PERINATAL PATHOLOGY (grech, peri around, about + armor. natus the birth + pathology) — morbid conditions and diseases of a fruit and the newborn, to-rye arise in the perinatal period. Perinatal period (see) begins with the 28th week of pregnancy when the weight of a fruit reaches 1000 and more and height of 35 cm and more, includes the period of childbirth and comes to an end at the end of the 7th days of life of the newborn. On time of emergence of Pct allocate antenatal (prenatal), intranatal (arisen at the time of delivery) and post-natal (puerperal), or early neonatal, pathology.
Genesis of Pct is difficult and caused by disturbances of fetoplacental blood circulation, endocrine, exchange and immunol, the relations in system mother — a placenta — a fruit, and also influence of the infectious and toxic agents getting through an organism of mother to a fruit, features of a course of childbirth and degree of a maturity of a fruit and the newborn. Fetoplacental insufficiency during pregnancy leads to development hron, hypoxias, hypotrophies, functional immaturity and is followed by decrease in viability of a fruit and probable development of asphyxia (see. Asphyxia of a fruit and newborn ) and pneumopathies. According to various researchers, among causes of death of a fruit and the newborn in a perinatal perio first place is won by asphyxia of a fruit and the newborn, the second place — inborn malformations and the third — respiratory disturbances and an intracranial birth trauma (see. Perinatal mortality ).
Promotes development of Pct patol. the course of pregnancy (threat of an abortion, not wearing out, roll in An iye, late toxicoses of pregnant women) and patol, the course of childbirth (bystry and long childbirth, premature izlity amniotic waters, anomaly of presentation, pathology of an umbilical cord and placenta in labor, untimely or traumatic carrying out operational rodorazreshayushchy interventions). Pathology in labor is the reason of development of a birth trauma and asphyxia of the newborn.
Among the factors leading to pathology and death of a fruit before childbirth (during the period after 28 weeks), on the first place — toxicosis of the second half of pregnancy, a Rhesus factor conflict and pe-renashivany pregnancies (see. Perenashivany pregnancies , Rhesus factor , Toxicoses of pregnant women ). Toxicoses of pregnant women exert a great influence on emergence embryopathies (see) and fetopathies (see) and perinatal incidence and mortality.
At the complicated course of pregnancy (extragenital diseases, late toxicoses of pregnant women, a perenashivaniye) the fruit often antenatalno tests oxygen insufficiency, its metabolic disturbances and changes of a water salt metabolism are observed. At a perenashivaniye of pregnancy at newborns during adaptation changes of a water salt metabolism in a look gr perkaliyemiya and an eksikoza prevail. The metabolic acidosis, a hypoproteinemia with decrease in content of albumine and globulins are found in the children born by women with heart diseases and late toxicosis of pregnant women. At a diabetes mellitus at mother disturbances of carbohydrate and lipidic metabolism at the newborn are possible, and the hypoglycemia is followed by the high catabolism of protein leading to a hypoproteinemia and changes of vodnosolevy exchange.
Such diseases and patol, conditions of endocrine system of mother as a diffusion toxic craw, Itsenko's disease — Cushing, dysfunction of ovaries and bark of adrenal glands, exert adverse impact on a fruit and the newborn: at children note disturbances of activity of c. N of page, cardiovascular and endocrine systems. Diseases of blood at the pregnant woman, napr, hypochromia anemia and Verlgof's disease, especially immune form, are followed by displays of anemia and thrombocytopenia at newborns. The myasthenia at mother causes emergence of a neonatal myasthenic syndrome at the newborn (see. Myasthenia ).
Pre-natal infection (see), according to WHO data, 22% of newborns are a cause of death; 20% of embryos and fruits perish in the pre-natal period or are born with malformations (see). Inf. diseases can develop as till the birth of the child (pre-natal infections), and after it (post-natal infections). Pre-natal infections are caused by various viruses, mycoplasmas, bacteria, protozoa and fungi. Contagiums get to an organism of a fruit in various ways; the basic is the ascending way, but are possible also hematogenous and transplacental. The ascending way of penetration of contagiums is observed at threat of abortion on early terms, at istmiko-cervical insufficiency, the long anhydrous period in labor.
