Harmful effects on fetal presentation. The influence of various factors on the growth and development of the embryo, fetus, children, adults of different age groups. The importance of hygiene factors for human health. TORCH - infections

"Individual development of the organism" - Homework. crushing stage. Give definitions. A - gastrula B - blastula C - neurula D - organogenesis. Zygote. Stages of gastrula and neurula. A - gastrula B - blastula C - neurula D - blastomere. The similarity of embryos of some animals in the early stages of development. What is the significance of the biogenetic law?

"Postembryonic period of development" - Equipment: To expand students' knowledge of the patterns of postembryonic development of organisms. Postembryonic period of development Egg membranes Metamorphoses. Topic: Postembryonic period of development. Develop the ability to work with different sources of information. To consolidate knowledge about the embryonic development of the organism.

"Biology Ontogenesis" - Differential activity of genes during ontogenesis. Topic: Genetics of development. M., 1988. Congenital malformations. Alikhanyan S.I., Akifiev A.P., Chernin L.S. General genetics. Ayala F., Kaiger J. Cellular and genetic mechanisms of ontogeny. Ontogeny: concept, periodization. modern genetics. Literature:

"Embryonic development of organisms" - grade 11. Why do scientists need to know the patterns of ontogeny? Generalization. Individual development of the organism - ontogeny. What periods are distinguished in ontogeny? What period of ontogeny is called embryonic? Anomalies. Embryogenesis stages. Bookmark organs. Postembryonic development.

"Ontogeny lesson" - Ontogeny. . . there is a brief and quick recapitulation of the phylogeny of this species. Evaluate your work in class. "How did I do in class?" (self-assessment sheet). Ontogenesis-. Blastula - "mulberry". 1 day after fertilization. 2 days after fertilization. ? The period of development from birth to death. Biogenetic law (Müller, Haeckel).

"Ontogenesis" - PERIODIZATION OF ONTOGENESIS. ONTOGENESIS as a BIOINFORMATIONAL PROCESS (CONTINUED 1) -. LIFE CYCLE and ONTOGENESIS: DEFINITION and GENERAL CHARACTERISTICS. GAMETES. Ontogenetic (organismal) level of organization of life -. ONTOGENESIS as a BIOINFORMATIONAL PROCESS (CONTINUED 3) -. LIFE CYCLE and ONTOGENESIS of a LIVING BEING, DEFINITION OF CONCEPTS and GENERAL CHARACTERISTICS -.

