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Semester 4 - Reproductive System > Session 9 - Foetus and Foetal Growth > Flashcards

Session 9 - Foetus and Foetal Growth Flashcards

1
Q

Define the pre-embryonic period

A

Fetilisation -> 3 weeks

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2
Q

Define the embryonic period

A

3 -> 8 weeks

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3
Q

Define the foetal period

A

8-38 weeks

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4
Q

What is the main method of measuring foetal size?

A

Crown Rump Length

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5
Q

What growth happens in the embryo?

A

 Intense morphogenesis and differentiation
 Little weight gain
 Placental growth most significant

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6
Q

What growth occurs in early foetus?

A

Protein deposition

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7
Q

What growth occurs in late foetus

A

Adipose deposition

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8
Q

What parts of respiratory system develop in the embryonic phase?

A

Bronchopulmonary tree, with airways but no gas exchanging parts

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9
Q

What significance does the late development of respiratory system have?

A

o Major implications for pre-term survival
 Threshold of Viability
 Viability is only a possibility after 24 weeks

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10
Q

What are the four stages of resp system development

A

Pseudoglandular stage
Canalicular
Terminal sac stage
Alveolar period

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11
Q

What is pseudoglandular stage?

A

o Weeks 8 – 16
o Duct systems begin to form within the bronchopulmonary segments created during the embryonic period
 Bronchioles

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12
Q

What is canalicular stage?

A 
o	Weeks 16 – 26 
o	Formation of respiratory bronchioles
	Budding from bronchioles formed during the pseudoglandular stage
o	May be viable at the end
o	More vascular
o	Some terminal sacs
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13
Q

What is terminal sac stage?

A

o Week 26 – Term
o Terminal sacs begin to bud from the respiratory bronchioles
o Some primitive alveoli
o Differentiation of pneumocytes
 Type 1 – Gas exchange
 Type 2 – Surfactant production from week 20

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14
Q

What is alveolar period?

A

o Late fetal  8 years

 95% of Alveoli are formed post-natally

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15
Q

How do the lungs prepare for birth?

A

Breathing’ movement
 Conditioning of the respiratory musculature
o Fluid filled
 Crucial for normal lung development

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16
Q

What is main part of brain development?

A

Corticospinal tract

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17
Q

When does corticospinal tract begin to develop?

A

4th month

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18
Q

Why can’t babies move properly at birth?

A

o Myelination of the brain only beings in the 9th month

 Corticospinal tract myelination incomplete at birth, as evidence by increased infant mobility in the 1st year

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19
Q

When does movement begin?

A

Week 8

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20
Q

How much of body weight is brain at birth?

A

12%

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21
Q

Give four changes which occur in brain during foetal period

A

o Cerebral hemisphere becomes the largest part of the brain
 Gyri and sulci form after 5 months as the brain grows faster than the head
o Histological differentiation of cortex in the cerebrum and cerebellum
o Formation and myelination of nuclei and tracts
o Relative growth of the spinal cord and vertebral column

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22
Q

In what order do senses develop

A

Hearing and taste mature before vision. The organ of corti in the inner ear is well developed in the fetus at 5 months, but the retina is immature at birth.

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23
Q

What is quickening?

A

o Fetal movements can be seen by USS at Week 8

o Maternal awareness of fetal movements from Week 17 onwards

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24
Q

What is the use of assessing foetal movements

A

o Low cost, simple method of ante-partum fetal surveillance

o Reveals fetuses that require follow-up

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25
Q

What is the significance of foetal heart rate?

A

Bradycardia associated with foetal demise

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26
Q

When is ascent of kidneys complete

A

Week 10

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27
Q

Outline kidney development

A

o Fetal kidney function begins in week 10
 Functional embryonic kidney is the Metanephros
o Renal pelvis, calyces etc present by week 23
o Histological differentiation of cortex and medulla almost complete by 8 months
o Fetal urine is a major contributor to amniotic fluid volume
o Fetal kidney function is not necessary for survival during pregnancy, but without it there is oligohydramnios.

