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
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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
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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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