spare?

A

Head

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36
Q

What is symphysis-fundal height?

A

Measurement made with tape measure between maternal public symphysis and uterine fundus to assess uterine expansion out of the pelvis

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37
Q

What is the average birth weight?

A

3500 g

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38
Q

What birth weight is suggestive of a growth restriction?

A

Less than 2500 g

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39
Q

What birth weight is determined as macrosomia?

A

> 4500 g

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40
Q

What does macrosomia indicate in the mother?

A

Maternal diabetes

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41
Q

What development of the respiratory system takes place in the embryonic period?

A

Bronchopulmonary tree from diverticulum that appears at week 4

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42
Q

How many generations of subdivisions are made in the bronchopulmonary tree by the end of the 6th month of development.

A

17

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43
Q

How many bronchopulmonary divisions arise postnatally?

A

6

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44
Q

When is the pseudo glandular stage of respiratory system development?

A

Weeks 8-16

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45
Q

What happens in the pseudo glandular stage of respiratory development?

A

Duct systems begin to form within bronchopulmonary segments to create bronchioles

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46
Q

What epithelium lines the bronchioles and their buds during the pseudo glandular stage?

A

Columnar

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47
Q

When is the canalicular stage of respiratory development?

A

Weeks 16-26

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48
Q

What happens in the canalicular stage of respiratory development?

A

Budding from bronchioles to form respiratory bronchioles

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49
Q

When is the terminal sac stage of respiratory development?

A

Weeks 26-term

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50
Q

What happens in the terminal sac stage of respiratory development?

A

3-6 alveolar ducts from each respiratory bronchiole end in terminal sacs that bud from the bronchioles, surrounded by flat alveolar cells in close contact with capillaries

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51
Q

When are there enough respiratory components to guarantee adequate gas exchange if delivery takes place?

A

End of the 7th month

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52
Q

What happens to type I pneumocytes lining terminal sacs during the last 2 months of development?

A

Become thinner so surrounding capillaries protrude to create the blood-air barrier

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53
Q

Are mature alveoli present before birth?

A

No

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54
Q

When do type II pneumocytes develop?

A

Month 6

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55
Q

What molecule is surfactant rich in?

A

Phospholipid

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56
Q

What is the composition of the fluid filling the lungs in T2 and T3?

A

High [Cl-], small amount of protein, mucus from bronchial glands and surfactant

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57
Q

What is the action of the significant increase in surfactant production in the last 2 weeks on the lungs?

A

Activates alveolar macrophages

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58
Q

What is the purpose of foetal breathing movements?

A

Condition respiratory musculature and draw in amniotic fluid

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59
Q

What is neonatal respiratory distress syndrome?

A

Insufficient surfactant production –> high blood-air surface tension –> alveoli collapse on expiration

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60
Q

What do partially collapsed alveoli in neonatal respiratory distress syndrome contain?

A

Fluid high in protein, hyaline membranes and lamellar bodies

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61
Q

How is neonatal respiratory distress syndrome managed if pre-term delivery is unavoidable?

A

Give glucocorticoids to mother to increase foetal surfactant production and administer synthetic surfactant to neotnate

62
Q

What is the foetal circulation arranged to ensure?

A

Oxygenated blood of ~80% sats from umbilical vein is circulated around foetus and retuned via umbilical artery at ~58%

63
Q

What range should foetal HR lie within from ~15 weeks onwards?

A

120-160 bpm

64
Q

What are the three shunts present in the foetal CVS?

A

Ductus venosus, foramen ovale, ductus arteriosus

65
Q

What guides flow of blood through foramen ovale?

A

Valve of IVC

66
Q

What guides a small amount of bloodflow from the RA to RV to allow for lung development?

A

Crista dividens

67
Q

Where does ductus arteriosus shunt blood from and to?

A

From PT to aorta

68
Q

When does foetal kidney function begin?

A

Week 10

69
Q

What is the result of renal agenesis in utero?

A

Oligohydramnios

70
Q

What are the possible consequences of oligohydramnios?

A

Club foot, lung hypoplasia

71
Q

Is foetal kidney function necessary for survival in utero?

A

No

72
Q

What is hydramnios?

A

Excess amniotic fluid

73
Q

What are the primary causes of hydramnios?

A

Idiopathic, maternal diabetes, CNS deformity, GI defects (prevented swallowing of neural/musclar cause)

74
Q

What is the first system to start and last system to finish developing in utero?

A

CNS

75
Q

What are corticospinal tracts required for?

