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The influence of harmful factors on the development of the embryo and fetus.
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Exogenous factors: Physical: Mechanical (trauma, twins, uterine fibroids, etc.); Thermal (heat shock, hypothermia); Irradiation (ultraviolet, x-ray, radioactive and cosmic); Chemical: Hypoxia; Iodine deficiency; Administration of medications, poisons, etc.; Biological: Lack or excess of vitamins; Lack or excess of hormones; Infections (viral, toxoplasmosis); Antigens, Rh antibodies; Lack or excess of nutrition; Stress reactions. Groups of factors that have a harmful effect on the development of the embryo.
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Genetic; Constitutional; Age, etc. The fetus and the mother’s body are a single whole, therefore it is possible for various bacteria and viruses, toxic substances, and medications to pass from the mother to the fetus’ body, which can cause a wide variety of changes in it. Particularly responsible in this regard is the period of the first three months of pregnancy, when the formation of fetal organs occurs. Almost all medicinal substances can have a harmful effect on the embryo; therefore, to prevent embryopathies, it is advisable to avoid prescribing unnecessary medications in the early period of pregnancy. Endogenous factors:
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Among the damaging factors that can act on the intrauterine development of the fetus, starting from the moment of conception, 5 groups can be distinguished. These are medications, physical factors external environment(radioactivity, heavy metals), maternal diseases (diseases of the internal and genital organs), bad habits (smoking, alcohol, drugs), maternal infections (rubella, cytomegalo virus, herpes virus, human immunodeficiency virus, etc.). These factors have a particularly adverse effect during the maturation of the parents' germ cells, the moment of fertilization and in the first months of pregnancy - severe developmental defects occur in the embryo and fetus, and the pregnancy is often terminated. What factors cause pathology of intrauterine development of the fetus in different periods?
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Alcohol If you systematically consume even a small amount of alcoholic beverages during pregnancy and consume it at the time of conception of a child (“holiday children”), the so-called fetal alcohol syndrome may occur, which is characterized by multiple developmental anomalies, as well as disturbances in the physical and mental development of the child in the future. Bad habits
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The incidence of congenital anomalies in children of drug addicts is 2.5-3%. There is slow fetal development and a higher rate of stillbirths. The main danger is the death of a newborn, associated with the complete cessation of drug intake into his body. Taking cocaine during pregnancy is dangerous for both the mother and the fetus. Complications for the expectant mother include convulsions, ruptures of cerebral vessels, myocardial infarction, cardiac arrhythmias, and sudden death. Taking cocaine during pregnancy causes miscarriages, premature birth, intrauterine growth retardation, intrauterine fetal death, and can lead to multiple malformations in the fetus (congenital malformations of the brain, spinal cord, kidneys), and to stroke in the newborn. Morphine, heroin and marijuana cause severe neurological disorders in children. Drugs
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More than 4,000 harmful substances, including antigenic, mutagenic, and carcinogenic, have been found in cigarette smoke. The presence of these substances helps explain the harmful effects of smoking. Among them, carbon monoxide is a toxic gas that disrupts oxygen transport and can cause dysfunction of the nervous system. Nicotine is especially destructive, since it has a pronounced vasoconstrictor effect and therefore has a negative effect on blood circulation in the uterus and placenta. In women who smoke heavily, pregnancy often ends in spontaneous miscarriage. Smoking
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Factors for pregnant women high risk substances such as lead, mercury, gasoline vapors, phenol, formaldehyde, cadmium compounds, manganese, fluorine, arsenic, pesticides. It is known that lead, whether ingested in the form of salts or inhaled in the air as lead oxide, can cause impaired brain development in children and mental retardation. When a pregnant woman is exposed to mercury, her newborn develops cerebral palsy and underdevelopment of the brain. Chemical substances
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How does ionizing radiation affect a growing fetus? Severe malformations and impaired fetal growth occur at exposure doses of more than 50 rads, but even doses of several rads can dramatically increase the risk of developing leukemia in a newborn child. An increase in the number of newborns suffering from Down syndrome is associated with chronic exposure to microwave radiation. Harmful factors environment, affecting the development of the fetus.
