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Study sets matching "ob exam fetal"

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Study sets matching "ob exam fetal"

11 terms
OB-FETAL
Fetal period
7 weeks
8 weeks
12 weeks
period from 9 weeks' gestation until pregnancy ends; characte…
Heartbeat detected on sonar
Heat development complete
Placenta complete... Gender can be determined
Fetal period
period from 9 weeks' gestation until pregnancy ends; characte…
7 weeks
Heartbeat detected on sonar
70 terms
OB Conception and fetal development
What makes up preconception counseling?
What do we look at during counseling?
What is the function of the ovum?
What happens if the ovum is not fertil…
Preconception counseling helps expecting mothers get the best…
If the mother is taking folic acid, what her nutritional stat…
-erupts from ovarian follicle... -collected by fimbria... -HIGH est…
It degenerates
What makes up preconception counseling?
Preconception counseling helps expecting mothers get the best…
What do we look at during counseling?
If the mother is taking folic acid, what her nutritional stat…
13 terms
OB Fetal Assessment and Monitoring
external fetal monitoring
toco
internal fetal monitoring
internal fetal monitoring
non invasive and performed by use of ultrasonic transducer
is placed over the fundus of the uterus
invasive and requires rupturing on membranes and attaching an…
mother must be dilated 2-3cm to have this done
external fetal monitoring
non invasive and performed by use of ultrasonic transducer
toco
is placed over the fundus of the uterus
56 terms
OB: Intrapartum Fetal Assessment
fetus at an inc. risk during L/D, 1/3…
leading cause of M and M of fetus
list some historical independent risk…
Past OB hx risk factors
labor (intra-partum)
intrauterine hypoxia and birth asphyxia
age <18 or >39... unmarried... weight < 50kg... smoking... no education b…
hx of perinatal los... hx of infant <2500 gm... hx of preterm birth…
fetus at an inc. risk during L/D, 1/3…
labor (intra-partum)
leading cause of M and M of fetus
intrauterine hypoxia and birth asphyxia
34 terms
OB - fetal monitoring
antepartum electronic monitoring is on…
normal and tachysystolic uterine activ…
what is fetal heart rate variability
what does the loss of fetal heart rate…
uteroplacental insufficiency ... it may help in assessing hypoxi…
normal = 5 or fewer contractions in 10 minutes... tachysystole…
normal variability is due to intact neurological control of h…
is the single most reliable sign of fetal compromise
antepartum electronic monitoring is on…
uteroplacental insufficiency ... it may help in assessing hypoxi…
normal and tachysystolic uterine activ…
normal = 5 or fewer contractions in 10 minutes... tachysystole…
OB- Electronic Fetal Monitoring
Variability
AMMM
Absent variability
Minimal variability
VISUAL assessment of Fetal Heart Rate away from baseline
Absent... Min... Mod... Marked
0-1 beats variation
<6 beats variation
Variability
VISUAL assessment of Fetal Heart Rate away from baseline
AMMM
Absent... Min... Mod... Marked
63 terms
OB Fetal Assessment and Monitoring
Umbilical Cord Anatomy
CORD ABNORMALITIES
Vasa Previa
Intrauterine Growth Restriction (IUGR)…
Two Arteries... One Vein... Wharton's jelly... No nerves... Average lengt…
One Artery (more waste buildup)... Velamentous insertion... Vasa Pr…
--placenta and cord will come and be below the presenting par…
head normal, body suboptimal (usually due to some pathologic…
Umbilical Cord Anatomy
Two Arteries... One Vein... Wharton's jelly... No nerves... Average lengt…
CORD ABNORMALITIES
One Artery (more waste buildup)... Velamentous insertion... Vasa Pr…
28 terms
Fetal Monitoring - OB Nursing
What causes fetal oxygen supply decrea…
Normal Uterine Activity pattern?
What are non-reassuring fetal heart ra…
FHR assessment interval - low risk pre…
1. reduction of blood flow through maternal blood vessels (i.…
- contractions occur every 2-5 minutes... - contractions are mod…
1. progressive increase or decrease of the baseline rate... 2. t…
Low Risk Labor... 1. First Stage, active phase --> q30 minutes... 2…
What causes fetal oxygen supply decrea…
1. reduction of blood flow through maternal blood vessels (i.…
Normal Uterine Activity pattern?
