Transcript 8 Pre-& Perinatal Pathology

Perinatal pathology
as.-prof. V.Voloshyn
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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).
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Classification of period:
•Antenatal (predelivery);
•Intranatal (during births);
•Postnatal (after births or neonatal).
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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.
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Classification of perinatal
pathology
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prematurity;
immaturity;
overmaturity;
infectious diseases;
uninfectious diseases.
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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.
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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
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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.
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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.
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Infectious diseases
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Etiology:
viruses: gerpes, cytomegaly, hepatitis, measles,
AIDS and other;
bacteria: pale treponema, listeria, tuberculosis;
mykoplazmae;
chlamidiae;
fungus;
the simplest (toxoplazmae).
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Infectious diseases
Ways of infection:
• antenatal;
• intranatal.
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The placenta membrane
inflammation
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Intrawomb herpes
Exciter – Herpes of
simplex II, rarer I
type.
A virus propagates
oneself in the
epithelium cells.
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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
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yellow or grey color.
Cytomegaly
• Etiology – Cytomegalovirus hominis.
• An exciter propagates oneself in an epithelium.
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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.
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Circling (Listeriosis)
• Etiology – Listeria monocytogenes.
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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)
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Complication of circling
• phlegmon of the
new-born;
• omphalitis;
• umbilical sepsis;
• mastitis.
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Classification of uninfectious
perinatal pathology:
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asphyxia of the new-born;
maternity trauma;
hemolytic illness;
hemorrhagic illness of new-born;
pneumopathies;
pneumonias.
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Asphyxia
• Foetus or new-born hypoxygen
condition, which is combined with a
hypercapnia. That can develop before
births, during births and after births.
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Asphyxia reasons
A) Reasons of asphyxia in antenatal period:
• anoxic state of mother;
• sharp violations of the utero-placenta or
placento-foetus blood circulation;
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Asphyxia reasons
B) Reasons of asphyxia in intranatal period:
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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.
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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.
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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.
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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.
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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.
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Morphological signs of maternity
trauma:
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maternity tumour;
hemorrhages;
cephalic haematoma;
hemorrhages in the skull cavity;
hemorrhages in the cerebrum ventricles;
damage of skull bones.
(film)
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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.
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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;
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In 22 days – a child died.
Forms of the haemolytic icterus:
• anaemic;
• icteric;
• oedematous.
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Pathoanatomy of the
haemolytic illness
1) at intra-uterine death 5-7 monthly foetus:
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autolysis;
maceration;
swelling of face;
increasing moderate of liver, spleen.
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Pathoanatomy of the
haemolytic illness
(continuation)
2) at an anaemic form :
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an icterus is absent;
anaemia of inner organs;
erytroblastosis is expressed moderately;
skin pallor & mucus covers pallor.
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Pathoanatomy of the
haemolytic illness
(continuation)
3) at a heavy post-natal icterus:
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bilirubin encephalopathy;
nuclear icterus;
erythroblastosis;
haemosyderosis;
bilious stasis;
hyperplasia of spleen;
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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.
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Bilirubin encephalopathy
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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.
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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.
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Haemorrhagic illness of new-born
Mechanisms of development:
• coagulopathia;
• thrombocytopathia;
• angiopathia;
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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);
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Haemorrhagic illness
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Pneumopathies
• Pneumopathies are a group
of uninfectious defeats of
breathings organs to which take
disease of hyaline membranes,
oedematous-haemorrhagic
syndrome, atelectasiss of lungs
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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!
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