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Teratogens are substances that can have a harmful effect on a growing fetus. An increase in the content of these substances in the bodies of a pregnant woman and child can occur if it is present during mining, metallurgical production and metal processing. The main inorganic substance with a teratogenic effect is lead, which causes disruption of the central nervous system and leads to the formation of mental retardation and various paralysis. The influence of mercury will cause a decrease in motor activity and intelligence in a child. The action of cadmium, arsenic and chromium salts will also lead to disruption of brain function. How do inorganic teratogens affect?
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During pregnancy, many different factors can have a harmful effect on the development of first the embryo and then the fetus. In this case, one should take into account the influence of harmful factors on the health of parents both during the formation of gametes and on the eve of conception. In this regard, pregnancy should be planned for a time when the future parents are healthy, do not abuse bad habits, are not associated with harmful production factors, eat normally, and mutually want a child. Damaging factors during the period of embryogenesis are most dangerous and can cause death, deformity or disease of the fetus. There are factors that do not cause pathological changes in the fetus, but contribute to miscarriage, which ultimately still leads to complications in the newborn. The influence of harmful factors on pregnancy.
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Due to nutritional deficiency and poor circulation in the uterus (after using amphetamines), mental and physical development of the fetus is delayed. A child under the influence of amphetamines appears half-asleep, does not breastfeed well, and quickly loses weight. There is an opinion that LSD causes mutations, premature births, miscarriages, placental abruption, etc. LSD is often used together with marijuana, cocaine, amphetamines or other psychoactive substances, which negates its relative “safety”. Almost all drugs cause delays in the physical and mental development of the fetus, and some threaten its life, causing miscarriage and all sorts of developmental defects. Children born after substance abuse suffer from flattening of the bridge of the nose, narrow upper lip, fusion of eyelids in the corners of the eyes, etc. The physical and mental development of such children is delayed, and they have mental disorders. Often these children are born with very small heads or very tiny eyes, and they often have hydrocephalus (a disorder of the structure of the brain).
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What does the fetus feel during the mother’s drug intoxication or during the “withdrawal” that she experiences? Most likely, the same as the mother. Drugs penetrate the placenta into the blood of the fetus and cause changes in its psyche. A mother who uses drugs risks not only physical weak child with "programmed" mental retardation, but also mentally disabled. Unfortunately, the constant “bombardment” of a child’s body with toxic substances is not limited to drugs. Their use is usually accompanied by smoking and drinking alcohol. As a result, the effect of malicious influence on the fetus is multiplied many times over.
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Smoking can put your baby's health at significant risk even before birth. But even if the mother stops smoking in the last month of pregnancy, the benefits for her and the child will be noticeable. Babies born to smoking mothers are often low-weight, have a more difficult time adapting to life “outside their mother,” and have problems with the central nervous system. nervous system and generally have poor health.
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Embryonic development is a complex and long-term morphogenetic process, during which a new one is formed from the paternal and maternal germ cells. multicellular organism, capable of independent life in the external environment. Embryonic development, or embryogenesis, -
American experts have proven that air pollution increases the likelihood of having children with developmental defects. More than a dozen studies conducted in the USA, Brazil, Mexico, South Korea, and Europe demonstrate a direct relationship between the concentration of harmful substances in the atmosphere and premature births, low birth weight infants, miscarriages and infant mortality. Causes of anomalies in embryogenesis
Chemicals that entered the premises from the outside The building itself and its furnishings Toxic fumes and particles from detergents and cleaning products used in everyday life. Bacteria, viruses, fungal and mold spores Dust Tobacco smoke Sources of air pollution
Lead Lead has been widely used in industry for many centuries. Nowadays, it is part of gasoline, paints and other products used at home and at work. Lead is dangerous to everyone's health, especially to babies and unborn children.
Young children are most sensitive to the toxic effects of lead, which manifests itself in changes in physical and psychological development - stunting, aggression, hyperactivity, and decreased learning ability. Newborns and children under 7 years of age may experience: · irritability; · stomach ache; ataxia (disorder of movement coordination); · loss of consciousness. Women who live in older (dilapidated) houses are more susceptible to high levels of lead. About 80% of homes built before 1978 were painted with lead paint. Peeling paint forms lead dust, which in turn is very dangerous for the body.
Radon Radon is a naturally occurring radioactive gas that is colorless, odorless, and tasteless. Sources: A high probability of high indoor radon levels is typical for houses built on the ground. The source of radon is uranium, which is present in small quantities in all soils and rocks. Radon also occurs naturally in some well water. Consequently, radon exposure occurs to varying degrees in different regions. Health effects: Long-term exposure to radon increases the risk of lung cancer.