Infection of a fruit with colibacillus occurs hl. obr. in the ascending way at inflammatory diseases at the pregnant woman (a colpitis, pyelonephritis). The Kolya-bacterial infection can cause both death of a fruit, and the birth of the child with manifestations sepsis (see), meningitis (see) and an encephalomeningitis (see. Brain ). The role of a streptococcus of group B as causative agent of a pre-natal and early post-natal infection which can proceed as sepsis or meningitis increases.
Clinically congenital bacterial infection can have local character (conjunctivitis, vezikulez, otitis), and also to proceed in the form of sepsis. Pre-natal infections, especially bacterial origin, can proceed with a clinical picture of serious hypoxemic conditions and quickly lead of children to death. Occur among bacterial pre-natal infections listeriosis (see) and syphilis (see). Listeriosis is rather rare disease of which the inflammatory centers in a liver are characteristic, a spleen, lungs, kidneys, adrenal glands, in a meninx and substance of a brain, and also in went. - kish. path. In the inflammatory centers the contagium comes to light. At inborn syphilis specific granulematozny process arises in skin, a spleen, a liver, lungs and c. N of page of a fruit. In the centers of an inflammation treponemas sometimes are found.
At defeat by a virus of herpes in a liver and lungs of a fruit the centers of an alterativny inflammation develop. Damage of skin at antenatal infection with a virus of herpes meets seldom.
Pre-natal infection with yeast-like fungi results from aspiration of contents of patrimonial ways at the time of delivery and much more rare antenatalno more often. The centers of defeat are localized in a respiratory organs or in went. - kish. a path, and also it is frequent in the form of the centers of an alterativny inflammation in a brain.
Rather often pre-natal diseases cause respiratory viruses — influenza viruses, a parainfluenza, adenovirus, etc. At a pre-natal course of a disease patol, changes are localized in respiratory tracts of the newborn, but changes in a liver, kidneys, c quite often prevail. and. page. Damage of a brain in the form of an encephalomeningitis is observed.
Development also of the diseases caused by enteroiatogenny viruses, first of all Koksaki-virusami is possible (see. Koksaki-virusnye of a disease ). In this case the encephalomeningitis with defeat of almost all departments of a brain can develop. Along with it myocarditis, focal damages of a liver, kidneys, adrenal glands is observed.
Viral infections, especially rubella (see), can be followed by disturbances of development of an embryo and fruit, and generally those its bodies in which the cart ~ breeds you awake infections. It occurs both due to direct damage of laying of body, and as a result of consumption by the breeding activator of the substrates intended for fetation.
At transplacental infection of a fruit a mycoplasma development of an encephalomeningitis and dee-kvamativny pneumonia with preferential changes of alveolotsit is also possible. Cytoplasm, and less often in a kernel of the struck cells contains the activator. Around it there is a focal destruction of a cell. Also hemorrhagic diathesis comes to light.
Developing of a pre-natal protozoan infection is possible — toxoplasmosis (see). The most characteristic of it is emergence of the centers of a necrosis in a brain with development on their place of cysts. Around these sites the gliosis of tissue of brain, and also focal adjournment of salts of calcium is noted.
In the post-natal period the dominating activators inf. diseases of newborns golden staphylococcus, colibacillus, a klebsiyella, and also the mixed virus and bacterial infection are.
Preventive actions for the prevention of Pct shall cover the period of pregnancy (antenatal prevention), the period of childbirth (intranatal prevention), and also the period after the birth of the child (post-natal prevention).
The principles of antenatal prevention of Pct are in creating for the pregnant woman such environment of work and life at which the possibility of preservation of her health and favorable fetation would be provided.
Systematic overseeing of the pregnant woman since early terms - pregnancies, timely diagnosis of possible complications and the differentiated observation depending on a risk degree of Pct are a basis of rendering preventive and to lay down. the help to both mother, and a fruit (see. Antenatal protection of a fruit ).
Use of pharmaceuticals during pregnancy shall • to be carried out under the close check of the doctor. The major problem connected using pharmaceuticals at pregnant women is the possibility of their transplacental transition and adverse influence on fruit (see). Through a placenta there pass Omnoponum (pantopon), morphine, ether, nitrous oxide, viadril, Promedolum, barbiturates, cardiac glycosides, aminazine, vitamins, the majority of hormones, antibiotics, streptocides and many other drugs. Barrier function placentae (see) it is shown only in fiziol, conditions. Under the influence of pathogenic factors (infectious, allergic, toxic) this function decreases.
