Transcript 18 Pre-& Perinatal Pathology1

Pre-and perinatal pathology
Children's Infection
Sepsis
as.-prof. V.Voloshyn
(By Ya.Ya. Bodnar, Yu. Orel)
Essence and structure of
prenatal pathology
Prenatal (antenatal) pathology includes
pathological processes of human embryo
from fertilization and ending with the birth
of a child. Prenatal period lasts 280 days or
40 weeks .
Kimatogenesic Period
The whole development from zygote forming to
birth is called kimatogenesis. Before it – progenesis
– the period of maturing of male and female sex
cells (gametes) to fertilization.
Kimatogenesis period is divided into three periods:
- Blastogenesis lasts from fertilization to 15-th day
of pregnancy;
- Embryogenesis - from 16-th to 75-th day of
pregnancy;
- Fetogenesis - lasts from 76-th to 280-th day of
pregnancy .
Gametopaties
There are genetic, chromosomal and genomic
mutations that cause congenital defects
(malformations).
Defects incompatible with life ended
spontaneous miscarriage (abortion).
Blastopaties
violation of blastocyst implantation (ectopic
pregnancy)
twins malformations
single malformations
malformations (defect) of the placenta and
umbilical cord.
Embriopaties
Pathology of the embryonic period from 16th to 75-th day of pregnancy, during which
followed the main organ.
Embriopaties include mainly congenital
defects - malformations.
Classification of congenital
malformations
1) the lack (absence) of any organs or body part agenesis, aplasia;
2) underdeveloped organ - hypoplasia;
3) excessive development - hyperplasia;
4) modified form: the merging of organs, atresia or
stenosis of holes or channels, uninosculation of
embryonic holes or fissures- dysraphia or
persistence, inside out - extrophia.
5) change in the organs location - ectopia;
6) persistence of embryonic organs, often branchial
Fetopatia
pathology of fetal period (period from 76-th to
280-th day of pregnancy. The main tissue
differentiation of organs is formed. There are
typical two types of displays: the violation of
tissue morphogenesis and reactive changes in the
form of blood disorder, dystrophy and necrosis,
perverse immune reactions and compensatoryadaptive processes .
Perinatal period
The term "perinatal period" includes late
fetal period (29 weeks of intrawomb
development to the delivery beginning),
intranatal period (parturition/during delivery)
and early neonatal (from birth till six days
inclusive).
Classification of perinatal
period
Antenatal (pre-natal) (predelivery);
Intrapartum (during labor);
Postpartum (postnatal or neonatal)
Classification of perinatal
pathology (GLOSSARY)
Newborn baby - baby which began to breathe
independently.
Stillborn fetus - Fetus which has absent breathing in
the moment of birth, and he does not succeed to be
caused artificial a way. Palpitation can proceed some
time in such fetus.
Immaturity - Anatomical unripe and undifferentiate
up some structures and organs.
Overmaturity - Fetus of pregnancy over 42 weeks
Reasons of prematurity
illness of fetus, especially intrawomb infection,
combined with the defeat of placenta of same
etiology;
disease of sexual organs of pregnant;
placenta insufficiency;
heavy toxicosis of pregnancy (severe gestosis);
extragenital pathology of mother;
criminal intervention.
Signs of prematurity :
gestation term is less than 37 weeks;
a little mass and length of child (less than 2,5 kg and 47
centimeters);
absence or weak expressed of ossification nuclei;
nose and ears cartilages mildness (auricles densely
adjoin to the cranium);
nails are soft, don't reach to the tip of fingers;
superfluous fluff is saved, especially on a shoulder girdle
and superior portion of the back;
boys testicles not in scrotum omitted;
in girls major pudenda lips don’t cover a clitoris and
small 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
are a like goblet capsule .
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 are
painted by meconium .
Infectious Diseases
Etiology :
viruses: herpes, cytomegalic, hepatitis, rubella, AIDS and others;
bacteria: pale treponema, listeria, tuberculosis;
mycoplasma;
chlamydia;
fungus;
protozoa (simplest) (toxoplasm).
Ways of infection:
antenatal;
intranatal .
The placenta membranes
inflammation
Intrauterine herpes
Pathogen - Herpes
simplex II (rarer I
type).
The virus multiplies
in cells of the
epithelium.
Morphological signs of
intrauterine herpes:
increasing of the epithelium size, especially the nuclei;
acidophilic and basophilic inclusions in the nuclei;
fragmentation of chromatin with marginal location of
lumps;
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 yellow or grey color.
Cytomegalia
Etiology
-
Cytomegalovirus hominis.
Pathogen multiplies in the epithelium.
Morphological signs of
cytomegalia
the oxyphilic and basophilic inclusion in the
epiteliocells nuclei with the brighten area
around them;
the light basophilic inclusion in a cytoplasm;
limphohystiocells infiltration with the
admixtures of erythromyeloblastes around
the injury areas;
sialadenitis develops most often;
macroscopic displays are expressed poorly.
Listeriosis
Etiology - Listeria monocytogenes.
Morphological signs of
listeriosis
listerios granulema: in a center is
an accumulation of leucocytes
around Listerias;
on peripheries is fibrinoid necrosis,
in the perifocal areas is granulation
tissue which consists of
hystiocytes;
in the inner organs – granulemas
(listeriomas)
Complications of listeriosis
phlegmon of
the new-born;
omphalitis;
umbilical sepsis
Classification of non-infectious
perinatal pathology:
asphyxia;
birth injury (maternity trauma);
hemolytic disease;
hemorrhagic disease of newborn;
pneumopathy;
pneumonia.
