The influence of harmful factors on the fetus. The influence of various factors on the growth and development of the embryo, fetus, children, adults of different age groups

slide 2

INFLUENCE OF HARMFUL FACTORS ON THE FETUS

The prevalence of spontaneous abortions is 15-20% of the total number of pregnancies; 50% of miscarriages in the first trimester have gross violations; 3-5% of newborns have malformations; in 15% of children, malformations are detected at the age of 5-10 years

slide 3

DYNAMICS OF SPONTANEOUS ABORTIONS IN RUSSIA (% of the total number of abortions) REPRODUCTIVE HEALTH Radzinsky V.Ye.

slide 4

Teratogenesis

The occurrence of malformations under the influence of factors external environment(teratogenic factors) or as a result of hereditary diseases

slide 5

Teratogenic factors

Distributed widely. During pregnancy, each woman takes an average of 3.8 drugs. In the US, 10-20% of pregnant women take drugs. In addition, harmful substances are found in everyday life (microwave oven, electronic clock) and at work.

slide 6

Chemical Physical Biological

Slide 7

Criteria for teratogenic factors

The connection between the action of the factor and the formation of a malformation has been proven. Epidemiological studies confirm this connection.

Slide 8

The main groups of teratogenic factors

Drugs and chemicals (tetracyclines, trichopolum, androgens, mercury, lead, phosphorus) Ionizing radiation (radiation fallout, radioisotope diagnostics, radiation therapy) Viral and bacterial infections (herpes, rubella, syphilis, toxoplasmosis) Metabolic disorders and bad habits (sugar diabetes, endemic goiter, phenylketonuria; smoking, alcoholism, drug addiction) In the United States, a special register of teratogenic factors is published

Slide 9

Features of the influence of teratogenic factors (TF)

Dose dependent. For each TF there is a teratogenic dose. Usually it is 1-3 orders of magnitude lower than the lethal one. Sensitivity to various TFs during fetal development may vary. Infectious agents as teratogenic factors do not have a threshold dose and are dose-dependent.

Slide 10

Periods of intrauterine development of a person

Initial - from the moment of fertilization to implantation of the blastocyst (up to 11 days). Embryonic (18-60 days after fertilization) Fetal (from 9 weeks of pregnancy to birth)

slide 11

Initial period

Differs in large compensatory-adaptive capabilities of the embryo. The law of "all or nothing" - if a large number of cells are damaged, the embryo dies, if individual blastomeres are damaged, further development is not disturbed Ovary Ovum Fertilization Ovulation 30-36 hours 3-4 days 5-6 days 2 cells 4 cells 8 cells Morula Blasto cyst

slide 12

Embryonic period

The embryo is most sensitive to the action of TF. Gross malformations are formed

slide 13

fruiting period

Malformations are not typical. Under the influence of the external environment, growth inhibition and / or cell death occurs, which is further manifested by underdevelopment or functional immaturity of organs

Slide 14

Major malformations

Malformations of the central nervous system - anencephaly, spina bifida, hydrocephalus. Formed as a result of non-closure of the neural tube with folic acid deficiency, infection, diabetes mellitus. Congenital heart defects - ASD, tetralogy of Fallot, aortic stenosis, etc. (phenylketonuria, SLE, rubella virus, genetic factors, alcohol, NSAIDs, diabetes mellitus) Cleft lip, hard palate Congenital clubfoot Congenital hip dislocation Malformations of the gastrointestinal tract - pyloric stenosis, Hirschsprung's disease, atresia of the esophagus, anus, etc.

slide 15

General approaches to prenatal prevention

Security environment Family planning (consanguineous marriages, childbearing after 35 years) Prenatal diagnosis - elimination of embryos with pathology Identification of heterozygous carriers Periconceptual preparation Invasive and non-invasive methods of intrauterine diagnosis

slide 16

Periconception preparation

medical genetic counseling, diagnosis of carriage and treatment of viral and bacterial infections, exclusion of prof. harm, rejection bad habits taking folic acid and tocopherols)

Slide 17

Methods of intrauterine diagnosis

Non-invasive methods: Ultrasound (10-14, 22-24, 32-34 weeks), Biochemical markers: 9-14 weeks b-hCG, PAPP-A 17-19 weeks AFP, 17-OPK, b-hCG, estradiol Invasive methods: Chorionic biopsy (9-11 weeks) Cordocentesis (22-24 weeks)

Slide 18

Medicines and chemicals

For the transplacental transition, the following matters: The molecular weight of the drug (up to 600 easily pass, 600 - 1000 is limited, more than 1000 almost do not penetrate). Majority medicines less than 600 and easily penetrate to the fetus. Fat-soluble substances easily diffuse through the placenta (ether, nitrous oxide). Binding to blood proteins. The greater the connection, the slower the penetration through the placenta and accumulation in the fetus. Route of administration to mother Stage of fetal development

Slide 19

Categories of drug safety

Risk categories for the use of drugs during pregnancy FDA (Food and Drug Administration) A - no risk to the fetus; B - the risk to the fetus has not been established either in animals or in humans; C - the risk to the fetus has not been established in humans; controlled studies in humans have not been conducted; D - there is a risk to the fetus, but can only be used if there is a risk to life; it is necessary to assess the degree of risk and benefit; X - proven risk to the fetus. During pregnancy are contraindicated.

