Fetal Growth and Development in the First Two Trimesters

Aikat, Aditi; Roy, Tarun Kumar; Bhattacharya, Niranjan

doi:10.1007/978-3-319-14874-8_5

Cited by 3 publications

(7 citation statements)

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“…8 The first trimester begins at ovulation and is realised by the union of egg and sperm, subsequent cell division and organogenesis. 9 It is during this time that the developing foetus is most susceptible to damage from external sources, such as tetragons (which are found in hair dyes and cleaning solutions), and maternal illness, such as cytomegalovirus and rubella, which are known to cause structural and neurological damage to the developing foetus. 10,11 The second trimester involves maturation and marks the time point of viability (23 weeks of gestation) should the newborn be born prematurely.…”

Section: The Developing Foetusmentioning

confidence: 99%

Quantifying physiological vital sign differences in newborns from 34+0/7 weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Paliwoda¹

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BackgroundTo ensure continued adaptation to extra-uterine life, all newborns have their physiological vital signs monitored intermittently post birth until discharge; these are tracked against predefined 'normal' reference ranges. Ascertaining an evidence base for 'normal' reference ranges is important for the early detection of deterioration in this population, who are at risk of not adapting to the extra-uterine environment due to being born prior to term. AimThe studies in this thesis aim to determine physiological vital sign reference ranges for well newborns between 34 +0/7 and 36 +6/7 weeks of gestation. ObjectivesThe objectives of the studies in this thesis were to: systematically summarise the evidence in peer-reviewed literature on physiological vital sign reference ranges for well newborns greater than or equal to 34 weeks of gestation; to review contemporary neonatal and midwifery textbooks and publicly available grey literature (i.e. organisational websites, hospital policies and early warning tools) for vital sign reference ranges pertaining to well newborns of ≥ 34 +0/7 weeks of gestation; to determine whether there are differences in vital signs in gestational age groups; and, if differences are identified, to establish physiological vital sign reference ranges for the well late preterm group and validate the reference ranges. Research DesignA systematic review of literature was initially undertaken followed by a scoping review of textbooks and grey literature to identify vital sign reference ranges for newborns ≥ 34 +0/7 weeks of gestation. Quantitative research methods were used to meet the remaining study objectives. Study One was conducted as a single site prospective observational study of 30 newborns, comprised of three gestational age groups: late preterm (34 +0/7 -36 +6/7 ), early term (37 +0/7 -38 +6/7 ), and term (39 +0/7 -40 +6/7 ). This involved continuously recording heart rate, respiratory rate, and peripheral oxygen saturation for up to six hours and periodic monitoring of temperature and blood pressure to determine whether physiological vital signs differed between the groups. The results of Study One informed the design of Study Two. This involved a shorter recording time of up to two hours and periodic monitoring of ii 0 Abstract temperature and blood pressure on 120 well, late preterm newborns in a single site prospective observational study. The reference ranges established in Study Two underwent validation in Study Three, in which a cross-sectional design was used to validate the data with data from the medical records of a group of late preterm newborns. ResultsThe searches of literature resulted in primary studies (n = 10), textbooks (n = 7) and grey literature (n = 11). Inconsistencies in and a dearth of vital sign ranges for gestational age groups other than term were identified. Details of how reference ranges were calculated were only provided in the peer reviewed literature.Study One generated a combined total of 284,542 heart rate values, 275,826 respiratory rate values...

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Section: The Developing Foetusmentioning

confidence: 99%

Quantifying physiological vital sign differences in newborns from 34+0/7 weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Paliwoda¹

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“…18 Knowledge of distinct intrauterine phases in which the growth and body composition of the fetus are related to the mode of nutrition are well documented. 1,2,[18][19][20][21][22] Studies of human intrauterine growth usually are based on anthropometric measurements of infants born at various gestational periods. Weight is a nonspecific measurement of growth; however, it is still the most widely used single clinical measurement of growth in intrauterine and postnatal life.…”

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confidence: 99%

“…[19][20][21][22][23] Measurements of growth after birth at all ages are mainly longitudinal. [18][19][20][21][22][23] However, growth measurements of body composition are not longitudinal in early development. [18][19][20][21][22][23] Numerous percentile charts have been constructed that relate embryo-fetal measurements to GA. 23,24 Recent studies have sought to demonstrate the importance of embryo crown-rump length (CRL) and placental/GS parameters as potential predictors of early pregnancy loss or maternal risk diseases.…”

mentioning

confidence: 99%

“…[18][19][20][21][22][23] However, growth measurements of body composition are not longitudinal in early development. [18][19][20][21][22][23] Numerous percentile charts have been constructed that relate embryo-fetal measurements to GA. 23,24 Recent studies have sought to demonstrate the importance of embryo crown-rump length (CRL) and placental/GS parameters as potential predictors of early pregnancy loss or maternal risk diseases. [24][25][26] However, those studies must be validated with embryonic and GS histologic features seen in embryonic and placental disorders, such as chronic massive intervillositis and gestational trophoblastic disease, among others.…”

mentioning

confidence: 99%

“…The accurate measurement of embryo/fetal crownheel length provides the best clinical measurement of skeletal growth. 18,22,23 Some studies investigated efficacy of first-trimester ultrasound parameters such as GS thickness for prediction of maternal risk disorders such as preeclampsia and/or the delivery of small-for-gestational-age neonates; however, there were no specific pathologic aspects reported. 24,25,27,28 Others have documented such parameters as median GS diameter to CRL ratio as better predictors of pregnancy loss than GS diameter and embryo CRL alone.…”

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confidence: 99%

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Measurements in First-Trimester Abortion Products: A Pathologic Study

