Teratogenic drugs

• Fetal hydantoin syndrome :

• Cause: exposure to hydantoin anticonvulsants during fetal development  such as: Phenytoin / Dilantin / carbamazepine .

• Presents with the following dysmorphic features :

1. Midfacial hypoplasia.

2. Small body size with microephaly.

3. Hypoplasia of the distal phalanx of the fingers and toes.

4. Hirsutism.

5. Cleft lip/palate.

6. Rib anomalies.

 Neuroblastoma has been shown to be associated with exposure to phenytoin and other hydantoins in utero.

• Fetal alcohol syndrome :

• Cause: exposure to alchol.

• Presents with:

1- Like hydantoin syndrome  midfacial hypoplasia / microcephaly / stunted growth. (NO Cleft palate & hirsuitism) 2- CNS damage , manifest with :

- Hyperactivity / Mental retardation / Learning disability.

• Old female >35 years (high risk pregnancy), at 10 – 12 weeks of gestation  scared of Down syndrome :

  • Made U/S and showed : increase fetal nuchal translucency

  • Most appropriate next step in management is: Chorionic Villus Sampling (CVS) "done at 10-12 weeks" for karyotyping.

Early Amniocentesis	Can be performed < 15 weeks. BUT reserved for whom CVS cannot be performed.
2nd trimester Amniocentesis	Done between 16 – 20 weeks GA.
Cordocentesis	- Can be performed : > 20 weeks gestation. - It's indicated in : Rapid karyotype Blood diseases as : Rh & fetal anemia In Mosaicism is suspected by CVS or amniocentesis to further assess fetal karyotype.
MS-AFP	Routinely performed in 2nd trimester for : Neural Tube Defect Abdominal wall defect Chromosomal anomalies if : B-hCG & estriol also assessed.

SO, the best test to detect fetal chromosomal anomalies in 1^st trimester is : CVS , indicated after abnormal U/S in high risk pregnancy.

• CVS increase risk of limb reduction defects , if the procedure is carried out between 9^th – 10^th week  so the most important influencing factor to decrease incidence of this is : Gestational Age of the fetus.

• Screening for GBS should be performed at 35-37 weeks gestation ( 2 – 3 weeks prior to the expected date of delivery ). With vaginal & rectal cultures.

• Positive cases should be treated with penicillin G during labor, even in the absence of frank chorioamnionitis, thus reducing the risk of neonatal infections.

• Toxoplasmosis in pregnancy :

  • DOC in first trimester: spiramycin

  • DOC in 2nd -3rd trimester: pyrimethamine and sulfadiazine.

  • Elective termination of pregnancy is an option in 1st trimester.

• Syphilis :

  • Penicillin desensitization is considered to be the treatment of choice for the pregnant patients with syphilis and having penicillin allergy.

• HIV :

- By treating HIV-infected women with zidovudine through our pregnancy & labor, and treating the newborn for the first 6 weeks of life  risk of HIV vertical transmission is reduced by 70% .

• Herpes simplex:

  • ACOG recommends to do Cesarean Section in all women who are in labor with active genital HSV lesions (1ry or 2ry).

Because risk of neonatal HSV infection is increased (which is fatal) if a normal vaginal delivery is done while mother has active HSV eruption.

• HBV :

  • Vertical transmission of hepatitis B from pregnant females to the unborn child can occur with active hepatitis B infection.

  • Newborns of mothers with active hepatitis B infection should be passively immunized at birth with hepatitis B immune globulin (HBIG) followed by active immunization with recombinant HBV vaccine.

• HCV :

  • The overall incidence of vertical transmission of HCV is approximately 2-5%.

  • All patients, including pregnant patients, with chronic hepatitis C should receive vaccinations against Hepatitis A and B if not already immune.