Volatile organic compounds (formaldehyde, pesticides, solvents, cleaning products) Chemicals are widely used as components of household products. Paints, varnishes and wax contain organic solvents, as do most cleaning, disinfectants, cosmetics, degreasers and other products. Solvents are liquids that dissolve other chemicals; most of them evaporate very quickly into the air. Different kinds Fuels also consist of organic chemicals.
Sources of chemicals: · household chemicals (cleaning products, hairspray, glue and paints); · clothes after dry cleaning may contain residual amounts of solvents; · building materials (floor coverings, wall coverings and adhesives); · glossy paper and newspapers made from low quality paper. Effect on health: · headaches; · skin irritations; shortness of breath; · nausea, vomiting; · nose bleed.
Pesticides Pregnant women should avoid using pesticides whenever possible. Although it has not been proven that insecticides can harm an unborn child, nevertheless, all these products are poisonous. A high concentration of pesticides in the air can lead to: · miscarriage; · premature birth; · congenital defects.
Electromagnetic fields Electromagnetic radiation (EMR) cannot be felt. But it exists and affects the human body. The exact mechanism of the effect of EMR has not yet been studied. The influence of this radiation does not appear immediately, but as it accumulates, so it can be difficult to attribute a particular disease that suddenly appears in a person to the devices with which he was in contact.
During pregnancy, EMR can lead to: · spontaneous abortions; · premature birth; · the appearance of congenital malformations in children. Electromagnetic radiation comes from many. Moreover, if several devices are located at a short distance from each other, their radiation seems to be layered. And in areas of such intersections, the electromagnetic field intensifies. Therefore, it is very important to arrange electrical appliances correctly. Devices that emit electromagnetic fields: Anything that is plugged into an outlet or runs on batteries. Refrigerator, coffee maker, toaster, microwave oven, electric stove, hair dryer, TV propagate electromagnetic waves to a greater or lesser extent.
Radiation Sources of radiation: · cosmic radiation; · radioactive substances in the soil (uranium, radon); · radionuclides in products; · equipment (X-ray). Radiation affects human health in different ways - redness on the skin may appear, on the one hand, and cancer may develop on the other. The harmfulness of the consequences depends on the amount of radiation, its type and time of exposure. Radiation effects on an unborn child deserve special attention, since the embryo is very sensitive to radiation, especially during the period from the second to the fifteenth week of pregnancy. The consequences of this environmental pollutant are truly tragic: · growth retardation; · deformity; · mental disabilities; · oncological diseases.
RUSSIAN STATE MEDICAL UNIVERSITY Department of Obstetrics and Gynecology, Faculty of Medicine (Head of the Department, Professor, Doctor of Medical Sciences O.V. Makarov) LECTURE INFLUENCE OF HARMFUL FACTORS ON THE FETUS Teratology is the science of developmental disorders or the formation of defects in the fetus (Greek Teras - “ monster") HARMFUL FACTORS Hypoxia Hyperthermia Hypothermia Ionizing radiation Organic teratogens Inorganic teratogens Infections Drugs Stages of intrauterine development Preimplantation period 7 days after fertilization Implantation 7th day after fertilization Organogenesis and placentation Until the end of 3-4 months of intrauterine development Fetal period 12 - 40 weeks pregnancy Embryonic period Stage of development Organogenesis Time from conception 4-8 weeks Formation of the brain and spinal cord 4 weeks Bookmark heart, kidneys and limbs Rapid development of the brain, eyes, heart and limbs Beginning of development of the intestines and lungs Appearance of fingers Development ears, kidneys, liver and muscles Closing of the palate, joint formation at 6 weeks 10 weeks Sexual differentiation 12 weeks b 8 weeks Congenital anomaly is a structural, metabolic and functional disorder of an organ, part of an organ or a large area of the body that occurs in utero. Congenital malformation is a term that includes various structural defects. The overall incidence of congenital birth defects is 600 per 10,000 of all live and stillborn children (6%). Unidentified cause 20% Monogenic - 6% Chromosomal - 5% External environmental - 6% Multifactorial 