Title: Placental Functions and Factors Affecting Fetal Growth
1Placental Functions and Factors Affecting Fetal
Growth
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5Maternal Placental Blood Flow
- Intervillous space of mature placenta contains
about 150 ml of blood which is replenished 3 or 4
times a minute - Uteroplacental blood flow increases from
- 50 ml per minute at 10 weeks
- 500/600 ml per minute at full term
6Placenta
- Metabolism
- Transfer
- Endocrine
7Placental Transfer (gases)
- Oxygen, Carbon Dioxide, Carbon Monoxide cross the
placenta by simple diffusion
8Placental Transfer (nutrients)
- Water freely moves
- No transfer of maternal cholesterol,
triglycerides or phospholipids - Small amounts of free fatty acids transported
- vitamins are essential
- Glucose quickly transferred
9Placental Transfer (hormones)
- Protein hormones do not reach the fetus, except
for the slow transfer of thryroxine and
triiodothyronine - Testosterone can cross
10Placental Transfer (antibodies)
- Some passive immunity is conferred on the feus by
the transfer of maternal antibodies (mainly gamma
globulins) - diptheria, smallpox and measles
- not whooping cough and chicken pox
11Glucose
- Glucose is the primary source of energy for the
fetal metabolism - Amino acids also required
- Both come from the mother via the placenta
12Placental Metabolism
- Particularly early in pregnancy, synthesis of
glycogen, cholesterol and fatty acids
13Dizygotic Twins
14Dizygotic Twins
15Monozygotic Twins
16Monozygotic Twins
17Conjoined Twins
18Critical Periods
- Since organogenesis occurs primarily in the
embryonic period (weeks 4-8) slight influences
can have drastic and irreversible effects - Sensitive periods?
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20Congenital Malformations
- Malformations present at birth, irrespective of
cause (genetic or environmental)
21Teratogens
- External agents that cause congenital
malformations
22The Six Principles of TeratologyWilson 1959
- Susceptibility to teratogenesis depends on the
genotype of the conceptus and the manner in which
this interacts with adverse environmental
factors. - Susceptibility to teratogenesis varies with the
developmental stage at the time of exposure to an
adverse influence. There are critical periods of
susceptibility to agents and organ systems
affected by these agents.
23The Six Principles of TeratologyWilson 1959
- Teratogenic agents act in specific ways on
developing cells and tissues to initiate
sequences of abnormal developmental events. - The access of adverse influences to developing
tissues depends on the nature of the influence. - nature of the agent
- route and degree of maternal exposure
- rate of placental transfer and systemic
absorption - composition of the maternal and embryonic/fetal
genotypes.
24The Six Principles of TeratologyWilson 1959
- There are four manifestations of deviant
development - Death
- Malformation
- Growth Retardation
- Functional Defect)
- Manifestations of deviant development increase in
frequency and degree as dosage increases from the
No Observable Adverse Effect Level (NOAEL) to a
dose producing 100 Lethality (LD100).
25Teratogens
- Drugs and medications
- Environmental chemicals
- Ionizing radiation
- Infections
- Metabolic imbalance
26Thalidomide
Fetal Alcohol Syndrome Fetal Alcohol Spectrum
Disorder
27Rubella Syndrome
- Symptoms in the infant may include
- Cloudy corneas or white appearance to pupil,
Deafness, Developmental delay, Excessive
sleepiness, Irritability, Low birth weight,
Mental retardation, Seizures, Small head size,
Skin rash at birth, Cardiac Anomalies
28Fetal Monitoring
29Ultrasonography
Uses reflection of very high frequency sound
waves of between 3.5 to 7.0 megahertz (i.e. 3.5
to 7 million cycles per second)
- Monitoring
- Chorionic sac during embryonic period
- placental and fetal size
- multiple births
- abnormal presentations
- biparietal diameter
30Fetal Blood Sampling
- Usually from the scalp, fetal blood pH is a good
indicator of placental gas exchange. - In the past, fetal blood sampling was used only
during labor through the mother's open cervix to
test blood from the fetal scalp for oxygenation.
Today, in many perinatal care centers, fetal
blood sampling is performed by specially trained
perinatologists as part of diagnosing, treating,
and monitoring fetal problems at various times
during pregnancy.
31Fetal Blood Sampling
- A fetal blood sample may be taken to
- diagnose genetic or chromosome abnormalities.
- check for and treat severe fetal anemia or other
blood problems such as Rh disease. - check for fetal oxygen levels.
- check for fetal infection.
- give certain medications to the fetus.
32How is fetal blood sampling performed?
- A long, thin needle is inserted into the mother's
uterus guided by ultrasound. - Blood may be taken from several sources
- blood vessels of the umbilical cord (also called
cordocentesis, funicentesis, or percutaneous
umbilical blood sampling, or PUBS) - a fetal blood vessel, usually in the liver or
heart - Fetal blood transfusions may also be performed in
this
33Amniocentesis
also referred to as amniotic fluid test or AFT
- used in prenatal diagnosis of chromosomal
abnormalities and fetal infections, in which a
small amount of amniotic fluid, which contains
fetal tissues, is extracted from the amnion or
amniotic sac surrounding a developing fetus, and
the fetal DNA is examined for genetic
abnormalities. - Little amniotic fluid present prior to 12th week
of gestation
34Chorionic Villus Sampling
- chromosomal abnormalities etc.
- The advantage of CVS is that it can be carried
out 10-13 weeks after the last period, earlier
than amniocentesis (which is carried out at 16-20
weeks).
35Alpha-Fetoprotein Assay
- AFP is a glycoprotein synthesized in the fetal
liver and yolk sac. - The fetus normally excretes AFP into its urine,
hence into the amniotic fluid. - High levels may also be present due to
- open neural tube defect
- open abdominal wall defect
- skin disease or other failure of the interior or
exterior body surface. - Various forms of tumours
36Factors Affecting Fetal Growth
37Placental Insufficiency
- Placental defects effectively reduce available
surface area - reduced uteroplacental blood flow may also occur
due to maternal hypotension or renal disease.
38Multiple Pregnancy
- Individuals of multiple births usually weigh
considerably less - in the third trimester placenta may not be able
to supply the total requirements for multiple
births
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40Small Babies
- Low birth weight
- lt 2,500g
- Premature
- lt 37 weeks of gestation
- Small for Date
- Smaller than expected for age