Slide 20

Absolute teratogens

Drugs used in oncology: Antimetabolites (6 - mercaptopurine) Alkylating compounds (cyclophosphamide) Antitumor antibiotics (actinomycin, sarcolysin)

slide 21

Antibacterial drugs during pregnancy (Gurtova B.L. et al. 2004)

Group I - contraindicated in pregnancy: tetracyclines, chloramphenicol, trimetaprim. Group II - use only for health reasons: aminoglycosides, nitrofurans, sulfonamides. Group III- antibiotics that do not have an embryotoxic effect: penicillins, cephalosporins, macrolides.

slide 22

Impact of antibiotics

Tetracycline and its derivatives early dates lead to malformations, in later cases - slowing down of fetal growth, damage to the rudiments of teeth, hepatotoxic effect Levomycetin - hypoplastic anemia Aminoglycosides - ototoxic effect

slide 23

Hormonal drugs

Estrogens lead to the development of adenosis and clear cell adenocarcinoma of the vagina and cervix in girls

slide 24

ionizing radiation

The effect of radiation on the female body occurs according to the general laws of radiation damage; a-radiation practically does not penetrate the skin, but it is very dangerous if it gets inside; b-radiation penetrates to a depth of 1-2 cm; gene mutations Transplacental transfer is the main source of isotope

Slide 25

Mechanisms of transplacental transfer of radionuclides

Hematogenous route - free transition of isotopes from the mother's blood to the fetal blood through the transplacental membrane (131I, 32P, etc.) Accumulation in the tissues of the placenta with subsequent exposure to the fetus (transuranium elements) Paraplacental passage through the fetal membranes and amniotic fluid (radioactive plutonium)

slide 26

Infection (mechanisms of action)

Viruses (cytomegalvirus, herpes, rubella), penetrating to the embryo and fetus, can have a direct teratogenic effect Infection leads to a change in the metabolism and function of the endometrium, which causes a violation of implantation or a violation of the development of the placenta

Slide 27

3. Viral and bacterial infection can affect the development of the placenta and lead to HFPN and fetal IUGR 4. Toxic action bacterial toxins can exert on the fetus

Slide 28

Bad habits

Smoking Alcohol use Drug addiction

Slide 29

TOBACCO SMOKING DURING PREGNANCY of which 20-30 years - 70% REPRODUCTIVE HEALTH Radzinsky V.Ye. Moscow, 2002

slide 30

Smoking

Tobacco contains more than 600 harmful factors: organic and inorganic acids, proteins, esters, aldehydes, phenols, etc. Currently, radioactive polonium has been identified in tobacco smoke Nicotine has the greatest effect

Slide 31

Nicotine

Exposure to nicotine in early pregnancy can lead to impaired implantation of the ovum and spontaneous abortion. Abortion and premature birth may be due to increased contractile activity of the uterus when smoking Nicotine leads to contraction of the vessels of the uterus and placenta with the development of placental insufficiency and fetal hypoxia

slide 32

Hypoxia of the fetus is also associated with an increase in its level of carboxyhemoglobin Disruption of placental development contributes to the occurrence of HFPN and IUGR of the fetus

Slide 38

67% 16% 4% 4% Fetal growth retardation Preeclampsia Threatened miscarriage Toxicosis PREGNANCY COMPLICATIONS DRUG addicts REPRODUCTIVE HEALTH Radzinsky V.Ye.

Slide 39

CONDITION OF NEWBORN IN DRUG addicts (Apgar score) REPRODUCTIVE HEALTH Radzinsky V.Ye.

View all slides

Kazan State Medical University Department of Obstetrics and Gynecology №2 Doctor of Medical Sciences, Professor Gabidullina R.I.

Slide 2: INFLUENCE OF HARMFUL FACTORS ON THE FETUS

slide 3

DYNAMICS OF SPONTANEOUS ABORTIONS IN RUSSIA (% of the total number of abortions) REPRODUCTIVE HEALTH Radzinsky V.Ye.

Slide 4: Teratogenesis

The occurrence of malformations under the influence of environmental factors (teratogenic factors) or as a result of hereditary diseases

Slide 5: Teratogenic factors

Slide 6: Teratogenic factors

Chemical Physical Biological

Slide 7: Criteria for teratogenic factors

The connection between the action of the factor and the formation of a malformation has been proven. Epidemiological studies confirm this connection.

