Small babies

Question 1

What characterizes the embryonic period in terms of development?

Answer 1

Intense morphogenesis and organogenesis, but very little absolute growth (except for placenta).

Question 2

When does fetal growth and weight gain accelerate?

Answer 2

During the fetal period.

Question 3

What is differential growth during fetal development?

Answer 3

• Early: Crown-Rump Length (CRL) grows steadily.
• Mid-late: Weight gain accelerates due to protein (early) and fat (late) deposition.

Question 4

What type of tissue deposition dominates in the late fetal period?

Answer 4

Adipose (fat) deposition.

Question 5

what is crown rump length?

Answer 5

It measures the length of the fetus from the top of the head to the bottom of the buttocks - estimates gestational age

Question 6

What is the CRL at 9 weeks?

Answer 6

5 cm

Question 7

What is the CRL at 12 weeks?

Answer 7

8.5 cm

Question 8

What is the CRL at 20 weeks?

Answer 8

19 cm

Question 9

What is the CRL at 28 weeks?

Answer 9

28 cm

Question 10

What is the CRL at 36 weeks?

Answer 10

36 cm

Question 11

How do body proportions change during development?

Answer 11

• At 9 weeks, head = ~½ of CRL
• Later, body and lower limbs grow faster than the head

Question 12

Which hormones are essential for fetal growth?

Answer 12

Insulin
IGF-I (nutrient dependent; dominates in T2 and T3)
IGF-II (nutrient independent; dominates in T1)
Leptin (placental)
EGF, TGF-α

Question 13

Which hormone dominates early fetal growth?

Answer 13

IGF-II

Question 14

What hormone dominates later fetal growth?

Answer 14

IGF-I

Question 15

What are two types of growth restriction caused by malnutrition?

Answer 15

Symmetrical and asymmetrical growth restriction.

Question 16

What is the “Developmental Origins of Health and Disease” hypothesis?

Answer 16

Suggests that fetal nutrition and hormone environment can influence adult health and disease risk.

Question 17

What is considered average birth weight?

Answer 17

3500 g

Question 18

What birth weight indicates growth restriction?

Answer 18

< 2500 g

Question 19

What is macrosomia?

Answer 19

Birth weight > 4500 g, often due to maternal diabetes.

Question 20

What are non-pathological influences on birth weight?

Answer 20

Placental (e.g., low PAPP-A), fetal (e.g., echogenic bowel), maternal (e.g., BMI extremes, smoking, hypertension).

Question 21

Why is accurate dating important?

Answer 21

To differentiate between prematurity, constitutional smallness, and growth restriction

Question 22

What is the best time to date a pregnancy using CRL?

Answer 22

Between 6–13 weeks; specifically 11+2 to 14+1 weeks for the first scan.

Question 23

What other measurements are used after the first trimester to estimate gestational age?

Answer 23

Head circumference and femur length (from 13 weeks onwards).

Question 24

What are the 4 components of fetal wellbeing assessment?

Answer 24

Maternal perception of fetal movements
Biochemical markers
Symphysis-fundal height (SFH)
Ultrasound scan (USS)

Question 25

Name 4 biochemical markers of fetal wellbeing.

Answer 25

hCG, hPL, estriol, alpha-fetoprotein.

Question 26

When is the uterus palpable at the umbilicus?

Answer 26

Around 22 weeks gestation.

Question 27

What SFH finding indicates concern for FGR?

Answer 27

<10th centile or serial measurements lower than expected.

Question 28

What does the first trimester scan assess?

Answer 28

Crown-rump length (dating) Viability Chorionicity Nuchal translucency

Question 29

Why is head circumference useful in dating?

Answer 29

It is less affected by fetal head shape.

Question 30

What does abdominal circumference (AC) and femur length (FL) assess?

Answer 30

Growth monitoring and anomaly detection, especially when combined with HC.

Question 31

What change is seen in normal umbilical artery Doppler over time?

Answer 31

Progressive increase in diastolic flow, decreasing resistance.

Question 32

What are stages of worsening Doppler findings in the umbilical artery?

Answer 32

A = normal B = reduced diastolic flow C = absent end-diastolic flow D = reversed end-diastolic flow

Question 33

What do absent/reversed end-diastolic flows indicate?

Answer 33

Fetal hypoxia; reversed flow is a late and concerning sign.

Question 34

What causes abnormal uterine artery flow?

Answer 34

Inadequate spiral artery remodelling — high resistance, low flow.

Question 35

What is the decidual reaction?

Answer 35

Transformation of endometrium to decidua to control trophoblast invasion.

Question 36

What happens if the decidual reaction is suboptimal?

Answer 36

Poor placentation, leading to pre-eclampsia, FGR, and other complications.

Question 37

Name fetal factors for FGR.

Answer 37

Chromosomal abnormalities Single gene disorders Epigenetic defects (e.g., methylation disorders) Infections (TORCH)

Question 38

Name maternal risk factors for FGR. 8

Answer 38

Hypertension, renal/cardiovascular disease Uterine malformations, gastric bypass Smoking, alcohol, drugs, eating disorders

Question 39

Name placental factors for FGR.

Answer 39

Infarction Abruption Single umbilical artery Placental insufficiency

Question 40

What are the effects of utero-placental compromise?

Answer 40

Fetal renal insufficiency Reduced amniotic fluid Growth restriction Fetal hypoxia

Question 41

When does symmetrical growth restriction typically occur?

Answer 41

Early in pregnancy during the hyperplasia phase.

Question 42

What is the Barker Hypothesis?

Answer 42

Poor fetal growth leads to permanent changes in metabolism, increasing risk of adult diseases like metabolic syndrome in later life.

Question 43

What does TORCH stand for?

Answer 43

T – Toxoplasmosis O – Other (commonly includes syphilis, varicella zoster, parvovirus B19, and HIV) R – Rubella C – Cytomegalovirus (CMV) H – Herpes simplex virus (HSV)