Congenital-Anomalies-(SlideShow)
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Transcript Congenital-Anomalies-(SlideShow)
Dr.Suresh Babu Chaduvula
Professor
Department of OBGYN
College of Medicine, KKU, Abha, KSA.
Incidence
Perinatal
CNS
: 2- 5 %
deaths – 20 %
malformations – 50 %
Physical and Mental disabilities
GENETIC:
Trisomies
– Down’s, Edward’s, Patau’s
syndromes [6%]
Single
gene disorders – Autosomal and X
linked disorders [5%]
Infections:
[2%]
TORCH and Parvo viral infections
Maternal Illnesses: [5%]
Diabetes, Epilepsy
Drugs: [1-2%]
Warfarin, Lithium, Phenytoin
Radiation:
Alcohol:
Hypoxia:
Multifactorial:
[20%] – Neural tube defects,
Congenital heart defects, cleft lip and palate
Idiopathic
– 60%
Advanced
maternal age – above 40 years –
Down’s syndrome or Mongolism
High Parity – at risk for malformations except
Anencephaly and spinabifida
1.
Teratogenic agent: dose
2.
Duration of gestation and exposure
3.Genetic
susceptibility of the fetus and
feto-maternal immune response
Growing
fetus is still affected following
organogenesis like:
Intrauterine
death
IUGR
Functional
disorders
1.
Folic acid deficiency
2. Epoxides and Arena oxides
3. Genetic – mutations
4. Maternal Diseases
5. Homeobox genes – regulatory genes - over
expressed during organogenesis
Conception
Before
31 days – All or None effect
Between
71
occurs at 14th day
31 and 71 days – Critical period
days to 280 days – continuous
development of internal organs and brain
occur
Category
A – Human studies reveals no fetal
effects
Category B – Animal studies and human
studies reveal no effects
Category C – Animal studies show adverse
effect but not in humans
Category D – Evidence of fetal risk but
benefits outweigh the risks
Category X - Contraindicated
Genetic
Counselling:
Recurrence is 6 fold and 70% in second and
third pregnancies
Age, family history, history of past
malformations
Antenatal complicatons like oligo, poly
hydramnios etc.,
MSAFP
CVS
USG
Amniocentesis
Triple
test – MSAFP, HCG, Estriol
Cordocentesis
Fetoscopy
3D or 4D USG
Preimplantation genetic diagnosis
Imperforate
anus
Tracheo-oesophageal
fistula
1.
2.
3.
4.
Grosser anomalies are detected earlier
The golden period for an anomaly scan is from 18 to 28
weeks (20-24 weeks is ideal).
Attempting an anomaly ultrasound scan during the III
trimester can be frustrating because
The foetal parts are more crowded
The liquor volume is lesser
Gross foetal movements are lesser and
The foetal bones shadow densely.
FOETAL PHYSIOLOGICAL HALLMARKS
Foetal mid Gut rotation occurs at 9-11 weeks
This results in physiological bowel herniation
This should not be misinterpreted as an omphalocoele
Foetal swallowing & urinary out put sets in at 14-18 weeks
Therefore, GI and Urinary abnormalities can be diagnosed
only after 14 week
Foetal epidermal keratinisation occurs around 14-18 weeks.
Hence 3 D can be done only after 18 weeks
Head and neck
Cerebellum
Choroid plexus
Cisterna magna
Lateral cerebral ventricles
Midline falx
Cavum septi pellucidi
Chest
The basic cardiac examination
includes a 4-chamber view of the fetal heart.
If technically feasible, an extended basic cardiac examination
can also be attempted to evaluate both outflow tracts.
Abdomen
Stomach (presence, size, and situs)
Liver, Gall-Bladder and Spleen
Kidneys
Bladder
Umbilical cord insertion site into the fetal abdomen
Umbilical cord vessel number
Spine
Cervical, thoracic, lumbar, and sacral spine
Extremities
Legs and arms (presence or absence)
Gender
Medically indicated in low-risk pregnancies only
For evaluation of multiple gestations
Lack of development
Bilateral renal agenesis
Insufficient development
Microcephaly
Redundant development
Incomplete closure
Incomplete separation
Aberrant morphogenesis
Polydactyly
Neutral tube defects
Syndactyly
Mediastinal thyroid
Defects of neurulation:
failure of the neural fold to close
Anencephaly
Spina bifida
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www.neurochirurgie-zwolle.nl/
spina.html
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Anencephaly
spina bifida
Bilateral cleft lip with cleft palate
Gastroschisis
Omphalocele
Ambiguous genitalia
Twin-Twin Transfusion Syndrome
Cystic Hygroma
Sacrococcygeal teratoma
Bladder exstrophy
Thank You All
&
All the Best