There are 10 presentations in total in the topic

RUSSIAN STATE MEDICAL UNIVERSITY Department of Obstetrics and Gynecology of the Medical Faculty (Head of the Department Professor, Doctor of Medical Sciences O.V. Makarov) LECTURE INFLUENCE OF HARMFUL FACTORS ON THE FETUS Teratology is the science of impaired development 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 Embryonic period Stage of development Organogenesis Time from conception 4-8 weeks Formation of the brain and spinal cord 4 weeks heart, kidneys, and limbs Rapid development of the brain, eyes, heart, and limbs Early development of the intestines and lungs Mild Appearance of fingers Ears, kidneys, liver and muscles development Closing of the palate, formation of joints at 6 weeks 10 weeks Half day differentiation 12 weeks 8 weeks Congenital anomaly - structural, metabolic and functional disorders of an organ, part of an organ or a large area of ​​the body that occur in utero. Congenital malformation is a term that includes various structural defects. The overall incidence of congenital malformations is 600 per 10,000 of all live and stillborn children (6%). Unknown cause 20% Monogenic - 6% Chromosomal - 5% Environmental - 6% Multifactorial 63% Classification of CM Common CM > 1 per 1000 newborns By frequency Moderately common CM 0.1 - 0.99 per 1000 newborns Rare CM< 0,01 на 1000 новорожденных По распространенности в организме - изолированные -системные -множественные -гаметопатии, бластопатии По сроку действия вредного фактора -эмбриопатии -фетопатии Классификация ВПР по степени тяжести и прогнозу для жизнеспособности Летальные пороки развития - 8% Малые аномалии развития - 60% ВПР средней степени тяжести - 32% Взаимосвязь сроков беременности и повреждающих факторов при возникновении пороков развития плода Порок развития Анэнцефалия Расщелина губы Расщелина неба Атрезия пищевода Атрезия прямой кишки Синдактилия Диафрагмальная грыжа Гипоспадия Крипторхизм Неправильное положение крупных сосудов Дефект межжелудочковой перегородки Открытый аортальный проток Терминационный срок беременности 26 дней 36 дней 10 недель 30 дней 6 недель 6 недель 6 недель 12 недель 7- 9 месяцев 34 дня 6 недель 9 месяцев Факторы риска развития ВПР непланируемые беременности поздний материнский возраст недостаточный пренатальный контроль вирусные инфекции прием лекарств с тератогенным действием алкоголь курение наркотики недостаточное питание профессиональные вредности бедное здравоохранение многих стран Ионизирующие излучения Ионизирующие излучения высоких энергий - рентгеновские лучи -гамма-лучи - естественная радиоактивность Электромагнитные излучения низких энергий - микроволны - радиоволны - ультразвук - радиолокационные волны -шум - вибрации TORCH - инфекции Т - toxoplasmosis - токсоплазмоз О - others - другие инфекции (сифилис, хламидиоз, энтеровирусные инфекции, гепатиты А и В, листериоз, корь, эпидемический паротит, папилломавирусная инфекция, грипп и др.) R - rubeola - краснуха С - сytomegalia - цитомегаловирусная инфекция H - herpes - герпесвирусная инфекция Инфекции Эмбриотоксические или фетолитические дефекты вирусов вызываются непосредственно трансплацентарной инфекцией (заражение вирусом плода), или опосредованно - через лихорадочное состояние матери Вирус краснухи, особенно в первые 90 дней беременности, вызывает врожденные пороки сердца, глухоту и катаракту Цитомегаловирусная инфекция может привести к микроцефалии и СЗРП Вирус Коксаки (энтеровирус) связан со значительным увеличением частоты возникновения расщелин губы и лица, стеноза привратника и других аномалий пищеварительного тракта и врожденных пороков сердца Вирус герпеса II типа (урогенитальный) может приводить к микроцефалии Онкогены и неорганические тератогены К онкогенам относятся вещества, способные реагировать с ДНК и видоизменять ее Доказана трансплацентарная токсичность полициклических ароматических углеводородов, бензо-а-пирена, метилхолантрена, различных триацинов, нитрозомочевины и вторичных аминов Повышение концентрации неорганических тератогенов происходит при горнорудных работах, металлургических и металлообрабатывающих процессах Свинец приводит к нарушению функции ЦНС, развитию умственной отсталости, церебральных параличей, микроцефалии Воздействие ртути приводит к нарушению двигательной активности и умственного развития у детей Кадмий, мышьяк, хроматы являются тератогенами, приводящими к снижению умственной активности