Transcript Slide 1
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RUBELLA
Dr askari
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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
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Clinical manifestations
Mild febrile illness
Generalized maculopapular rash
Artheralgia or arrthritis
Head and neck lymphadenopathy
Conjunctivitis
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Infectiuos period
Incubation period 12+13 days
Viremia precede clinical signs
Infectious period during viremia and 5_7
days of the rash
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Risk of fetal infection
80% during first 12 weeks
54% during 13_14
weeks
25% during second trimester
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Sign and symptom
Eye defects:cataract,glucoma
Heart disease:PDA,pul artery stenosis
sensorineural deafness most common
CNS defects :microcephaly,developmental
delay,mental retardation
Pigmentary retionpathy
Neonatal purpura
Hepatosplenomegaly
Radiolucent bone dz
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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
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Some abnormality in sono
Fetal growth retardation
Ventricolomegaly
Intracranial calcification
Microcephaly
Microphethalemia
Meconium peritonitis
Hepatosplenomegaly
Cardiac malformation
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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%>
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VARICELLA ZOSTER VIRUS
Dr askari
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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
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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 varicella
pnemonia perticulary in pregnancy
Pnemonia :fever,tachypnea,dry
cough,pluretic pain,nodullar infiltration in
CXR<like other viral pnemonia>
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Diagnosis
Usually diagnosed clinicaly
Tzank smear
Tissue culture
Direct fluorescent antibody testing
In fetus with nucleic acid amplification
technique on amniotic fluid
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Fetal varicella infection
Chiken pox occure during first half of
pregnancy fetus may developed congenital
anomaly
Congenital infection after 20 weeks are
uncommon
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Congeital varicella sx
Chorioretiniris
Microphethalemia
Cerebral cortical atrophy
Growth restriction
Hydronephrosis
Skin or bone defects
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Risk of congenital infection
0.4% before 13 weeks
2%
13_20 weeks
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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
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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
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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
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Thanks for your attention
Thanks for your attention
عدم وجود عالئم اورژانس
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اخذ شرح حال
تایید سن بارداری
انجام آزمایشهای CBC, BS, FL
مشاوره با خانواده و ارائه مشکل
اقدام مطابق راهنمای شوک هموراژیک و القای
زایمان
پالکت کمتر از 100000
فیبرینوژن زیر 100
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نتایج نرمال آزمایشات
تمایل مادر به ختم سریع بارداری
عدم تمایل مادر به ختم زودهنگام بارداری
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عدم تمایل مادر به ختم زودهنگام بارداری
کنترل هفتگی پالکت و فیبرینوژن
انتظار تا 4هفته از زمان مرگ برای شروع زایمان
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اقدام جهت ختم بارداری
انجام CT, BTدر شروع زایمان
انجام مشاوره داخلی در صورت اختالل CT , BT
انجام زایمان جنین مرده
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بررسی علل مرگ جنین
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معاینه جفت وبند ناف وپرده ها
پاتولوژی جفت
ظاهر جنین
فتوگرافی و X-RAYاز جنین
مشاوره خانواده جهت بارداری بعدی
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