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Teratology
Occupational, Environmental, Infections and Conditions
| Question | Answer |
|---|---|
| Occupational exposures... | organic solvents, radiation, chemotherapeutic agents, aerosolized meds, pesticides, acrylic nail or grooming, lead |
| Radation | <5 rads is believed to be okay |
| Lead | greatest concern for neurobehavioral development |
| Occupational exposure to solvents (in general) | Spontaneous abortion, neural tube defects...association is controversial |
| Methylmercury | CNS abnormalities (microcephy, seizures, mental retardation, cerebral palsy) |
| Infectious agents | Viruses, vaccines, bacteria, parasites, zoonoses |
| Congenital infections common features: | fetal or newborn death, livera nd spleen enlargement, low birth wt, anemia and/or low platelet count, small head size, skin rash, jaundice |
| Congenital infections: common features (cont.) | blindness and/or deafness, brain calcifications, seizures, hydrocephalus and MR |
| Rubella manifestations | cataracts, heart defects, deadness, mental retardation, heptosplenomegaly, pregnancy loss |
| Rubella vaccination | mothers be vaccinated 1-2 weeks before and 4-6 weeks after conception, deter conception for at least 28 days post-vaccination |
| Mumps in Pregnancy | normal, possible miscarriage, malformations of eyes, ears, urogenital, hydrocephalus; congenital cardiomyotpathy |
| CMV | 50,000 infants infected annually; can results from primary or secondary infections; maternal-fetal transmission rate of 40%; |
| 90% of CMV babies are typically asymptomatic birth but 5-15% will develop... | long term effects such as hearing loss, visual impairment, learning difficulties |
| Congenital CMV is characterized by... | 1. heptatosplenomegaly, microcephaly, cerebral calcifications, deadness, chorioretriniis |
| Prenatal diagnosis of CMV is possible through... | level III US (oligo, IGUR, ventriculomegaly) |
| Transplacental herpes | 1. IUGR 2. Microcephaly 3. Chorioretinitis 4. Hydranencephy 5. Hydrops fetalis 6. Limb hypoplasia 7. IUGR |
| Neonatal herpes | High risk at delivery (up to 50%), characterized by Skin, eye, mouth disease, CNS disease, morality is high |
| Hep A | fecal-oral transmission, immune globulin must be given within 2 weeks of exposure, fetal infection rare, fetal risk related to degree of maternal morbidity, generally good outcomes |
| Hep B | transmitted by blood and body fluids, vertical transmission most common at time of delivery, chronic carriers risk cirrhosis and heptocellular carcinoma; infants should receive gamma globulin and hep B vaccine post-delivery |
| Hep C | spread by exposure to blood, vertical transmission is common, high viral load or concurrent HIV infection increases risk, |
| Varicella | Maternal infection leads to fetal infection ~25% of time, greatest risk for varicella embryopathy is between 8 and 20 weeks |
| Varicella birth defects | 1. Scarring of the skin 2. Limb dysplasia 3. IUGR 4. Visual impairment 5. Microcephaly 6. Developmental delays |
| Parvovirus B-19 | joint pain in adults, vertical transmission risk 25-50%, minimal risk for malformation, 5-10% risk for fetal death |
| Parvovirus and manifestations | bone marrow damage, anemia, hydrops, mycarditis |
| Parvovirus treatment | Serial US for 2-12 weeks after maternal infection, follow up with MSAFP, in utero blood transfusions may be an option, bone marrow depression may persist after birth and require transfusions |
| HIV rate of transmission | 14-25% |
| HIV AZT Group protocol | reduces transmission when taken in 2nd and 3rd trimesters to 8%, limit invasive procedures, delivery by c-section |
| HIV... can it be passed in breastmilk? | Yes! 27-40% of time |
| Toxoplasmosis (think Cats!) | Lymphadenopathy, infection most often acquired by eating undercooked infected meat or by handling soil or cat feces containing the organism |
| Risk of fetal damage from Toxoplasmosis is highest when... | primary infection occurs during pregnancy, |
| Severity of Toxoplasmosis infection transmission varies by... | trimester! 1st trimester rate 40%, second 18% and 3rd 3% |
| Severely affected infants may die from Toxoplasmosis or have... | 1. encehalitis/hydrocephalus, chriorteinis, hepatosplenomegaly, deafness/blindness, mental retardation/CP |
| West Nile Virus | 2-3rd trimester transmission with one infant assoc. with CP |
| Listeriosis | soft cheeses, deli meats, hot dogs, etc. |
| LCMV | carried by rodents and mice, can cause miscarriage or detal damage to brain and eyes, no available treatment... do not handle cage or litter of pet rodents |
| Flu shot recommended if patient will be in... | 2nd or 3rd trimester during flu season |
| Hyperthermia | over 102 degrees for 48 hours |
| Hyperthermia and patterns of malformations | Growth deficiency, CNS defects, ONTDS, cleft lip/palate, micrognathia, etc. |
| Critical periods for NTD | 4-6 weeks |
| Critical period for hyperthermia in general | 4-14 weeks |
Created by:
KChatham
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