- contractions occur every 2-5 minutes... - contractions are mod…
34 terms
EXAM 1: OB Fetal Testing
How do you get a Daily Fetal Movement…
What is the fetal alarm signal?
NST (Nonstress Test) - what is the pro…
Why is client placed on left lateral s…
-Mother eats... -count for 60 min; 1-3 daily... -if < 3 within 60 m…
When mother has felt no movements within 12 hours
-Mother is attached to an external fetal monitor ultrasound…
inferior vena cava runs on the right side and will allow for…
How do you get a Daily Fetal Movement…
-Mother eats... -count for 60 min; 1-3 daily... -if < 3 within 60 m…
What is the fetal alarm signal?
When mother has felt no movements within 12 hours
78 terms
OB fetal assessment
apgar severe distress
apgar moderate distress
apgar no distress
heart rate
0-3
4-6
7-10
0 - absent / 1 - <100 / 2 > 100
apgar severe distress
0-3
apgar moderate distress
4-6
37 terms
ob fetal skeleton
abnormal growth and density of cartila…
shortening of the proximal long bones
shortening of the distal extremities
shortening of both prox and distal ext…
skeletal dysplasia
rhizomelic
mesomelic
severe micromelic
abnormal growth and density of cartila…
skeletal dysplasia
shortening of the proximal long bones
rhizomelic
16 terms
OB 2 Fetal Assessment
Antenatal tests
High risk pregnancy
UPI (uteroplacental insufficiency)
Pregnancy complications
BPP: biophysical profile - part of this test is the NST.... NST…
Biophysical factors... Psychosocial factors... Sociodemographic fac…
The gradual decline in delivery of needed substances by the p…
Polyhydramnios: happens when have diabetes sometimes (excess)…
Antenatal tests
BPP: biophysical profile - part of this test is the NST.... NST…
High risk pregnancy
Biophysical factors... Psychosocial factors... Sociodemographic fac…
8 terms
ob fetal circulation
1st
2nd
3rd
4th
cotyledons make up the placenta... maternal arteries imbed thems…
-oxygen, nutrients and "bad stuff" absorb into the FETAL VENU…
venules travel to the surface of placenta, join other venules…
some blood goes to the liver for nourishment-most blood bypas…
1st
cotyledons make up the placenta... maternal arteries imbed thems…
2nd
-oxygen, nutrients and "bad stuff" absorb into the FETAL VENU…
14 terms
DMS Fetal brain OB
What are the three major divisions of…
What does the prosencephalon develop?
What does the mesencephalon develop?
What does the rhombencephalon develop?
Forebrain, midbrain, and hindbrain. That is, forebrain means…
The thalamus
The cerebral peduncles and the gradreminal plate
Two structures: the metencephalon and myencephalon. The meten…
What are the three major divisions of…
Forebrain, midbrain, and hindbrain. That is, forebrain means…
What does the prosencephalon develop?
The thalamus
14 terms
DMS Fetal brain OB
What are the three major divisions of…
What does the prosencephalon develop?
What does the mesencephalon develop?
What does the rhombencephalon develop?
Forebrain, midbrain, and hindbrain. That is, forebrain means…
The thalamus
The cerebral peduncles and the gradreminal plate
Two structures: the metencephalon and myencephalon. The meten…
What are the three major divisions of…
Forebrain, midbrain, and hindbrain. That is, forebrain means…
What does the prosencephalon develop?
The thalamus
OB fetal development stages
WEEK 3
WEEK 4
WEEK 5
WEEK 6
development of brain, spinal cord, GI and heart... the neural tu…
Brain differentiates... Limb buds grow and develop more
Heart beats at regular rhythm... Beginning structures of eyes an…
Beginning formation of lungs... Fetal circulation est... liver prod…
WEEK 3
development of brain, spinal cord, GI and heart... the neural tu…
WEEK 4
Brain differentiates... Limb buds grow and develop more
39 terms
ob ch 9 (Fetal Heart)
When to check heart rate low risk-
When to check heart rate High risk
Normal ph for cord blood
Category I FHR tracings
latent q 1 hr, active q 30 min, second stage q 15 min.
latent q30, active q30, second q5.
7.2-7.3
are normal. They are strongly predictive of normal fetal acid…
When to check heart rate low risk-
latent q 1 hr, active q 30 min, second stage q 15 min.
