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Occupational, Environmental, Infections and Conditions

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