Другие факторы окружающей среды недостаточность питания прием недоброкачественных продуктов (проросший картофель) загрязнение питьевой воды физические агенты, используемые в медицине и др. Алкоголь и курение при беременности Алкоголь менее 30 мл этилового спирта в день не оказывает вредного влияния на плод При употреблении 30-60 мл этилового спирта в день у 10% детей происходит задержка внутриутробного роста и наблюдается небольшое число врожденных аномалий При ежедневном употреблении > 60 ml of ethyl alcohol, the pregnant woman is classified as an alcoholic, anomalies in the fetus are expressed mainly in a decrease in body weight at birth and postnatal delay in physical and mental development. Smoking during pregnancy may be accompanied by an increase in the frequency of spontaneous abortions and neural tube defects, placental abruption, premature birth, preeclampsia General recommendations for prescribing drugs during pregnancy Assess potential benefits and potential harms. Avoid drug use in the first trimester Do not prescribe drug combinations. Use the lowest effective dose for the shortest amount of time. Give preference to local dosage forms. Advise the pregnant woman about taking any medications, including analgesics, vitamins, dietary supplements, herbal preparations, and other self-medication. Monitor the intake of all medications by the pregnant woman Monitor the condition of the mother and fetus during the period of drug therapy. Determination of risk categories for teratogenicity of drugs in the Food and Drug Administration (FDA) classification - no risk - 0.7% of drugs B (“best” - the best) - no evidence of risk - 19% C (“coution” - caution) - no risk excluded - 66% D ("dangerous" - dangerous) - proven risk - 7% X - contraindicated in pregnancy - 7% A Drugs that have an undesirable effect on the growth and development of the fetus Drugs a n d s AP F inhibitors Anti thyroid drugs Benzodiazepines Beta blockers B NSAID arbitrages Tetracyclines Warfarin P o b tible effect Renal failure o f f etition or newborn s r o v ke) n e m e r a n i n g y o n d o u t h o u t h o u t n o l o l a) D u p r e d i n g d i n g o f fe t io n t and o f the sec ond t ri m e s t r e f on e) s t r o m e n g r e s (short application at the beginning of the 1st trimester of the coun try fetal brain hemorrhage Antimicrobial agents Penicillins, cephalosporins, macrolides are not dangerous for the fetus Aminoglycosides - best avoided, they have an otonephrotoxic effect Streptomycin - only for tuberculosis in pregnant women, in this case the risk of its use is lower than for tuberculosis irreversible change in brain function). Nalidixic acid derivatives - do not prescribe during pregnancy, cause hydrocephalus. Levomycetin - use before childbirth leads to the development of a "gray syndrome" of the fetus, less dangerous for the fetus during pregnancy. Metronidazole - it is possible to use from the II trimester, it is better not to prescribe in the I Antifungal drugs - they are not absorbed in the digestive tract, therefore they are safe. Antihypertensive drugs The best drug is hydralazine (peripheral vasodilator) Dopegyt can lead to hemolytic anemia, cause intestinal meconial obstruction Beta-blockers in large doses increase the tone of the uterus, contribute to intrauterine growth retardation of the fetus Ganglioblockers - paralytic ileus in the newborn Rauwolfia drugs - nasal congestion, oppression respiratory function Nitrates are metabolized into cyanides, which poison the newborn (with prolonged use) Recommendations for prescribing drugs during + - drug of choice during pregnancy and in (+) - can be prescribed postpartum (-) - it is better not to prescribe - - analgesics, antipyretics, anti-inflammatory drugs phenacetin _ paracetamol + antipyrine, amidopyrine - cause agranulocytosis in the fetus (+) be careful! agranulocytosis rarely quinine butadione - nephritis; neonatal liver necrosis in the postpartum period as a teratogen, embryonic death indomethacin (-) with prolonged use in high doses. No more than 1 week, up to 28 weeks. pregnancy, in small doses of prostaglandins + quickly excreted drugs, opiates + once without consequences. Do not administer less than 2-3 hours before the birth of the fetus, depression of the respiratory center. Nursing is not allowed. Contraindicated for the treatment and analgesia of preterm labor. atropine + in therapeutic