Slide 8: The main groups of teratogenic factors

Slide 9: Features of the influence of teratogenic factors (TF)

Slide 10: Periods of intrauterine development of a person

Initial - from the moment of fertilization to implantation of the blastocyst (up to 11 days). Embryonic (18-60 days after fertilization) Fetal (from 9 weeks of pregnancy to birth)

slide 11: start

Slide 12: Embryonic period

The embryo is most sensitive to the action of TF. Gross malformations are formed

slide 13: fruiting period

Slide 14: Major malformations

slide 15

Slide 16: General approaches to prenatal prevention

Environmental protection Family planning (consanguineous marriages, childbirth after 35 years) Prenatal diagnosis - elimination of embryos with pathology Identification of heterozygous carriers Periconception preparation Invasive and non-invasive methods of intrauterine diagnosis

Slide 17: Periconceptual preparation

medical genetic counseling, diagnosis of carriage and treatment of viral and bacterial infections, exclusion of prof. harmfulness, giving up bad habits, taking folic acid and tocopherols)

Slide 18: Methods of intrauterine diagnosis

Non-invasive methods: Ultrasound (10-14, 22-24, 32-34 weeks), Biochemical markers: 9-14 weeks b-hCG, PAPP-A 17-19 weeks AFP, 17-OPK, b-hCG, estradiol Invasive methods : Chorionic biopsy (9-11 weeks) Cordocentesis (22-24 weeks)

Slide 19: Medicines and chemicals

For the transplacental transition, the following matters: The molecular weight of the drug (up to 600 easily pass, 600 - 1000 is limited, more than 1000 almost do not penetrate). Most drugs are less than 600 and easily penetrate the fetus. Fat-soluble substances easily diffuse through the placenta (ether, nitrous oxide). Binding to blood proteins. The greater the connection, the slower the penetration through the placenta and accumulation in the fetus. Route of administration to mother Stage of fetal development

Slide 20: Categories of drug safety

Slide 21: Absolute teratogens

Drugs used in oncology: Antimetabolites (6 - mercaptopurine) Alkylating compounds (cyclophosphamide) Antitumor antibiotics (actinomycin, sarcolysin)

Slide 22: Antibacterial drugs during pregnancy (Gurtovoy B.L. et al. 2004)

Group I - contraindicated in pregnancy: tetracyclines, chloramphenicol, trimetaprim. Group II - use only for health reasons: aminoglycosides, nitrofurans, sulfonamides. Group III - antibiotics without embryotoxic action: penicillins, cephalosporins, macrolides.

Slide 23: The effects of antibiotics

Tetracycline and its derivatives in the early stages lead to malformations, in the later stages - slowing down the growth of the fetus, damage to the rudiments of the teeth, hepatotoxic effect Levomycetin - hypoplastic anemia Aminoglycosides - ototoxic effect

slide 24: hormonal drugs

Estrogens lead to the development of adenosis and clear cell adenocarcinoma of the vagina and cervix in girls

slide 25: ionizing radiation

The effect of radiation on the female body occurs according to the general laws of radiation damage a - radiation practically does not penetrate the skin, but is very dangerous when ingested b - radiation penetrates to a depth of 1-2 cm g - radiation has the highest penetrating power with the formation of free radicals, leads to gene mutations Transplacental transfer is the main source of isotope

Slide 26: Mechanisms of transplacental transfer of radionuclides

Hematogenous route - free transition of isotopes from the mother's blood to the fetal blood through the transplacental membrane (131 I, 32 P, etc.) Accumulation in the tissues of the placenta with subsequent effects on the fetus (transuranium elements) Paraplacental passage through the fetal membranes and amniotic fluid (radioactive plutonium)

Slide 27: Infection (mechanisms of action)

Slide 28: Infection (mechanisms of action)

3. Viral and bacterial infection can affect the development of the placenta and lead to HFPN and IUGR of the fetus 4. Bacterial toxins can have a toxic effect on the fetus

slide 29 bad habits

Smoking Alcohol use Drug addiction

slide 30

TOBACCO SMOKING DURING PREGNANCY of which 20-30 years - 70% REPRODUCTIVE HEALTH Radzinsky V.Ye. Moscow, 2002

slide 31 smoking

slide 32: nicotine

RUSSIAN NATIONAL RESEARCH FACILITY
MEDICAL UNIVERSITY them. N.I. PIROGOV
MINISTRY OF HEALTH AND DEVELOPMENT OF THE RUSSIAN FEDERATION
Department of Obstetrics and Gynecology, Faculty of Medicine
(Head of the Department Professor, Doctor of Medical Sciences Yu.E. Dobrokhotova)
LECTURE
IMPACT OF HARMFUL FACTORS
ON THE FRUIT

Teratology is the science of developmental disorders or
the formation of defects in the fetus
(Greek Teras - "monster")
HARMFUL FACTORS
hypoxia
hyperthermia
Hypothermia
ionizing radiation
Organic teratogens
Inorganic teratogens
infections
medicinal substances

Stages of intrauterine development
Preimplantation
period
7 days after
fertilization
Implantation
7th day after
fertilization
Organogenesis and
placentation
Until the end of 3-4 months of intrauterine development
fetal period
12 - 40 weeks
pregnancy