28
Q

How often do bladder fill and empty?

A

o Bladder fills and empties every 40 – 60 minutes in the fetus (seen on USS)

29
Q

What is the threshold of viability?

A

Viability is only a possibility once the lungs have entered the terminal sac stage of development (after 24 weeks).

30
Q

What is respiratory distress syndrome

A

o Often affects infants born prematurely
o Insufficient surfactant production
o If pre-term delivery is unavoidable or inevitable
 Glucocorticoid treatment (of the mother)
 Increases surfactant production in the fetus

31
Q

Give six techniques to assess foetal development

A 
o	Ultrasound Scan
o	Doppler ultrasound
o	Non-Stress Tests (NST)
   	Monitors hear-rate changes associated with fetal movement
o	Biophysical profiles (BPP)
   	5 measured variables
o	Fetal movements kick chart
32
Q

When is a foetus regarded as having growth restriction?

A

If its weight is below the 10th percentile for gestational age

33
Q

Give two types of growth restriction

A

Symmetrical growth restriction

Asymmetrical growth restriction

34
Q

What is symmetrical growth restriction?

A

 Growth restriction is generalised and proportional

35
Q

Asymmetrical growth restriction

A

 Abdominal growth lags
 Relative sparing of head growth
 Tends to occur with deprivation of nutritional and oxygen supply to fetus

36
Q

Why is estimation of foetal age important?

A

It is important to distinguish between a fetus born prematurely and one born full term but small.

37
Q

Give two methods of dating a pregnancy?

A

o Fertilisation age

o Age since mother’s Last Menstrual Period (LMP)

38
Q

Give problems with
o Fertilisation age

o Age since mother’s Last Menstrual Period (LMP)

A

o Fertilisation age
 Use of calendar months may cause inaccuracies
o Age since mother’s Last Menstrual Period (LMP)
 Irregular cycles may cause confusion

39
Q

Give five developmental criteria of foetus

A 
o	Crown-Rump (CR) length
  	Used in T1
o	Foot length
o	Biparietal diameter of head
  	Used in T2/T3
o	Weight after delivery
o	Appearance after delivery
40
Q

What is another way of measuring foetal age?

A

Symphysis – Fundal height
o Distance between symphysis pubis to top of uterus (fundus)
o Measured with a tape measure

41
Q

Give three problems with Symphysis – Fundal height

A

 Number of fetuses can cause variation
 Volume of amniotic fluid can cause variation
 The lie of the fetus can cause variation

42
Q

What is use of daily rhythmns?

A

A fetus has daily rhythms of heart rate, breathing and activity. Heart rate variability is a good index of developing control systems.

43
Q

What is oligohydraminos?

A

o Too little
o Placental insufficiency
o Fetal renal impairment
o Pre-eclampsia

44
Q

PWhat is polyhramnois?

A 
o	Too much
o	Fetal abnormality
   	E.g. inability to swallow 
   	Structural – blind-ended oesophagus
 	Neurological – unable to coordinate swallowing movements
45
Q

What is quickening?

A

o Maternal awareness of fetal movements from Week 17 onwards
o Low cost, simple method of ante-partum fetal surveillance
o Reveals fetuses that require follow-up

46
Q

Classify birth weights

A

o < 2,500g = Growth Restriction
o 3,500g = Average
o > 4,500g = Macrosomia
o Maternal diabetes

47
Q

Describe the effects of poor nutrition in early pregnancy

A

o Neural tube defects

 E.g. DiGeorge Syndrome

48
Q

Describe the effects of poor nutrition in late pregnancy

A

o Asymmetrical Growth Restriction

 Subsequent oligohydramnios

49
Q

Describe foetal circulation before birth

A

o Oxygenated blood enters fetus via the Umbilical Vein from the placenta
o Oxygenated blood bypasses the liver via the Ductus Venosus
o Oxygenated blood passes from the RA  LA via the Foramen Ovale
o Blood passes from the pulmonary artery  Aorta via the Ductus Arteriosus
o Deoxygenated blood returns to the placenta via the two Umbilical Arteries

50
Q

Why is resistance so high in the lungs?

