KLM CHAPTER 6 : THE FETAL PERIOD

Estimation of Fetal Age

CRL (Crown-Rump Length) , Fetal Head and femur length measurement are used to evaluate expected date of delivery as well as age and size of fetus Clinically Gestational age is used, i.e. Age from LNMP (Last Normal Menstrual Period) Trimesters of Pregnancy: Gestational period is divided into three trimesters Each trimester of Three months In First trimester , Major system are developed In second trimester, fetus grows in size In third trimester , fetus can survive if born prematurely At 35th week, fetus weighs 2500 gram, that is the level of Fetal Maturity

Measurement and Characteristics of Fetuses: CRL method is used in first trimester Basic measurements are: Biparietal Diameter Head Circumference Abdominal Circumference Femur Length Foot Length Metabolic disturbances of mother may cause change in fetal weight Freshly Expelled fetus has shiny ,translucent appearance Fetus dead for many days has have a tanned appearance and lack normal resilience Highlights Of Fetal Period Nine to Twelve Weeks: At begining of 9th week: Head constitutes half of the crown-heel length Face is broad, eyes widely seperated, ears are low set and eyelids fused External genitalia appear fused Liver is major source of erythropoiesis

 By the end of twelve week: CRL has more than doubled Primary ossification center appears in skeleton (cranium & long bones) Upper limb has almost reached their final length Mature fetal form of external genitalia is established Erythropoiesis decreased in liver and begins in spleen Until the middle of tenth week ,intestinal coils are visible in umbilical cord By eleventh week, intestines return to abdomen B/w 9th and 12th week urine formation begins, Urine is discharged into amniotic fluid via urethra Thirteen to Sixteen Weeks: Sex of fetus can be recognized by 12 to 14th week By 14th Week: Limb movements become coordinated Slow eye movements occur Scalp hair patterning is determined th By 16 Week: Head relatively small Bones clearly visible Ovaries differentiated containing follicles containing oogonia Eyes face anteriorly External ears close to their definite position Seventeen to Twenty Weeks: Growth slows down Fetal movements "Quickening" are felt by mother Skin covered by greasy vernix caseosa (dead epidermal cells + fatty substance) By 18th Week: Uterus is formed Canalization of vagina begins Ovarian follicles containing oogonia visible th By 20 Week: Completely covered with fine downy hair lanugo Brown fat formed produces heat (Root of neck, sternum, perineal area) Testis begin to descend but located in posterior abdominal wall same as ovaries in females Twenty-One to Twenty-Five Weeks: Substantial weight gain Skin wrinkled and translucent At 21 weeks , rapid eye movements begin At 22-23 weeks, blink startle response begins

 At 24 weeks, epithelial cells of lung secrete surfactant At 24 weeks, fingernails are present 22-25 weeks fetus born may survive Twenty-Six to Twenty-Nine Weeks: Lungs and pulmonary vasculature developed sufficiently CNS matured to direct body By 26 weeks: Eyelids are open Subcutaneous fat smoothing many wrinkles Toenails become visible White fat increases to 3.5% of body weight Spleen become important size of erythropoiesis By 28th week, bone marrow produces cells Thirty to Thirty-Four Weeks: At 20 weeks, pupillary reflex of eye can be elicited Skin pink,smooth , Upper and lower limb has cubby appearance Quantity of white fat is 8% of body weight Thirty-Five to Thirty-Eight Weeks: At 35th week , spontaneous orientation to light At 36th week, circumference of head and abdomen are equal At 37th week, fetal foot length is larger than fetal femur length Fetuses reach a CRL of 360mm and weight of 3400 g Amount of white fat is 16% of body weight Adds 14 g fat /day Thorax prominent, breasts protrude Testis in scrotum in full-term male infants

Expected Date of Delivery:

266 days or 38 weeks after fertilization, 280 days or 40 weeks after LNMP Common rule is to count back 3 month from last LNMP and add 1 year and 7 days

Factors Influencing Fetal Growth:

Glucose and Amino acids are required Cigarette smoking, multiple pregnancies, Alcohol,impaired uteroplacental/uroplacental blood flow, Genetic Factors Factors operating throughout pregnancy Maternal vascular disease ,Intrauterine infection, alcohol cause Intrauterine Growth Restriction (IUGR)

 Small for Gestational Age (SGA) Factors affecting last trimester produce underweight infants

Procedure for Assessing Fetal Status: Perinatology is the branch of medicine that is concerned with the well-being of the fetus and newborn infant, generally covering the period from approximately 26 weeks after fertilization to 4 weeks after birth. Ultrasonography, Diagnostic Amniocentesis, Alpha-fetoprotein assay,Spectrophotometer, Chorion villous sampling, Sex Chromatin Pattern, Fetoscopy Send "MedCom" (without inverted commas) to 9900 and receive all first year stuff FREE on ur mobile via sms daily... Prepared By: Muhammad Kamran For More Study Stuff.... Join Us @

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