Congenital anomaly - structural, metabolic and
functional disorders of an organ, part of an organ or large
parts of the body that occur in utero.
Congenital malformation is a term that includes various
structural defects. The overall frequency of congenital malformations is 600 per 10,000 of all
live and stillborn children (6%).
Unidentified cause 20% Monogenic - 6%
Chromosomal - 5%
External - 6%
Multifactorial 63%

Classification of VLOOKUP

By frequency
Common CM > 1 in 1000
newborns
Moderately frequent congenital malformations 0.1 - 0.99 per
1000 newborns
Rare congenital malformations< 0,01 на 1000
newborns
Prevalence in the body
- isolated
-systemic
-multiple
- gametopathies, blastopathies
By expiration date
harmful factor
-embryopathy
- fetopathy

Classification of congenital malformations by severity and prognosis for viability

Lethal vices
development - 8%
Minor anomalies
development - 60%
CD of an average degree
severity - 32%

Preembryonic period

Stage of development
First crush division
Movement into the uterine cavity
Time from
conception
30 hours
4 days
Implantation
5-6 days
Dual layer disc
12 days
Lionization (female fetuses)
16 days
Three-layer disc and primary strip
19 days

Embryonic period
Stage of development
Organogenesis
Time from
conception
4-8 weeks
Formation of the brain and spinal cord
4 weeks
Bookmark of the heart, kidneys and limbs
The rapid development of the brain, eyes, heart and
limbs
Beginning of intestinal and lung development
Appearance of fingers
Development of ears, kidneys, liver and muscles
Closing of the sky, formation of joints
6 weeks
10 weeks
Sexual differentiation
12 weeks
8 weeks

Relationship between gestational age and damaging factors in the event of fetal malformations

malformation
Anencephaly
cleft lip
cleft palate
Esophageal atresia
rectal atresia
syndactyly
Diaphragmatic hernia
hypospadias
cryptorchidism
Incorrect position of large vessels
Ventricular septal defect
Open aortic duct
Termination
gestational age
26 days
36 days
10 weeks
30 days
6 weeks
6 weeks
6 weeks
12 weeks
7- 9 months
34 days
6 weeks
9 months

ionizing radiation

ionizing
radiation
high energy
- X-rays
-gamma rays
- natural
radioactivity
electromagnetic
radiation
low energy
- microwaves
- radio waves
- ultrasound
- radar
waves
-noise
- vibrations

infections

Embryotoxic or fetolytic defects
viruses are caused directly
transplacental infection (infection with a virus
fetus), or indirectly - through febrile
mother's condition
Rubella virus, especially in the first 90 days
pregnancy, causes congenital heart defects,
deafness and cataracts
Cytomegalovirus infection can lead to
microcephaly and sdfd
Coxsackievirus (enterovirus) is associated with significant
increased incidence of cleft lip and
face, pyloric stenosis and other anomalies
digestive tract and birth defects
hearts
Herpesvirus type II (urogenital) can
lead to microcephaly

TORCH - infections

T - toxoplasmosis - toxoplasmosis
O - others - other infections (syphilis, chlamydia,
enterovirus infections, hepatitis A and B, listeriosis,
measles, mumps, papillomavirus
infection, influenza, etc.)
R - rubeola - rubella
C - cytomegalia - cytomegalovirus infection
H - herpes - herpes virus infection

Oncogenes and inorganic teratogens

Oncogenes are substances that can react with
DNA and modify it
Proved transplacental toxicity of polycyclic
aromatic
hydrocarbons,
benzo-a-pyrene,
methylcholanthrene, various triacines, nitrosoureas and
secondary amines
Increasing the concentration of inorganic teratogens
occurs during mining, metallurgical and
metalworking processes
Lead leads to dysfunction of the central nervous system, the development
mental
backwardness,
cerebral
paralysis,
microcephaly
Mercury exposure leads to impaired motor
activities and mental development in children
Cadmium,
arsenic,
chromates are teratogens,
leading to a decrease mental activity

Other environmental factors

malnutrition
reception of substandard
products (sprouted
potato)
drinking water pollution
physical agents,
used in medicine, etc.

Drugs that have an undesirable effect on the growth and development of the fetus

Medicinal
funds
ACE inhibitors
Antithyroid
drugs
Benzodiazepines
Beta blockers
Barbiturates
NSAIDs
Tetracyclines
warfarin
Possible effect
fetal kidney failure or
newborn
Hypothyroidism in the fetus (with overdose)

When used during pregnancy
possible growth retardation (indicated for
atenolol)
Drug dependence in the fetus
Narrowing of the ductus arteriosus (starting from the second
trimester and beyond)
Disturbance of pigmentation of teeth, can slow down
bone growth (short application at the beginning of I
trimester did not lead to teratogenic
effect)
Hemorrhage in the fetal brain

Alcohol and smoking during pregnancy

Alcohol less than 30 ml of ethyl alcohol per day
has a harmful effect on the fetus
When using 30-60 ml of ethyl alcohol per day
10% of children develop IUGR and are observed
congenital anomalies
With daily use of >60 ml of ethyl
alcohol, the fetus develops FGR, congenital
anomalies, postnatal delay in physical and
mental development
Smoking
in
time
pregnancy
maybe
be accompanied
increase
frequencies
spontaneous abortions and defects of the nervous
tubes, placental abruption, premature
childbirth, gestosis.