A

Coordinated voluntary movements

76
Q

When do coordinated voluntary movements of the foetus begin?

A

4th month

77
Q

What is ‘quickening’?

A

Patterns of foetal movement that are detectable by the mother

78
Q

When does quickening usually arise?

A

17 weeks onwards

79
Q

What does the start of quickening depend on?

A

Number of previous pregnancies, size of baby, size of mother

80
Q

Can foetal movements be identified before 8 weeks?

A

No

81
Q

Why do breathing and suckling movements start in the 4th month of development?

A

To ‘practise’ for postnatal life

82
Q

Why are humans neurologically immature at birth?

A

Due to implications on head size and vaginal delivery

83
Q

When does myelination of the brain start?

A

9th month

84
Q

What evidence of postnatal brain myelination is there in the neonate?

A

Increasing infant mobility in the 1st year

85
Q

What determines viability of a pre-term baby?

A

Development of the respiratory and CNS

86
Q

When does myelination start in the spinal cord?

A

20 weeks

87
Q

When do the gyri and sulci arise?

A

28 weeks

88
Q

What causes development of the gyri and sulci?

A

Cerebellar hemispheres grown larger than the skull

89
Q

What respiratory event occurs at the same time as the onset of myelination in the brain?

A

Increased surfactant production

90
Q

What forms the maternal arm of the materno-foetal exchange system at the placenta?

A

Uterine arteries and veins emptying into intervillous spaces

91
Q

What forms the foetal arm of the materno-foetal exchange system at the placenta?

A

Umbilical arteries branching into foetal capillaries in the chorionic villi and umbilical vein

92
Q

How does foetal pO2 compare to the maternal value?

A

Foetal = 4 kPa, maternal = 11-13 kPa

93
Q

What allows the foetal oxygen content to be sufficient at the partial pressure seen in utero?

A

Foetal haemoglobin variant, foetal Hb levels > adult male levels, increased maternal 2,3-DPG levels, foetal haematocrit levels > adult levels

94
Q

Does the foetal haemoglobin variant bind as effectively as the adult variant to 2,3 DPG?

A

No

95
Q

How do hormones in the mother contribute to the concentration gradient between the maternal and foetal circulations?

A

Progesterone causes hyperventilation creating a physiological respiratory alkalosis that results in lowered maternal pCO2

96
Q

Describe the Bohr effect in the mother that aids gas exchange at the placenta.

A

CO2 moves into intervillous blood causing reduced pH and lowering the affinity of Hb for O2

97
Q

Describe the Bohr effect seen in the foetus that aids gas exchange at the placenta.

A

Foetal CO2 is lost causing an increased pH resulting in an increased affinity of Hb for oxygen

98
Q

What is the difference between the double Bohr and Haldane effects?

A

Bohr-determined by pCO2, Haldane-determined by [O2]

99
Q

Describe the double Haldane effect.

A

In the maternal blood Hb releases O2 and therefore accepts more CO2 whilst in the foetus more CO2 is released so it can accept more O2

100
Q

What prevents local alterations of pCO2 in the materno-foetal circulation?

A

Double Haldane effect

101
Q

Where does the ductus venosus connect?

A

Umbilical vein to IVC

102
Q

What is the purpose of the ductus venosus?

A

Cause blood entry to the RA bypassing the liver so that sats only drop by 5%

103
Q

Why is the liver hugely metabolically active in utero?

A

Synthesising haematological and immunological proteins

104
Q

Does the foetal liver have hepatobiliary function?

A

No

105
Q

What regulates the small amount of blood entry into the liver sinusoids in utero?

A

Sphincter within ductus venosus

106
Q

What prevents heart overload in the foetus during uterine contractions?

A

Closure of the sphincter in ductus venosus

107
Q

Why might physiological jaundice be seen at birth?

A

Foetal liver does not have hepatobiliary function so cannot conjugate bilirubin

108
Q

What forces the 2-leaved foramen ovale apart?

A

p(RA) > p(LA)

109
Q

What forms the crista dividens?

A

Free border of septum secundum

110
Q

What effect does the crista dividens have on bloodflow?

A

Divides into 2 streams

111
Q

Where does the minor steam of blood from the crista dividens flow?

A

To the RV to mix with deoxygenated blood from the SVC

112
Q

What causes the sats of blood in the LA to be around 60%?

A

Small amount of pulmonary venous return

113
Q

What shunts blood from the PT into the aorta?

A

Ductus arteriosus

114
Q

Why is blood shunted from the PT into the aorta distal to the supply to the head and heart?

