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PREVENTION OF MATERNAL AND FETAL INFECTION

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PREVENTION OF MATERNAL AND FETAL INFECTION

  1. 1. PREVENTION OF MATERNAL AND FETAL INFECTION <ul><li>Professor Peter Baillie </li></ul><ul><li>MBBCH (WWRAND), FCOG, MRCOGG, FRCOG </li></ul><ul><li>- Dean (Biological Sciences) </li></ul><ul><li>Director (Clinical Nutrition & Research Center) </li></ul><ul><li>BAQAI MEDICAL UNIVERSITY </li></ul>
  2. 2. IS INFECTION IN PREGNANCY A MAJOR PROBLEM? <ul><li>MATERNAL DEATH RATE 400-600 PER 100,000 DELIVERIES. </li></ul><ul><li>INTRAUTINE DEATH RATE 10 TO 83 PER 1000 DELIVERIES </li></ul><ul><li>NEWBORN DEATH RATE </li></ul><ul><li>WORSE IN PAKISTAN THAN NEIGHBOURS. </li></ul><ul><li>LONG TERM EFFECT – SCHOOL PERFORMANCE. </li></ul>
  3. 3. LONG TERM SOLUTION LIES IN SOCIETY <ul><li>“ THE CAUSES OF DISEASE LIE IN MOLECULAR MEDICINE, BUT THE CURES LIE IN EPIDEMIOLOGY” – GEOFFREY ROSE. </li></ul><ul><li>e.g. </li></ul><ul><li>INFECTIOUS DIARRHOEA IN THE DEVELOPED WORLD IS RARE BECAUSE THE EMPHASIS IS ON CLEAN WATER. </li></ul>
  4. 4. <ul><li>INFECTIOUS DIARRHOEA IN THE DEVELOPING WORLD IS COMMON AND LETHAL BECAUSE OF SUBNUTITIONAL LACK OF RESISTANCE AND AN EMPHASIS ON ANTIBIOTIC TREATMENT OF INDIVIDUALS. THIS LEADS TO ANTI BIOTIC RESISTANCE AND SPIRALLING INFECTIVE COSTS. </li></ul>
  5. 5. PROBLEM OF INFECTION IN PREGNANCY IN PAKISTAN <ul><li>THE MORTALITY OF VIRAL HEPATITIS </li></ul><ul><li>MATERNAL 1% IN DEVELOPED WORLD </li></ul><ul><li>10%+ IN DEVELOPING WORLD </li></ul><ul><li>FETAL 10% IN DEVELOPED WORLD </li></ul><ul><li>50 – 90% IN DEVELOPING </li></ul><ul><li>WORLD </li></ul><ul><li>MANAGEMENT GUIDELINES IN DEVELOPED WORLD ARE CONSERVATIVE AND INAPPLICABLE TO OUR CIRCUMSTANCES. </li></ul>
  6. 6. PREGNANCY AND INFECTION <ul><li>FUNDAMENTALLY IN ALL LIVING CREATURES THERE IS A CONFLICT BETWEEN SURVIVAL AND REPRODUCTION FOR LIMITED ENERGY RESOURCES. THE PRICE IN HUMAN PREGNANCY. </li></ul><ul><li>THE WISDOM OF BODY (HOMEOSTASIS) IS CRITICAL AND ALTERS ACCORDING TO REPRODUCTION IN GROWTH, METABOLISM, BRAIN FUNCTION AND IMMUNOLOGY. </li></ul><ul><li>ADAPTATION TO INTRAUTERINE LIFE </li></ul><ul><li>ADAPTATION TO EXTRAUTERINE LIFE </li></ul><ul><li>ADAPTATION TO REPRODUCTIVE LIFE </li></ul><ul><li>REPRODUCTIVE LIFE </li></ul><ul><li>SENESCENCE </li></ul>
  7. 7. <ul><li>THIS IS SYSTEMS BIOLOGY </li></ul><ul><li>WE WILL CONFINE OURSELVES TO INFECTION AND IMMUNOLOGY (DEFENCE MECHANISMS) </li></ul>
