Part 4: Transplacental Disorders

“In our plan of teaching… the purpose is to get the student to think, and to think not only when he is in his seat but also when he is on his feet, which is a much more difficult proposition.”
– John Murphy –
Transplacental Disorders

The transplacental disorders make a useful addition to your mental armoury, especially when diagnosing disease met in the neonatal period.

Transplacental disorders are caused by the transmission of an agent from the maternal circulation across the placenta to affect a developing baby. A good example is maternal rubella infection, in which the virus enters the developing baby and causes serious congenital malformations.

A more extreme example of a transplacental disease is neonatal hyperthyroidism secondary to maternal Grave’s Disease.
Look up eponyms as you come across them. A good place to look is www.whonamedit.com
Robert Graves (1797-1853). Physician of the great Dublin school, Graves was a tall vigorous man with many talents. One such talent was art and he was said to be a gifted painter. He was also exceptional with languages and was once imprisoned in Austria as a German spy because no one believed an Irishman could speak German so well. In another of his many travels he saved a ship and its mutinous crew during a storm in the Mediterranean. The ship sprang a leak, pumps failed and the crew attempted to abandon. Graves holed the one lifeboat with an axe and repaired the pumps with leather from his own shoes. All aboard survived.

An excellent teacher, Graves helped to bring the traditions of the great Boerhaave to Ireland, such as learning medicine at the bedside. He said, “From the very commencement the student should set out to witness the progress and effects of sickness and ought to persevere in the daily observation of disease during the whole period of his studies.” Graves was the first to fully describe exophthalmic goitre, now called Graves’ disease, which may affect neonates by passing across the placenta of the mother while pregnant. Among his other achievements were timing the pulse by watch and giving food and liquids to patients with fever instead of withholding nourishment. He light-heartedly suggested that his epitaph should read: “He fed fevers.”