Antimicrobials

Penicillins, cephalosporins, macrolides
dangerous to the fetus
Aminoglycosides - best avoided, they have
otonephrotoxic action
Streptomycin - only for tuberculosis in
pregnant women, in which case the risk of its use
lower than tuberculosis
Tetracyclines - absolutely contraindicated -
lead to impaired development of bones, teeth
Sulfonamides - should not be used, they
interfere with bilirubin binding
newborn and lead to the development of nuclear
jaundice (an irreversible change in the function
brain).

Antimicrobials

Derivatives of nalidixic acid - not
prescribe during pregnancy, cause
hydrocephalus.
Levomycetin - use before childbirth
leads to the development of "gray syndrome"
fetus, less dangerous to the fetus during
pregnancy.
Metronidazole - possible use with II
trimester, in I it is better not to prescribe
Antifungal drugs are not
absorbed in the digestive tract
therefore safe.

Antihypertensive drugs

The best drug is hydralazine (peripheral
vasodilator)
Dopegyt can lead to hemolytic anemia,
cause meconium ileus
Beta-blockers in high doses increase
uterine tone, promote intrauterine
fetal growth retardation
Ganglioblockers - paralytic intestinal
obstruction in a newborn
Rauwolfia preparations - nasal congestion,
respiratory depression
Nitrates are metabolized to cyanides,
poisoning the newborn (with prolonged
application).

General recommendations for prescribing
medicines during pregnancy
Assess potential benefits and potential harms.
Avoid medications in the first trimester
Do not prescribe drug combinations.
Use the lowest effective dose for
minimum time.
Give preference to local dosage forms.
Advise pregnant women about taking any
drugs, including analgesics, vitamins, dietary supplements,
herbal preparations and other drugs used for
self-treatment.
Monitor the intake of all medications during pregnancy
Monitor the condition during drug therapy
mother and fetus.

Definition of risk categories
teratogenicity of drugs in
food and drug classification
Administration (FDA)
A - no risk - 0.7% of drugs
B (“best” - the best) - no evidence of risk 19%
С (“сaution” - caution) - the risk is not excluded
- 66%
D (“dangerous” - dangerous) - proven risk - 7%
X - contraindicated during pregnancy - 7%

Risk factors for the development of congenital malformations

unplanned pregnancies
late maternal age
insufficient prenatal control
viral infections
taking teratogenic drugs
alcohol
smoking
drugs
malnutrition
occupational hazards
poor healthcare in many countries

Indications for periconceptual prophylaxis
congenital malformations
Diabetes mellitus and other endocrine and metabolic
diseases.
Repeated spontaneous abortions and stillbirths
fruits.
Genetic risk of multifactorial defects
development.
The birth of fetuses with intrauterine growth retardation and
history of premature birth.
Chronic diseases (hypertension, epilepsy,
bronchial asthma, etc.).
Obesity.
Prolonged use of drugs.
Some infectious diseases (rubella,
toxoplasmosis, etc.)

Scheme of measures for periconceptual prevention of congenital malformations

Geneticist
– 1st meeting before the onset
pregnancy, 2nd and 3rd meeting in period I and II
trimester of pregnancy.
Anamnesis
Pedigree
Inspection
Cytogenetic and other genetic
research according to indications
Offspring prognosis
Recommendations for planning pregnancy
and prevention of congenital malformations in the fetus.

Periconceptual treatment for women:
High Content Multivitamins
folic acid
Diet for 2-3 months. before conception and 2-3 months.
after pregnancy
Prenatal diagnosis of congenital malformations and
chromosomal abnormality in the fetus
ultrasound examination
Screening of maternal serum
markers
Invasive diagnostic methods (according to
testimony)

Geneticist - 4th meeting

Medical genetic
counseling
Examination of a newborn
testimony)
(on

Decalogue of commandments for the prevention of congenital malformations (geneticist Eduardo Castillo, Brazil)

Any fertile woman can be pregnant.
Try to complete your family while you are young.
Carry out prenatal control in the prescribed manner.
Get vaccinated against rubella before pregnancy.
Avoid medications unless strictly necessary.
Avoid alcoholic drinks.
Avoid smoking and smoking areas.
Eat well and varied, preferring fruits and vegetables.
Ask for advice on the risks to pregnancy in your
work.
If in doubt, consult your doctor or doctor
specialized service.

