Signs of fetal hypoxia, detection and treatment tactics during pregnancy

During pregnancy, the mother's body provides everything necessary for the baby growing inside her. The fetus receives oxygen and nutrients from the woman's circulatory system through the placenta. But it happens that there is not enough oxygen and a dangerous condition develops - fetal hypoxia. Why does she appear? What are its risks? How to identify the condition? And what treatment methods does modern medicine offer? To these questions FAN answered by Candidate of Medical Sciences, obstetrician-gynecologist at the Women's Medical Center Evgeniy Petreikov.

Causes of fetal hypoxia

From the moment of conception, the organisms of mother and child form a single system. And the health of the future baby largely depends on the woman’s health and the normal course of pregnancy. Intrauterine fetal hypoxia develops against the background of blood supply disturbances in the woman’s body. Insufficient blood flow provokes oxygen starvation of the fetus and causes dangerous processes.

This can happen for various reasons, including:

• chronic diseases of women;
• pregnancy pathologies.

“With systemic diseases of the mother that affect the blood vessels, the body does not give enough blood to the placenta,” comments obstetrician-gynecologist Evgeniy Petreikov. “Such diseases include lupus erythematosus, primary antiphospholipid syndrome, chronic hypertension, which causes vascular tone.”

These diseases place a woman at risk for developing fetal hypoxia during pregnancy. Pathology can also occur against the background of genetic abnormalities in the mother, epilepsy and iron deficiency anemia. The latter condition is especially widespread among expectant mothers. With anemia, the blood carries significantly less oxygen throughout the body, and the fetus does not receive it in sufficient quantities.

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Causes

The factors that provoke the development of hypoxia in the newborn are very numerous. Conventionally, they can be divided into 4 large groups:

Antenatal causes (acting during pregnancy)

These include:

• severe somatic diseases of the mother (cardiovascular, respiratory, endocrine pathology),
• chronic intoxication of a pregnant woman (smoking, drinking alcohol, using drugs, occupational hazards, disturbed ecology).

This list also includes:

• premature and post-term pregnancy,
• gestosis,
• severe pronounced anemia,
• bleeding during pregnancy (previa, placental abruption),
• intrauterine infection of the fetus with chronic maternal infections and acute infection suffered during pregnancy,
• polyhydramnios and oligohydramnios,
• multiple pregnancy.

In addition, hypoxia may be to blame for:

• Rhesus conflict pregnancy and antiphospholipid syndrome,
• permanent threat of miscarriage and development of fetoplacental insufficiency,
• constant stress, unfavorable living conditions, poor nutrition.

Intrapartum causes (complicated labor)

This group includes:

• protracted or, conversely, rapid labor,
• birth injury to the fetus (damage to the brain or spinal cord),
• labor stimulation with oxytocin,
• surgical delivery (application of obstetric forceps, caesarean section).

This group also includes:

• drop in blood pressure during childbirth,
• preeclampsia and eclampsia during childbirth,
• placental abruption during childbirth,
• hypoxia of a woman during general anesthesia,
• uterine ruptures,
• anomalies of labor (discoordination of labor forces).

Pathology from the umbilical cord

• true nodes and their tightening of the umbilical cord,
• rupture of the umbilical vessels,
• umbilical cord entanglement,
• umbilical cord compression.

Fetal causes (from the fetus).

These reasons include:

• hemolytic disease of the fetus and newborn (anemia due to hemolysis of red blood cells),
• fetal malformations (anomalies of the cardiovascular and pulmonary systems),
• infectious intrauterine diseases,
• hemorrhages in the brain, adrenal glands.

Asphyxia of the newborn

Asphyxia, which subsequently turns into hypoxia of the newborn, develops as a result of blockage of the respiratory tract (ingestion of amniotic fluid and meconium by the child, blockage of mucus, tight entanglement of the umbilical cord, prolonged and problematic birth of the head, and others).

Oxygen starvation of the fetus in pregnancy pathologies

Chronic diseases can provoke complications during pregnancy, so women suffering from hypertension, anemia or other systemic diseases need especially careful attention from a doctor. They must strictly follow the specialist’s recommendations and register with the antenatal clinic as early as possible.

But even for a seemingly healthy expectant mother, pregnancy may not proceed as desired. Previously undetected vascular diseases can lead to the formation of blood clots during pregnancy. Serious and severe complications of pregnancy are:

• placental abruption, in which part of the vessels supplying the placenta “switches off” and bleeding begins;
• placenta previa is its pathologically low location, disrupting the blood supply to the uterus. The lower the placenta is located, the thinner the walls of the uterus become and the fewer vessels nourish the placenta and the fetus in it;
• preeclampsia is a pathological condition that causes a sharp increase in blood pressure in a woman, which can lead to dangerous consequences, including the death of the mother.