Nogueira

Sousa

Braga

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Related to the advances in prenatal diagnosis and the emergence of medically challenging situations, there has been an increased interest in conducting a pathologic study of first-trimester abortion products. Objective.— To evaluate measurements across a large group of first-trimester spontaneous abortion specimens. Potential goals include a validation of prenatal embryo and gestational-sac measurements as a function of gestational age (GA). Design.— A retrospective case study of first-trimester spontaneous abortions between June 2015 and April 2017 in Centro de Genética Clínica Embryo-Fetal Pathology Laboratory, Porto, Portugal. Considering the inclusion criteria, 585 complete gestational sacs, 182 embryos, and 116 umbilical cords were selected. We recorded the weight of the gestational sacs and embryos and measurements of gestational sacs, umbilical cords, and embryo crown-rump length. Models were computed using regression techniques. Results.— Gestational-sac diameter percentiles 5, 25, 50, 75 and 95 were calculated according to GA, and at each 1-week interval the diameter increased an average of 3 mm. Umbilical cord length percentiles 5, 25, 50, 75 and 95 were calculated according to GA, and at each 1-week interval, the length increased an average of 1.35 mm. Embryo crown-rump length estimated mean ± SD values were GA 6 weeks, 5.3 ± 2.3 mm; GA 7 weeks, 9.4 ± 4.8 mm; GA 8 weeks, 13.7 ± 8.2 mm; GA 9 weeks, 20.8 ± 9.1 mm; GA 10 weeks, 22.6 ± 13.4 mm; GA 11 weeks, 29.4 ± 12.9 mm; and GA 12 weeks, 52 mm. Conclusions.— Pathologic measurements obtained should be compared to expected measurements and correlated with ultrasound findings, clinical information, and microscopic findings. Deviations from expected values could lead to an understanding of early pregnancy loss.

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The impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes in offspring: A systematic review

Whitehead¹

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<p>Allergic disease and atopy create a substantial emotional and financial burden for affected individuals and their families. Significant healthcare costs are also incurred with New Zealand children showing consistently high rates of allergic disease when compared with global statistics. The potential to decrease the incidence of allergic disease and atopy through modification of maternal diet has been the subject of recent attention with the possibility for transgenerational impact being of considerable interest. The objectives of this systematic review were firstly to investigate the relationship between maternal diet in pregnancy and lactation on allergic outcomes in the offspring, and to then relate these findings to the New Zealand context. The following databases were accessed as part of this review: PubMed via helicon (advanced search), ProQuest (MEDLINE) via helicon, CINAHL Complete (EBSCO host via helicon). Limits were “humans”. The key search terms were ‘diet’ or ‘supplements’, ‘pregnancy’ or ‘lactation’, ‘allergy’ or ‘atopy’ or ‘asthma; NOT ‘elimination’ or ‘avoidance’. The studies for inclusion in this review were restricted to studies written in the English language. The final search was undertaken 11/04/17 once data extraction completed and one new study found. Initial search was 14/07/16. Search period 14/04/16-11/04/17. Randomised controlled trials and cohort studies that systematically recorded maternal intake of diet or supplements were included. The health-related outcomes assessed were asthma, wheeze, eczema and allergic rhinitis. Data was extracted for this review using the Cochrane Public Health Group’s template. Risk of bias was assessed using the Cochrane risk of bias assessment tool for the randomised controlled trials and the Newcastle-Ottawa Scale for the cohort studies. Risk of bias was assessed again and presented using the Grade summary of findings tables. Overall, 54 studies were included in this review, collectively involving more than 100,000 children and comprising of 16 randomised controlled trials and 38 cohort studies that were selected based on predetermined inclusion and exclusion criteria. Data on vitamins, oligo-elements, food groups and dietary patterns during pregnancy and lactation were also collected. A meta-analysis was not performed due to the diversity in variables, multiple outcomes assessed, and the variety of measurements implemented within the studies. This work presents a comprehensive summary and review of the identified studies that explored the impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes. Although individual studies demonstrated various associations between maternal diet during pregnancy and lactation to impact on health outcomes for the offspring, overall, this work did not show any consistent findings collectively across the studies reviewed. This was due to the differing methods of measurement of association, intake and outcome assessment used in the reviewed studies which further complicated the ability to compare and contrast the findings of the studies with each other. Each study was assessed both for its individual findings and then collectively according to the variables assessed. The findings of this review lend support for the undertaking of additional trials and studies with more consistent and controlled measurements of interventions and outcomes to better facilitate comparisons between studies. Key findings from the reviewed studies, which included only one New Zealand based study, were related to the New Zealand context. Additional New Zealand based information and related works highlighted a need for personally tailored maternal nutrition information to be delivered consistently by all health professionals interacting with pregnant women. Key words: diet, supplements, pregnancy, lactation, allergy, atopy, asthma.</p>

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Fetal Growth and Development in the First Two Trimesters

Cited by 3 publications

References 47 publications

Quantifying physiological vital sign differences in newborns from 34+0/7 weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Quantifying physiological vital sign differences in newborns from 34+0/7 weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Measurements in First-Trimester Abortion Products: A Pathologic Study

The impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes in offspring: A systematic review

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Fetal Growth and Development in the First Two Trimesters

Cited by 3 publications

References 47 publications

Quantifying physiological vital sign differences in newborns from 34+0/7&nbsp;weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Quantifying physiological vital sign differences in newborns from 34+0/7&nbsp;weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Measurements in First-Trimester Abortion Products: A Pathologic Study

The impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes in offspring: A systematic review

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Quantifying physiological vital sign differences in newborns from 34+0/7 weeks of gestation and establishment of vital sign reference ranges for the late preterm population

Quantifying physiological vital sign differences in newborns from 34+0/7 weeks of gestation and establishment of vital sign reference ranges for the late preterm population