63% Classification of congenital malformations Common congenital malformations > 1 per 1000 newborns By frequency Moderately common congenital malformations 0.1 - 0.99 per 1000 newborns Rare congenital malformations< 0,01 на 1000 новорожденных По распространенности в организме - изолированные -системные -множественные -гаметопатии, бластопатии По сроку действия вредного фактора -эмбриопатии -фетопатии Классификация ВПР по степени тяжести и прогнозу для жизнеспособности Летальные пороки развития - 8% Малые аномалии развития - 60% ВПР средней степени тяжести - 32% Взаимосвязь сроков беременности и повреждающих факторов при возникновении пороков развития плода Порок развития Анэнцефалия Расщелина губы Расщелина неба Атрезия пищевода Атрезия прямой кишки Синдактилия Диафрагмальная грыжа Гипоспадия Крипторхизм Неправильное положение крупных сосудов Дефект межжелудочковой перегородки Открытый аортальный проток Терминационный срок беременности 26 дней 36 дней 10 недель 30 дней 6 недель 6 недель 6 недель 12 недель 7- 9 месяцев 34 дня 6 недель 9 месяцев Факторы риска развития ВПР непланируемые беременности поздний материнский возраст недостаточный пренатальный контроль вирусные инфекции прием лекарств с тератогенным действием алкоголь курение наркотики недостаточное питание профессиональные вредности бедное здравоохранение многих стран Ионизирующие излучения Ионизирующие излучения высоких энергий - рентгеновские лучи -гамма-лучи - естественная радиоактивность Электромагнитные излучения низких энергий - микроволны - радиоволны - ультразвук - радиолокационные волны -шум - вибрации TORCH - инфекции Т - toxoplasmosis - токсоплазмоз О - others - другие инфекции (сифилис, хламидиоз, энтеровирусные инфекции, гепатиты А и В, листериоз, корь, эпидемический паротит, папилломавирусная инфекция, грипп и др.) R - rubeola - краснуха С - сytomegalia - цитомегаловирусная инфекция H - herpes - герпесвирусная инфекция Инфекции Эмбриотоксические или фетолитические дефекты вирусов вызываются непосредственно трансплацентарной инфекцией (заражение вирусом плода), или опосредованно - через лихорадочное состояние матери Вирус краснухи, особенно в первые 90 дней беременности, вызывает врожденные пороки сердца, глухоту и катаракту Цитомегаловирусная инфекция может привести к микроцефалии и СЗРП Вирус Коксаки (энтеровирус) связан со значительным увеличением частоты возникновения расщелин губы и лица, стеноза привратника и других аномалий пищеварительного тракта и врожденных пороков сердца Вирус герпеса II типа (урогенитальный) может приводить к микроцефалии Онкогены и неорганические тератогены К онкогенам относятся вещества, способные реагировать с ДНК и видоизменять ее Доказана трансплацентарная токсичность полициклических ароматических углеводородов, бензо-а-пирена, метилхолантрена, различных триацинов, нитрозомочевины и вторичных аминов Повышение концентрации неорганических тератогенов происходит при горнорудных работах, металлургических и металлообрабатывающих процессах Свинец приводит к нарушению функции ЦНС, развитию умственной отсталости, церебральных параличей, микроцефалии Воздействие ртути приводит к нарушению двигательной активности и умственного развития у детей Кадмий, мышьяк, хроматы являются тератогенами, приводящими к снижению умственной активности Другие факторы окружающей среды недостаточность питания прием недоброкачественных продуктов (проросший картофель) загрязнение питьевой воды физические агенты, используемые в медицине и др. Алкоголь и курение при беременности Алкоголь менее 30 мл ethyl alcohol per day does not have a harmful effect on the fetus. When drinking 30-60 ml of ethyl alcohol per day, 10% of children experience intrauterine growth retardation and a small number of congenital anomalies are observed. With daily consumption of >60 ml of ethyl alcohol, a pregnant woman is classified as an alcoholic, and abnormalities in the fetus are expressed mainly in the reduction of body weight at birth and postnatal retardation of physical and mental development Smoking during pregnancy may be accompanied by an increase in the frequency of spontaneous abortions and neural tube defects, placental abruption, premature birth, preeclampsia General recommendations for prescribing medications during pregnancy Assess the potential benefits and potential harm. Avoid the use of medications in the first trimester. Do not prescribe combinations of medications. Use the minimum effective dose for the minimum time. Give preference to local dosage forms. Advise the pregnant woman about taking any medications, including