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UROGENITAL > 11. Fetal Period > Flashcards

11. Fetal Period Flashcards

1
Q

FETAL PERIOD starts with what process

A

PLACENTAL INVASION

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2
Q

important part of PLACENTATION

A

Establishing BLOOD SUPPLY

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3
Q

what is needed for establishing a BLOOD SUPPLY in PLACENTA formation

A

SPIRAL ARTERY REMODELING

Invasion of SYNCYTIOTROPHOBLASTS causes Small SPIRAL ARTERIES to
- have LARGE LUMEN
- Disrupts muscular layer so LOSE SENSITIVITY to VASOCONSTRICTORS

ALLOW MAXIMUM GAS EXCHANGE

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4
Q

in PLACENTAL DEVELOPMENT when are TERMINAL VILLI formed

A

by 20 WEEKS

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5
Q

HORMONE PRODUCTION by PLACENTA

A
  • hCG (human chorionic gonadotrophin)
  • hPL (human placental lactogen)
  • PROGESTERONE
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6
Q

PLACENTA forms a …. BARRIER

A

IMMUNOLOGICAL BARRIER

  • LYMPHOID CELLS
  • PHAGOCYTES
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7
Q

when does FETAL SKIN become IMPERMEABLE to FLUID EXCHANGE

A

16 WEEKS

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8
Q

what is AMNIOTIC FLUID PRODUCED by

A

FETAL URINE,
swallowed and recycled by fetus
bathes fetal LUNGS

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9
Q

AMNIOTIC FLUID (measurable by ultrasound scan) increases to PEAK of … at how many weeks, before REDUCING to … by ..

A

800 ml at 30 WEEKS
reduces

approx 400 ml by 42 weeks

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10
Q

AMNIOTIC FLUID is PREDOMINANTLY..

A

WATER

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11
Q

characteristics of AMNIOTIC FLUID

A

PROTECTIVE
has HOMEOSTATIC EFFECTS

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12
Q

conditions that can cause INCREASED AMNIOTIC FLUID

A
  • DIABETES
  • MACROSOMIA (larger fetus than normal)
  • FETAL PATHOLOGIES
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13
Q

conditions that can cause DECREASED AMNIOTIC FLUID

A
  • IUGR (intrauterine growth restriction - not growing as expected)
  • RENAL PATHOLOGIES (kidneys)
  • RUPTURED MEMBRANES
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14
Q

things that happen with LIMBS during FETAL DEVELOPMENT

A
  • NAILS form
  • fingers SEPARATE
  • BONES remain mostly CARTILAGINOUS and only HARDEN SLOWLY
  • INCREASE in fetal MOVEMENTS from 25 weeks (although start movements earlier)
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15
Q

things that happen with FACE and HEAD during FETAL DEVELOPMENT

A
  • ENLARGEMENT of the SKULL (sutures do not fuse until CHILDHOOD)
  • EXTERNAL EARS form
  • SUCKING REFELEXES observed from 17 WEEKS
  • HAIR begins to grow from 20 WEEKS
  • Face becomes more human-like
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16
Q

when do SUTURES of SKULL FUSE

A

ONLY in CHILDHOOD

  • Do not fuse premature or can cause problems in brain development
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17
Q

when do SUCKING REFLEXES BEGIN

A

17 WEEKS

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18
Q

when does HAIR start to GROW

A

20 WEEKS

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19
Q

what happens in ABDOMINAL DEVELOPMENT

A
  • ROTATION and HERNIATION of GUT (by 12 WEEKS)
  • SWALLOWING develops
  • DEPOSITION of BODY FAT (on fetus around abdomen)
  • DIAPHRAGM CLOSES (separation between thorax and abdominal cavity)
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20
Q

in ABDOMINAL GROWTH
when does ROTATION and HERNIATION (protruding through /rupture) of the GUT take place

A

By WEEK 12

(allows space for gut to grow and rotate before returning to proper place IN abdomen)

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21
Q

when do KIDNEYS BEGIN to PRODUCE URINE

A

FROM 16 WEEKS

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22
Q

VOLUME of URINE EXCRETED by KIDNEYS (from 16 weeks) INCREASES to …. at 40 WEEKS

A

38 ml/hour at 40 WEEKS

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23
Q

when is RENAL DEVELOPMENT only COMPLETE

A

36 WEEKS

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24
Q

EXTERNAL GENITALIA visible from..

