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Perinatal pathology as.-prof. V.Voloshyn 1 Perinatal period • The term “perinatal period” is united late fetus period (from 29 week of intrawomb development and to beginning of births), “intranatal” (during births) and “early neonatal” (from age to the sixth days inclusive). 2 Classification of period: •Antenatal (predelivery); •Intranatal (during births); •Postnatal (after births or neonatal). 3 Glossary New-born baby Baby which began to breathe independently. Stillborn foetus Foetus which has absents breathing in the moment of birth, and he does not succeed to be caused artificial a way. Palpitation at such foetus can proceed some time. Immaturity Some organ’s structures are unripe anatomically and undifferentiated up. Overmaturity Foetus has a gestational period over 42 weeks. 4 Classification of perinatal pathology • • • • • prematurity; immaturity; overmaturity; infectious diseases; uninfectious diseases. 5 Reasons of prematurity illness of foetus, especially intrawomb infection which is combined with the defeat of placenta by same etiology; disease of sexual organs of pregnant; placenta insufficiency; heavy toxicosis of pregnancy; extragenital pathology of mother; criminal intervention. 6 Signs of prematurity: • gestation term less than 37 weeks; • a little mass and length of child (less than 2,5 kg and 47 centimeters); • absence or weak expressed of ossify nucleus; • nose and ears cartilages mildness (auricles densely adjoin to the cranium); • nails are soft, does not reach to the tip of fingers; • superfluous fluff is saved, especially on a shoulder girdle and superior portion of the back; • in boys testicles did not go down in a scrotum; • in girls major pudenda lips don’t cover a clitoris and small 7 pudenda lips. Signs of immaturity: • myocardium is poor by sarcoplasm; • the cardiomyocytes transversal striped is weak; • the follicles of spleen are shallow; • the kidney glomeruluses have a like goblet capsule. 8 Signs of overmaturity: • dryness, shelling, partial skin maceration; • general hypotrophy; • presence of ossify nucleuses of proximal epiphysis of tibia and humeral bones; • an umbilical cord and placenta membranes of is painted by Meconium. 9 Infectious diseases • • • • • • Etiology: viruses: gerpes, cytomegaly, hepatitis, measles, AIDS and other; bacteria: pale treponema, listeria, tuberculosis; mykoplazmae; chlamidiae; fungus; the simplest (toxoplazmae). 10 Infectious diseases Ways of infection: • antenatal; • intranatal. 11 The placenta membrane inflammation 12 Intrawomb herpes Exciter – Herpes of simplex II, rarer I type. A virus propagates oneself in the epithelium cells. 13 Morphological signs of the intrawomb herpes: • increasing of the epithelium size, especially the nuclei; • the acidofil and basofil including in the nuclei; • fragmentation of chromoplasm with the marginal location of clods; • an inflammatory reaction is poorly expressed or absents round the alteration areas; • gigantic cells metamorphoses of hepatocytes and Kupffer cells; • gigantic cells pneumonia; • gigantic cells brain defeat; • macroscopically: the area of the injury organ have rather 14 yellow or grey color. Cytomegaly • Etiology – Cytomegalovirus hominis. • An exciter propagates oneself in an epithelium. 15 Morphological signs of cytomegaly: • the acidofil and basofil including in the epiteliocells nuclei with the brighten area round them; • the light basofil including in a cytoplasm; • limphohystiocells infiltration with the admixtures of erythromyeloblastes round the injury areas; • sialadenitiss develops most often; • macroscopic displays are expressed poorly. 16 Circling (Listeriosis) • Etiology – Listeria monocytogenes. 17 Morphological signs of circling • listerios granulema: in a center is an accumulation of leucocytes around Listeriaes; • on peripheries is fibrinoid necrosis, in the perifocal areas is granulation tissue which consists of hystiocytes; • in the inner organs – granulemaes (listeriomaes) 18 Complication of circling • phlegmon of the new-born; • omphalitis; • umbilical sepsis; • mastitis. 19 Classification of uninfectious perinatal pathology: • • • • • • asphyxia of the new-born; maternity trauma; hemolytic illness; hemorrhagic illness of new-born; pneumopathies; pneumonias. 20 Asphyxia • Foetus or new-born hypoxygen condition, which is combined with a hypercapnia. That can develop before births, during births and after births. 21 Asphyxia reasons A) Reasons of asphyxia in antenatal period: • anoxic state of mother; • sharp violations of the utero-placenta or placento-foetus blood circulation; 22 Asphyxia reasons B) Reasons of asphyxia in intranatal period: • • • • • • anoxic state of mother; Reasons of asphyxia of period: premature placenta exfoliation; violation of the utero-placenta blood circulation; abnormal position of placenta; blood stream violation on an umbilical cord as a result of: squeezing by foetus head, umbilical cord falling out of mother's maternity ways, overstrain umbilical cord, umbilical cord tight rounds the foetus neck, veritable knots of umbilical cord. 23 Types of asphyxia • dark blue asphyxia, characteristic for a chronic intrawomb asphyxia; • white asphyxia as a result of the acute haemodynamic violation like as a collapse. 