analgesics, vitamins, dietary supplements, herbal preparations and other means used for self-medication. Monitor the intake of all medications by the pregnant woman. Monitor the condition of the mother and fetus during the period of drug therapy. Determination of drug teratogenicity risk categories in the Food and Drug Administration (FDA) classification - no risk - 0.7% of drugs B (“best” - best) - no evidence of risk - 19% C (“caution” - caution) - no risk excluded - 66% D (“dangerous” - dangerous) - the risk has been proven - 7% X - contraindicated during pregnancy - 7% A Medicines that have an undesirable effect on the growth and development of the fetus Medicines DRUGS INHIBITORS ANTI TIRE DRUGS Benzodiazepines BETA BLOCKERS B Arbiturates NSAIDs Tetracyclines Warfarin Possible effect RENAL insufficient ity of the fetus or of the newborn Hypothyroidism of the fetus (prior to z i r o v k e) M ed i c i n g D e p e n d e n t i o n s o f fetal performance PREGNANCY POSSIBILITY AND GROWTH DELAY (shown for tenol o la) D u c c t u s a r t e r i o s u s (beginning from the second trimester and onwards) Disturbance of pigmentation of teeth, can be Preserve the sprouts (short use at the beginning of the first trimester of the country o d i l o c t e r a t o g e n o m e f e c t ) Hemorrhage in the fetal brain Antimicrobial agents Penicillins, cephalosporins, macrolides are not dangerous for the fetus Aminoglycosides - it is better to avoid, they have an otenphrotoxic effect Streptomycin - only for tuberculosis in pregnant women, in this case the risk of its use is lower than for tuberculosis Tetracyclines - are absolutely contraindicated - lead to disruption of the development of bones and teeth Sulfonamides - should not be used, they disrupt the binding of bilirubin in the newborn and lead to the development of kernicterus (irreversible change in function brain). Nalidixic acid derivatives should not be prescribed during pregnancy, they cause hydrocephalus. Levomycetin - use before childbirth leads to the development of “gray syndrome” of the fetus, less dangerous for the fetus during pregnancy. Metronidazole - can be used from the second trimester; in the first trimester it is better not to prescribe Antifungal drugs - they are not absorbed in the digestive tract, therefore they are safe. Antihypertensive drugs The best drug is hydralazine (peripheral vasodilator) Dopegit can lead to hemolytic anemia, cause intestinal meconium obstruction Beta-blockers in large doses increase the tone of the uterus, promote intrauterine growth restriction of the fetus Ganglioblockers - paralytic intestinal obstruction in the newborn Rauwolfia preparations - nasal congestion, depression respiratory function Nitrates are metabolized into cyanides, which poison the newborn (with long-term use ) Recommendations for prescribing medications during + -drug of choice during pregnancy and in (+) -can be prescribed in the postpartum period (-) -better not to prescribe - -analgesics, antipyretics, anti-inflammatory drugs are contraindicated phenacetin _ paracetamol + antipyrine, amidopyrine - cause agranulocytosis in fruit (+) be careful! agranulocytosis rarely butadione quinine - nephritis; necrosis of the newborn liver in the postpartum period due to teratogen, death of the embryo indomethacin (-) with long-term use in large doses. No more than 1 week, up to 28 weeks. pregnancy, in small doses prostaglandins + drugs, opiates are quickly eliminated + once without consequences. Do not administer less than 2-3 hours before the birth of the fetus, depression of the respiratory center. Breastfeeding women are not allowed. Contraindicated for the treatment and pain relief of premature labor. atropine + in therapeutic doses, harmless anesthesia + local anesthesia + Recommendations for prescribing medications during pregnancy and the postpartum period The drugs of choice are penicillins, cephalosporins, macrolides Antibiotics and chemotherapy drugs penicillins + cephalosporins + aminoglycosides - serious otonephrotoxic effect tetracyclines - deposition in bone growth areas and inhibition of skeletal growth, yellow teeth, kernicterus in the postpartum period due to blocking of bilirubin transport systems, chloramphenicol - agranulocytosis in the prenatal period. Teratogen? The newborn has “gray syndrome” - collapse, asphyxia, cyanosis, vomiting, flatulence clindamycin + erythromycin + sulfonamides (+) anemia. Do not use during lactation. Inhibition of bilirubin elimination, possible kernicterus furadonin (-) hemolysis, yellow teeth, hyperbilirubinemia