When to check heart rate High risk
latent q30, active q30, second q5.
62 terms
OB - Electronic Fetal Monitoring
main purpose of FHR?
advantage of FHR over doppler?
2 ways to externally assess uterine ac…
2 ways to internally assess uterine ac…
assess fetal oxygenation
picks up decels and variability
- palpation... - tocodynamometer
- intrauterine pressure catheter (IUPC)... - fetal scalp electro…
main purpose of FHR?
assess fetal oxygenation
advantage of FHR over doppler?
picks up decels and variability
13 terms
OB/GYN Fetal Syndromes
Trisomy 13
Trisomy 13
*Holoprosencephaly... *Microcephaly (smal…
Meckel Gruber Syndrome
Known as Patau Syndrome
90% Cardiac defects... Mid-line defects... Brian Anomalies
Sono findings associated with Trisomy 13
Different Considerations for Trisomy 13 (Patau Syndrome)
Trisomy 13
Known as Patau Syndrome
Trisomy 13
90% Cardiac defects... Mid-line defects... Brian Anomalies
86 terms
OB FetalSkeletal
Limbs develop from...
Limbs are covered by...
Do arms or legs develop first?
When do arms develop
Mesoderm
Ectoderm
Arms
4th week
Limbs develop from...
Mesoderm
Limbs are covered by...
Ectoderm
113 terms
OB- Fetal Monitoring
labor
fetal oxygen supply
baseline
Intermittent Auscultation (IA)
period of physiologic stress for the fetus
___________ must be maintained during labor to prevent fetal…
the _________ of the FHR is the average FHR over 10 minutes r…
is a high-touch, low-technology method of assessing fetal sta…
labor
period of physiologic stress for the fetus
fetal oxygen supply
___________ must be maintained during labor to prevent fetal…
37 terms
Fetal Distress: OB
What is the most common non-hemorrhagi…
What is normal fetal heart rate?
What is the normal PaCo2 & PO2 in the…
What are two signs of fetal hypoxia?
"fetal distress"... -aka nonreassuring fetal status or non reass…
120-160... -<120 = fetal bradycardia... ->160 = fetal tachycardia
PaCo2=48 torr (at maternal PACo2 of 40-45 mmHg)... PO2= 30 torr…
-Fetal bradycardia... -late decelerations
What is the most common non-hemorrhagi…
"fetal distress"... -aka nonreassuring fetal status or non reass…
What is normal fetal heart rate?
120-160... -<120 = fetal bradycardia... ->160 = fetal tachycardia
75 terms
OB/GYN - Fetal Monitoring
What is the purpose of intrapartum fet…
Overall assessment (interpretation) of…
Components of intrapartum fetal monito…
What is the purpose of FHR monitoring?…
To monitor the well-being of the fetus during the labor proce…
Category 1 - normal... Category 2 - "everything in between"... Cate…
Fetal HR... Maternal uterine contraction
Indicator of fetal well-being... Alternative to continuous FHR m…
What is the purpose of intrapartum fet…
To monitor the well-being of the fetus during the labor proce…
Overall assessment (interpretation) of…
Category 1 - normal... Category 2 - "everything in between"... Cate…
39 terms
Ob fetal skeletal quiz
Rhizomelia
Mesomelia
Micromelia
What is the most common lethal skeleta…
Shortening of proximal bone segment... (Femur/humerus)
Shortening of middle segment ... (Radius/ulnar)... (Tibia/fibula)
Shortening of entire extremity
Thanatorphoric dysplasia
Rhizomelia
Shortening of proximal bone segment... (Femur/humerus)
Mesomelia
Shortening of middle segment ... (Radius/ulnar)... (Tibia/fibula)
18 terms
Ob: Maternal-Fetal Physiology
Hyperemesis begins at
Hyperemesis stops at
Hyperemesis caused by (4)
what happens to maternal CO2 in pregna…
week 4-6 ... (this is a condition of severe nausea and vomiting…
14-16 weeks
- increased progesterone ... -increased HCG ... -increased relaxed…
decreases- important because it causes an increase in the CO2…
Hyperemesis begins at
week 4-6 ... (this is a condition of severe nausea and vomiting…
Hyperemesis stops at
14-16 weeks
43 terms
OB: Fetal Surveillance
Fetal Surveillance, who should be test…
What is Chorionic Villi Sampling?... Wha…
CVS:... When can it be performed?... Risks…
Explain the CVS procedure