The influence of medicinal and narcotic substances on embryonic development
Completed by: biology teacher - Kuchina Larisa Viktorovna
MBOU "Anninskaya secondary school with UIOP"
Anna 2015
Purpose of the work: to study the influence of medicinal and narcotic substances on human embryonic development.
Factors affecting embryogenesis
alcohol
heredity
mother's age
ecological situation
diet
mother's illness
medications
smoking
For example, the development and formation of the human cardiovascular system falls on the 20-40th day after fertilization, the limbs - on the 24-46th day, the nervous system - on the 15-25th day. Thus, from 15 to 25 days, the nervous system is exposed to teratogenic effects, but not the limbs.
thalidomide
steroid hormones with androgenic activity
Anesthetic
Analgesic
Medicines that are absolutely contraindicated during pregnancy:
Teratogenic drugs:
Effect of drugs on fetal development.
Influence of cocaine
Effects on the fetus: Tachycardia. Fetal growth retardation. Decreased growth of the fetal brain and body. Newborns may suffer from a heart attack and / or cerebrovascular accident due to high blood pressure and vasospasm (the risk is especially increased if the pregnant woman uses within 48 - 72 hours before delivery). irritability, delayed development of speech and impaired mental abilities.
The influence of opiates (heroin, morphine, codeine, "white Chinese", "poppy straw", "hanka", "gauze")
Complications of Pregnancy: The lifestyle of opiate abusers often leads to preterm birth (premature babies). Slowing down the birth process of every second child. Stillbirth and miscarriage (due to abrupt cessation of use). Consequences of exposure to the fetus: Violation of the growth of the fetus. Increased or decreased (depending on the dose) excitability of the fetus. Increased risk of malposition of the fetus (breech presentation).
Disorders manifested during infancy: Low body weight. Microcephaly. Increased risk of sudden death. High morbidity and mortality (due to the suppression of systems responsible for the body's resistance to opiates). Disorders manifesting at an older age: Slowed mental, motor and speech development child by 18 months Attention deficit and hyperactivity. Sleep disorders. Anger and irritability. Bad speech skills. Tactile, visual and auditory perception is below normal.
Withdrawal syndrome in a newborn
Influence of stimulants and ecstasy
Influence of benzodiazepines
Influence of marijuana, hashish
Complications of pregnancy: there may be longer labor. Consequences of exposure to the fetus: Slowed growth of the fetus. It may subsequently affect the boys - their reproductive functions are reduced. It can manifest itself in disorders of the nervous system and vision. At breastfeeding it is possible to transfer the drug to the newborn through the mother's milk.
The influence of hallucinogens (fungi of the genus psilotsibum, LSD, PCP or phencyclidine, cyclodol, diphenhydramine, taren).
Pregnancy complications: increased risk of miscarriage. Consequences of exposure to the fetus: Microcephaly. Violation of attention. Sudden bouts of excitement, instability of mood. Limitation of joint mobility. Neurological disorders (weakened reflexes)
Thank you for your attention!

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INFLUENCE OF HARMFUL FACTORS ON THE FETUS INFLUENCE OF HARMFUL FACTORS ON THE FETUS The prevalence of spontaneous abortions is 15-20% of the total number of pregnancies; 50% of miscarriages in the first trimester have gross violations. The prevalence of spontaneous abortions is 15-20% of the total number of pregnancies; 50% of miscarriages in the first trimester have gross violations; 3-5% of newborns have malformations; 3-5% of newborns have malformations; in 15% of children, malformations are detected at the age of 5-10 years; 15% of children, malformations are detected at the age of 5-10 years

Teratogenic factors Widely distributed. During pregnancy, each woman takes an average of 3.8 drugs. In the US, 10-20% of pregnant women take drugs. In addition, harmful substances are found in everyday life (microwave oven, electronic clock) and at work.

Criteria of teratogenic factors Proved the relationship between the action of the factor and the formation of malformation Proved the relationship between the action of the factor and the formation of malformation Epidemiological studies confirm this relationship Epidemiological studies confirm this relationship The action of the harmful factor coincides with the critical periods of intrauterine development rare exposure to a damaging factor characteristic malformations are rarely formed If exposure to a damaging factor is rare characteristic malformations are rarely formed

The main groups of teratogenic factors Drugs and chemicals (tetracyclines, trichopolum, androgens, mercury, lead, phosphorus) Drugs and chemicals (tetracyclines, trichopolum, androgens, mercury, lead, phosphorus) therapy) Ionizing radiation (radiation fallout, radioisotope diagnostics, radiation therapy) Viral and bacterial infections (herpes, rubella, syphilis, toxoplasmosis) Viral and bacterial infections (herpes, rubella, syphilis, toxoplasmosis) Metabolic disorders and bad habits (diabetes mellitus, endemic goiter, phenylketonuria; smoking, alcoholism, drug addiction) Metabolic disorders and bad habits (diabetes mellitus, endemic goiter, phenylketonuria; smoking, alcoholism, drug addiction) A special registry of teratogenic factors is published in the United States

Features of the influence of teratogenic factors (TF) Dose-dependent character. Dose-dependent character. For each TF there is a teratogenic dose. Usually it is 1-3 orders of magnitude lower than the lethal one. There is a dose of teratogenic effect for each TF. Usually it is 1-3 orders of magnitude lower than the lethal one. Sensitivity to different TFs during fetal development may vary. Sensitivity to different TFs during fetal development may vary. Infectious agents as teratogenic factors do not have a threshold dose and are dose-dependent.