24 Morphological signs of asphyxia • dark liquid blood is in the cavities of heart and large blood vessels; • cyanosys and akrocyanosys; • edemata feet, scrotum and sexual labia; • hemorrhages on the serosa membranes; • lungs have a meaty consistency, do not fill a thoracic cavity, airless pieces sink in the water; • axsufflation of perifetus waters elements; • coagulopathy of consumption. 25 Maternity trauma • local damage of foetus tissues during a labour (birth), which arose up as a result of operating of mechanical force directly on a foetus, but not on a placenta or umbilical cord, and shows up breaks, fractures, dislocations, laying out (smashed?) of the tissues. 26 The damage degree of foetus depends: • degree of prematurity or overmaturity of foetus; • degree of forming and size of the skull; • degree of forming of the cerebral falx and cerebella tentorium; • rigidity of maternity channel tissues; • form and sizes of pelvis; • violation of moving apart of maternity ways tissues at the premature break of foetus bubble; • dynamics of maternity act (swift births); • standing duration of the foetus head in the uterus neck channel. 27 Morphological signs of maternity trauma: • • • • • • maternity tumour; hemorrhages; cephalic haematoma; hemorrhages in the skull cavity; hemorrhages in the cerebrum ventricles; damage of skull bones. (film) 28 Haemolytic illness arises up at incompatibility of mother blood and foetus blood mainly on the rhesus-factor (mother has Rh"–", foetus has Rh“+”), which results in haemolysis of foetus erythrocytes by the mother's antibodies. 29 ІІІ pregnancy, ІІ delivery І pregnancy (1999) – healthy baby, ІІ pregnancy (2002) – died down. Mother has ІІІ Rh (-), titre аntibodies 1:64; Caesarean section; 37-38 weeks, valuation by Apgar scale 7/8 balls, Mass 2550; Child АВ (ІV) Rh (+); Bilirubin from umbilical cord – 62,1; through 7 hours - 101,3 mkmoll/l; through 13 hours - 133,6 mkmoll/l In 1 day of life – with the signs of intestinal impassability. Haemolytic disease neonate is translated in the neonate intensive therapy department; perforation and peritonitis developed through intestinal impassability ІV degrees; 30 In 22 days – a child died. Forms of the haemolytic icterus: • anaemic; • icteric; • oedematous. 31 Pathoanatomy of the haemolytic illness 1) at intra-uterine death 5-7 monthly foetus: • • • • autolysis; maceration; swelling of face; increasing moderate of liver, spleen. 32 Pathoanatomy of the haemolytic illness (continuation) 2) at an anaemic form : • • • • an icterus is absent; anaemia of inner organs; erytroblastosis is expressed moderately; skin pallor & mucus covers pallor. 33 Pathoanatomy of the haemolytic illness (continuation) 3) at a heavy post-natal icterus: • • • • • • bilirubin encephalopathy; nuclear icterus; erythroblastosis; haemosyderosis; bilious stasis; hyperplasia of spleen; 34 Pathoanatomy of the haemolytic illness (continuation) 4) at an oedematous form: • a skin is pale, semilucent, brilliant. partly is macerationed; • a hypoderm and tissues of brain oedematic; • transudation in the body cavity; • liver multiplying is in 4-6 times; • lungs mass is diminished. 35 Bilirubin encephalopathy 36 Haemorrhagic illness of new-born • Hemorragic illness of new-born is a clinic & anatomic syndrome, which is characterized internal and external hemorrhages which arises up in new-born in the first days after births. 37 Haemorrhagic illness of new-born Etiology – 1) related to heredity or; 2) influence of exogenous factors (acceptance of medications by the pregnancy woman), and also; 3) infectious diseases of new-born. 38 Haemorrhagic illness of new-born Mechanisms of development: • coagulopathia; • thrombocytopathia; • angiopathia; 39 Haemorrhagic illness of new-born Pathoanatomy: partial or segmental pulmonary hemorrhages; linear or spot hemorrhages are on a pleura; massive haematomas of adrenal glands; spot hemorrhages in the kidney's cortex and medullar layers; melena (unreal); 40 Haemorrhagic illness 41 Pneumopathies • Pneumopathies are a group of uninfectious defeats of breathings organs to which take disease of hyaline membranes, oedematous-haemorrhagic syndrome, atelectasiss of lungs 42 Pneumonias Pneumonias – exciters are mostly cocci which get to the respiratory tracts of foetus in an intranata period together with aspirated perifoetus maintenance or after births at application of instrument room artificial ventilation of liungs. Morphological signs: - aspirated perifoetus maintenance and water are presence in bronchial tubes, alveolus ducts and alveolus.43 Thank you for attention! 44