A

Allows pulmonary circulation to develop without significantly reducing oxygen sats

115
Q

When are transient episodes of hypoxia seen in utero?

A

During labour when uterine contractions compress the umbilical vein

116
Q

What happens to bloodflow in the foetus during transient episodes of hypoxia?

A

Redistributed from GI tract, kidneys and limbs to the heart and brain

117
Q

What are the effects of foetal chemoceptors detecting low pO2?

A

Vagal stimulation resulting in bradycardia

118
Q

Why does foetal vagal stimulation result in bradycardia?

A

To reduce oxygen demands

119
Q

What can chronic hypoxaemia lead to in the foetus?

A

Growth restriction and behavioural changes

120
Q

What causes behavioural changes due to chronic hypoxaemia in the foetus?

A

REM sleep pattern disruption

121
Q

What are the necessary hormone for foetal growth?

A

Insulin, human placental lactogen, leptin, IGFI, IGFII, EGF, TGF-alpha

122
Q

What type of cellular growth is seen at 0-20 weeks?

A

Hyperplasia

123
Q

What type of cellular growth is seen at 20-28 weeks?

A

Hyperplasia and hypertrophy

124
Q

What type of cellular growth is seen at 28 weeks to term?

A

Hypertrophy

125
Q

What type of growth restriction is seen at 0-20 weeks?

A

Irreversible symmetrical

126
Q

What type of growth restriction is seen at 28 weeks to term?

A

Reversible asymmetrical

127
Q

Where is foetal leptin produced?

A

Placenta

128
Q

What do mutations to IGFI gene result in?

A

IUGR and growth retardation after birth

129
Q

Which growth hormone dominated in T2 and T3?

A

IGFI

130
Q

What effects does IGFI have?

A

Mitogenic and anabolic

131
Q

Is IGFI or II nutrient-independent?

A

IGFII

132
Q

What is the benefit of IGFII dominating foetal growth in T1?

A

Nutrient independent so is not affected by maternal nutritional status that may be poor due to nausea and vomiting

133
Q

What is Barker’s hypothesis?

A

Nutritional and hormonal status during foetal life can influence adult health

134
Q

What does Barker’s hypothesis suggest IUGR leads to?

A

Obesity, hypertension, hyoercholestrolaemia, CVD, T2DM

135
Q

What is the purpose of amniotic fluid?

A

Allow for foetal movements, prevent adherence of embryo to amnion and protection from jolts

136
Q

Where is amniotic fluid derived in early pregnancy?

A

In part by amniotic cells but primarily from maternal blood

137
Q

When does the foetus begin to swallow amniotic fluid?

A

Beginning of the 5th month

138
Q

When does the foetal kidney start to contribute towards amniotic fluid volume?

A

9 weeks

139
Q

What foetal system other than the urinary system contributes to amniotic fluid volume?

A

Respiratory

140
Q

How does the volume of amniotic fluid progress through pregnancy?

A

10 ml @ 8 weeks, 1l @ 38 weeks, reduces post-EDD

141
Q

Why does amniotic fluid volume decrease post-EDD?

A

Senescence of placenta

142
Q

What volume can the foetal kidneys contribute to the amniotic fluid in T3?

A

Up to 800 ml

143
Q

What is the composition of amniotic fluid?

A

98% water, electrolytes, creatinine, urea, bile pigments, renin, glucose, hormones, foetal cells, lanugo, vernix caseosa

144
Q

What is vernix caseosa?

A

Covering of skin from foetal surfactant that water-proofs the skin

145
Q

What forms meconium?

A

Bile and intestinal secretions, creatinine, urea, rening glucose, hormones, foetal cells, lanugo and vernix caseosa

146
Q

What is meconium?

A

First stool passed by the neonate

147
Q

When may meconium leak into the amniotic cavity?

A

Foetal distress

148
Q

How does amniotic fluid enter the foetus?

A

Intramembranous across placenta and foetal membranes, through lungs and by swallowing

149
Q

How does amniotic fluid exit the foetus?

A

As urine, from the lungs and head

150
Q

How does amniotic fluid move out of the amniotic cavity?

A

Transmembranous

151
Q

Describe the process of amniocentesis.

A

Fine-gauge needle under US guidance to remove amniotic fluid at 15 weeks

152
Q

What is amniocentesis used for?

A

Prenatal diagnosis of chromosomal abnormalities, CMV, toxoplasmosis, SCD, thalassaemia and CF

Semester 4 (33 decks)

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