in a newborn (during feeding) antifungal + antitrichomonas + from the second trimester Recommendations for prescribing medications during pregnancy and the postpartum period Desensitizing, antihistamines + in very high doses - slowdown in brain development (+) swelling of the nasal mucosa, shortness of breath; in rare cases, drowsiness, lethargy, anorexia and intestinal atony Antihypertensive drugs reserpine peripheral vasodilators + the newborn may have hypoxia and hypotension alpha-blockers + do not cross the placenta beta-blockers (+) Anticonvulsants (anti-epileptics) Barbiturates Benzodiazepines may develop disorders during lactation autonomic nervous system (hypersecretion, decreased activity, hypoglycemia and bradycardia) Used for health reasons (+) developmental defects? It is good to use during induction of anesthesia (does not increase blood pressure). Depression of the respiratory center in a newborn + delayed decay in the fetal liver: drowsiness in the postpartum period Recommendations for prescribing medications during pregnancy and the postpartum period Anti-asthmatic drugs theophylline + completely harmless beta-sympathomimetics (+ tocolysis) parthusisten, ipradol, bricanil, ginipral ( +) tachycardia, hypoglycemia in the fetus corticosteroids (+) long-term use leads to intrauterine adrenal insufficiency indirect anticoagulants (-) penetrate the placenta, hemorrhages in the fetus. Due to poverty, heparin can be used for heart defects + the drug of choice, does not penetrate the placenta Diuretics (-) very carefully! Contraindicated for gestosis. Only for pulmonary edema, cerebral edema, nephrotic syndrome Cardiac glycosides + toxic effects of overdose Antithrombotic drugs are possible only with Recommendations for prescribing medications during pregnancy and the postpartum period Hormones natural estrogens + harmless stilbenes - can induce adenocarcinoma of the vagina in the fetus sigetin + prevention of hypoxia fetus, improvement of uteroplacental blood circulation gestagens (progesterone, duphaston) + with 19-norsteroids (norkolut, norethisterone, primolut-norm) (-) possible virilization of female fetuses hormonal contraceptives (accidental intake) synthetic estrogens + 19-norsteroids (-) acceptable for several weeks in early dates pregnancy. Possible virilization of female fetuses due to luteal phase deficiency; can be used from the beginning of pregnancy to 20 weeks. androgens - virilization of female fetuses anabolics - virilization of female fetuses thyroxine (+) for hypothyroidism, euthyroid goiter. There are known cases of the development of hyperthyroidism in the fetus; iodine preparations (-) goiter and hyperthyroidism in the newborn; antithyroid drugs (-) congenital goiter, hypothyroidism, cretinism; Recommendations for prescribing medications during pregnancy and the postpartum period; Vaccines tetanus + rabies + cholera, diphtheria, paratyphoid pertussis , typhus, (+) (+) can cause abortion, premature birth vitamin A (+) very carefully - malformations of the central nervous system, eyes, upper palate vitamin B + vitamin C (+) in large doses - death of the embryo, abortion in the first trimester ; aortic stenosis vitamin D (-) in case of overdose - organ calcification vitamin K (vicasol) + vitamin B12 + Laxatives Vitamins no side effects when feeding may be jaundice in a newborn Indications for periconceptional prevention of congenital malformations Diabetes mellitus and other endocrine and metabolic diseases. Repeated spontaneous abortions and stillbirths. Genetic risk of multifactorial malformations. Birth of fetuses with intrauterine growth retardation and a history of premature birth. Chronic diseases (hypertension, epilepsy, bronchial asthma, etc.). Obesity. Long-term use of medications. Some infectious diseases (rubella, toxoplasmosis, etc.) Decalogue of commandments for the prevention of congenital birth defects (geneticist Eduardo Castillo, Brazil) Any fertile woman can be pregnant. Try to complete your family while you are young. Carry out prenatal control in the prescribed manner. Get vaccinated against rubella before pregnancy. Avoid medications unless strictly necessary. Avoid alcoholic drinks. Avoid smoking and smoking areas. Eat well and varied, preferring fruits and vegetables. Ask for advice about pregnancy risks at your job. If in doubt, consult your doctor or specialist provider. Thank you for your attention!
Kazan State Medical University Department of Obstetrics and Gynecology No. 2 Doctor of Medical Sciences, Professor Gabidullina R.I.