doses, anesthesia is harmless + local anesthesia + Recommendations for prescribing drugs during pregnancy and in the postpartum period The drugs of choice are penicillins, cephalosporins, macrolides Antibiotics and chemotherapy drugs penicillins + cephalosporins + aminoglycosides - serious otonephrotoxic effect tetracyclines - deposition in bone growth zones and inhibition of skeletal growth, yellow teeth, nuclear jaundice in the postpartum period due to blocking of bilirubin transport systems levomycetin - agranulocytosis in the prenatal period. Teratogen? The newborn has a “gray syndrome” - collapse, asphyxia, cyanosis, vomiting, flatulence clindamycin + erythromycin + sulfonamides (+) anemia. Do not use during lactation. Inhibition of bilirubin elimination, nuclear jaundice possible furadonin (-) hemolysis, yellow teeth, in the newborn hyperbilirubinemia (during feeding) antifungal + antitrichomonas + from the second trimester doses - slowing down the development of the brain (+) swelling of the nasal mucosa, shortness of breath; in rare cases, drowsiness, lethargy, anorexia and atony of the intestine Antihypertensive drugs reserpine peripheral vasodilators + the newborn may have hypoxia and hypotension autonomic nervous system (hypersecretion, decreased activity, hypoglycemia and bradycardia) Are used for health reasons (+) malformations? It is good to use when introducing into anesthesia (do not increase blood pressure). Inhibition of the respiratory center in the newborn + delayed decay in the fetal liver: drowsiness in the postpartum period Recommendations for prescribing drugs during pregnancy and in the postpartum period +) tachycardia, hypoglycemia in the fetus corticosteroids (+) long-term use leads to intrauterine adrenal insufficiency indirect anticoagulants (-) penetrate the placenta, hemorrhages in the fetus. Due to poverty, you can use heparin + the drug of choice for heart defects, it does not cross the placenta. Diuretics (-) very carefully! When gestosis is contraindicated. Only with pulmonary edema, cerebral edema, nephrotic syndrome Cardiac glycosides + toxic effects of overdose Antithrombotic agents are possible only with Recommendations for prescribing drugs during pregnancy and in the postpartum period Hormones natural estrogens + stilbenes are harmless - can induce adenocarcinoma of the vagina in the fetus sigetin + prevention of hypoxia fetus, improvement of uteroplacental circulation gestagens (progesterone, duphaston) + with 19-norsteroids (norcolut, norethisterone, primolyut - norms) (-) virilization of female fetuses is possible hormonal contraceptives (accidental intake) synthetic estrogens + 19norsteroids (-) are acceptable for a few weeks in early pregnancy. Virilization of female fetuses of luteal phase insufficiency is possible, it can be used from the beginning of pregnancy up to 20 weeks. androgens - virilization of female fetuses anabolics - virilization of female fetuses thyroxine (+) in hypothyroidism, euthyroid goiter. Known cases of fetal hyperthyroidism iodine preparations (-) goiter and hyperthyroidism in the newborn antithyroid drugs (-) congenital goiter, hypothyroidism, cretinism Recommendations for prescribing drugs during pregnancy and in the postpartum period Vaccines tetanus + rabies + cholera, diphtheria, paratyphoid whooping cough , typhoid, (+) (+) can cause abortion, premature birth vitamin A (+) very carefully - malformations of the central nervous system, eyes, upper palate vitamin B + vitamin C (+) in large doses - death of the embryo, abortion in the first trimester ; aortic stenosis vitamin D (-) in overdose - calcification of organs vitamin K (vikasol) + vitamin B12 + Laxatives Vitamins no side effects when feeding may be jaundice in the newborn Indications for periconceptual prevention of congenital malformations Diabetes mellitus and other endocrine and metabolic diseases. Repeated spontaneous abortions and the birth of dead fetuses. Genetic risk of multifactorial malformations. The birth of fetuses with intrauterine growth retardation and a history of premature birth. Chronic diseases (hypertension, epilepsy, bronchial asthma, etc.). Obesity. Prolonged use of drugs. Some infectious diseases (rubella, toxoplasmosis, etc.) 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 about pregnancy risks at your job. If in doubt, consult your doctor or specialist doctor. Thanks for attention!

