Lecture 32: Fetal Pathology Flashcards
What are the congenital TORCH infections?
Toxoplasmosis Other = syphilis and parvovirus B19 Rubella Cytomegalovirus Herpes (both hematogenous and ascending spread)
What are the triad of symptoms that rubella causes?
- cataracts
- hearing loss
- heart murmur
3-11 weeks of gestation
What are the triad of cytomegalovirus symptoms?
- Chorioretinitis
- Cerebral calcifications
- microcephaly
Highest risk in first trimester
What is the perinatal period?
From conception to 1st week of birth
What is the neonatal period?
From birth to 4 weeks
What is pre-term? Term? Post term?
Pre-term is conception to 38 weeks
Term is 38-42 weeks
Post-term = after 42 weeks
What are the most common chromosomal aberrations?
- Trisomy 21
- turners
- Trisomy 13 and 18
What are the key characteristics of turners?
Most common cause of early pregnancy loss
Characterized by cystic hygroma with hydrops (fluid outpouching of neck)
Horeshoe kidney and bicuspid aortic valves
Very heterogeneous disease
What are the histological features of CMV?
One single owl eye
Where does hematopoiesis take place in fetus?
Liver
What are the risk factors for preterm birth?
- Preterem premature rupture of placental membranes (PPROM)
- intrauterine infection
- uterine, cervical and placental structural abnormalities
- multiple gestation
What is the association of fetal size and placental size?
Direct correlation between placenta and fetus size
What are the complications of prematurity?
- Hyaline membrane disease and chronic neonatal lung disease
- Necrotizing enterocolitis
- Intraventricular hemorrhage
- Sepsis
- developmental delay (long term complications)
What are the characteristics of hyaline membrane disease?
Most common cause of respiratory distress in newborns
Difficulty breathing within 30 minutes of birth
Cyanosis within hours
Granular densities described as ground glass seen
Damages endothelial cells so no surfactant and less gas exchange taking place
How do you treat hyaline membrane disease?
Administration of exogenous surfactant
What are the characteristics of chronic neonatal lung disease?
Nodular with multiple fissures
Lung should feel firm and cystic
What happens when damage can’t be repaired
What are the characteristics of necrotizing enterocolitis?
- Immaturity of GI tract includes motility, digestion, circulatory regulation, and barrier function
- pathogenesis includes
i. intestinal immaturity
ii. immune immaturity
iii. ischemia and hypoxia
iv. genetic predisposition
v. feeding practices - increased risk with decreasing birth weight
- presents with feeding intolerance, abdominal distentionand bloody stools
- high mortality, increasing incidence, looks clear in gross appearance + hemorrhagic appearance
What are the longterm complications of necrotizing enterocolitis?
- neurodevelopmental delay
- growth delay
- bowel strictures, short gut syndrome, abdominal adhesios with obstruction
What is a germinal matrix?
A transient structure comprised of glial and neuronal cells with a dense venous network
Birthplace of the neurons
What are the characteristics in intraventricular hemorrhage in germinal matrix?
If baby is born too soon, then baby has bleeding in germinal matrix that spills into lateral ventricles
Occurs within hours of birth
What is the classification of low birth weight?
2500 grams
What percentage of births are preterm?
12%
What is the significance of growth restriction?
Full-term infants may suffer from functional immaturity if their growth is restricted
Increase morbidity due to growth restriction
What is a sarcoma?
Cancer that arises from transformed MESENCHYMAL cells
-made of bone, fat, muscle, vascular or hematopioietic tissue