All these conditions require mandatory medical monitoring. They are dangerous not only due to fetal asphyxia, but also pose a direct threat to the life of a woman. Treatment of the mother during their diagnosis is carried out strictly in a hospital setting. And if preeclampsia is detected, the doctor will recommend a set of mandatory measures that will reduce the risk of transition from mild to moderate and severe pathology, and also reduce the severity of oxygen starvation of the fetus.

“Observations show that as the mother’s age increases, the risk of pathologies during pregnancy increases,” notes obstetrician-gynecologist Evgeniy Petreikov. — Today, more and more women decide to become mothers for the first time at the age of 30–35. At the same time, many may develop chronic diseases that in ordinary life they simply do not notice and do not contact doctors about. Thus, hypertension is often detected after pregnancy, which becomes a risk factor for complications.”

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Consequences and prognosis

Mild and moderate hypoxia with timely and high-quality treatment does not lead to serious consequences, but severe hypoxia is dangerous due to the development of the following conditions:

• anxiety, restlessness of the child and mental lability;
• retardation in physical and mental development, headaches and development of neurocirculatory dystonia;
• increased intracranial pressure;
• development of epileptic syndrome and hydrocephalus;
• formation of brain cysts;
• damage to the cranial nerves and loss of their functions.

Rare consequences of severe hypoxia in a newborn include disability of the child or death.

The prognosis depends on the degree of hypoxia. With mild and moderate hypoxia and adequate therapy, the prognosis is favorable; with severe brain hypoxia, the prognosis is questionable.

Types of hypoxia

Based on the nature of the development of the condition, doctors distinguish two types.

• Chronic fetal hypoxia . It develops from the first weeks after conception against the background of chronic diseases of the mother. And it manifests itself as a pronounced retardation in the growth and development of the child. Chronic hypoxia is especially noticeable in the third trimester, when the baby must gain 200-300 grams of weight weekly. And against the background of oxygen starvation, his weight gain can be only 50-60 grams. The main danger of this condition lies not only in the pronounced developmental delay. Chronic hypoxia can lead to fetal death or cause acute asphyxia, which can also be fatal.
• Acute fetal hypoxia. It can develop during pregnancy and childbirth. This is always a dangerous pathological condition that occurs quickly and requires immediate action by doctors. Acute oxygen deficiency can result from placental abruption - complete or in a large area, which is always accompanied by bleeding. It is provoked by an epileptic attack in the mother, during which the woman’s breathing is disrupted or temporarily stopped.

Fetal hypoxia during childbirth caused by eclampsia is especially dangerous. It can cause a stroke in the mother or lead to the death of the woman and child.

Consequences of hypoxia in a newborn

A mild degree usually does not have serious consequences. Severe hypoxia can lead to damage to the central nervous system, cerebral edema, convulsions, and areflexia. Damage to the respiratory system leads to pneumopathy and pulmonary hypertension. Problems with the cardiovascular system can be heart and vascular defects.

You can tell that a newborn is suffering from hypoxia by frequent regurgitation, vomiting, and enterocolitis. The consequences of severe perinatal hypoxia are DIC syndrome and secondary immunodeficiency.

How to determine fetal hypoxia

If a woman registers with the antenatal clinic on time, regularly visits the doctor and follows his recommendations, the likelihood of hidden oxygen starvation in the child is minimal. A doctor, assessing the patient’s condition, can assume the development of fetal hypoxia during pregnancy based on a number of signs already in the early stages.

At each visit to the doctor, the expectant mother’s blood pressure, abdominal volume, weight are measured, and the heartbeat of the future baby is listened to. Based on these signs, the doctor monitors the growth and development of the baby. And if he notices deviations, he will definitely order additional examinations.

In the later stages, when a woman clearly feels the baby’s movements, they become an indicator of his healthy development. You should be concerned and definitely consult a doctor if the sensation of movement suddenly disappears. It seems that the baby has calmed down or has begun to move much less and less frequently than usual. An equally alarming sign will be excessive activity of the child. If the frequency of movements has rapidly increased, this can also serve as a symptom of fetal hypoxia during pregnancy. And requires immediate medical attention.

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TOPIC: FETAL HYPOXIA AND NEWBORN ASPHYXIA

Hypoxia of the intrauterine fetus is a pathological condition associated with oxygen deficiency during pregnancy and childbirth. This pathology is one of the most common among perinatal pathologies and is one of the most common causes of perinatal morbidity (21-45% in the structure of all perinatal pathologies).

The term perinatal refers to the period of intrauterine development from 28 weeks, the period of labor and 7 days after the birth of the child (newborn period).

The causes of fetal hypoxia and asphyxia of the newborn are common and divided into 4 groups:

the first three are common for hypoxia of the intrauterine fetus and asphyxia of newborns, group 4 is characteristic only for asphyxia of newborns.