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Influence of harmful factors on the development of the embryo and fetus.

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Exogenous factors: Physical: Mechanical (trauma, twins, uterine fibroids, etc.); Thermal (heat shock, hypothermia); Irradiation (ultraviolet, X-ray, radioactive and space); Chemical: Hypoxia; Lack of iodine; The introduction of medicines, poisons, etc .; Biological: Lack or excess of vitamins; Lack or excess of hormones; Infections (viral, toxoplasmosis); Antigens, Rh antibodies; Lack or excess of nutrition; stress reactions. Groups of factors that have a harmful effect on the development of the embryo.

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genetic; constitutional; Age-related, etc. The fetus and the mother's body are a single whole, so it is possible for various bacteria and viruses, toxic substances, and drugs to pass from the mother to the fetus's body, which can cause a wide variety of changes in it. Particularly responsible in this respect is the period of the first three months of pregnancy, when the formation of the organs of the fetus. Almost all medicinal substances can have a harmful effect on the embryo, therefore, in order to prevent embryopathies, it is advisable to avoid prescribing excessive medications in the early period of pregnancy. Endogenous factors:

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Among the damaging factors that can affect the intrauterine development of the fetus, starting from the moment of conception, 5 groups can be distinguished. These are drugs, physical environmental factors (radioactivity, heavy metals), maternal diseases (diseases of internal and genital organs), bad habits (smoking, alcohol, drugs), infections in the mother (rubella, cytomegalovirus, herpes virus, immunodeficiency virus person, etc.). Especially adverse effects of these factors during the maturation of the germ cells of the parents, the moment of fertilization and in the first months of pregnancy - severe malformations occur in the embryo and fetus, often the pregnancy is interrupted. What factors cause the pathology of intrauterine development of the fetus in different periods?

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Alcohol With the systematic use of even a small amount of alcoholic beverages during pregnancy and its use at the time of conception of a child (“children of the holiday”), the so-called fetal alcohol syndrome may occur, which is characterized by multiple developmental anomalies, as well as violations of the physical and mental development of the child in the future. Bad habits

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The incidence of congenital anomalies in children of drug addicts is 2.5-3%. There is a slow development of the fetus, a higher frequency of stillbirths. The main danger is the death of a newborn, associated with the complete cessation of the flow of drugs into his body. Taking cocaine during pregnancy is dangerous for both the mother and the fetus. Among the complications in the expectant mother are convulsions, ruptures of cerebral vessels, myocardial infarction, heart rhythm disturbance, sudden death. Cocaine use during pregnancy causes miscarriage, premature birth, intrauterine growth retardation, intrauterine fetal death, can lead to multiple fetal malformations (congenital malformations of the brain and spinal cord, kidneys), and stroke in the newborn. Morphine, heroin and marijuana cause severe neurological disorders in a child. drugs

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More than 4,000 harmful substances have been found in cigarette smoke, including antigenic, mutagenic, and carcinogenic. The presence of these substances helps to explain the harmful effects of smoking. Among them, carbon monoxide is a toxic gas that interferes with oxygen transport and can cause dysfunction of the nervous system. Particularly destructive is nicotine, which has a pronounced vasoconstrictive effect and, due to this, has a negative effect on the processes of blood circulation in the uterus and placenta. In heavy smokers, pregnancy often ends in spontaneous miscarriages. Smoking

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For pregnant women, high-risk factors are substances such as lead, mercury, gasoline fumes, phenol, formaldehyde, cadmium, manganese, fluorine, arsenic, and pesticides. It is known that lead, whether it enters the digestive tract in the form of salts or is inhaled in the air in the form of lead oxide, can cause impaired brain development in a child and mental retardation. When exposed to mercury on the body of a pregnant woman, her newborn develops cerebral palsy and underdevelopment of the brain. Chemical substances

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How does ionizing radiation affect a growing fetus? Severe malformations and impaired fetal growth occur at exposure doses of more than 50 rads, but even doses of several rads can dramatically increase the risk of developing leukemia in a newborn child. An increase in the number of newborns suffering from Down syndrome is associated with chronic exposure to microwave radiation. Harmful environmental factors affecting the development of the fetus.

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Teratogens are substances that can have a harmful effect on a growing fetus. An increase in the content of these substances in the bodies of a pregnant woman and a child may be in the case of her presence in mining, metallurgical industries and metal processing. The main inorganic substance with a teratogenic effect is lead, which causes disruption of the central nervous system and leads to the formation of mental retardation and various paralysis. The influence of mercury will cause a decrease in motor activity and intelligence in a child. The action of cadmium, arsenic and chromium salts will also lead to disruption of the brain. How do inorganic teratogens affect?

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During pregnancy, many different factors can have a harmful effect on the development of the embryo, and then the fetus. In this case, the influence of harmful factors on the health of parents should be taken into account both during the formation of gametes and on the eve of conception. In this regard, pregnancy should be planned for a time when future parents are healthy, do not abuse bad habits, are not associated with harmful production factors, eat normally, and mutually want a child. Damaging factors during the period of embryogenesis are the most dangerous and can cause death, deformity or disease of the fetus. There are factors that do not cause pathological changes in the fetus, but contribute to miscarriage, which ultimately still leads to complications in the newborn. Influence of harmful factors on pregnancy.