A

Hypoxic Pulmonary Vasoconstriction.

51
Q

Describe changes in foetal circulation after birth

A 
The infant takes its first breath, removal Hypoxic Pulmonary Vasoconstriction and greatly reducing the resistance of the lungs. 
o	Greater venous return to LA
   	Pressure in LA > RA
   	Closure of the Foramen Ovale
   	(Minutes)
o	Increased O2 saturation of blood and decreased [Prostaglandins] (placenta has been removed)
   	Constriction of Ductus Arteriosus
   	Constriction of Umbilical Artery
   	 (Hours)
o	Stasis of blood in Umbilical Vein and Ductus Venosus
	Clotting of blood
	Closure due to subsequent fibrosis
	(Days)
52
Q

Give two main roles of aminiotic fluid

A

Mechanical protection

Moist environment so foetus does not dehydrates

53
Q

How much amniotic fluid at
8 weeks
38 weeks
42 weeks

A

o ~10ml at 8 weeks
o ~1 Litre at 38 weeks
o Falls to ~300ml at 42 weeks

54
Q

How is amniotic fluid produced early in pregnancy?

A

 Formed from maternal fluids

 Fetal extracellular fluid by diffusion across non-keratinised skin

55
Q

How is amniotic fluid produced later in preg?

A

Turnover via foetus

56
Q

What do amniotic fluid contain? What is it useful?

A

Cells from foetus and amnion.

It included a variety of proteins, and if sampled via a Amniocentesis, can be diagnostically useful.

57
Q

How much urine does foetus produce at 25 weeks
and
term

A

25 weeks - 100ml

term - 500ml

58
Q

Why does foetus swallow amniotic fluid? What does it form?

A

Absorbs water and electrolytes

Debris accumulates in foetal gut and forms meconium

59
Q

What is bilirubin formed by? Who conjugates it?

A

Haemoglobin breakdowwn in foetus and mother

Conjugated by mother

60
Q

What problems can occur with bilirubin in foetus? What can cure it?

A

o Neonate may become jaundiced if conjugation does not establish quickly
 Liver has never had to conjugate bilirubin before during pregnancy, so it takes a little bit of time for the liver to kick in
 Exposure to light (phototherapy) stimulates the liver to begin conjugation

61
Q

What is the driving force for oxygen diffusion from mother to foetus?

A

Oxygen diffuses across the placenta from maternal blood across a thin barrier
The driving factor for this is the gradient of partial pressures between maternal and umbilical blood, as the placenta has a large area for and low resistance to diffusion.
o Maternal pO2 increased
o Umbilical venous pO2 must be must lower

62
Q

What is dangerous about foetal hypoxia?

A

Fetal oxygen stores are very low (about 2 minutes worth), which can be a problem in labour, particular if the problem involves the placenta. Contraction of the myometrium can compress placenta blood vessels.

63
Q

What is a good indicator for foetal O2?

A

Foetal heart rate is a good indicator of foetus O2 saturation.

64
Q

What is normal foetal pO2?

A

o Fetal pO2 is 4kPa

 Normal arterial pO2 in adults is 13.3kPa

65
Q

What is different about foetal haemoglobin?

A

o Fetus has different haemoglobin, without beta chains, which is better at these lower partial pressures of O2.
 The higher affinity of fetal haemoglobin ‘sucks across’ the O2
 Fetal Haemoglobin is 70% saturated at 4kPa
 Adult Haemoglobin is 45% saturated at 4kPa

66
Q

What is double bohr effect?

A

An increase in pCO2 or [H+] concentrations results in Haemoglobin losing affinity for and releasing more oxygen. This is called the Bohr Effect. This happens both in the maternal and fetal blood, so is termed the Double Bohr Effect.

67
Q

What is CO2 transfer moderated by?

A

Placental CO2 therefore needs to be facilitated by lowering maternal pCO2. This is achieved by Hyperventilation, stimulated by Progesterone.

Semester 4 - Reproductive System (30 decks)

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