A

12 WEEKS

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25
Q

when do TESTICLES DESCEND (from pelvis into scrotum)

A

16 WEEKS

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26
Q

in FEMALE FETUS, when are the OOCYTES at their MAXIMUM number

A

20 WEEKS

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27
Q

what happens in BRAIN DEVELOPMENT

A
  • INCREASED SIZE and GYRATION (ROTATION)
  • FISSURE FORMATION
  • VENTRICULAR ENLARGEMENT
  • 4X INCREASE in CORTICAL GREY MATTER from 20 WEEKS
  • NOCICEPTION from 21 WEEKS (sensory, cant detect painful stimuli)
28
Q

when does NOCICEPTION (sensory, detect stimuli) begin

A

21 WEEKS

29
Q

how much INCREASE in BRAINS CORTICAL GREY MATTER from 20 WEEKS

A

4X

30
Q

FETAL GROWTH is LINEAR until

A

20 WEEKS

31
Q

how ACCURATE are ULTRASOUNDS at detecting size of fetus

A

40-50%

Symphysial Fundal Height: 25-35%

however correlation of fetal size with pathology is poor

32
Q

CAUSES of FETAL OVERGROWTH (growth > 95th percentile)
(common)

A
  • mostly IDIOPATHIC (NO IDENTIFIABLE CAUSE)
  • DIABETES
  • FETAL OVERGROWTH SYNDROMES
33
Q

FETAL GROWTH RESTRICTION (Failure to achieve genetic growth potential) PATHOLOGICAL CAUSES:

(can still be small and healthy unless FGR)

A
  • PLACENTAL functioning
  • INFECTIONS (CMV etc)
  • GENETIC/CHROMOSOMAL problems
  • potentially Starvation of mother
34
Q

QUICKENING of FETAL MOVEMENTS are when

A

16-20 WEEKS

more than 80% of time will be asleep

more active at night - diurnal rhythm

Reduction/Loss of fetal movements may be pathological

35
Q

how is LUNG DEVELOPMENT

A

CONTINUOUS from 4th week (from splanchnic mesoderm)

Critical period: 16-24

can see FETAL BREATHING FROM 20 WEEKS

increases from 15 to 30% in 3rd trimester

36
Q

when do ALVEOLI of LUNGS DEVELOP

A

AFTER 24 WEEKS

further development after birth from 100 million to 300 million

37
Q

in LUNG DEVELOPMENT what do TYPE 2 PNEUMOCYTES PRODUCE from 28 WEEKS
in what phase
what does it prevent

A

SURFACTANT (PHOSPHOLIPID)

in SACCULAR PHASE

  • PREVENTS ALVEOLAR COLLAPSE
38
Q

FETAL RESPIRATORY CHANGES at BIRTH

A
  • LUNGS INFLATE and FILL with air, PUSHING AMNIOTIC FLUID OUT of lungs
  • INCREASED FETAL OXYGENATION
  • this causes DECREASES in BLOOD FLOW RESISTANCE
39
Q

what does SURFACTANT in LUNGS do

A

REDUCES SURFACE TENSION of ALVIOLI
- AIDS BREATHING
- PREVENTS ALVELOAR COLLAPSE

40
Q

how is FETAL HAEMOGLOBIN (HbF) in comparison to ADULT HEAMOGLOBIN

A

HIGHER AFFINITY for OXYGEN

so HIGHER AMOUNT of circulating Haemoglobin (16-18 g/dl)
(adult : 11-15 g/dl)

(HgF makes up 90% of fetuses haemoglobin)

41
Q

important BYPASSES in FETAL LUNGS

A
  • DUCTUS ARTERIOSIS
    connects pulmonary artery and aorta
  • FORAMEN OVALE ( allows right to left shunt)

have HIGHER VASCULAR RESISTANCE

42
Q

how is FETAL CIRCULATION

A

relative HYPOXIA (low oxygen levels)
pH 7.25

MIXED OXYGENATION

43
Q

at BIRTH how does fetal circulation CONVERT to ADULT CIRCULATION

A
  • LOWER PULMONARY OXYGENATION
  • LOWER VASCULAR RESISTANCE
  • FORAMEN OVALE CLOSES
  • DUCTUS ARTERIOSUS CLOSES

increased oxygenation
Haemolysis over weeks to compensate

44
Q

is FETAL HAEMOGLOBIN higher or lower than ADULT HAEMOGLOBIN

A

HIGHER (16-18 g/dl)

(adult 11-15 g/dl)

with HIGHER AFFINITY

45
Q

FETAL DISORDERS include what types of abnormalities

A

CHROMOSOMAL, GENETIC and STRUCTURAL anomalies of fetus

46
Q

FETAL ANOMALIES can occur in approx how many pregancies

A

2-3%

47
Q

examples of ANEUPLOIDY FETAL ANOMALIES

A
  • Down syndrome (Trisomy 21)
  • Turner Syndrome (1 X chromosome)
  • Trisomy 13 aka Patau’s
  • Trisomy 18 aka Edward’s
48
Q

examples of GENETIC CONDITIONS in FETAL ANOMALIES

A
  • Beckwith-Weideman
  • Fragile X Syndrome
49
Q

examples of STRUCTUAL FETAL ANOMALIES

A
  • Cardiac
  • Neurological
  • Skeletal
  • Genetic
  • Thoracic
  • Renal/Urological
50
Q