Periods of intrauterine development of a person Initial - from the moment of fertilization to implantation of the blastocyst (up to 11 days). Initial - from the moment of fertilization to implantation of the blastocyst (up to 11 days). Embryonic (18-60 days after fertilization) Embryonic (18-60 days after fertilization) Fetal (from 9 weeks of pregnancy to birth) Fetal (from 9 weeks of pregnancy to birth)

Initial period Differs in large compensatory-adaptive capabilities of the embryo. The law of "all or nothing" - if a large number of cells are damaged, the embryo dies, if individual blastomeres are damaged, further development is not disturbed Ovary Ovum Fertilization Ovulation h 3-4 days 5-6 days 2 cells 4 cells 8 cells Morula Blasto cyst

Major malformations CNS malformations - anencephaly, spina bifida, hydrocephalus. They are formed as a result of non-closure of the neural tube with a deficiency of folic acid, infection, diabetes mellitus. Malformations of the central nervous system - anencephaly, spina bifida, hydrocephalus. Formed as a result of non-closure of the neural tube with folic acid deficiency, infection, diabetes mellitus. Congenital heart defects - ASD, tetralogy of Fallot, aortic stenosis, etc. (phenylketonuria, SLE, rubella virus, genetic factors, alcohol, NSAIDs, diabetes mellitus) Congenital heart defects - ASD, tetralogy of Fallot, aortic stenosis, etc. (phenylketonuria, SLE, rubella virus, genetic factors, alcohol, NSAIDs, diabetes mellitus) Cleft lip, hard palate Cleft lip, hard palate Congenital clubfoot Congenital clubfoot Congenital hip dislocation Congenital hip dislocation Malformations of the gastrointestinal tract - pyloric stenosis, Hirschsprung disease, esophageal atresia , anus, etc. Malformations of the gastrointestinal tract - pyloric stenosis, Hirschsprung's disease, atresia of the esophagus, anus, etc.

General approaches to prenatal prevention 1. Environmental protection 2. Family planning (consanguineous marriages, childbearing after 35 years) 3. Prenatal diagnosis - elimination of embryos with pathology 4. Identification of heterozygous carriers 5. Periconceptual preparation 6. Invasive and non-invasive methods of intrauterine diagnosis

Periconceptual preparation, genetic counseling, genetic counseling, diagnosis of carriage and treatment of viral and bacterial infections, diagnosis of carriage and treatment of viral and bacterial infections, exclusion of prof. harmfulness, exclusion prof. harmfulness, giving up bad habits, giving up bad habits, taking folic acid and tocopherols) taking folic acid and tocopherols)

Methods of intrauterine diagnosis 1. Non-invasive methods: Ultrasound (10-14, 22-24, weeks), Ultrasound (10-14, 22-24, weeks), Biochemical markers: Biochemical markers: 9-14 weeks - HCG, PAPP-A 9-14 weeks - hCG, PAPP-A weeks AFP, 17-OPK, -hCG, estradiol weeks AFP, 17-OPK, -hCG, estradiol 2. Invasive methods: Chorionic biopsy (9-11 weeks) Chorionic biopsy (9-11 weeks ) Cordocentesis (22-24 weeks) Cordocentesis (22-24 weeks)

Drugs and chemicals For the transplacental transition, the following matters: The molecular weight of the drug (up to 600 easily pass, 600 - 1000 limited, more than 1000 almost do not penetrate). Most drugs are less than 600 and easily penetrate to the fetus. The molecular weight of the drug (up to 600 is easily transferred, 600 - 1000 is limited, more than 1000 almost do not penetrate). Most drugs are less than 600 and easily penetrate the fetus. Fat-soluble substances easily diffuse through the placenta (ether, nitrous oxide). Fat-soluble substances easily diffuse through the placenta (ether, nitrous oxide). Binding to blood proteins. The greater the connection, the slower the penetration through the placenta and accumulation in the fetus. Binding to blood proteins. The greater the connection, the slower the penetration through the placenta and accumulation in the fetus. Method of mother administration Method of mother administration Stage of intrauterine development Stage of intrauterine development

Categories of drug safety Risk categories for the use of drugs during pregnancy FDA (Food and Drug Administration) A - no risk to the fetus; B - the risk to the fetus has not been established either in animals or in humans; C - the risk to the fetus has not been established in humans; controlled studies in humans have not been conducted; D - there is a risk to the fetus, but can only be used if there is a risk to life; it is necessary to assess the degree of risk and benefit; X - proven risk to the fetus. During pregnancy are contraindicated.

