Teratology
8 important questions on Teratology
Environment (teratogens, mechanical)
What are Teratogens?
1. Critical period
2. Dose dependent
(3. Genotype dependent > multifactorial)
How can congenital anomalies be prevented?
- Diet (e.g. Folic acid, iodine, alcohol, smoking)
- Controlling pre-conceptional and gestational diabetes
- Avoiding exposure to hazardous substances (e.g. Some drugs)
- Vaccination (e.g. Rubella virus)
- Education to health staff
What is preconception screening?
- Higher grades + faster learning
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What are the three phases of fetal growth?
- Cellular hyperplasia - week 8-20: rapid mitosis and increase of DNA
- Both cellular hyperplasia and hypertrophy - week 20-32: less mitoses, more increase of cell size
- Cellular hypertrophy - Week 32-birth: rapid increase of cell size, rapid accumulation of fat, growth of muscle mass and connective tissue. The growth velocity diminishes after week 34.
What is intrauterine growth restriction (IUGR) ?
- A fetus/baby with with of less than 2500g at term
- or < percentile 10 of the normal population
- Higher risk perinatal mortality!
What is the Twin-Twin Transfusion syndrome (TTTS) ?
- Vacular anastomoses (verbinding)
- monochorial twins (up to 30%)
- Mortality about 30%
- severe morbidity if survival
What is Twin Reversed Arterial Perfusion Sequence (TRAP) ?
- Monochorial twins
- artery to artery anastomosis: if the arterial pressure in one part of a twin is higher than in the other part, there is reversal of the blood flow in the perfused (cardiac) part, the other part of the tins functions as a pump
- mortality about 50%
Complications twinning - Discordant twins
Monochorial twins:
placenta vascular anastomoses -> unequal blood flow between the fetuses
Dichorial twins:
genetic differences, in utero "crowding"
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