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RUBELLADr 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

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اورژانس عالئم وجود عدم

حال شرح اخذ بارداری سن تایید آزمایشهای CBC, BS, FLانجام مشکل ارائه و خانواده با مشاوره

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القای و هموراژیک شوک راهنمای مطابق اقدامزایمان

از کمتر 100000پالکت زیر 100فیبرینوژن

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آزمایشات نرمال نتایج

بارداری سریع ختم به مادر تمایل بارداری زودهنگام ختم به مادر تمایل عدم

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بارداری زودهنگام ختم به مادر تمایل عدم

فیبرینوژن و پالکت هفتگی کنترل تا زایمان 4انتظار شروع برای مرگ زمان از هفته

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بارداری ختم جهت اقدام

انجامCT, BT زایمان شروع در اختالل صورت در داخلی مشاوره CT , BTانجام مرده جنین زایمان انجام

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جنین مرگ علل بررسی

ها وپرده ناف وبند جفت معاینه جفت پاتولوژی جنین ظاهر و جنین X-RAYفتوگرافی از بعدی بارداری جهت خانواده مشاوره

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