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VIDEO DEMONSTRATION ON

VIDEO DEMONSTRATION ON. EFFECTS OF TERATOGENS ON FETAL DEVELOPMENT. GUIDED BY:- Mr. CHITHRAVEL H.O.D. OBSTETRICS AND GYNECOLOGICAL Nursing ETCM COLLEGE OF NURSING. PREPARED BY:- SHAIK AMEEN FATIMA M.Sc Nursing IInd Year ETCM COLLEGE OF NURSING.

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VIDEO DEMONSTRATION ON

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  1. VIDEO DEMONSTRATION ON EFFECTS OF TERATOGENS ON FETAL DEVELOPMENT

  2. GUIDED BY:-Mr. CHITHRAVELH.O.D. OBSTETRICS AND GYNECOLOGICALNursingETCM COLLEGE OF NURSING PREPARED BY:- SHAIK AMEEN FATIMA M.Sc Nursing IInd Year ETCM COLLEGE OF NURSING

  3. EFFECTS OF TERATOGENS ON FETAL DEVELOPMENT

  4. INTRODUCTION The care of child bearing and child rearing families is a major focus of community health nursing practice. To have healthy children, midwife has to promotethe health of childbearing woman and her family from the time before children is born. The role of community health nurse is mainly focusing on promoting healthy growth and development of fetus from its conception. So she has to understand the teratogens and its effect on fetal development

  5. MEANING • The word “Teratogen” is derived from the Greek word Teratos means monster. Teratogen refers to any agent that causes a structural abnormality following fetal exposure during pregnancy. • A teratogen is an agent that acts during embryonic and fetal development to produce permanent alteration of structure and function.

  6. TYPES OF HUMAN TERATOGENS Human Teratogens includes: 1) Maternal conditions. 2) Exposure to radiation. 3) Drugs. 4) Chemicals.

  7. 1. MATERNAL CONDITIONS An expanded acronym “STORCH,” replacing TORCH, specific infections that adversely affect the fetus. S- Syphilis. T- Toxoplasmosis. O- Others. (Varicella) R- Rubella C- Cytomegalovirus H- Herpes, HIV, Hepatitis B, Human papilla virus.

  8. SYPHILIS Causative agent: Spirochete treponema pallidum Mode of transmission: Sexually transmitted Effect on fetus: Still birth, preterm labor, growth retardation, fetal hydrops, and congenital syphilis Treatment: Injection Penicillin Prevention of Syphilis: • Mother with infectious syphilis should abstain from sexual activity until rendered noninfectious by antibiotic therapy. • Help the mother to talk openly with partner about STDs, HIV, and hepatitis B infection. • Avoid multiple sex partners.

  9. Effect on fetus Still birth Preterm labor fetal hydrops

  10. TOXOPLASMOSIS Causative agent: Toxoplasma gonadi Mode of transmission: Eating un cooked meat & or exposure to cysts deposited in soil contaminated with cat feces. Effect on fetus: Retinitis, strabismus, hydrocephalus, microcephaly, abortion, still birth, hearing & visual impairment, mental retardatation. Treatment:Pyrimethamine, sulphanamide. Prevention of Toxoplasmosis • Advise the mother to avoid exposure to litter used by infected cats. • Blood examination for Toxoplasma antibodies should be performed during antenatal visits or as indicated.

  11. Effect on fetus:

  12. VARICELLA (Chicken pox) Causative agent: Herpes zoster. Mode of transmission: Infected person. Effect on fetus: 1. Preterm delivery. 2. Congenital Varicella syndrome: Features are Skin scarring, eye defects (microopthalmia, chorio retinitis, and cataract) hypoplacia of the limbs, neurological abnormalities like microcephaly, cortical atrophy, mental retardation, low birth weight, Treatment: Vaccine Varicella zoster immune globulin. Prevention • Chicken pox can be prevented through vaccination. • Two doses of Varicella vaccine four to eight weeks apart are recommended for healthy non-pregnant women with no history of chicken pox or previous vaccination

  13. Effect on fetus: • Hypoplacia of the limbs, Microcephaly Low birth weight

  14. RUBELLA (German measles) Causative agent: Togo virus. Mode of transmission: Infected person. Effect on fetus: Congenital rubella syndrome: - Intra uterine growth retardation, intracranial calcification, microcephaly, cataracts, sensorineural defects, cardiac defects, hepatosplenomegaly, osteitis, miscarriage. Treatment: Antiviral agents. Prevention of Rubella • A rubella vaccine can prevent rubella. • The rubella vaccine should not be given to pregnant women or to a woman who may become pregnant within 1 month of receiving the vaccine. • If the women have chances of becoming pregnant, she must make sure that she is immune to rubella through a blood test or proof of immunization

  15. Effect on fetus

  16. CYTOMEGALOVIRUS Causative agent: Herpes virus. Mode of transmission: Respiratory & genito urinary tract. Effect on fetus: Hepatosplenomegaly, Thrombocytopenia, purpura, hepatitis, intrauterine growth retardation, mental retardation, neonatal death if infection is severe. Treatment:Anti viral agent, ganciclover. Prevention of Cytomegalovirus Infection • Warn pregnant women to avoid any individuals with confirmed or suspected CMV infection. • Pregnant women should be counseled about the risks and the need to practice good hygiene

  17. Effect on fetus:

  18. HERPSE SIMPLEX Causative agent: Herpes simplex virus. Mode of transmission: Sexually transmitted. Effect on fetus: Risk of miscarriage, premature labor. Treatment:Anti viral agent Prevention of Herpes Simplex • Because the chances of contracting this disease increase with the sexual activity, so avoiding sex is first step toward prevention. • The pregnant women should tell her doctor if she has ever been exposed to anyone with herpes, even if she has never had any symptoms. The doctor can take special precautions at the time of delivery to protect the baby from getting infected with herpes

  19. HIV/ AIDS Causative agent: Retrovirus. Mode of transmission: Sexually transmitted. Effect on fetus: premature labor, low birth weight, HIV embryo-pathy growth, retardation, craniofacial abnormalities, microcephaly, fetal infection. Treatment: Anti retro viral, zidovudine, ritonavir, nevirapine. Prevention of AIDS and HIV Infection • Preconception screeing for HIV • If positive for HIV refer to experts for prompt treatment. • Advice for termination of pregnancy if HIV positive. • Wide spread counseling.

