Occupational, Environmental, Infections and Conditions
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| Occupational exposures... | organic solvents, radiation, chemotherapeutic agents, aerosolized meds, pesticides, acrylic nail or grooming, lead
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| Radation | <5 rads is believed to be okay
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| Lead | greatest concern for neurobehavioral development
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| Occupational exposure to solvents (in general) | Spontaneous abortion, neural tube defects...association is controversial
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| Methylmercury | CNS abnormalities (microcephy, seizures, mental retardation, cerebral palsy)
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| Infectious agents | Viruses, vaccines, bacteria, parasites, zoonoses
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| 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
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| Congenital infections: common features (cont.) | blindness and/or deafness, brain calcifications, seizures, hydrocephalus and MR
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| Rubella manifestations | cataracts, heart defects, deadness, mental retardation, heptosplenomegaly, pregnancy loss
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| Rubella vaccination | mothers be vaccinated 1-2 weeks before and 4-6 weeks after conception, deter conception for at least 28 days post-vaccination
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| Mumps in Pregnancy | normal, possible miscarriage, malformations of eyes, ears, urogenital, hydrocephalus; congenital cardiomyotpathy
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| CMV | 50,000 infants infected annually; can results from primary or secondary infections; maternal-fetal transmission rate of 40%;
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| 90% of CMV babies are typically asymptomatic birth but 5-15% will develop... | long term effects such as hearing loss, visual impairment, learning difficulties
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| Congenital CMV is characterized by... | 1. heptatosplenomegaly, microcephaly, cerebral calcifications, deadness, chorioretriniis
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| Prenatal diagnosis of CMV is possible through... | level III US (oligo, IGUR, ventriculomegaly)
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| Transplacental herpes | 1. IUGR 2. Microcephaly 3. Chorioretinitis 4. Hydranencephy 5. Hydrops fetalis 6. Limb hypoplasia 7. IUGR
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| Neonatal herpes | High risk at delivery (up to 50%), characterized by Skin, eye, mouth disease, CNS disease, morality is high
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| 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
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| 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
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| Hep C | spread by exposure to blood, vertical transmission is common, high viral load or concurrent HIV infection increases risk,
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| Varicella | Maternal infection leads to fetal infection ~25% of time, greatest risk for varicella embryopathy is between 8 and 20 weeks
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| Varicella birth defects | 1. Scarring of the skin 2. Limb dysplasia 3. IUGR 4. Visual impairment 5. Microcephaly 6. Developmental delays
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| Parvovirus B-19 | joint pain in adults, vertical transmission risk 25-50%, minimal risk for malformation, 5-10% risk for fetal death
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| Parvovirus and manifestations | bone marrow damage, anemia, hydrops, mycarditis
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| 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
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| HIV rate of transmission | 14-25%
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| HIV AZT Group protocol | reduces transmission when taken in 2nd and 3rd trimesters to 8%, limit invasive procedures, delivery by c-section
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| HIV... can it be passed in breastmilk? | Yes! 27-40% of time
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| Toxoplasmosis (think Cats!) | Lymphadenopathy, infection most often acquired by eating undercooked infected meat or by handling soil or cat feces containing the organism
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| Risk of fetal damage from Toxoplasmosis is highest when... | primary infection occurs during pregnancy,
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| Severity of Toxoplasmosis infection transmission varies by... | trimester! 1st trimester rate 40%, second 18% and 3rd 3%
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| Severely affected infants may die from Toxoplasmosis or have... | 1. encehalitis/hydrocephalus, chriorteinis, hepatosplenomegaly, deafness/blindness, mental retardation/CP
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| West Nile Virus | 2-3rd trimester transmission with one infant assoc. with CP
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| Listeriosis | soft cheeses, deli meats, hot dogs, etc.
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| 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
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| Flu shot recommended if patient will be in... | 2nd or 3rd trimester during flu season
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| Hyperthermia | over 102 degrees for 48 hours
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| Hyperthermia and patterns of malformations | Growth deficiency, CNS defects, ONTDS, cleft lip/palate, micrognathia, etc.
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| Critical periods for NTD | 4-6 weeks
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| Critical period for hyperthermia in general | 4-14 weeks
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Created by:
KChatham
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