Antibacterial drugs during pregnancy (Gurtovoy B.L. et al.) Group I - contraindicated in pregnancy: tetracyclines, chloramphenicol, trimetaprim. Group I - contraindicated in pregnancy: tetracyclines, chloramphenicol, trimetaprim. Group II - use only for health reasons: aminoglycosides, nitrofurans, sulfonamides. Group II - use only for health reasons: aminoglycosides, nitrofurans, sulfonamides. Group III - antibiotics without embryotoxic action: penicillins, cephalosporins, macrolides. Group III - antibiotics without embryotoxic action: penicillins, cephalosporins, macrolides.

The impact of antibiotics Tetracycline and its derivatives in the early stages lead to malformations, in the later stages - a slowdown in fetal growth, damage to the rudiments of teeth, hepatotoxic effect hepatotoxic effect Levomycetin - hypoplastic anemia Levomycetin - hypoplastic anemia Aminoglycosides - ototoxic effect Aminoglycosides - ototoxic effect

Ionizing radiation The effect of radiation on the female body occurs according to the general laws of radiation damage; radiation practically does not penetrate the skin, but it is very dangerous when it gets inside; radiation practically does not penetrate the skin, but it is very dangerous when it gets inside; radiation penetrates to a depth of 1-2 cm; radiation penetrates depth of 1-2 cm radiation has the greatest penetrating power with the formation of free radicals, leads to gene mutations radiation has the greatest penetrating power with the formation of free radicals, leads to gene mutations Transplacental transfer is the main in the penetration of isotopes

Mechanisms of transplacental transfer of radionuclides Hematogenous pathway - free transfer of isotopes from mother's blood to fetal blood through the transplacental membrane (131 I, 32 P, etc.) Hematogenous path - free transfer of isotopes from mother's blood to fetal blood through the transplacental membrane (131 I, 32 P, etc.) Accumulation in placental tissues with subsequent exposure to the fetus (transuranium elements) Accumulation in placental tissues with subsequent exposure to the fetus (transuranic elements) Paraplacental passage through the membranes and amniotic fluid (radioactive plutonium) membranes and amniotic fluid (radioactive plutonium)

Infection (mechanisms of action) 1. Viruses (cytomegalvirus, herpes, rubella), penetrating to the embryo and fetus, can have a direct teratogenic effect 2. Infection leads to a change in the metabolism and function of the endometrium, which causes a violation of implantation or a violation of the development of the placenta

TOBACCO SMOKING DURING PREGNANCY of them years - 70% REPRODUCTIVE HEALTH Radzinsky V.Ye. Moscow, 2002

Smoking Tobacco contains more than 600 harmful factors: organic and inorganic acids, proteins, esters, aldehydes, phenols, etc. Tobacco contains more than 600 harmful factors: organic and inorganic acids, proteins, esters, aldehydes, phenols, etc. radioactive polonium currently found in tobacco smokeradioactive polonium currently found in tobacco smoke nicotine has the greatest impact nicotine has the greatest impact

Nicotine Exposure to nicotine in early pregnancy can lead to impaired implantation of the ovum and spontaneous abortion. Exposure to nicotine in early pregnancy can lead to impaired implantation of the ovum and spontaneous abortion. Abortion and premature birth may be due to an increase in uterine contractility when smoking Abortion and premature birth may be due to an increase in uterine contractility when smoking Nicotine leads to contraction of the vessels of the uterus and placenta with the development of placental insufficiency and fetal hypoxia development of placental insufficiency and fetal hypoxia

Nicotine Fetal hypoxia is also associated with an increase in the level of carboxyhemoglobin in it Fetal hypoxia is also associated with an increase in the level of carboxyhemoglobin in it Violation of placental development contributes to the occurrence of HFPN and IUGR of the fetus through the amnion, accumulating in the internal organs of the fetus, causes long-term intoxication Nicotine, intensively penetrating the placenta and accumulating in it, penetrating through the amnion, accumulating in the internal organs of the fetus, causes prolonged intoxication ) Violation of the structure and function of the central nervous system (microcephaly, impaired intelligence, coordination of movements) Growth retardation, especially noticeable after the birth of a child Growth retardation, especially noticeable after the birth of a child Characteristic anomalies in the development of the facial skull (microft almia, facial lengthening, low forehead, chin underdevelopment, small saddle nose, large wide open mouth, strabismus, flattening of the occiput) Characteristic anomalies in the development of the facial skull (microphthalmia, face lengthening, low forehead, chin underdevelopment, small saddle nose, large wide open mouth , strabismus, flattening of the occiput)

The pathogenesis of ASP is not well understood. It is known that ethanol easily crosses the placenta and the blood-brain barrier of the fetus, accumulates in the central nervous system, causing toxic effects. Ethanol easily penetrates the placenta and the blood-brain barrier of the fetus, accumulates in the central nervous system, causing a toxic effect. long-term effects In the liver of the fetus there is no alcohol dehydrogenase enzyme that destroys ethanol, so the fetus is exposed to prolonged exposure Embryotoxic and teratogenic effects are caused by the metabolite of ethanol - acetaldehyde Embryotoxic and teratogenic effects are exerted by the metabolite of ethanol - acetaldehyde