TERATOGEN

PRESENTED BY DR. REENA GEORGE

 TERATOGEN

A teratogen is a substance that interferes with normal fetal

development and causes congenital disabilities. Drugs, alcohol,
chemicals and toxic substances are examples of teratogens.
Teratogens can also increase the risk for miscarriage, preterm
labor or stillbirth
Infections and viruses
Infections, viruses, parasites and other bacterial illnesses can pose serious threats to a
pregnant person and the fetus. The acronym TORCH helps to classify some of these:

Toxoplasmosis (an infection that spreads through cat feces).

Other infections like group B streptococcus, listeria, candida and sexually transmitted
infections (STIs).
Rubella.
Cytomegalovirus (CMV).
Herpes simplex virus.
Syphilis.
Nonprescription drugs that can be harmful include diet pills and high dosages
of aspirin (Norgard & others, 2006). However, recent studies indicated that low doses
of aspirin pose no harm for the fetus but that high doses can contribute to maternal
and fetal bleeding

Psychoactive Drugs Psychoactive drugs are drugs that act on the nervous system
to alter states of consciousness, modify perceptions, and change moods. Examples
include caffeine, alcohol, and nicotine, as well as illicit drugs such as cocaine,
methamphetamine, marijuana, and heroin
Incompatible Blood Types Incompatibility between the mother’s and father’s blood types
poses another risk to prenatal development. Blood types are created by differences in the
surface structure of red blood cells. One type of difference in the surface of red blood cells
creates the familiar blood groups—A, B, O, and AB. A second difference creates what is
called Rh-positive and Rh-negative blood. If a surface marker, called the Rh-factor, is
present in an individual’s red blood cells, the person is said to be Rh-positive; if the Rh-
marker is not present, the person is said to be Rhnegative. If a pregnant woman is Rh-
negative and her partner is Rh-positive, the fetus may be Rh-positive. If the fetus’ blood is
Rh-positive and the mother’s is Rh-negative, the mother’s immune system may produce
antibodies that will attack the fetus. This can result in any number of problems, including
miscarriage or stillbirth, anemia,jaundice, heart defects, brain damage, or death soon after
birth
Generally, the first Rh-positive baby of an Rh-negative mother is not at risk, but with
each subsequent pregnancy the risk increases. A vaccine (RhoGAM) may be given to
the mother within three days of the fi rst child’s birth to prevent her body from making
antibodies that will attack any future Rh-positive fetuses in subsequent pregnancies.
Also, babies affected by Rh incompatibility can be given blood transfusions before or
right after birth

Environmental Hazards Many aspects of our modern industrial world can endanger
the embryo or fetus. Some specifi c hazards to the embryo or fetus include radiation,
toxic wastes, and other chemical pollutants
 Maternal Diseases Maternal diseases and infections can produce defects in offspring
by crossing the placental barrier, or they can cause damage during birth. Rubella
(German measles) is one disease that can cause prenatal defects. Women who plan to
have children should have a blood test before they become pregnant to determine if they
are immune to the disease (Coonrod & others, 2008).
Syphilis (a sexually transmitted infection) is more damaging later in prenatal
development—four months or more after conception. Damage includes eye lesions,
which can cause blindness, and skin lesions. Another infection that has received
widespread attention is genital herpes. Newborns contract this virus when they are
delivered through the birth canal of a mother with genital herpes
AIDS is a sexually transmitted infection that is caused by the human immunodefiiency
virus (HIV), which destroys the body’s immune system

The more widespread disease of diabetes, characterized by high levels of

sugar in the blood, also affects offspring

Other Parental Factors

Maternal Diet and Nutrition A developing embryo or fetus depends completely

on its mother for nutrition, which comes from the mother’s blood
Maternal Age When possible harmful effects on the fetus and infant are considered, two
maternal ages are of special interest: (1) adolescence, and (2) 35 years and older The
mortality rate of infants born to adolescent mothers is double that of infants born to
mothers in their twenties

Emotional States and Stress When a pregnant woman experiences

intense fears, anxieties, and other emotions or negative mood states,
physiological changes occur that may affect her fetus
 Paternal Factors

