rUBELLA

2. Dr askari rUBELLA

3. GERMAN MEASLES • RNA virus • Abortion and sever congenital malformation in the 1 trimester • Peak incidence in late winter and spring • Minor importance in absence of pregnancy

4. Clinical manifestations • Mild febrile illness • Generalized maculopapular rash • Artheralgia or arrthritis • Head and neck lymphadenopathy • Conjunctivitis

5. Infectiuos period • Incubation period 12+13 days • Viremia precede clinical signs • Infectious period during viremia and 5_7 days of the rash

6. Risk of fetal infection • 80% during first 12 weeks • 54% during 13_14 weeks • 25% during second trimester

7. Sign and symptom • Eye defects:cataract,glucoma • Heart disease:PDA,pul artery stenosis • sensorineural deafness most common • CNS defects :microcephaly,developmentaldelay,mental retardation • Pigmentaryretionpathy • Neonatal purpura • Hepatosplenomegaly • Radiolucent bone dz

8. Diagnosis • Diagnosis made with serology • Rubella isolated from :urin,CSF,nasopharenx • Enzyme linked immuno assay IGM 4_5 days after clinical dz or 8 weeks after appearance rash • Peak serum titer IGG demonstrated 1_2 weeks after rash or 2_3 weeks after viremia • High rubella IGG avidity in recarrent infection

9. Some abnormality in sono • Fetal growth retardation • Ventricolomegaly • Intracranial calcification • Microcephaly • Microphethalemia • Meconium peritonitis • Hepatosplenomegaly • Cardiac malformation

10. Management and prevention • No specific treatment for rubella • Avoidance of droplets for 7 days after rash • Vaccine in non pregnant women at child bearing age and hospital personels • Avoided vaccine 1 month before pregnancy and during pregnancy • No evidence that vaccine induced malformation<1%>

16. Dr askari Varicella zoster virus

17. Varicella zoster virus • Double stranded DNA herpes virus • Acquired predominantely during childhood • 95% of adults have serological evidence of immunity • Transmitted by direct contact or respiratory transmission • Incubation period is 10_21 days • Contagious from 1 day prior to the onset rash until lesion crusted over • 60_95%risk of infection after exposure in non immune women

18. Clinical manifestations • 1_2 days flu like sx • Pruritic vesicular lesions crusted over 3_7days • Infection tend to be more sever in adult • Mortality is prodominately due to varicellapnemoniaperticulary in pregnancy • Pnemonia :fever,tachypnea,drycough,plureticpain,nodullar infiltration in CXR<like other viral pnemonia>

19. Diagnosis • Usually diagnosed clinicaly • Tzank smear • Tissue culture • Direct fluorescent antibody testing • In fetus with nucleic acid amplification technique on amniotic fluid

20. Fetal varicella infection • Chiken pox occure during first half of pregnancy fetus may developed congenital anomaly • Congenital infection after 20 weeks are uncommon

21. Congeitalvaricellasx • Chorioretiniris • Microphethalemia • Cerebral cortical atrophy • Growth restriction • Hydronephrosis • Skin or bone defects

22. Risk of congenital infection • 0.4% before 13 weeks • 2% 13_20 weeks

23. Peripartum infection • Exposure before or during delivery poses a serious threat to newborn with attack rate 25_50% and mortality rate 25% • IgVZV should be administered to neonate born to mother who have clinical evidence of VZV 5 days before up to 2 days after delivery

24. Exposure to virus • Exposed seronegative pregnant women need to given varizIG within 96hrs of exposure • Isolated this pregnant women from other pregnant women • Considered CXR • Most women require only supporative care • Pneumonia managed in hospital with IV fluid and IV acyclovir 500 mg/m2 or 10_15 mg/kg q8h

25. vaccination • Live virus vaccine: • Varivax<1995> in adolescents and adults with no history of varicella with 2 doses given 4 to 8 weeks apart with 97%seroconversion • Zostavax <2006> not recommended for individuals younger than 60 years

32. Thanks for your attention Thanks for your attention

33. عدم وجود علائم اورژانس • اخذ شرح حال • تایید سن بارداری • انجام آزمایشهای CBC, BS, FL • مشاوره با خانواده و ارائه مشکل

34. اقدام مطابق راهنمای شوک هموراژیک و القای زایمان • پلاکت کمتر از 100000 • فیبرینوژن زیر 100

35. نتایج نرمال آزمایشات • تمایل مادر به ختم سریع بارداری • عدم تمایل مادر به ختم زودهنگام بارداری

36. عدم تمایل مادر به ختم زودهنگام بارداری • کنترل هفتگی پلاکت و فیبرینوژن • انتظار تا 4 هفته از زمان مرگ برای شروع زایمان

37. اقدام جهت ختم بارداری • انجام CT, BTدر شروع زایمان • انجام مشاوره داخلی در صورت اختلال CT , BT • انجام زایمان جنین مرده

38. بررسی علل مرگ جنین • معاینه جفت وبند ناف وپرده ها • پاتولوژی جفت • ظاهر جنین • فتوگرافی و X-RAY از جنین • مشاوره خانواده جهت بارداری بعدی