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Block 11 > Small Babies > Flashcards

Small Babies Flashcards

1
Q

Embryonic period is characterised by

A

Intense organogenetic activity
Growth is very little except for the placenta

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2
Q

When is there an acceleration in growth of the foetus

A

After 8 weeks

Leads to exponential increase in weight of foetus

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3
Q

What is an accurate measure of assessing the age of the embryo

A

Crown rump length CRL

At 9 weeks = 5cm

At 38 weeks = 36cm

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4
Q

Weight gain in the early foetal stage is due to _____

A

Deposition of new protein

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5
Q

Weight gain in the late foetus stage is due to

A

Deposition of adipose tissue

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6
Q

How do body proportions change as the foetus grows

A

At week 9 the head and neck account for half of the length of the foetus

As foetus grows (limbs and trunk) = more proportionate

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7
Q

What is main mechanism of growth in the first 20 weeks

A

Hyperplasia

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8
Q

What is the mechanism of growth in 20-28 weeks

A

Hyperplasia and hypertrophy

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9
Q

What is the mechanism of growth after 28 weeks

A

Hypertrophy

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10
Q

Growth restriction can be……

A

Symmetrical = proportional growth of the head and body

Asymmetrical = head is spared and body is disproportionately smaller

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11
Q

Hormones that are essential for foetal growth

A

Insulin

IGFII = nutrient independent in dominates in T1

IGF I - nutrient dependent and dominates in T2 and T3

Leptin = important in placental formation

Epidermal growth factor EGF and TGF alpha (transforming growth factor)

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12
Q

Which hormone is nutrient independent and what trimester does it dominate

A

Insulin like growth hormone I

Trimester 1

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13
Q

What is macrosomia

A

Baby weight greater than 4.5kg

Indicative of gestational diabetes

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14
Q

What is considered a healthy weight for a newborn

A

3.5kg

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15
Q

Less than ________kg is suggestive of foetal growth restriction

A

2.5kg

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16
Q

Why can babies have a low birth weight

A
  • if are born prematurely
  • smaller mothers give birth to smaller babies
  • if have suffered growth restriction
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17
Q

There is a greater risk of ________________ & ________________ in IUGR babies

A

Mortality
Morbidity

18
Q

What things can be looked at in an antenatal assessment of foetal wellbeing

A
  • mother ( fetal movements or not)
  • biochemical tests
  • regular measurement of uterine expansion by measuring symphysis-fundal height
  • ultrasound scan
19
Q

What are we trying to detect in a biochemical test

A
  • hCG maintains corpus luteum
  • HPL (human placental lactogen) regulates metabolism of macromolecules
  • alpha fetoprotein - transfer of heavy metal ions in to the foetal bloodstream
20
Q

What are the negatives of biochemical tests

A

Expensive

Poor positive predictive value

21
Q

A 12 week scan is carried out for what reasons

A

Rule out ectopic pregnancies
Number of foetuses?

22
Q

A 20 week scan is carried out for what reasons

A

Assess foetal growth and any anomalies

23
Q

What is used between 7-13 weeks

A

Crown rump length

To date the pregnancy, estimate EDD

24
Q

Head and abdominal circumference with femur length is measured at ______

A

20 weeks

25
Q

What is a Doppler ultrasound used for

A

Assessment of wave pattern of blood through umbilical artery
Used in assessment of IUGR at risk babies

26
Q

What is the Normal results of a Doppler ultrasound

A

Increase in diastolic velocity

There will be a decrease in the indices measured such as PSV, MDV and TAPV

PSV = peak systolic velocity
MDV = mean diastolic velocity
TAPV = time averaged peak velocity

27
Q

Worsening umbilical artery Doppler shows

A

1) increased systolic: diastolic ratio with no rise in diastolic flow

2) absent end diastolic flow in the umbilical artery

3) reverse diastolic flow - there is reflux through the artery

28
Q

What are features are indicative of early foetal hypoxia

A

Raised umbilical artery pulsatility

Absent end diastolic flow

29
Q

What other artery can a Doppler look at

A

Uterine artery

30
Q

What is the pathogenesis of IUGR

A

Normally to establish a high flow, low resistance system remodelling of the spiral arteries is required. Remodelling is carried out by invading trophoblasts which migrate into the arterioles and replace the endothelial cells with trophoblast cells

Reduction/loss of vascular smooth muscle in spiral arteries so cannot spasm and create high flow, low resistance flow that is needed

31
Q

What is the decidual reaction

A

Endometrium becomes the decidua
Reaction creates Goldilocks zone - enough invasion to allow permissive circulation but not too much that it invades the myometrium as well

32
Q

A sub-optimal decidual reaction can lead to what kind of adverse effects in pregnancy

A

Placental insufficiency

Pre-eclampsia

33
Q

What are foetal risk factors for IUGR

A

Genetics: chromosomal abnormalities or single gene disorders
Epigenetics = methylation disorder
Infections = TORCH

34
Q

What infections can increase a foetuses risk for IUGR

A

TORCH

Toxoplasmosis
Others varicella, syphilis and parvovirus
Rubella
Cytomegalovirus
HIV

35
Q

What maternal risk factors are there for IUGR

A

Pre-existing medical conditions such as chronic hypertension, renal disease and CVD
Drug exposure = smoking and alcohol

36
Q

Which placental factors pose a risk for IUGR

A

Placental infarction
Placental abruption = placenta torn away from decidua
Placental insufficiency = hypertensive disorders and maternal diabetes

37
Q

Why does timing of the insult matter

A

Early phase insult = hyperplasia phase in which foetus is symmetrically affected in terms of IUGR

Late phase insult = hypertrophy phase where foetus is asymmetrically affected

38
Q

How is the head sparing effect achieved

A

Decreased glycogen deposition in the liver
Decreased adipose tissue deposition in the system

= decreased abdominal size in proportion to body

39
Q

What is the barker hypothesis

A

Foetal programming during development leading to adult metabolic disorders

Obesity, diabetes, insulin insensitivity, hypertension, hyperlipidemia and CHD

40
Q

A sub-optimal in utero environment may impact adult health how

A

Pulmonary insufficiency

Hypertension

Renal insufficiency

Insulin insufficiency

Altered glucose/lipid metabolism

Immune deficiency

Neurodegenerative and cognitive diseases

Obesity

Block 11 (13 decks)

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