  20. HEPATITIS B Causative agent: Hepatitis B virus. (HBV) Mode of transmission: Prenatal route. Effect on fetus: Risk of fetal death, born with carriers, risk of liver damage, cancer of the liver. Treatment:There is no specifictreatment; prevention can be done through vaccine. Vaccine can be administered in 3doses, given at 0, 1month later, 6month after the 1st dose. Prevention of Hepatitis B • Through vaccination, Other measures are, • (If carrier) Cover open wounds, don't share razors or manicure tools. • Practice safe sex ,Don’t share needles, razors, toothbrushes; manicure tools or other items that could bear contaminated blood.

  21. 2. EXPOSURE TO RADIATION Exposure to radiation from natural sources is 80%, about 15% from diagnostic procedure, it includes, x-rays, ionizing radiation, radioisotopes used in diagnostic imaging. Elevated doses produce adverse outcomes, depending on stage of development, • During blastogenesis- failure to implant. • During organogenesis- risk of malformations, growth retardation. • During fetogenesis- brain damage.

  22. Prevention of Radiation exposure during pregnancy • Advice the mother not to have x-rays. • Avoid working in the places where radiation exposures are more. • If exposures occur refer the mother to experts to get adequate information.

  23. 3.TERATOGENICITY OF DRUGS • Drug exposures during pregnancy have teratogenic effect. • The duration of exposure and gestational age at exposure are also very critical in the determination of teratogenic potential. Factors that determine the effects of teratogens (Drugs): • Dose reaching fetus • Point in development when drug exposure occurs • Duration of exposure • Environmental factors • Susceptibility of the fetus

  24. Medications those are known to cause harm to the unborn baby Hormones • Androgens • Diethylstillbestrol • Danazol

  25. Anticoagulants • Warfarin • Other coumarin anticoagulants Antineoplastics • Methotrexate • Busulfan • Cyclophosphamide • Aminopterin & Methylaminopterin

  26. Anticonvulsants • Phenytoin • Valproic acid • Carbamazepine • Phenobarbital • Primidone Other drugs • Angiotensin-converting • enzyme inhibitors • Amiodarone • Cocaine • Lithium • Quinine • Thalidomide

  27. Treatment recommendations: Prescription drugs: • Chronic maternal diseases such as diabetes, hypertension, epilepsy, and asthma, must continue to be treated throughout pregnancy to protect the mother’s health as well as fetus development. • Chronic diseases may be more safely managed during pregnancy with alternative drugs used. • Temporary changes in treatment regimens may be necessary during this period. • Acute maternal diseases such as bacterial and viral infections must also be effectively managed with antibiotics and antipyretics. • For fever and pain salicylates and nonsteroidal anti-inflammatory drugs are not recommended during the third trimester.

  28. Non-prescription drugs: • Pregnancy can cause various physical condition or symptoms that may be relieved through drug treatment. • The most common physical complaints associated with pregnancy include nausea, epigastric distress, constipation and hemorrhoids. Many of these symptoms may be managed with nonprescription drug products that are effective alternatives for these minor conditions. • Nausea, vomiting and heartburn may be greatly improved through avoidance of large meals. • Taking many small meals throughout the day may be better choice than 3 large meals. Avoiding certain foods, smells, or situation that lead to vomiting may prevent vomiting.

  29. 4. CHEMICALS Smoking: • Smoking interferes with oxygen and nutrients supply to the fetus, because of nicotine constricts uterine blood flow. This compromises cell growth and may have an adverse effect on, • Mental development, • Small for date of newborn, • Prematurity and Spontaneous abortion, • Sudden infant death syndrome, • Passive smoking associated with low birth weight at term.

  30. Prevention of smoking • Advice the mother to have prenatal check up during 1st trimester to have a in-depth knowledge of risk factors of smoking. • Psychological and behavioral support should be given to quit smoking to the partner. • Refer the couples to Local units located near maternity centers.

  31. Alcohol Alcohol consumption during pregnancy has deleterious consequences for the fetus. Children born with common pattern of anomalies known as fetal alcohol syndrome. Abnormalities include a cluster of craniofacial abnormalities, CNS dysfunction, pre- and or postnatal stunting of growth, hearing, language, and speech disorders.

  32. Prevention of Alcohol • Educate the couple about the complication of alcohol consumption affecting the fetal development. • Advice the mother to avoid alcohol during pregnancy. • Refer her to support groups.

  33. Conclusion During organogenesis teratogenic agents are more likely to cause major congenital malformations however T anatomical or structural abnormalities are present at birth although they may not be diagnosed until later in life. Rural mothers are not aware of teratogens and their effect on fetal development, hope this session on effects teratogens on fetal development gave knowledge on same.

  34. Thanks for your attention

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