Genetic risks... Family history... Ethnic groups at high risk of ge…
prenatal screening for chromosomal disorders, enzyme deficien…
Done between 10 and 13 weeks of gestation... Spotting/bleeding…
Trenscervical:... Lithotomy position. Speculum. requires full bl…
Fetal Surveillance, who should be test…
Genetic risks... Family history... Ethnic groups at high risk of ge…
What is Chorionic Villi Sampling?... Wha…
prenatal screening for chromosomal disorders, enzyme deficien…
OB - Fetal Development and Delivery
Stage I of pregnancy
Stages of pregnancy
Stage II of pregnancy
Stage III of pregnancy
Conception to implantation, "ovum" (12-14 days)
I-III
Implantation to 3 cm, "embryo" (about 8 weeks)
Stage III, "fetus" (stage II to delivery)
Stage I of pregnancy
Conception to implantation, "ovum" (12-14 days)
Stages of pregnancy
I-III
48 terms
Fetal Heart Anomalies - OB
30% of fetal heart defects are-
VSD :
What is the most common congenital hea…
What is VSD
Ventricular Septal Defect
Ventricular Septal Defect
VSD
defect in the interventricular septum allowing communication…
30% of fetal heart defects are-
Ventricular Septal Defect
VSD :
Ventricular Septal Defect
114 terms
OB: Conception and Fetal Development
Fundus
Cervix
Flagellum
Movement
Top of uterus
Bottom of uterus
Sperm Tail
Purpose of sperm tail
Fundus
Top of uterus
Cervix
Bottom of uterus
37 terms
OB - Fetal Distress
What is the most common non-hemorrhagi…
What is the normal fetal HR?
What is normal PaC02 and Pa02 in the h…
What are two signs of fetal hypoxia?
Fetal distress
Normal- 120-160
Pa02- 30 (as fetal blood leaves placenta)... PaC02- 48
Fetal Brady & Late decels
What is the most common non-hemorrhagi…
Fetal distress
What is the normal fetal HR?
Normal- 120-160
60 terms
OB Fetal Heart Monitoring
What supplies are needed for sterile v…
Any nursing considerations prior to as…
How are results of sterile vaginal exa…
Assessment findings communicated to pa…
Sterile gloves, lube
-Placenta previa would mean vaginal exam is contraindicated... -…
sterile, cervical dilation, effacement (thinned out), station…
giving them a sense of control so they feel like they know th…
What supplies are needed for sterile v…
Sterile gloves, lube
Any nursing considerations prior to as…
-Placenta previa would mean vaginal exam is contraindicated... -…
87 terms
OB: Fetal and Neonatal Physiology
growth and functional development of t…
fetal contractions begin at what month…
HR inc. to ___bpm at birth
after ____ week, blood cells are forme…
-within 1 month from fertilization organs begin to develop... -n…
after 1 month... 65 bpm
140
3rd
growth and functional development of t…
-within 1 month from fertilization organs begin to develop... -n…
fetal contractions begin at what month…
after 1 month... 65 bpm
45 terms
OB: maternal fetal physiology
When can abortion Medical and surgical…
Where is the stem cell taken from in t…
Thelarche means?... Adrenarche?... When does…
Fertilization of the egg by the sperm…
surgical: up to 14weeks gestation... medical: up to 9 weeks gest…
inner mass=death
development of breast buds... appearance of pubic hair then axil…
14 days after the last period... 3-7 days
When can abortion Medical and surgical…
surgical: up to 14weeks gestation... medical: up to 9 weeks gest…
Where is the stem cell taken from in t…
inner mass=death
21 terms
OB - Fetal Chest/Lungs
Name the 5 stages of lung development…
What is the last structure to develop…
When does differentiation of lung tiss…
Waht is respiratory distress syndrome?
1. Embryonic (up to 7 wks)... 2. Pseudoglandular (6-16 wks)... 3. C…
Alveoli
> 16 weeks
Breathing disorder of premature newborns when the alveoli in…
Name the 5 stages of lung development…
1. Embryonic (up to 7 wks)... 2. Pseudoglandular (6-16 wks)... 3. C…
What is the last structure to develop…
Alveoli
198 terms
OB- Maternal and Fetal Physiology
How often are visits made during pregn…
Fundal Height
When is fundal height used?