Slide 2: INFLUENCE OF HARMFUL FACTORS ON THE FETUS
The prevalence of spontaneous abortions is 15-20% of the total number of pregnancies; 50% of miscarriages in the first trimester have severe disorders; 3-5% of newborns have developmental defects; in 15% of children, developmental defects are detected at the age of 5-10 years
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DYNAMICS OF CONTROLLED ABORTIONS IN RUSSIA (% of total number abortions) REPRODUCTIVE HEALTH Radzinsky V.E.
Slide 4: Teratogenesis
The occurrence of malformations under the influence of environmental factors (teratogenic factors) or as a result of hereditary diseases
Slide 5: Teratogenic factors
Widely distributed. During pregnancy, each woman takes an average of 3.8 types of drugs. In the US, 10-20% of pregnant women use drugs. Besides, harmful substances found in everyday life (microwave oven, electronic watch) and at work
Slide 6: Teratogenic factors
Chemical Physical Biological
Slide 7: Criteria for teratogenic factors
The connection between the action of the factor and the formation of malformations has been proven. Epidemiological studies confirm this connection. The action of the harmful factor coincides with critical periods of intrauterine development. With rare exposure to the damaging factor, characteristic developmental defects are rarely formed
Slide 8: Main groups of teratogenic factors
Medicines and chemicals (tetracyclines, trichopolum, androgens, mercury, lead, phosphorus) Ionizing radiation (radioactive fallout, radioisotope diagnostics, radiation therapy) Viral and bacterial infections (herpes, rubella, syphilis, toxoplasmosis) Metabolic disorders and bad habits ( diabetes, endemic goiter, phenylketonuria; smoking, alcoholism, drug addiction) A special registry of teratogenic factors is published in the USA
Slide 9: Features of the influence of teratogenic factors (TF)
Dose-dependent nature. For each TF there is a dose of teratogenic action. Usually it is 1-3 orders of magnitude lower than lethal. Sensitivity to various TFs may change during fetal development. Infectious agents as teratogenic factors do not have a threshold dose and dose-dependent nature
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Slide 10: Periods of human intrauterine development
Initial - from the moment of fertilization until implantation of the blastocyst (up to 11 days). Ebryonic (18-60 days after fertilization) Fetal (from 9 weeks of pregnancy to birth)
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Slide 11: Initial period
It is distinguished by the great compensatory and adaptive capabilities of the embryo. The “all or nothing” law - if a large number of cells are damaged, the embryo dies, if individual blastomeres are damaged, further development is not disrupted Ovary Ovum Fertilization Ovulation 30-36 hours 3-4 days 5-6 days 2 cells 4 cells 8 cells Morula Blastocyst
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Slide 12: Embryonic period
The embryo is most sensitive to the action of TF. Gross malformations are formed
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Slide 13: Fruiting period
Developmental defects are not typical. Under the influence of the external environment, growth inhibition and/or cell death occurs, which is subsequently manifested by underdevelopment or functional immaturity of organs
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Slide 14: Major developmental defects
Malformations of the central nervous system - anencephaly, spina bifida, hydrocephalus. They are formed as a result of non-fusion of the neural tube due to folic acid deficiency, infection, and diabetes mellitus. Congenital heart defects - ASD, tetralogy of Fallot, aortic stenosis, etc. (phenylketonuria, SLE, rubella virus, genetic factors, alcohol, NSAIDs, diabetes mellitus) Cleft lip, hard palate Congenital clubfoot Congenital hip dislocation Malformations of the gastrointestinal tract - pyloric stenosis, Hirschsprung's disease, atresia of the esophagus, anus, etc.
