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CORNELL NS 3410 - Gestation
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NS 3410 1st Edition Lecture 18Outline of Last LectureI. Structure of Long BonesII. Bone LamellaeIII. Microscopic Structure of Bone: Compact BoneIV. Chemical Composition of BoneV. Skeletal OssificationOutline of Current LectureI. Guest Lecture on GestationCurrent LectureI. Guest Lecture on Gestation- Menstrual age: first day of the last menstrual period- Fetal age: begins at conception- Gestational age: interchangeable with menstrual age- Major cell differentiation and fetal development occurs during weeks 2-8- Less dynamic, but continued differentiation and growth after week 8- Three phases cell growth: hyperplasia (rapid increase in cell number), hyperplasia and hypertrophy (up to 32 weeks), hypertrophy (fetal glycogen and fat deposition)- Skeletal Development-Skeletal matrix laid down in first month-Embryonic formation commences in second month- Vertebra Ossification: mineralization begins during week 8. Ossification centers can be seen at 16-19 weeks- Limb Development: most tissue arises from mesenchymal cells. Upper limb buds develop 2 days prior to lower limb buds.These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.- Rates of Fetal Growth: mean weight gain peaks at 32-34 weeks and growth/weight gain decreases thereafter- Knowledge of gestational age is important to evaluate growth, time invasive procedures, treatment of preterm delivery or post-term pregnancy, management of maternal or fetalcomplications, interpretation of serum screening results- First trimester: gestational sac is the first sonographic sign of pregnancy (5 weeks), yolk sac is the first anatomical structure to appear within the gestational sac, by 6th menstrualweek the early embryo can be identified (usually with cardiac activity; crown-rump length is the best estimation of GA once it appears)- Second trimester: fetal biometry (measurement of the fetus and various segments of fetal anatomy; importance is to measure gestational age, fetal weight, interval fetal growth, management). At 13 weeks CRL replaced by BPD, HC, AC, FL-BPD: performed between 14-42 weeks, first US parameter to be consistently measured.-HC: parallel to base of skull-FL: align transducer with long axis of bone; measure only the ossified portions of the femur-AC: measured at the level of the liver; right and left portal veins meet. Ellipse is fit to theouter skin edges- Other useful measurements:-TCD: transverse cerebellar diameter correlates with gestational age-FL: measured from heel to foot-BD: measurement of extraorbital diameter- Ultrasound summary:-The earliest ultrasound measurement is most reliable of gestational ageFetal weight calculated using biometric measurements-Serial measurements may be necessary- Intrauterine Growth Restriction (IUGR)-10% of infants in population will have birth weights at or below the 10th percentile-Intrauterine growth restriction: fetus whose estimated weight by ultrasound appears less than the 10th percentile-Clinical significance: prematurity, perinatal asphyxia, low neonatal blood sugar, fetal death; long term complications: obesity, hypertension, type 2 diabetes, hypercholesterolemia -4-8% all pregnancies-Types of IUGR: symmetric and asymmetric -Caused by abnormalities of uteroplacental vasculature, placenta abruption, placenta previa, infarcts, abnormal cord insertions-Maternal causes: hypertension, diabetes, chronic renal disease, restrictive lung disease, smoking and substance uses, malnutrition, environment -Fetal: multiple gestations, genetic disorders, congenital anomalies-Twin-Twin Transfusion Syndrome: condition in which blood is transfused from a donor twin to its recipient sibling; associated with high morbidity and mortality -Twin Reversed Arterial Perfusion Syndrome: normally formed donor twin with heart failure and recipient twin who lacks a heart and other structures -Trisomy 21(down syndrome): due to triplication of 21q22, nondisjunction most common


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CORNELL NS 3410 - Gestation

Type: Lecture Note
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