B8-021 CBCL IUGR Flashcards by Felicia Jones

[…] signaling in the placenta integrates nutrient availability to regulate fetal growth

mTOR

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medical conditions associated with placental insufficiency [3]

preeclampsia
chronic HTN
vascular disease (lupus)

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how does disruption of uteroplacental contact cause placental insufficiency?

loss of contact between uterine wall and placenta –> reduced surface area for gas/nutrient exchange –> less fetal growth

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how does disruption of typical morphology cause placental insufficiency?

gas/nutrient exchange affected by differing surface area

Examples:
too thick/thin = inefficient or hyperefficient
if cord placement is off, nutrients could take longer to reach fetus

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in a normal placenta, how do trophoblasts remodel the spiral arteries for maximal blood delivery?

larger, allowing for high volume low pressure system

(also replace with fibrous tissue to limit vasoconstriction)

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describe the deficient spiral artery remodeling occurring in preeclampsia

less depth of invasion

blood arrives with higher pressure, less volume, and pulsatility –> placental stress

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histopathologic characteristics of severe/early placental insufficiency

fibrinoid deposits (injury to fetal villi)
syncytial knots (syncytiotrophoblast apoptosis)

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the amount in maternal blood reflects the size of the footprint of the placenta on maternal wall

pregnancy associated plasma protein (PAPP-A)

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decreased PAPP-A is a risk factor for

IUGR

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pregnancy associated plasma protein (PAPP-A) is produced by […] cells

syncytiotrophoblast

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AFP is produced by […] cells

fetal liver

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used to screen for neural tube defects and abdominal wall defects

AFP

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elevated AFP may signal [2]

leaky, damaged placenta
fetal malformations

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elevated levels of DIA and hCG is a risk factor for

preeclampsia
IUGR

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in animal models where undernutrition is created, the […] pathway creates downregulation of placental transporters prior to the reduction in fetal growth

mTOR

(decreased amino acid transport is a direct contribution to IUGR)

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ways to measure placental insufficiency [4]

umbilical artery doppler
proteins in mother’s blood
morphology of placenta
uterine artery doppler

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[symmetrical or asymmetrical IUGR]
early in gestation

symmetrical

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[symmetrical or asymmetrical IUGR]
late in gestation

asymmetrical

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[symmetrical or asymmetrical IUGR]
is more common

asymmetrical

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[symmetrical or asymmetrical IUGR]
all measurements at antenatal scan are proportionally reduced

symmetrical

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[symmetrical or asymmetrical IUGR]
abdominal circumference decreased
other measurements normal

asymmetrical

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[symmetrical or asymmetrical IUGR]
caused by a genetic disorder or infection intrinsic to fetus

symmetrical

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[symmetrical or asymmetrical IUGR]
caused by utero-placental insufficiency

asymmetrical

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some physical features of IUGR babies at birth

absence of buccal fat
large head
loose, dry skin
thin umbilical cord
poor muscle mass

(basically signs of undernutrition)

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short term complications of IUGR that are a consequence of being born preterm [2]

pulmonary hypertension necrotizing enterocolitis

short term complications of IUGR [3]

hypothermia polycythemia renal dysfunction

signs of IUGR during pregnancy [4]

poor maternal weight gain HTN reduced fetal activity abnormal fundal height

fundal height that is [...] or more behind dates requires US investigation

3 cm

fundal height of normal pregnancy progresses at [...] / week

1 cm

IUGR is commonly known as EFW or AC being less than [...]% for gestational age

placentas with insufficiency will show obliteration of [...]

terminal villi (reduction of surface area in fetal capillary network)

in placental insufficiency, umbilical doppler will show a reduction in blood flow during

diastole (can even become absent or reversed in later stages)

a AFI measure below [...] cm on US is considered the threshold for oligohydramios

[poly/oligo]hydramnios is seen with IUGR

oligo

what are the limitations of using EFW and AC as defining measurements in the diagnosis of IUGR? [3]

intrinsic error of US does not account for ethnicity/other characteristics that alter the typical curve does not include doppler findings

about [...] of suspected IUGR fetuses are normal constitutional small fetuses

2/3

placental cell-type primarily responsible for nutrient transport

syncytiotrophoblast

clinical definition of IUGR

EFW <10%

phase I of fetal growth is characterized by

hyperplasia

process in pregnancy that is responsible for the transition of high pressure low blood flow to low pressure high blood flow system

spiral artery remodeling

what pathway links nutrient availability to fetal growth?

mTOR

an abnormal uterine artery doppler will show low blood flow from [...] to [...]

from mother to placenta

clusters of nuclei from apoptotic syncytiotrophoblasts are called

syncytial knots

[...] cells are in direct contact with maternal blood and interface with maternal uterine connective tissue

syncytiotrophoblast

[...] cells lie underneath the syncytiotrophoblasts

cytotrophoblasts

cytotrophoblasts differentiate and fuse into [...]

syncytiotrophoblasts

[...] cells form the uterine lining

decidual

cells that form the placental barrier and line the outside of placental villi

syncytiotrophoblasts

[...] can trigger premature placental aging

oxidative stress (caused by inflammation or hypoxia)

increases the bioavailability of IGF, which regulates placental development

PAPP-A

[...] women have increased rates of babies SGA

short

women who continue to smoke beyond [...] weeks gestation have an increased risk for a baby of SGA

15 weeks

fetal microcephaly, intracranial calcifications, and chorioretinitis

congenital toxoplasma

MCA doppler measures bloodflow to the

fetal brain

what would you expect to see on MCA doppler in FGR due to placental insufficiency?

increased diastolic flow

what would you expect to see on umbilical artery doppler in FGR due to placental insufficiency?

decreased diastolic flow

poor pregnancy [...] can be non-pathological cause of SGA

dating

what is the cause of hypoglycemia in IUGR infants?

decreased placental transfer of nutrients --> reduced supply

an undernourished fetus will direct most of the blood flow to the [...] [2]

heart brain

genetic aberration occurring in the trophoblast or in progenitor cells leading to abnormal placental development and IUGR

confined placental mosaicism (only affects placenta; no genetic abnormalities seen in fetus)