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Reproductive And Development > 3-3-16-Fetal And Neonatal Physiology (Lopez) > Flashcards

3-3-16-Fetal And Neonatal Physiology (Lopez) Flashcards

1
Q

Weeks 3-8 are described as the ___ period

Weeks 9-36 are described as the ___ period

Week 38 is considered ___ term

A

Embryonic

Fetal

Full

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2
Q

Major morphologic abnormalities can occur during weeks ___

Physiologic defects and minor morphologic abnormalities can occur during weeks ___

A

3-7

8-full term

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3
Q

list the 3 sequential phases of growth:

A
  • Pure hyperplasia
  • Hyperplasia and concomitant hypertrophy
  • Hypertrophy alone

The time courses of the 3 phases of growth are organ specific–> placenta goes through all 3 phases of growth, but these phases are compressed b/c the placental life span is relatively short

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4
Q

___ is the primary form of placental growth

Growth of the fetus occurs almost entirely by ____

A

Hypertrophy

Hyperplasia

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5
Q

___ of the fetus increases almost in proportion to age

___ of the fetus increases almost in proportion to the cube of the age of the fetus

A

Length

Weight

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6
Q

List roles that the placenta plays in fetal growth and development:

A
  • Transport and storage functions

- Synthesis of steroids (estrogen and progesterone) and protein hormones (hCG and hCS’s)

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7
Q

___ is an abnormality of fetal growth and development. The growth-restricted fetus is at substantial risk of morbidity and mortality and may occur as a result of decreased placental reserve caused by any insult

A

Intrauterine Growth Restriction (IGR)

Mothers who smoke during pregnancy tend to have small placentas and are at high risk of delivering a low birth weight baby

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8
Q

___ stimulate fetal growth

The fetus uses ___ as its major energy source

A

Glucocorticoids, insulin, GH, IGFs, and thyroid hormones

Glucose

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9
Q

___ promote the storage of glucose as glycogen in the fetal liver

___ contributes to the storage of glucose as glycogen, as well as to the uptake and utilization of AAs and lipogenesis

A

Glucocorticoids

Insulin

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10
Q

___ acts by binding to its receptors, primarily in the liver, and triggering the production of somatomedin or IGF-1

___ are mitogenic peptides that are extremely important for fetal growth

___ are obligatory for normal growth and development

A

GH (postnatally)= may only have a minimal effect on fetal growth, fetal liver has relatively few GH receptors

IGF-1/2=present in fetal circulation from end of 1st trimester, their levels increase thereafter in both mother and fetus

Thyroid hormones=hypothyroidism has adverse effects on fetal growth

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11
Q

The fetal heart begins beating during the __ week after fertilization, initially contracting at 65 bpm and rate increases steadily to ~140 bpm immediately before birth

A

4th

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12
Q

During the 3rd week of fetal development, nucleated RBCs are formed in the ___ of the placenta

A

Yolk sac and mesothelium

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13
Q

During the 4th-5th weeks of fetal development, non-nucleated RBCs form by __ cells of the fetal BV’s

A

Fetal mesenchymal and endothelial cells

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14
Q

At the 6th week of fetal development, the ___ now forms blood cells

A

Liver

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15
Q

At about the 12th week of fetal development, ___ tissues begin forming RBCs

A

The spleen and lymphoid

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16
Q

From the 3rd month on of fetal development, ___ becomes the principal sources of RBCs

A

Bone marrow–> also produces WBCs

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17
Q

___ begins to be formed in the 3rd week after fertilization, the content of which rises to ~15 g/dL by midgestation.

A

Hb–> [Hb] of fetal blood at term is higher than [Hb] of maternal blood, which may be only 12 mg/dL

Fetal Hb has higher affinity for O2: can carry 20-30% more O2 than maternal Hb

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18
Q

Most of the reflexes of the fetus involving the spinal cord and brain stem are present by __ months after pregnancy

A

3rd-4th

Cerebral cortex development continues after birth

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19
Q

___ is composed of swallowed amniotic fluid and partly of mucus, epithelial cells, and other residues of excretory products from the GI tract and glands

A

Meconium

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20
Q

Regarding fetal metabolism, ___ accumulates rapidly starting at 12 weeks gestation. About 1/3 of this compound in a fully developed fetus is stored in the liver and can be used for formation of additional Hb

A

Iron

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21
Q

Urine excretion begins in the ___ trimester and fetal urine accounts for ~70-80% of the amniotic fluid

A

2nd

22
Q

The renal control systems for the regulation of EC volume, electrolyte balance, and acid-base balance are almost __ until late fetal life

A

Non-existent–> functional development is not complete until the end of 1st month of life

23
Q

During the last 3-4 months of pregnancy, the respiratory movements of the fetus are mainly ___ and the lungs remain almost completely deflated

A

Inhibited

Inhibition of respiration prevents filling of the lungs with fluid and debris from the meconium; small amounts of fluid are secreted into the lungs by the alveolar epithelium up until birth

24
Q

List stimuli for breathing at birth:

A
  • asphyxiation during birth
  • sudden drop in ambient temperature and cooling of skin

Breathing initiates within seconds of birth

25
Q

What are some causes of hypoxia during delivery?

