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P020A

P020A . Lecture 5 - . Course Objective #30. Identify the causative agent and the effects on the fetus in the following maternal infections: Rubella Toxoplasmosis Syphilis Cytomegalovirus. Development. Cephalocaudal Proximal-distal . Rubella. AKA German Measles.

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P020A

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  1. P020A Lecture 5 -

  2. Course Objective #30 • Identify the causative agent and the effects on the fetus in the following maternal infections: • Rubella • Toxoplasmosis • Syphilis • Cytomegalovirus

  3. Development • Cephalocaudal • Proximal-distal

  4. Rubella • AKA • German Measles

  5. Congenital Rubella Syndrome • AKA • “Blueberry Muffin Syndrome” • 1st trimester • 85% affected • After 20 weeks • Defects rare

  6. Congenital Rubella SyndromeEtiology • Intrauterine Infection • Critical Time period • 1st trimester

  7. Congenital Rubella SyndromeFYI • 1941 Australian epidemic • 78 infants w/CRS • 1964-65 US epidemic • 20.5 M cases of Rubella  • 20,000 infants w/CRS

  8. Congenital Rubella SyndromeS&S • Varied • ID • Normal – severe • Sensory defects • Deaf* • Blind

  9. Congenital Rubella Syndrome • S&S • Cardiac defects • Microcephaly • Bone abnormalities • Purpura

  10. Congenital Rubella Syndrome • Treatment • Prevention • Rubella vaccine licensed in 1969 • MMR • 2005 Rubella eradicated in US

  11. Rubella Virus Eliminated in the United States • Washington Post --Monday, March 21, 2005 • The invisible "chain of transmission" of rubella virus has been broken in the United States. With it disappears a disease that a little more than a generation ago struck fear in the heart of every pregnant woman. • Fewer than 10 people a year in this country now contract the infection known popularly as German measles. Since 2002, all cases have been traceable to foreigners who carried the virus in from abroad.

  12. Congenital Toxoplasmosis • Toxoplasmosis • Protozoa Parasite • “Transplacental spread”  Congenital Toxoplasmosis

  13. Congenital Toxoplasmosis • Etiology • Raw, undercooked meat, • Cat feces, • Non-pasteurized milk

  14. Congenital Toxoplasmosis • Incidence • 1:10,000 births • Prognosis • Many die in 1st month

  15. Congenital Toxoplasmosis • S&S • Varywidely depending on period of infection

  16. Congenital Toxoplasmosis • S&S • Triad • Hydrocephalus • Intracranial calcification • Chorioretinitis

  17. Congenital Toxoplasmosis • Severe ID • Blindness • Epilepsy • Low birth weight • Hepatosplenomegaly • Jaundice

  18. Congenital Toxoplasmosis • Tx • Antibiotics

  19. Congenital Toxoplasmosis • Dx • Amniocentesis • Ultrasound

  20. Congenital Syphilis • Etiology: • Spirochete bacterium • Bacteria!!!!

  21. Congenital Syphilis • Mom  infant • during pregnancy or birth • Fetus vulnerable • after 18 weeks

  22. Congenital Syphilis • Incidence • 1:100,000 live births (CDC, 2002) • @ 50% die in utero or shortly before or after birth

  23. Congenital SyphilisS&S Early stage • Failure to thrive, • Nasal discharge • Blistery rash • No nasal bridge

  24. Congenital Syphilis • Late stage • Hutchinson’s triad • Hutchinson’s teeth • Keratitis • Deaf

  25. Congenital Syphilis • Late stage • ID • Bone pain • Vision/hearing loss

  26. Congenital Syphilis • Treatment • Mom • Prenatal care • Antibiotics • Delivery • Cesarean

  27. Congenital Cytomegalovirus • Herpes-like infection

  28. Congenital Cytomegalovirus • Etiology • Transplacental spread

  29. Congenital CytomegalovirusFYI • Mom may be asymptomatic • 1% all newborns test positive for CMV • 95% asymptomatic • 5% congenitally affected

  30. Congenital cytomegalovirus • The mother's illness may not have symptoms, so she may be unaware that she has CMV.

  31. Congenital CytomegalovirusS&S • Inflammation of the retina • Hepatosplenomegaly • Jaundice • Low birth weight • Petechiae • Seizures • Microcephaly

  32. Congenital CytomegalovirusDx Tests • Antibody titer against CMV • Bilirubin level • TORCH screen

  33. Congenital CytomegalovirusTx • Focus on specific problems

  34. Congenital CytomegavirusPrognosis • Up to 90% of infants who have symptoms of their infection at birth will have neurologic abnormalities later in life. Only about 5 - 10% of infants without symptoms will have these problems.

  35. Congenital CytomegalovirusFYI -neonatal death is common

  36. Congenital CytomegalovirusPrevention • CMV is almost everywhere • Wash hands p touching diapers • ⌀ kiss kids < 6 yrs • ⌀ share food c kids • PG ⌀ work with < 2 1/2

  37. Objective #31 • Describe the cause, sequence of events, pathology and preventative factors of erythroblastosisfetalis.

  38. Course Objective #32 • Describe the relationship of the Rh factor disorders and kernicterus

  39. ErythroblastosisFetalis • What is erythroblastosisfetalis?

  40. ErythroblastosisFetalis • Hemolytic disease • ABO incompatibility • Rh incompatibility

  41. ErythroblastosisFetalis • Neonate red blood cell destruction

  42. ErythroblastosisFetalisS&S • Anemia • Hepatoslenomegaly • Jaundice • Hydrops

  43. ErythroblastosisFetalisDx test • Complete blood count and immature red blood cell (reticulocyte) count • Bilirubin level • Blood typing

  44. ErythroblastosisFetalisTreatment • Phototherapy: • bilirubin breaks down when exposed to UV light • Blood transfusion

  45. Maternal-Fetal Blood Incompatibilities -Rh Incompatibility -ABO Incompatibility

  46. ABO Incompatibility • Etiology • Mom blood type • O • Fetus blood type • A • B

  47. ABO Incompatibility S&S • Mild • Anemia • Jaundice

  48. ABO Compatibility • Severe  • Kernicterus • Brain damage d/t h bilirubin levels

  49. ABO Incompatibility Treatment • Phototherapy

  50. Rh incompatibility • Mom blood type • Rh- • Fetus blood type • Rh+

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