Men’s exposure to lead, radiation, certain pesticides, and petrochemicals

may cause abnormalities in sperm that lead to miscarriage or diseases,
such as childhood cancer .The father’s smoking during the mother’s
pregnancy also can cause problems for the offspring.
In one study, heavy paternal smoking was associated with the risk of
early pregnancy loss . This negative outcome may be related to
secondhand smoke.
Hemolytic disease of the newborn (HDN) — also called
erythroblastosis fetalis — is a blood disorder that occurs when the
blood types of a mother and baby are incompatible. HDN is relatively
uncommon in the United States due to advances in early detection and
treatment, limiting it to approximately 4,000 cases a year.
Methemoglobinemia (MetHb) is a rare blood disorder that
affects how red blood cells deliver oxygen throughout your
body. Not everyone has symptoms, but nearly all people with
this condition have skin, nails or lips that are a distinctive shade
of blue or purple. In some cases, methemoglobinemia can be
life threatening.
Teratology
Teratology is the study of abnormalities of physiological
development in organisms during their life span. It is a sub-
discipline in medical genetics which focuses on the
classification of congenital abnormalities in dysmorphology
caused by teratogens.
PRENATAL DIAGNOSTIC TESTS
fetal diagnosis specialists provide accurate prenatal
diagnosis of birth defects using the latest technological
advances. Prenatal testing can involve blood tests,
imaging studies, chromosome analysis and other genetic
testing to assess your health as well as the baby's health.
Ultrasound examination
Fetal MRI
Fetal echocardiogram
Amniocentesis
Chorionic villus sampling
Fetal blood sampling
Ultrasound examination
An ultrasound examination is a non-invasive imaging study. The transducer
(a small, hand-held instrument) produces sound waves to create a picture
based on the density of the body tissues. The ultrasound exam can be used to
identify the gestational age of the fetus and whether the level of growth is
appropriate, assess the number of babies in the pregnancy, evaluate the
placental structure, location and blood flow, and - most importantly - it
allows a physical examination of the fetus. It is this complete evaluation of
the fetus that allows the most appropriate treatments to be undertaken.
Fetal MRI
A fetal MRI (magnetic resonance imaging) is another imaging test that offers
physicians information about anatomic structures. This test does not use
ionizing radiation to obtain the images, rather a magnetic field is used to
create the pictures for evaluation. It is safe for pregnant woman and fetuses
during the second and third trimesters. The MRI images can supplement the
information obtained from the fetal ultrasound and can provide additional
information regarding the fetal brain that can not be obtained from
ultrasound, as well as information about other fetal anatomic structures that
may guide care for the baby after delivery.
Fetal Echocardiogram
A fetal echocardiogram is an ultrasound specifically looking at the unborn
baby's heart structure and function. The fetal echocardiogram is performed using
similar equipment as that used for the detailed ultrasound of the whole baby, but
more specialized pictures and information are obtained of the baby's heart. The
fetal heart evaluation may be very important to help physicians prepare and plan
for infant’s delivery and for any special interventions needed. It is also
important with many different types of birth defects other than heart defects to
assess the heart’s function and determine appropriate treatment or fetal therapies
that may be needed.
Amniocentesis
An amniocentesis is a prenatal test that allows information about
the baby to be obtained from the amniotic fluid. This test can be
done any time after the 15th week of gestation. While watching
with ultrasound, a thin needle is guided through the mother's
abdominal wall into a pocket of amniotic fluid located in the
uterus. The amniotic fluid removed can be sent for testing
depending on what is indicated. Amniocentesis may provide
important information about the fetal chromosomes in addition to
many other tests which can be run if indicated.
Chorionic villus sampling
Chorionic villus sampling is a prenatal test performed between the 10th and
13th week of the pregnancy. It can be performed with a needle through the
abdomen, or through the cervix using a small catheter (tiny tube). This is also
done under direct ultrasound guidance. A small amount of tissue from the
placenta is removed and sent to the lab for evaluation of chromosomes, or for
specific genetic tests.
Fetal blood sampling
Fetal blood sampling (cordocentesis) can be performed in rare
situations where fetal blood is required to evaluate the fetus.
Medication can be administered and fetal blood transfusions
can be performed when needed for treatment of the unborn
baby.
IMMEDIATE NEWBORN CARE AT BIRTH
Although most newborn babies require only simple
supportive care at and
immediately after delivery, immediate care of the
newborn is essential for the
survival of the babies.
NEWBORN CARE DURING THE FIRST DAY
Assess the baby
Assess the baby every 30 minutes to 1 hour for at least 6 hours or until the
newborn is stable and stays warm and pink. On the first day, check the baby
for the following:
1. Breathing: the normal baby breathes 30-60 times a minute with no
gasping, grunting or in-drawing of the chest.
2. Warmth: check if the baby is warm - use a thermometer to take an
axillary temperature (must be between 36.50C to 37.40C).
3. Colour: check that the tongue, lips and mucous membranes (inside
the mouth) are pink.
4. Bleeding: check the cord for bleeding; if present, add another cord
clamp.
5. Breastfeeding: check if the baby is breastfeeding.
6. Take a complete history (maternal history, antenatal history and labour/
delivery) and do a physical examination.
NEONATAL RESUSCITATION
1. High-risk deliveries that may require resuscitation
include:
• ≤36 weeks gestation.
• Meconium staining.
• Foetal distress.
• Known congenital malformations.
• Multiple births.
• Malpresentation.
• Maternal complications such as diabetes, haemorrhage,
hypertension.
NEONATAL CARE ENVIRONMENT
Sound environment
• Avoid loud noise.
Light environment
• Use dimmed night light. This will help in starting a day/night sleep
schedule and support diurnal variations in hormone and temperature
levels.
Positioning
• Nesting is one of the key factors in maintaining the beneficial position
of a neonate and should be practiced routinely. It enhances muscle
strength and body control.
Handling
• Minimize handling of the neonate to avoid physiological and behavioural
stress.
Touch
• KMC facilitates intimate touching of the baby by the mother and should
be encouraged. Beyond KMC, for preterm neonates <30 weeks GA,
touch may be stressful rather than soothing. For older preterm
neonates, gentle touching can be helpful.
NEONATAL PAIN
Newborns experience pain. Pain in the neonate can be
classified into
three categories:
• Acute or physiological pain: from skin-breaking
procedures or tissue
injury caused by diagnostic or therapeutic interventions.
• Established pain: surgery or localized inflammatory (e.g.
abscess or
birth trauma).
• Prolonged pain: results from severe diseases like
necrotizing
enterocolitis or meningitis
 consequences of low birth weight

