Professional Documents
Culture Documents
FWACS;FMCOG;FICS;D.MAS
TERM PLACENTAL BARRIER IS A
CONTRADICTION: Most drugs pass thru
> 2/3 of women in pregnancy took non
prescription medications
Risk-benefit ratio of drugs info should be
epilepsy
< 1% drug exposure maybe( main suspect by
15,000/day ; teratogenic
Isotretinoin (accutane)& etretinate (tegison);
derivatives of vit A
Isotretinoin: intractible cystic acne; drug
of TM
Busulphan, cyclophosphamide, chlorambucil,
melphalan, carmustine, thiotepa
Teratogenic:
Busulphan for leukemia( iugr, cleft palate, eye
defects
Cyclophosphamide for ovarian endometrial
hypertelorism
Vincristine, vinblastine( onconvin, vincasar):
teratogenic ? Causal or casual
Benefit> risk
Daunorubicin, doxorubicin, bleomycin,
dactinomycin: ? Teratogenic benefit> risk
Same applies to the miscelaneous agents like
hydroxyurea
Tx of autoimmune dx and post organ
transplant
Azathioprine ; renal transplant? Anomaly
NTD
Offsprings of epileptic: 5 x risk of
epilepsy( 2-3%)
Teratogen: epilepsy or + drugs
Epilepsy with no drugs teratogenic
spermicides
Antibacterial, antifungal ,antivirals,
antiparasitic
Antibacterials: only known teratogenic is
tetracycline , effect is cosmetic and
transient(yellowish to brown discoloration of
decidous not permanent teeth, except given
in childhood.(6/12-5yrs) no risk of structural
malformations
Penicillins: ok
Sulfonamides: no risk except in premature/;
jaundice
Sulfa with trimethoprim; not a known
teratogen
Sulfasalazine: ok
Nitrofuantoin: ok
Aminoglycosides and other antiTB drugs:
Streptomycin/kanamycin(dose related):
Ototoxicity in 3-11% of exposed. Ok for short
term course.
No teratogenic risk with rifampicin, PAS, or
ethambutol,
Metronidazole: ok , nil teratogenic effects
Erythromycin;ok
Cephalosporins:ok
Clindamycin:ok
Fluroquinolones: no info, do not use in preg.
Clotrimazole, miconazole, nystatin: not
teratogenic
Amphotericin B: systemic mycotic infections:
not teratogenic
Griseofulvin: mycotic infection of skin and
phenobarbital,
secobarbital,butalbital,diazepam,chlordiazep
oxide, chloral hydrate and meprobamate,
Barbiturates: no evidence of teratogenicity
Diazepam: no evidence of teratogenicity ,
evidence
Chloral hydrate: safe in preg.
Antidepressants; tricyclic/non tricyclic agents
Tricyclic: Limb reduction defects found with
teratogenic
Others relatively safe
Phenothiazines ; also used as antiemetics in
preg.( chlorpromazines,
perphenazine,triflupromazine): not
teratogenic
others,; halpoperidol: no evidence of
teratogenicity
Avoid in preg, however leads to 70% chance
of relapse of affective disorder vs 20% with
continuation
Risk: 1st tm;11.5% risk; CVS and ebstein
hypothyroidism,Polyhydraminos; b/c of
diabetes insipidus
Perinatal effect: hypotonia, lethargy and poor
feeding
Propylthiouracil and methimazole cross
placenta to cause goiter in fetus
T3 and T4 do not
PTU> METIMAZOLE which causes scalp
effects
Terbutaline: (preterm labor): not teratogenic
Cromolyn sodium: safe
Isoproterenol and metaproterenol: (topical
day
Others: neurodevelopmental delay
FAS: at least 1 from of each of 3 categories
Growth deficiency pre & postnatally
Facial anomalies including small palpebral
fissure, indinstict or absent philtrium,
epicanthic folds, flattened nasal bridge, short
nose length of nose, thin upper lip, low set
unparallel ears and retarded mid facial dev.
CNS dysfunction including microcephaly ,
various degree of mental retardation or other
neurodev anomaly like attention deficit and
hyperactivity
Overall nos drinks/ occassion was the
alchohol strongest predictor; binge drinking
dangerous
Overall nos drinks/ occassion parralels
admission,SIDS
Social problems may be more important,
humans
Barbiturates; uncommon
Problem; effect of withdrawal
infant
Antihypertensives: thiazide diuretics may
no effect
Clonidine ; safe
Heparin : do not cross
Warfarin; 98% bound to plasma protein:
Antibiotics
Penicillin; safe
Cephalosporins: safe
Tetracyclines; tooth staining & delayed bone
hypothyroidism
Caffeine: exccess; infant wakefulness; limit
intake
Smoking: infant risk from passive smoking
Diagnostic radiation is not tratogenic
< 5 to 10 cGy : non teratogenic
Mat chest radiograph 0.008cGy
IVU-0.4cGY
CT-0.25cGy per slice
Barium enema-1cGy
Technetium 99m scan -1to 3 cGy
Thallium 201 scan-0.5 to 1 cGy
Maternal consideration : do not hesitate: ?
Fetal irradiation of 2 cGy is associated with
child risk of leukemia by 1.3 to 1.8 fold
Uss is safe
MRI: no ionizing irradiation
Therapeutic radiation : teratogenic
Fetilization to implantation: all or none
Teratogenic effects: microcephaly, mental
system
Fever in 1 st tm may cause NTD and
dysmorphic syndromes?
Saunas? teratogenic
During period of organogenesis
Is medication a known teratogen
Potential adverse fetal/neonatal effect
Risk benefit ratio to mother
Is dx more of factor than drug
Sources of info on medication
Counselling of pt
Unknown: 65- 70% of congenital
malformations;
20-25% secondary to genetic abnorm
3-5% intrauterine infection
4% - mat dx DM, Phenyketonuria, epilepsy
< 1% drug exposure maybe( main suspect by
drugs
Use minimum dose for desired effect
Absence of data does not imply safety