Kazan State Medical University
Department of Obstetrics and Gynecology №2
Influence of harmful
factors on the fetus
Doctor of Medical Sciences, Professor Gabidullina R.I.

INFLUENCE OF HARMFUL FACTORS ON THE FETUS

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

REPRODUCTIVE HEALTH
DYNAMICS OF SPONTANEOUS ABORTIONS IN RUSSIA
(% of the total number of abortions)
12
10,2
9,8
10
8,9
9,0
2000
2001
8,3
8
7,2
7,3
1995
1996
7,5
7,8
6
1997
1998
1999
2002
2003
Radzinsky V.E.

Teratogenesis

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

Teratogenic factors

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

Teratogenic factors

Chemical
Physical
Biological

Criteria for teratogenic factors

The connection between the action of the factor and
the formation of a malformation
Epidemiological studies confirm
this connection
The action of the harmful factor coincides with
critical periods of intrauterine
development
With rare exposure to a damaging factor
characteristic malformations are rare

The main groups of teratogenic factors

(tetracyclines, trichopolum, androgens, mercury, lead,
phosphorus)
Ionizing radiation (radioactive 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

Features of the influence of teratogenic factors (TF)

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

Periods of intrauterine development of a person

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

Initial period

Differs in large compensatory-adaptive
embryonic possibilities. The all-or-nothing law
damage to a large number of cells, the embryo dies, with
damage to individual blastomeres, further development is not
violated
30-36 h
3-4 day
2 cells
4 cells
fertilization
rhenium
Ovary
Ovum
Ovulation
8 cells
morula
Blasto
cyst
5-6day

Embryonic period

SPONTANEOUS RECU
Embryonic period
Explaina
The embryo is most sensitive to the action of TF. gene
infection
Gross malformations are formed
Causes:
endo
autoi
S
Unexpla
allog
to

fruiting period

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

Major malformations

Malformations of the central nervous system - anencephaly, cleft
spine, hydrocephalus. Formed as a result
neural tube rupture due to folate deficiency
acids, infections, diabetes.
Congenital heart defects - ASD, tetralogy of Fallot, stenosis
aorta, etc. (phenylketonuria, SLE, rubella virus,
genetic factors, alcohol, NSAIDs, diabetes mellitus)
Cleft lip, hard palate
congenital clubfoot
Congenital dislocation of the hip
Malformations of the gastrointestinal tract - pyloric stenosis, disease
Hirschsprung, atresia of the esophagus, anus, etc.

General approaches to prenatal prevention

1.
2.
3.
4.
5.
6.
environmental protection
Family planning (consanguineous marriages,
childbearing after age 35)
Prenatal diagnosis - elimination
embryos with pathology
Identification of heterozygous carriers
Periconception preparation
Invasive and non-invasive methods
intrauterine diagnosis

Periconception preparation

medical genetic counseling,
carrier diagnosis and treatment
viral and bacterial infection,
exception prof. harmfulness,
rejection of bad habits,
taking folic acid and tocopherols)

Methods of intrauterine diagnosis

1.
2.
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)

Medicines and chemicals

for the placental transition
meaning:
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
placenta (ether, nitrous oxide).
Binding to blood proteins. The more connection, the
slower penetration through the placenta and accumulation in
fetus.
Route of administration to the mother
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 - no risk to the fetus has been established in animals or in
person;
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 when
life risk; it is necessary to assess the degree of risk and
benefits;
X - proven risk to the fetus. During pregnancy
contraindicated.

