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CNAA / Theses / 2007 / May /

Particularities of affecting the foetus and the newborn in intrauterine infection


Author: Valeriu David
Degree:doctor of medicine
Speciality: 14.00.15 - Pathological Anatomy
Year:2007
Scientific adviser: Ion Fuior
doctor habilitat, professor, Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care
Institution:
Scientific council:

Status

The thesis was presented on the 30 May, 2007
Approved by NCAA on the 20 September, 2007

Abstract

Adobe PDF document – 0.67 Mb / in romanian

Thesis

CZU 618.3-002-053.31

Adobe PDF document 8.87 Mb / in romanian
138 pages

Keywords

intrauterine infection, mother-plancenta-foetus, pathomarphological investigation, intracitoplasmatic inclusions, pulmonary blood circulation, pneumopathy, hyaline membrans, perinatal lethality, ways of affection, optic microscopy, electronooptic microscopy

Summary

Intrauterine infection presents an acute problem in perinatal period, being determined by a high rate of morbidity and mortality. Within the morphological retrospective research of 601 cases of children who died during the perinatal period, it was found that the causal structure of perinatal mortality, is due to “Some infections which origins are found in the perinatal period” – 71,05±2,2% and intrauterine infection rate being – 52,22%.

408 cases of death in various periods of gestation were present in a huge study with the appliance of the complex methods of examination with the help of immuno-fluorescence, bacteriology, histiovirusoscopy and bacteriososcopy, electronic microscopy, morphology of specimen tissue, and a profound research.

Results obtained showed the morphologic particularities in affecting the foetuses and newborns and anatomic-physiologic particularities of the pulmonary blood circulation.

In the etiologic structure of the intrauterine infection the viral infections are the main – 55,4±3,3% and infection with mixt determinism in – 20,6±4,4% cases. Bacteria infection presented 16,9±4,5% cases.

The transmission of the pathological effects on the foetus, takes place, as a rule, through the placenta, being the main in the mother-placenta-foetus system. The study applied on 291 placentas of the same number of foetuses, showed that in the inflammatory process, the inflammation presented 77,7±2,8%, the mixt way prevailed – 36±4,7% and the ascendant – 21,6±5,2%, the rate of the haematogenous way being in 19,2±5,3% cases. Intrauterine infection of the foetus is produced hematogen-transplacentar in 194 (66,7±3,4%) cases, mixt – 53 (18,2±5,4%) cases and on the ascendant way – 44 (15,1±5,4%) cases. At the same time, their incidence depending on the infectious etiologic pathology.

The role of the anatomic-physiologic particularities of the pulmonary blood circulation was established in the evolution of various clinical-morphopatological forms, in particular the lungs, which is a basic mediator factor in the intrauterine influence.

Among the risk pathologies of the perinatal period, as many decades until now, the pneumopathy – 75,3±3,2% prevails (162 cases). It was appreciated that amongst the decisive factors of the etiology of the pneumopathy, the infectious factors have a great role in 115 cases, (95,7%), in particular, those with viral origin– 58,6±3,9%, and mixt – 19,1±6,2%. The infection of bacterial origin has also an important role– 14,2±7,1%. In conformity with the data obtained at the level of electronic microscopy, the appearance of the pneumopathy as part of the bacterial infection is due to the disorder of the forming of the glycogen, being an essential component in the surfactant synthesis.

The study performed with the appreciation of the sequence of the injury of the foetal organs and the central nervous system as part of the intrauterine infection depending on the etiology, ways of affection and the particularities of the fetal blood circulation, morphopatological change being different in cases of placenta affection, including the implementation of the results obtained in the medical practise, they will allow the real appreciation of the individual status of the baby, will increase the effectiveness of prophylaxis of the basic disease and will diminish its complications by the appliance of the a early etiotrop therapy and adequate pathogenesis.