Perinatal Infections and Teratology Flashcards
all newborn findings that are common consequences of fetal infections
microcephaly micropthalmia midfacial hypoplasia growth restriction deafness valvular congenital heart disease skin scarring, skin lesions hydrops fetalis - abnormal fluid accumulation in 1+ fetal compartments brain calcifications pneumonia hepatosplenomegaly thrombocytopenia petechiae hyperbilirubinemia
‘Z-TORCH’
common diseases that can cause fetal infection
Zika
Toxoplasmosis
Other (Syphilis, varicella, zika)
Rubella (congenital)
CMV
Herpes
zika
brain calcifications and microcephaly
Toxoplasmosis
increase in spontaneous abortions in 1st trimester
main association = brain calcifications
maternal infection timing
a. 1st trimester = miscarriage, full spectrum of malformations
b. 2nd = less likely to get an infection, but if do…more severe
c. 3rd = later the maternal infection, more likely a fetal infection will be, but less severe it will be
Syphilis
most newborns have no symptoms
often matched hydrops fetalis
Hutchinson’s teeth (blunted upper incisors)
congenital rubella
not seen often
every woman is screened for it
cataract, small eyes, micropthalmia, infections of the head, small head
retard
deafness
long bone abnormalities
baby born with == hepatosplenomegaly, jaundice, pneumonia, hydrops fetalis
CMV
very frequent
90% have no symptoms
10% = hearing loss + brain calcifications
if 1st trimester infection = micropthalmia, microcephaly, hydrocephalus, cataracts, etc
Herpes
primary = first infection, worst infection…more likely to infect baby
- spreads through the body systemically before immune system has created a defense for it
secondary = recurring local infection…less likely ot infect baby….since mom can pass down immunity
viruses that are not teratogenic but can still infect baby and kill them
Hep B and C measles influenza rhinovirus enterovirus HIV
timing of exposure to teratogenic medications
embyronic risk is 2-8 weeks after conception or 4-10 weeks after last menstrual period
neural tube defects = time for defect is 28 days
fetal alcohol syndrome
CNS abnormalities
can be small
short palpebral fissures, upturned nose, hypoplastic philtrum
category A, B, C, D, X teratogenic drugs
A = safest
B = relatively safe
C = counsel women about the possible risk
D = rarely need to use; risks exist, but benefit may outweigh them
X = don’t use (Accutane)
aminopterin
teratogenic drug
folic acid antagonist
abortion pill…when didn’t work - babies had severe malformations
warfarin
dont use with pregnancy
if taken during 1st trimester = fetal warfarin syndrome
nasal hypoplasia, stippled epiphysis of bones
thalidomide
teratogenic drug
limb reduction (phocomela), oligodactyly, syndactyly, polydactyly, etc
Diethylstilbestrol
synthetic estrogen used to prevent pregnancy loss
associated with increased incidence of vaginal adenosis and adenocarcinoma of the vagina
effects of DES have pretty much passed now
androgens
have to ingest a shit ton to fuck up your kid
can have an issue if have a defect in 21-hydroxylase
= masculinization of female fetus
phenytoin (Dilantin)
remember fetal hydantoin syndrome
nail agenesis hypoplasia
broad nasal bridge, wide fontanel, low hairline
valproic acid
increased risk of NTDs by 2-3%
sensory and motor deficit
carbamazipine
increased risk of NTD by 1-2%
isotretinoin (Retin A)
used systematically for severe acne…topical use is safe though
small or absent ears
lithium
lower the dose as much as possible
malformations in 1st trimester
epstein anomaly = poor development of tricupsid valve
ionizing radiation on pregnant women
hallmark = microcephaly in addition to poor overall growth
would need a fair amount of procedures to do damage
uncontrolled diabetes in pregnant women
cardiac malformations
NTDs
sacral agenesis