CHARACTERISTICS of DOWN SYNDROME (TRISOMY 21)

A
  • ADDITIONAL CHROMOSOME 21 (3 copies)
  • INCURABLE
  • MENTAL impairment
  • CARDIAC disorders
  • Characteristic FEATURES

many require lifelong care (but varies)

51
Q

what can DOWN SYNDROME be related to

A

MATERNAL AGE at conception

  • more likely in older women
    (especially increases after 40)
52
Q

94% of TRISOMY 21 is due to

A

NON-DISJUNCTION

failure of sister chromosomes to divide equally during cell division

leads to oocyte with 2 copies of chromosome 21 (instead of haploid)
with sperm becomes 3 copies of chr. 21

53
Q

other GENETIC CAUSES of TRISOMY 21 (less common)

A
  • 2.4% MOSAICISM
    after fertilisation.
    some cells have 3 chr. 21, some don’t
    characteristics vary
  • 3.3% ROBERTSONIAN TRANSLOCATION
    correct number in a parent but different arrangement of chr. 21
54
Q

methods of SCREENING for TRISOMY 21

A
  • BIOCHEMICAL TESTS (triple or quad) (biochemical markers)
  • look at NUCHAL TRANSLUCENCY
  • COMBINED TEST (biochemical and nuchal)
  • INTEGRATED TEST
  • NON-INVASIVE PRENATAL TEST (free foetal DNA)

(diagnostic: invasive test , CVS or amniocentesis)

55
Q

screening for FETAL ANATOMY

A

FETAL STRUCTURAL ANOMALY SCREENING

56
Q

RISK FACTORS for CARDIAC DISORDERS in FETUS

A
  • FAMILY HISTORY
  • DIABETES
  • CHROMOSOMAL problems history
  • GENETIC problems history
  • DRUGS
57
Q

examples of DEFECTS seen in FETAL CARDIAC DISORDERS

A
  • VALVULAR defects
  • SEPTAL defects
  • VENTRICULAR defects
  • OUTFLOW TRACTS defects
58
Q

NEUROLOGICAL DISORDERS

A

often SEVERE

related to NEURODEVELOPMENTAL DELAY and CEREBRAL PALSY

might see:
Ventriculomegaly (ventricle enlargement)
cerebellar
loss of sulcation/gyration
bleeds

59
Q

example of a NEURAL TUBE DEFECT (FAILURE TO CLOSE)

A

SPINA BIFIDA

risk reduced by folic acid

60
Q

what is MICROCEPHALY and what are causes

A

FAILURE of BRAIN and SKULL to GROW

associated with MENTAL IMPAIRMENT

CAUSES: VIRAL (ZIKA virus), CHROMOSOMAL. CRANIOSYNOSTOSIS (sutures fuse premature), ALCOHOL, DRUGS

61
Q

SKELETAL DISORDERS includes having

A
  • MISSING BONES
  • ABNORMAL SHAPE of BONES
  • MINERALISATION problems
  • FRACTURES

CRANIO-FACIAL PROBLEMS
- CLEFT LIP and PALATE (corrective surgery)

62
Q

GASTROINTESTINAL DISORDERS

A
  • ECHOGENIC BOWEL
    (genetic, CMV, Cystic Fibrosis)

ABDOMINAL WALL DEFECTS:
- GASTROSCHISIS
bowel/liver outside of abdomen, doesn’t return after herniation

  • OMPHALOCELE
    herniation covered with Peritoneum
    (can be chromosomal disorders)
63
Q

RENAL DISORDERS include KIDNEYS that are:

A
  • ABSENT
  • UNILATERAL (one side)
  • WRONG POSITION
  • abnormal looking - CYSTIC or FAILURE to DEVELOP CORRECTLY

serious if both kidneys

RENAL DISORDERS can also include BLADDER problems (less common, more common in boys)

64
Q

DRUG RELATED problems from which DRUGS

A
  • THALIDOMIDE (given for morning sickness)
    caused severe malformations in fetus,
    underdeveloped upper limbs
  • ANTIEPILEPTICS
    eg SODIUM VALPROATE (10%)
    can cause Spina Bifida, Cleft Palate, Cardiac defects
65
Q

is SCREENING for TRISOMY 21 100% effective

A

NO

most accurate is non-invasive

Biochemical
TRIPLE (69%)
QUAD (81%

NUCHAL TRANSLUCENCY (80%)
COMBINED (82-87%)
INTEGRATED (96%)

66
Q

which GASTROINTESTINAL DISORDER is related to CHROMOSOMAL DISORDERS

A

OMPHALOCELE - herniation covered with peritoneum

NOT gastroschisis (bowel/liver outside abdomen)

UROGENITAL (19 decks)

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