Absolute teratogens

Medicines used in
oncology:
1. Antimetabolites (6 - mercaptopurine)
2. Alkylating compounds
(cyclophosphamide)
3. Antitumor antibiotics
(actinomycin, sarcolysin)

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

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

Impact of antibiotics

Tetracycline and its derivatives in the early
timing leads to malformations, in
late - slowing down the growth of the fetus,
damage to the rudiments of the teeth,
hepatotoxic effect
Levomycetin - hypoplastic anemia
Aminoglycosides - ototoxic
action

Hormonal drugs

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

ionizing radiation

The effect of radiation on the female body occurs through
general laws of radiation damage
a-radiation practically does not penetrate the skin, but very
dangerous if swallowed
b-radiation penetrates to a depth of 1-2 cm
g-radiation has the highest penetrating
ability to form free radicals,
leads to gene mutations
Transplacental transfer is the main
penetration of isotopes

Mechanisms of transplacental transfer of radionuclides

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

1.
2.
Viruses (cytomegalvirus, herpes, rubella),
penetrating to the embryo and fetus, can have
directly teratogenic
Infection leads to changes in metabolism and
functions of the endometrium, which causes
implantation failure or
placental development

Infection (mechanisms of action)

3. Viral and bacterial infection can
influence the development of the placenta and
lead to HFPN and IUGR
fetus
4. Toxic effect on the fetus can
render bacterial toxins

Bad habits

Smoking
Alcohol consumption
Addiction

REPRODUCTIVE HEALTH
TOBACCO SMOKING DURING PREGNANCY
Moscow, 2002
23%
active smoking
No
77%
of which 20-30 years - 70%
Radzinsky V.E.

Smoking

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

Nicotine

Early exposure to nicotine
pregnancy can lead to
implantation of the ovum and spontaneous
abortion.
Abortion and preterm birth can be
caused by an increase in contractile
uterine activity during smoking
Nicotine causes uterine blood vessels to contract and
placenta with development of placental
fetal insufficiency and hypoxia

Nicotine

Fetal hypoxia is also associated with an increase in
carboxyhemoglobin level
Placental developmental disorder contributes to
occurrence of HFPN and fetal IUGR
Nicotine penetrates intensively through the placenta and
accumulating in it, penetrating through the amnion,
accumulating in the internal organs of the fetus, causes
prolonged intoxication

REPRODUCTIVE HEALTH
ALCOHOL USE DURING PREGNANCY
Moscow, 2002
use moderately
42%
46%
abused
do not use
12%
of which 20-25 years - 43%
26-30 years old - 26%
Radzinsky V.E.

Alcohol

The systematic use of alcohol in
pregnancy can lead to
development of fetal alcohol syndrome
(ASP)

ASP

Violation of the structure and function of the central nervous system
(microcephaly, intellectual disability,
movement coordination)
Growth retardation, especially noticeable after
child birth
Characteristic anomalies in the development of the facial skull
(microphthalmia, facial lengthening, low forehead,
underdevelopment of the chin, small saddle
nose, large wide open mouth, strabismus,
neck flattening)

ASP pathogenesis

Not studied enough. It is known that
Ethanol readily crosses the placenta and
fetal blood-brain barrier, accumulates in the CNS,
having a toxic effect
The liver of the fetus lacks the enzyme alcohol dehydrogenase,
destroying ethanol, so the fetus is exposed
prolonged exposure
Embryotoxic and teratogenic effects
ethanol metabolite - acetaldehyde

REPRODUCTIVE HEALTH
THE SHARE OF TEENAGE GIRLS,
DRUG USERS
Moscow, 2002
CAUSES:
- just like that - 70%
- for the company - 20%
- other - 10%
10%
Average age
first
use
drugs
15.8 ± 0.2 years
Radzinsky V.E.

REPRODUCTIVE HEALTH
COMPLICATIONS OF PREGNANCY IN DRUG addicts
Fetal growth retardation
Preeclampsia
Threat of interruption
pregnancy
Toxicosis
67 %
16 %
4% 4%
Radzinsky V.E.

REPRODUCTIVE HEALTH
CONDITION OF NEWBORN IN DRUG addicts
(Apgar score)
25%
30%
8 points and
more
6-7 points
4-5 points
45%
Radzinsky V.E.