Decrease in Pct is closely connected with improvement of obstetric care to mothers. Thanks to development new laboratory, functional and a wedge, methods of a research it is possible to control fetation. By means of ulrazvukovy scanning (see. Ultrasonic diagnosis ) cavities of the uterus take measurement and establish durations of gestation since 4 weeks, reveal not developed and polycarpous pregnancy, predict a possibility of abortion. Since 12 — 13 weeks of pregnancy it is possible to receive the image of a head, and from 16 weeks — trunks of a fruit and to take their measurement in time to reveal lag or other pathology of development, based on direct correlation between the biparietal diameter of eatery and duration of gestation. Ultrasonic scanning allows to reveal hydrocephaly, a nanocephalia, universal hypostasis of a nlod and other anomalies of development, to determine the sizes of a placenta, its localization and premature amotio.
The pct of immune and genetic character comes to light by means of methods of ultrasonic diagnosis, amniocentesis (see) with an intake of amniotic liquid and blood of a fruit. Use of amniocentesis allows to make immune genetic researches. Fetoamnioskopiya and sex determination of a fruit at the hereditary pathology linked to a floor promote decrease in number of inborn genetic diseases.
Research of amniotic waters by method spektrofotometriya (see) allows to diagnose vnutriutrobno a hemolitic disease of a fruit. Biochemical, researches of amniotic waters in this case reveal increase in protein content, glucose, and also fruit protein of alpha-fetoprotein. The research of protein content, alpha and beta pro-theine, immunoglobulins in blood of a fruit and amniotic waters is important in diagnosis of a pre-natal infection, weight of a hemolitic disease and probability of development of a SFE of l other memb a wound of a disease.
An electrocardiography and a phonocardiography of a fruit (see), cardiomonitor observation and amnioskopiya (see) are used for assessment of a condition of a fruit before childbirth. With their help timely reveal a hypoxia of a fruit and pathology of an umbilical cord. The research of microdoses of blood from the prelying part is used for definition of an acid-base state and tension of oxygen. The complex data obtained in the way biochemical of a research of amniotic waters, blood of a fruit and kardiotakhogramm, permit to improve prevention of Pct.
Prevention of infectious pathology is of great importance during pregnancy, childbirth and in the early neonatal period. For these purposes it is necessary to carry out timely diagnosis and treatment acute and latent inf. diseases at pregnant women, strictly to observe a dignity. - a gigabyte. the mode during the rendering grants to the woman in labor and newborn (rational care of the newborn, breastfeeding etc.).
See also Antenatal pathology .
Bibliography: Bebson S. G., etc. Maintaining pregnant women with the increased risk and an intensive care of the newborn, the lane with English, M., 1979; Garmasheva N. JI. and Konstantinova H. H. Introduction to perinatal medicine, M., 1978; Ate and z and r about in and I. P. Cerebral disturbances at the newborns who transferred a birth trauma and asphyxia, D., 1977; To and r yu-shenkov A. P. Influence of harmful factors on a fruit, M., 1978; Kosheleva N. G. Prevention of perinatal incidence and mortality, M., 1979; Novikova E. Ch.; and Polyakova G. P. Infectious pathology of a fruit and newborn, M., 1979; Pathological anatomy of diseases of the perinatal period and period of chest age, under the editorship of V. K. Romashevsky, M., 1979; Potter E. Pathological anatomy of fruits, newborns and children of early age, the lane with English, M., 1971; The Prevention of perinatal incidence and mortality, the lane with English, M., WHO, 1973; Savelyeva G. M. Resuscitation of the newborns (who were born in asphyxia), M., 1973; A. V. Tsinzerling and Kalashnikov E. P. Pre-natal infections in the perinatal period, Arkh. patol., t. 41, No. 10, page 49, 1979; Infections of the fetus and the newborn infant, ed. by S. Krugman a. A. A. Gershon, p. 1, N. Y., 1975; To loos K. u.Vo-gel M. Pathologie der Perinatalperiode, Stuttgart, 1974; Neonatal medicine, ed. by F. Cockburn a. S. M. Drillien, Oxford a. o., 1974; Neonatalogy, ed. by R. Behrman, St Louis, 1973; Topics in perinatal medicine, ed. by B. Wharton, Kent, 1980.
A. V. Tsinzerling, I. P. Yelizarov.