Fetal Development Assessment Quiz

Fetal Development Assessment

• Fetal heart sounds can be detected as soon as 6 weeks via echocardiography.
• Ultrasound scanning of the fetus can identify the gestation sac as early as 4 weeks after conception.
• Palpation of the entire fetus is a positive sign after 24th week of pregnancy.
• Fetal movement can be felt by a trained examiner between the 20th and 24th week of pregnancy.

Braxton Hicks Contractions

• These are "practice contractions" that help ensure the placenta receives adequate blood flow.

Cervical Changes

• Goodell's Sign: Softening of the cervix due to vascularization and edema caused by estrogen.
• Operculum: A mucus plug that seals out bacteria and helps prevent infection.

Vaginal Changes

• Chadwick's Sign: Deep violet color of the vaginal walls due to increased circulation and estrogen.
• Leukorrhea: Increased vaginal discharge due to increased epithelial cell activity.
• Vaginal pH Change: Shift from alkaline (greater than 7) to acidic (4 or 5) due to Lactobacillus acidophilus growth and lactic acid production.

Ovarian Changes

• Ovulation ceases during pregnancy.

Breast Changes

• Feeling of tingling, fullness or tenderness in the breasts due to high estrogen.
• Increase in breast size.
• Darkening of areola and increase in diameter.
• Montgomery’s tubercles: Enlarged sebaceous glands that keep the nipple supple and prevent cracking.

Systemic Changes

Integumentary System

• Striae gravidarum: Stretch marks due to abdominal wall tension from the enlarging uterus.
• Diastasis: Separation of rectus muscles.
• Linea nigra: Brown line from umbilicus to symphysis pubis.
• Melasma: "Mask of pregnancy" due to melanocyte-stimulating hormone.
• Vascular spiders: Due to increased estrogen.

Respiratory Changes

• Nasopharynx Congestion: Due to increased estrogen levels.
• Dyspnea: Shortness of breath in the late third trimester due to upward pressure on the lungs and elevated diaphragm.
• Residual Volume: Decreases by up to 20% due to diaphragmatic pressure.
• Tidal Volume: Increases by up to 40%.
• Oxygen Consumption: Increases by 20%.
• Mild Hyperventilation: To blow off excess CO2.
• Temperature: Slightly increases due to progesterone.
• Increased Blood Volume: To provide for an adequate exchange of nutrients in the placenta.
• Pseudoanemia: Plasma volume increases faster than RBCs, causing a decline in hemoglobin and erythrocyte concentration.
• Iron, Folic Acid, Vitamin Needs:
  • Fetus requires 350-400mg of iron for growth.
  • Mother requires additional 400mg of iron for increased RBC mass.
  • Total iron requirement = 800mg.
  • Folic acid deficiency linked to neural tube disorders.
  • Foods high in folic acid: spinach, asparagus, legumes.

Cardiovascular Changes

• Peripheral Blood Flow: Impaired blood flow to lower extremities in the third trimester due to pressure on veins and arteries.
• Edema and Varicosities: Can occur in the vulva, rectum, and legs due to impaired blood flow.
• Supine Hypotension Syndrome: Weight of the uterus presses on vena cava, obstructing blood flow. This can cause lightheadedness, faintness, and palpitation.
• Increased Fibrinogen: Necessary for clotting and increased due to estrogen.
• Increased WBC: Protective mechanism due to increased blood volume.
• Decreased Protein Level: Protein used by the fetus.

Gastrointestinal Changes

• Heartburn (Pyrosis): Reflux of stomach contents due to relaxed cardioesophageal sphincter caused by relaxin and progesterone.
• Flatulence and Constipation: Slow gastric emptying and intestinal peristalsis due to relaxin and progesterone.
• Nausea and Vomiting:
  • Due to decreased glucose levels (glucose used by the fetus), FBS 95mg/dl or lower.
  • Increased hCG, estrogen, and progesterone levels.
  • Hyperptyalism: Increased saliva formation due to estrogen.
• Subclinical Jaundice: Decreased bile emptying leads to reabsorption of bilirubin, causing generalized itching.
• Hypertrophy of Gumlines and Bleeding: Increased cholesterol in bile can lead to stone formation and bleeding gums.

Urinary System

• Fluid Retention:
  • Increased aldosterone production due to progesterone.
  • Renin-angiotensin-aldosterone system (RAAS) regulates blood volume and vascular resistance.
  • Aldosterone promotes sodium reabsorption and maintains fluid osmolarity.
• Renal Function:
  • Increased urine output by 60-80%.
  • Decreased specific gravity of urine.
  • Increased glomerular filtration rate (GFR) and renal plasma flow.
• Glomerular Filtration Rate (GFR): Increased by 50% during pregnancy.

Endocrine Changes

• Hormonal Changes:
  • hCG (Human Chorionic Gonadotropin): Secreted by trophoblast cells in early pregnancy.
  • hPL (Human Placental Lactogen): Antagonist to insulin, allowing more glucose for fetal growth.
  • Relaxin: Secreted by corpus luteum, inhibits uterine activity, softens cervix, and collagen in joints.
  • Prostaglandins: Affect smooth muscle contractility and may trigger labor.
  • Pituitary Gland:
    • Produces GH and MSH.
    • Oxytocin aids in labor.
    • Prolactin prepares for lactation.
  • Thyroid and Parathyroid:
    • Thyroid enlarges, increasing basal metabolic rate.
    • Parathyroid regulates calcium metabolism.
  • Adrenal Glands:
    • Increased corticosteroids and aldosterone levels, help suppress immune response to fetus.
    • Regulate glucose metabolism.
    • Aldosterone promotes sodium reabsorption.
  • Pancreas:
    • Increased insulin production due to higher glucocorticoid levels.
    • Fetal glucose level 30mg/100ml.
    • Pregnant women need high calorie diets and frequent meals.
    • Early pregnancy FBS 80-85mg/100ml.