Low birth weight is associated with long-term neurologic

disability, impaired language development , impaired academic
achievement, and increased risk of chronic diseases including
cardiovascular disease and diabetes. Preterm infants carry
additional risk due to immaturity of multiple organ systems,
including intracranial hemorrhage, respiratory distress, sepsis,
blindness, and gastrointestinal disorders. Preterm birth is the
leading cause of all under-5 child mortality worldwide
Asphyxia. lack of oxygen or excess of carbon dioxide in
the body that is usually caused by interruption of breathing
and that causes unconsciousness

Retrolental fibroplasia (RLF), describes a disorder

occurring in premature, low-birth-weight infants. In this
condition, there is abnormal development of blood vessels in
the retina. Initially, the abnormal vessels develop in the
retinal periphery.
Consequences of Preterm Birth and Low Birth Weight

Children born low in birth weight are more likely than their
normal birth weight counterparts to develop a learning
disability, attention deficit hyperactivity disorder, or breathing
problems such as asthma . Approximately 50 percent of all low
birth weight children are enrolled in special education
programs.
Nurturing Low Birth Weight and Preterm Infants

Two increasingly used interventions in the neonatal intensive care unit

(NICU) are kangaroo care and massage therapy. Kangaroo care
involves skin-to-skin contact in which the baby, wearing only a diaper, is
held upright against the parent’s bare chest, much as a baby kangaroo is
carried by its mother (Ludington-Hoc & others, 2006).
Kangaroo care is typically practiced for two to three hours per day, skin-to-
skin over an extended time in early infancy
Preterm infants often have difficulty coordinating their
breathing and heart rate, and the close physical contact with
the parent provided by kangaroo care can help to stabilize the
preterm infant’s heartbeat, temperature, and breathing .
Preterm infants who experience kangaroo care also gain more
weight than their counterparts who are not given this care . A
recent study also revealed that kangaroo care decreased pain
responses in preterm infants
The weeks after childbirth present challenges for many new
parents and their offspring. This is the postpartum period,
the period after childbirth or delivery that lasts for about six
weeks or until the mother’s body has completed its
adjustment and has returned to a nearly prepregnant
state. It is a time when the woman adjusts, both physically
and psychologically, to the process of childbearing.
The postpartum period involves a great deal of adjustment
and adaptation. The adjustments needed are physical,
emotional, and psychological.