Embryonic development is a complex and lengthy morphogenetic process during which a new multicellular organism is formed from the paternal and maternal germ cells, capable of independent life in the environment. Embryonic development, or embryogenesis, -

American experts have proven that air pollution increases the likelihood of having children with developmental defects. More than a dozen studies conducted in the United States, Brazil, Mexico, South Korea, and Europe demonstrate a direct relationship between the concentration of harmful substances in the atmosphere and premature births, low birth weight, miscarriages, and infant mortality. Causes of anomalies in embryogenesis

Chemicals entering the premises from the outside The building itself and its furnishings Toxic fumes and particles from detergents and cleaning products that are used in everyday life. Bacteria, viruses, fungal and mold spores Dust Tobacco smoke Sources of air pollution

Lead Lead has been widely used in industry for many centuries. Today, it is found in gasoline, paints, and other products used at home and at work. Lead is hazardous to the health of every person, especially for babies, as well as unborn children.

Young children are most sensitive to the toxic effects of lead, which manifests itself in changes in physical and psychological development - stunting, aggression, hyperactivity, as well as a decrease in learning ability. Newborns and children under 7 years of age may experience: irritability; · stomach ache; ataxia (disorder of coordination of movements); · loss of consciousness. Women who live in old (dilapidated) houses are more exposed to high levels of lead. About 80% of residential buildings built before 1978 were painted with lead paint. Peeling paint forms lead dust, which in turn is very dangerous for the body.

Radon Radon is a naturally occurring radioactive gas that is colorless, odorless and tasteless. Sources: A high probability of high radon content in the room is typical for houses built on the ground. The source of radon is uranium, which is present in small amounts in all soils and rocks. Radon also occurs naturally in the water of some wells. Consequently, radon exposure manifests itself to varying degrees in different regions. Health effects: Long-term exposure to radon increases the risk of lung cancer.

Volatile organic compounds (formaldehydes, pesticides, solvents, cleaning agents) Chemicals are widely used as components in household products. Paints, varnishes and wax contain organic solvents, as do most cleaners, disinfectants, cosmetics, degreasers and other products. Solvents are liquids that dissolve other chemicals; most of them very quickly evaporate into the air. Various fuels are also made up of organic chemicals.

Sources of chemicals: · household chemicals (cleaners, hairspray, glue and paints); There may be residual amounts of solvents in clothes after dry cleaning; building materials (floor coverings, wall coverings and adhesives); · Glossy paper and newspapers made from poor quality paper. Health effects: · headaches; skin irritation; shortness of breath · nausea, vomiting; · nose bleed.

Pesticides Pregnant women should avoid the use of pesticides whenever possible. Although insecticides have not been proven to harm an unborn baby, they are nonetheless poisonous. A high concentration of pesticides in the air can lead to: · miscarriage; premature birth; congenital defects.

Electromagnetic fields Electromagnetic radiation (EMR) cannot be felt. But it exists and affects the human body. The exact mechanism of EMR action has not yet been studied. The influence of this radiation does not appear immediately, but as it accumulates, so it can be difficult to attribute this or that disease that suddenly arose in a person to the devices with which he was in contact.
During pregnancy, EMR can lead to: · spontaneous abortions; premature birth; The appearance of congenital malformations in children. Electromagnetic radiation comes from many. Moreover, if several devices are located at a small distance from each other, their radiation seems to be layered. And in the zones of such intersections, the electromagnetic field is amplified. Therefore, it is very important to arrange electrical appliances correctly. Devices that emit electromagnetic fields: Anything that plugs into an outlet or runs on batteries, accumulators. Refrigerator, coffee maker, toaster, microwave oven, electric stove, hair dryer, TV to a greater or lesser extent propagate electromagnetic waves.

Radiation Sources of radiation: · cosmic radiation; radioactive substances in the soil (uranium, radon); · radionuclides in products; equipment (X-ray). Radiation affects human health in different ways - reddening of the skin may appear, on the one hand, on the other hand, cancer develops. The harmfulness of the consequences depends on the amount of radiation, on its type and time of exposure. The radiation effect on the unborn child deserves special attention, since the embryo is very sensitive to radiation, especially during the period from the second to the fifteenth week of pregnancy. The consequences of this environmental pollutant are truly tragic: · growth retardation; ugliness; · mental deviations; · oncological diseases.