  8. 8. PREGNANCY AND IMMUNOLOGY (DEFENCES AGAINST INFECTION) <ul><li>PREGNANCY SHOULD NOT HAPPEN AS THE FETUS AND PLACENTA ARE FOREIGN TO THE BODY – LABOUR IS DELAYED FETO-PLACENTAL REJECTION ( SLOUGHING OF A GRAFT) </li></ul><ul><li>IMMUNOLOGY THEREFORE CENTRAL TO PREGNANCY, NOT HORMONES, AND IS COMPLETELY DIFFERENT TO NON PREGNANT STATE. </li></ul><ul><li>EXQUISITE IMMUNE SYSTEM WHICH COMPRISES CIRCULATING ANTIBODIES, CELL MEDIATED IMMUNITY AND INNATE IMMUNITY. </li></ul>
  9. 9. <ul><li>IN PREGNANCY,  CIRCULATING ANTIBODIES,  CELL MEDIATED IMMUNITY AND COMPENSATORY  INNATE IMMUNITY IN MOTHER. FETUS IMMATURE IMMUNOLOGICALLY. </li></ul><ul><li>CLINICAL IMPLICATIONS – AUTOIMMUNE DISEASE, VIRAL INFECTIONS AND SEVERE INFECTIONS IN PREGNANCY IN DEPRIVED COMMUNITIES ESPECIALLY AFTER PREGNANCY </li></ul><ul><li>---> DEATH </li></ul>
  10. 10. <ul><li>KISS </li></ul>
  11. 11. WHAT CAN BE DONE? <ul><li>PREVENTION – SOCIETAL, MEDICAL </li></ul><ul><li>PHARMACOLOGICAL PREVENTION e.g. MALARIA, HIV. EFFECTS OF DRUGS ON FETUS. </li></ul><ul><li>IMMUNIZATION esp. NEONATE </li></ul><ul><li>TREATMENT – ANTISEPSIS PREFERABLE TO ANTIBIOTICS. </li></ul>
  12. 12. SPECIFIC INFECTIONS AND PREGNANCY CONDITIONS <ul><li>EARLY PREGNANCY – STARTS 6 MONTHS PRIOR TO PREGNANCY AND ENDS AT 8 WEEKS WITH PLACENTAL FORMATION – EFFECTS ON TOXINS. </li></ul><ul><li>INDUCED ABORTION </li></ul><ul><li>PUERPERAL BACTERIAL SEPSIS – MAY BE DELAYED esp. BY ANTIBIOTICS </li></ul><ul><li>POPULATION EDUCATION AS IN NEPAL </li></ul><ul><li>ANTISEPSIS NOT ANTIBIOTICS </li></ul><ul><li>RECOGNITION OF SEVERE SEPSIS </li></ul><ul><li>DIC </li></ul>
  13. 13. FETAL INFECTION <ul><li>PLACENTOTROPHIC VIRUSES – DNA, RNA esp. C.M.V, HIV, RUBELLA, HERPES, PARVO VIRUS </li></ul><ul><li>Bacterial Vaginosis -> Premature Delivery </li></ul><ul><li>Clinical Dilemma </li></ul><ul><li>Cervical Invasion And Inflammation </li></ul><ul><li>Labour and ruptured membrane H.P.V, Streptococcus </li></ul><ul><li>Neonate Clean Delivery Reduces Neonatal Deaths By 25 – 40% </li></ul><ul><li>Post Delivery Environment </li></ul><ul><li>Early Care In deprived Environment </li></ul><ul><li>NEONATAL IMMUNIZATION </li></ul>
  14. 14. CONCLUSIONS <ul><li>SOCIETAL EDUCATION – NEPAL </li></ul><ul><li>DOCTORS – UNDERSTAND PREGNANCY </li></ul><ul><li>– ANTIBIOTIC USAGE </li></ul><ul><li>– RECOGNITION OF </li></ul><ul><li>PREGNANCY RELATED </li></ul><ul><li>ILLNESS </li></ul><ul><li>THE IMPORTANCE OF CHECKS AND BALANCES IN PAKISTAN e.g. DENGUE. </li></ul>
  15. 15. <ul><li>THANKYOU </li></ul>

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