A
  • compression of umbilical cord
  • premature separation of placenta
  • excessive uterine contractions
  • excessive anesthesia of the mother (depressed maternal breathing)
26
Q

At birth, the alveoli are ___ due to surface tension of the amniotic fluid filling them

A

Collapsed

27
Q

More than ___ mm Hg negative inspiratory pressure is needed to overcome surface tension and open the alveoli for the 1st time

A

25–> 1st inspirations of the normal neonate are capable of creating as much as 60 mm Hg negative pressure in the intrapleural space; 1st inspiratory movements brings in nearly 40 mL air

28
Q

___ decrease surface tension in the alveoli

A

Surfactant

29
Q

Surfactant is secreted by __ cells and its main constituent is phosphatidylcholine and is dissolved non-uniformly in the alveolar fluid

A

Type II alveolar

30
Q

The synthesis of surfactant begins in the ___ trimester

A

Last

31
Q

___ is a failure to secrete adequate amounts of surfactant resulting in collapsed alveoli and development of pulmonary edema. It is common in pre-mature infants and infants born to diabetic mothers

A

Respiratory Distress Syndrome

32
Q

List the 4 unique shunts of fetal circulation:

A
  • placenta
  • ductus venosus
  • foramen ovale
  • ductus arteriosus
33
Q

The massive blood flow to the ___ shunts blood away from the lower trunk and lowers the effective blood flow to all abdominal viscera, including the kidneys

A

Placenta

34
Q

The ___ branch repeatedly under the amnion and form dense capillary networks within the terminal villi

The ___ returns oxygenated blood (which has a PO2 of 30-35 mm Hg) back to the fetus from the placenta and enters the ___

A

Umbilical arteries

Umbilical vein

Ductus venosus

35
Q

This 2nd shunt bypasses the fetal liver, which is largely nonfunctional and allows blood from the umbilical vein to enter the IVC directly

A

Ductus venosus

36
Q

This is the 3rd major shunt through which blood enters the right atrium and then crosses to enter the left atrium. It is an oval hole in the septum dividing the atria, located in the posterior aspect of the right atrium

A

Foramen ovale

37
Q

Regarding the foramen ovale, blood with the highest O2 content (PO2~27 mm Hg) enters the ___ from the IVC to supply carotid and brain

A

Left ventricle

38
Q

The foramen ovale creates a ___ shunt

A

Right-to-left–> of the 69% of the combined CO that enters the RA through the IVC, ~27% shunts through the foramen ovale directly into the LA

39
Q

The rest of the combined CO that enters the RA from the IVC does not shunt through the foramen ovale. This relatively well-oxygenated blood joins the relatively poorly oxygenated combined CO that enters the RA from the __

A

SVC and coronary vessels–> none of the incoming blood from the SVC or coronary vessels shunts through the foramen ovale; it goes through the tricuspid valve to the RV

40
Q

The PO2 in the RV is somewhat ___ than the LV and the blood from the RV enters the ___

A

Lower

trunk of the pulmonary artery

41
Q

This is the 4th major shunt, also a right-to-left shunt that directs blood from the pulmonary artery to the aorta. It contains substantial smooth muscle in its vessel wall

A

Ductus arteriosus

42
Q

The patency of the ductus arteriosus is due to active relaxation of its smooth muscle, mediated by ___

A

PGE2

43
Q

What happens to pulmonary vascular resistance at birth?

What happens to pulmonary blood flow at birth?

What happens to mean pulmonary arterial pressure at birth?

A

Decreases significantly due to lung expansion

Increases significantly

Decreases

44
Q

A loss of blood flow from the placenta causes a 2x increase in __ resistance at birth which increases aortic pressure and increases pressures in the LV and LA

A

Systemic vascular

45
Q

The foramen ovale should close at birth due to:

A
  • Increased venous return to the LA and elevated LA pressure
  • Decrease in RA pressure

As the flap of the FO pushes against the septum, blood flow from the LA to RA is prevented and eventually this flap seals shut

46
Q

Closure of which shunts establishes separate right and left circulatory systems?

A

Ductus arteriosus and foramen ovale

47
Q

___ is a heart problem that occurs soon after birth in some babies. The opening allows O2 rich blood from the aorta to mix with O2 poor blood from the pulmonary artery that can put a strain on the heart and increase BP in the lung arteries

A

Patent Ductus Arteriosus–> it remains open (patent)

48
Q

characterize the following features of neonate physiology:

Heart rate: ___ bpm

BP: ___

RR: ___ breaths/min

Metabolism: ____

Kidneys: ___

A

100-150 bpm–> HR is higher in premature neonate

70/50 during 1st few days after birth; 90/60 a few months after; 115/70 at adolescence

~40 breaths/min

2x adult

Kidneys are immature (functional development not complete until end of 1st month of life); high fluid turnover; rapid acid formation; can only concentrate urine to only 1.5x osmolality of plasma whereas adult can concentrate urine 3-4x plasma osmolality (problems with acidosis and dehydration)

49
Q

Normal adult levels of Hb A are achieved by __ months of age

A

4

50
Q

Because neonate is in a stage of rapid ossification of its bones at birth, a ready supply of __ throughout infancy is necessary

A

Ca2+–> absorption of Ca by GI tract is poor in the absence of Vit D

51
Q

Abs inherited from the mother protect the infant for about ___ months against major diseases

A

6–> inherited Abs against whooping cough are normally insufficient to protect neonate; infant requires immunization against whooping cough within the 1st month or so of life

52
Q

As a general rule, Gestational Age=

A

Fertilization age + 2 weeks

Reproductive And Development (16 decks)

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