Asphyxia
Fetus or new-born hypoxygen
condition, which is combined with a
hypercapnia. It can develop before
births, during births and after births
Asphyxia reasons
Reasons of asphyxia in antenatal period:
anoxic state of mother;
acute violations of the utero-placenta or placento-fetus blood
circulation;
B) Reasons of asphyxia in intranatal period:
anoxic state of mother;
Reasons of asphyxia in intranatal period:
premature placenta exfoliation (abruptio placenta);
violation of the utero-placenta blood circulation;
abnormal position of placenta (placenta previa (передлежання));
blood stream violation on an umbilical cord as a result of:
pressure by fetus head, umbilical cord falling out of mother's
maternity ways, umbilical cord overstrain, umbilical cord tight
arounds the fetus neck, veritable knots of umbilical cord.
Types of asphyxia
Blue asphyxia
(typical of
chronic
intrauterine
asphyxia);
White asphyxia
as a result of the
acute
haemodynamic
violation like as
a collapse.
Morphological signs of
asphyxia
dark liquid blood in the cavities of heart and
large blood vessels;
acrocyanosis and cyanosis;
swelling of the feet, scrotum and sexual labia;
hemorrhage in serous membranes;
lungs have a meaty consistency (fleshy
consistency), do not fill a thoracic cavity,
airless pieces sink in water;
aspiration of amniotic fluid elements;
consumption coagulopathy
Maternity trauma
local damage of fetus tissues
during fetal descent act, which arose
up as a result of operating of
mechanical force directly on a fetus,
but not on a placenta or umbilical
cord,
and
shows
up
breaks,
fractures, dislocations, laying out
(smashed?) of the tissues.
The damage degree of fetus
depends from:
degree of prematurity or overmaturity of fetus;
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 fetus bubble;
dynamics of maternity act (rapid delivery);
standing duration of the fetus head in the uterus
neck channel.
Morphological signs of
birth injury
labour tumor;
hemorrhages;
cephalic haematoma;
hemorrhages in the cranial cavity;
hemorrhages in the cerebrum
ventricles;
damage of cranial bones.
Haemolytic illness
arises
up
at
incompatibility
of
mother blood and
fetus blood mainly
on
the
rhesusfactor (mother has
Rh"–", fetus has
Rh“+”),
causing
hemolysis of fetus
erythrocytes by the
mother's
antibodies.
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
Haemolytic disease neonate is translated in the neonate intensive
therapy department; perforation and peritonitis developed through
intestinal impassability ІV degrees;
After 22 days - the child died.
The forms of hemolytic
jaundice
anaemic;
icteric;
oedematous.
Pathoanatomy of the
haemolytic illness
1) in intrauterine fetal death of 7.5 months:
autolysis;
maceration;
swelling of face;
moderate enlargement of the liver, spleen;
Pathoanatomy of the haemolytic illness (continuation)
2) at an anaemic form :
icterus is absent;
anaemia of inner organs;
erytroblastosis is expressed moderately;
skin pallor & mucus covers pallor.
Pathological anatomy of hemolytic
disease(continuation)
3) at a heavy postnatal jaundice:
bilirubin
encephalopathy;
nuclear icterus
(kernicterus);
erythroblastosis;
haemosyderosis;
bile stasis;
hyperplasia of spleen;
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.
Bilirubin encephalopathy
Hemorrhagic disease of
newborn
Hemorrhagic disease of newborn - is a clinic &
anatomic syndrome, which is characterized by
internal and external hemorrhages which arises up in
new-born in the first days after births.
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.
Hemorrhagic disease of
newborn
Mechanisms of development:
coagulopathia;
thrombocytopathia;
angiopathia;
Pathological anatomy :
partial or segmental pulmonary hemorrhage;
linear or spotty hemorrhages on pleura;
massive adrenal hematomas;
spotty hemorrhages in cortical and medullar layers of
kidneys;
melena (false);
Pneumopathies
Pneumopathies are a
group
of uninfectious
defeats
of
breathings
organs
which
include
disease
of
hyaline
membranes, oedematoushaemorrhagic syndrome,
atelectasis of lungs
Pneumonia
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.
Sepsis features, which distinguish it from other
infectious diseases:
1. Septicemia - polyethiological disease. It can be
caused by different microorganisms. But most of all staphylococcus. Meningococcus, Klebsiella,
aeruginosa, and mixed infections.
2. Epidemiological feature – uncontagious disease.
Sepsis is not reproduced in the experiment.
3. Clinical feature: the absence of recurrence is not
possible to allocate periods for specific infectious
diseases.
4. Immunological - no immunity.
Stages of pathogenesis
Systemic inflammatory response syndrome
(destruction of the endothelium, mediated
cascade).
Septic arterial hypotension (NO, TNF).
Septic shock (cardiac weakness, disturbance of
microcirculation).
Syndrome of multiple organ failure ("shock
kidney" distress syndrome, etc.).
According to clinical morphological
features distinguish septicemia, septicpiyemiyu, septic (bacterial) endocarditis
and chroniosepsis.
Apostematic nephritis
SEPTIC EMBOLISM IN LUNGS
CHANGES IN THE LUNGS AND
KIDNEYS IN SEPTIC SHOCK
Thank you for attention!