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Slide 15
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Slide 16: General approaches to prenatal prevention
Environmental protection Family planning (consanguineous marriages, childbearing after 35 years of age) Prenatal diagnosis - elimination of embryos with pathology Identification of heterozygous carriers Periconceptional preparation Invasive and non-invasive methods of intrauterine diagnostics
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Slide 17: Periconceptional preparation
medical and genetic counseling, diagnosis of carriage and treatment of viral and bacterial infections, exclusion of prof. harmfulness, giving up bad habits, taking folic acid and tocopherols)
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Slide 18: Methods of intrauterine diagnostics
Non-invasive methods: Ultrasound (10-14, 22-24, 32-34 weeks), Biochemical markers: 9-14 weeks b-hCG, PAPP-A 17-19 weeks AFP, 17-OPK, b-hCG, estradiol Invasive methods : Chorionic villus biopsy (9-11 weeks) Cordocentesis (22-24 weeks)
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Slide 19: Medicines and chemicals
For transplacental transition, the following are important: The molecular weight of the drug (up to 600 easily passes, 600 - 1000 is limited, more than 1000 almost does not penetrate). Most drugs are less than 600 and easily penetrate the fetus. Fat-soluble substances diffuse easily across the placenta (ether, nitrous oxide). Binding to blood proteins. The greater the connection, the slower the penetration through the placenta and accumulation in the fetus. Method of administration to mother Stage of intrauterine development
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Slide 20: Drug safety categories
FDA (Food and Drug Administration) risk categories for using medications during pregnancy: A – no risk to the fetus; B – the risk to the fetus has not been established in either animals or humans; C – the risk to the fetus has not been established in humans; no controlled studies have been conducted in humans; D – there is a risk to the fetus, but can only be used if there is a risk to life; it is necessary to assess the degree of risk and benefit; X – proven risk to the fetus. Contraindicated during pregnancy.
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Slide 21: Absolute teratogens
Medicines used in oncology: Antimetabolites (6 - mercaptopurine) Alkylating compounds (cyclophosphamide) Antitumor antibiotics (actinomycin, sarcolysin)
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Slide 22: Antibacterial drugs during pregnancy (Gurtovoy B.L. et al. 2004)
Group I – contraindicated during pregnancy: tetracyclines, chloramphenicol, trimetaprim. Group II - use only for health reasons: aminoglycosides, nitrofurans, sulfonamides. Group III - antibiotics that do not have embryotoxic effects: penicillins, cephalosporins, macrolides.
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Slide 23: Impact of antibiotics
Tetracycline and its derivatives in the early stages lead to malformations, in the late stages - slowing down fetal growth, damage to the tooth buds, hepatotoxic effect Levomycetin - hypoplastic anemia Aminoglycosides - ototoxic effect
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Slide 24: Hormonal drugs
Estrogens lead to the development of adenosis and clear cell adenocarcinoma of the vagina and cervix in girls
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Slide 25: Ionizing radiation
Impact of radiation on female body occurs according to the general laws of radiation damage a - radiation practically does not penetrate the skin, but is very dangerous if ingested b - radiation penetrates to a depth of 1-2 cm g - radiation has the greatest penetrating ability with the formation of free radicals, leading to gene mutations Transplacental transfer is main in the penetration of isotopes
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Slide 26: Mechanisms of transplacental transfer of radionuclides
Hematogenous pathway – free transition of isotopes from the mother’s blood to the fetal blood through the transplacental membrane (131 I, 32 P, etc.) Accumulation in the tissues of the placenta with subsequent exposure to the fetus (transuranium elements) Paraplacental transition through the fetal membranes and amniotic fluid (radioactive plutonium)
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Slide 27: Infection (mechanisms of action)
Viruses (cytomegaalvirus, herpes, rubella), penetrating the embryo and fetus, can have a direct teratogenic effect. Infection leads to changes in the metabolism and function of the endometrium, which causes impaired implantation or impaired development of the placenta
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Slide 28: Infection (mechanisms of action)
3. Viral and bacterial infections can affect the development of the placenta and lead to the occurrence of CFRF and IUGR in the fetus 4. Bacterial toxins can have a toxic effect on the fetus
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Slide 29: Bad habits
Smoking Alcohol consumption Drug addiction
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Slide 30
TOBACCO SMOKING DURING PREGNANCY, of which 20-30 years - 70% REPRODUCTIVE HEALTH Radzinsky V.E. Moscow, 2002
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Slide 31: Smoking
Tobacco contains more than 600 harmful factors: organic and inorganic acids, proteins, esters, aldehydes, phenols, etc. Currently, radioactive polonium has been identified in tobacco smoke. Nicotine has the greatest impact
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Slide 32: Nicotine
Exposure to nicotine in early pregnancy can lead to impaired implantation of the fertilized egg and spontaneous abortion. Abortion and premature birth may be caused by increased contractility of the uterus during smoking Nicotine leads to contraction of the vessels of the uterus and placenta with the development of placental insufficiency and fetal hypoxia