What is done at regular visits?
-Every month until 28-32 weeks... -At this point it becomes ever…
Measuring size of uterus... -from pubic bone to the top of the u…
16 wks-36 wks... -after 36 wks the baby drops and it is no longe…
BP... Weight... Fetal heart rate... Measuring fundal height... Urine dips…
How often are visits made during pregn…
-Every month until 28-32 weeks... -At this point it becomes ever…
Fundal Height
Measuring size of uterus... -from pubic bone to the top of the u…
30 terms
PEDS/ OB: Fetal Assessment
Ultrasound?
ultrasound definition?
MFM is?
purposes of ultrasound?
done on almost every patient. sometimes with midwife groups t…
an intrument which uses reflective sound waves as they travel…
maternal fetal medicine specialist. they do color ultrasounds…
validate pregnancy. determine how advanced the pregnancy is.…
Ultrasound?
done on almost every patient. sometimes with midwife groups t…
ultrasound definition?
an intrument which uses reflective sound waves as they travel…
19 terms
OB: fetal distress
what causes these:... early decels:... varia…
what is a definite indicator of fetal…
what are possible causes of fetal dist…
progressive fetal asphyxia that if not…
early: head compression... variable: cord compression... late: feta…
fetal scalp pH. below 7.2.
nuchal cord (common)... uterine infection... placenta abruption or…
fetal distress
what causes these:... early decels:... varia…
early: head compression... variable: cord compression... late: feta…
what is a definite indicator of fetal…
fetal scalp pH. below 7.2.
26 terms
OB - Fetal Urogenital Tract
To get a prognosis concerning fetal re…
Urinary tract anomalies account for wh…
What is the name given to the permanen…
When do the metanephros form? What do…
Amniotic Fluid Volume (AFV)
33%
Metanephros (forms after the pronephros and mesonephros)
7th week gestation... 1. metanephric diverticulum (ureteric bud)…
To get a prognosis concerning fetal re…
Amniotic Fluid Volume (AFV)
Urinary tract anomalies account for wh…
33%
157 terms
OB-fetal development and genetics
What are the three stages of fetal dev…
Preembryonic stage begins with
Fertilization typically occurs
Pirate your fertilization the sperm in…
1.Preembryonic stage-(fertilization through the second week)…
Begins with fertilization/conception.
Around two weeks after the last normal menstrual period in a…
Before ovulation
What are the three stages of fetal dev…
1.Preembryonic stage-(fertilization through the second week)…
Preembryonic stage begins with
Begins with fertilization/conception.
33 terms
OB fetal and neonatal physiology
CO to lungs in fetal development?
what keeps the ductus arterious open?…
what are the 3 shunts in fetal circula…
why does the foramen ovale stay open i…
5-10%
the low fetal O2 (25mmhg) and the locally produced prostaglan…
ductus arterious... foramen ovale... ductus venosis
the pressure in the RA is consistently more than the LA.
CO to lungs in fetal development?
5-10%
what keeps the ductus arterious open?…
the low fetal O2 (25mmhg) and the locally produced prostaglan…
58 terms
fetal assessment OB
what do you use Leopoid's Maneuver for?
how do you do Leopoid's Maneuver
how early can an ultrasound detect car…
four types of external fetal monitoring
finding the PMI point of maximum impulse (babies heart rate)…
do on moms stomach. want mom in left lateral tilt. then feel…
4 weeks gestation
ultrasound, fetal doppler, electronic fetal monitor, fetoscpoe
what do you use Leopoid's Maneuver for?
finding the PMI point of maximum impulse (babies heart rate)…
how do you do Leopoid's Maneuver
do on moms stomach. want mom in left lateral tilt. then feel…
34 terms
EXAM 1: OB Fetal Testing
How do you get a Daily Fetal Movement…
What is the fetal alarm signal?
NST (Nonstress Test) - what is the pro…
Why is client placed on left lateral s…
-Mother eats... -count for 60 min; 1-3 daily... -if < 3 within 60 m…
When mother has felt no movements within 12 hours
-Mother is attached to an external fetal monitor ultrasound…
inferior vena cava runs on the right side and will allow for…
How do you get a Daily Fetal Movement…
-Mother eats... -count for 60 min; 1-3 daily... -if < 3 within 60 m…
What is the fetal alarm signal?
When mother has felt no movements within 12 hours
29 terms
OB FETAL HEAD & ABDOMEN
Antrum of lateral ventricle
Nuchal Lucency
Nuchal Fold
Cisterna Magna
6-10mm
<3 mm (11w0d-13w6d)
<5mm (until 20wks)
<10mm
Antrum of lateral ventricle
6-10mm
Nuchal Lucency
<3 mm (11w0d-13w6d)
37 terms
OB intrapartum fetal assessment
Influences on fetal heart rate
parasympathetic nervous system
sympathetic nervous system
fetal autonomic system sensitive to ch…
CNS (regulates autonomic)... autonomic nervous system
vagus nerve stimulation slows FHR... stimulated by pressure on f…
increases FHR and strength of heart contraction ... stimulated b…
oxygen exchange... carbon dioxide production ... BP changes
Influences on fetal heart rate
CNS (regulates autonomic)... autonomic nervous system
parasympathetic nervous system
vagus nerve stimulation slows FHR... stimulated by pressure on f…
47 terms
EXAM 1: OB Fetal Testing
How do you get a Daily Fetal Movement…
What is the fetal alarm signal?
NST (Nonstress Test) - what is the pro…
Why is client placed on left lateral s…
-Mother eats... -count for 60 min; 1-3 daily... -if < 3 within 60 m…
When mother has felt no movements within 12 hours
-Mother is attached to an external fetal monitor ultrasound…
inferior vena cava runs on the right side and will allow for…
How do you get a Daily Fetal Movement…
-Mother eats... -count for 60 min; 1-3 daily... -if < 3 within 60 m…
What is the fetal alarm signal?
When mother has felt no movements within 12 hours
19 terms
OB-Electronic Fetal Monitoring
Tachysystole
Baseline FHR
Absent variability
Minimal variability
More than 5 UCs per 10 minutes over 30 minute period
Average FHR during 10 minute period... Must be observed for 2 mi…
Amplitude undetected
Amplitude range <6 bpm
Tachysystole
More than 5 UCs per 10 minutes over 30 minute period
Baseline FHR
Average FHR during 10 minute period... Must be observed for 2 mi…
193 terms
OB: Maternal-Fetal Diseases
Overt diabetes =
Diabetes increases risk for what compl…
Hyperglycemia during organogenesis is
Diabetes increases risk for what compl…
Pre-Gestational diabetes; present before pregnancy
Spontaneous abortions, 2-3 fold increased risk of fetal malfo…
teratogenic
Stillbirths, Polyhydraminos, Preterm labor, Fetal macrosomia,…
Overt diabetes =
Pre-Gestational diabetes; present before pregnancy
Diabetes increases risk for what compl…
Spontaneous abortions, 2-3 fold increased risk of fetal malfo…
18 terms
OB fetal wellbeing
at risk pregnancies
decrease/cessation of fetal activity
transabdominal ultrasound
transvaginal ultrasound
-age less than 16, more than 35... -chronic HTN, preeclampsia, D…
may indicate possible fetal compromise.... may require immediate…
-need full bladder(1-1.5qt water advised 2hrs prior)
-most accurate in 1st trimester.... -used when you need to see v…
at risk pregnancies
-age less than 16, more than 35... -chronic HTN, preeclampsia, D…
decrease/cessation of fetal activity
may indicate possible fetal compromise.... may require immediate…
24 terms
Fetal Monitoring OB
need to know
tocodynamometer
frequency of contractions
duration of contraction
best place to put the fetal monitor is on the fetal back
measures the contractions of the mother
the beginning of one contraction to the beginning of the next…
the beginning of contraction to the end of same contraction
need to know
best place to put the fetal monitor is on the fetal back
tocodynamometer
measures the contractions of the mother
25 terms
OB - Fetal Thorax
lungs
lung buds, proximal foregut
16 to 20
16 to 24
adequate development of the fetal ____ is the most important…
____ ____ develop from the ____ _____
_______ weeks --> all bronchi have formed
_______ weeks --> terminal sacs, alveoli, and capillaries beg…
lungs
adequate development of the fetal ____ is the most important…
lung buds, proximal foregut
____ ____ develop from the ____ _____
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