Stages at which oxygen transport may suffer.

· Mother's condition.

· Uteroplacental circulation.

· Condition of the fetus.

GROUP 1 - MOTHER DISEASES.

1. Blood loss - obstetric bleeding - with placental abruption, placenta previa, uterine rupture; blood diseases (anemia, leukemia, etc.).

2. shock states of any origin.

3. Congenital and acquired heart defects with hemodynamic impairment.

4. Diseases of the bronchopulmonary system with impaired gas exchange.

5. Intoxication of any kind - household, industrial, bad habits.

SECOND GROUP - PATHOLOGY OF UROPLACENTAL AND UMBLISH BLOOD FLOW.

1. Umbilical cord pathology (collisions):

umbilical cord nodes

umbilical cord entwined around limbs

umbilical cord prolapse

· pressing of the umbilical cord during childbirth with a breech presentation (therefore, childbirth with a breech presentation is a borderline pathology, since in some cases the birth can take place without complications, and in others, with a slight delay in the advancement of the fetus, the head, emerging as the last one, compresses the umbilical cord for a long time.

2. Bleeding:

with placental abruption

· with placenta previa. In this case, blood circulation slows down or stops.

3. Rupture of blood vessels during membrane attachment of the umbilical cord (see Anomalies in the development of the ovum) - pathology of the attachment of the umbilical cord (to the membranes, edge of the placenta). The growth of blood vessels can lead to rupture, most likely this occurs during amniotomy.

4. Impaired placental circulation due to dystrophic changes in blood vessels:

· with gestosis

· in post-term pregnancy. Placental aging processes—trophic disorders—occur.

· Anomalies of labor - very protracted or rapid labor, incoordination of labor.

GROUP 3 - REASONS RELATED TO THE FETUS.

· Genetic diseases of newborns.

· Hemolytic disease of the newborn is associated with an immunological conflict between mother and child and begins in utero.

· Heart defects.

· Other developmental anomalies.

· Intrauterine infection.

· Intracranial injury to the fetus.

GROUP 4 - the only reason typical only for asphyxia of newborns - partial or complete blockage of the respiratory tract.

PATHOGENESIS OF FETAL HYPOXIA. Consists of a variety of pathophysiological and biochemical processes.

In the fetus, in response to a hypoxic condition, the release of corticosteroids increases, the number of circulating erythrocytes and BCC increases. At this stage: tachycardia, increased motor activity of the fetus, increased respiratory movements of the fetus, closure of the glottis. Intrauterine breathing is simply excursions of the chest - like training breathing movements.

With increasing acute or ongoing chronic hypoxia, we see processes of activation of anaerobic glycolysis. Centralization of blood circulation leads to deterioration of peripheral circulation. That is, the fetus strives to provide blood to vital organs (heart, brain), and hypoxia of the intestines, kidneys, and legs occurs, hence the release of meconium.

Then adaptation fails - the adrenal cortex is depleted, clinically this is expressed by bradycardia, arrhythmia, and muffled heart sounds. Fetal movements slow down and eventually stop.

Further, the IOC decreases, collapse occurs, hypovolemia with the formation of blood clots, and numerous hemorrhages occur, that is, disseminated intravascular coagulation syndrome.

Therefore, the cause of hemorrhages is always a hypoxic background (and when forceps are applied, or the head is standing in one plane for a long time).

The accumulation of carbon dioxide causes irritation of the respiratory center. The fetus begins to breathe through an open glottis, that is, it aspirates everything that comes in its way: amniotic fluid, mucus, blood, and newborns are born with ready-made atelectasis. The first breath of such a child can lead to spontaneous pneumothorax even without any external influences.

CLASSIFICATION BY CLINICAL FEATURES.

Hypoxia of the intrauterine fetus depending on the severity: acute and chronic. Depending on whether there are clinical signs of HVP or not, HVP is classified into:

· threatening GWP

· started GWP

Threatening GVP is a condition when there are no clinical manifestations yet, but there is a condition of the mother or fetus that can lead to GVP (post-term pregnancy, labor anomalies, etc.).

the onset of hypoxia is a condition with clinical manifestations of hypoxia.

CLINIC.

1. With hypoxia, tachycardia, bradycardia (with deeper GVP), arrhythmia, and muffled tones occur. Normal heart rate is 120-160 beats per minute.

2. The appearance of meconium in the amniotic fluid.

3. At the beginning of GVP - increased frequency and intensification of movements. With developed gastrointestinal tract - slowing down and slowing down of movements.

Threatening gastrointestinal tract infections require prevention, while those that have begun require treatment.

EARLY DIAGNOSIS.

1. Various tests (biochemical, functional, hardware.

2. Clinical findings - especially palpitations.

Functional tests:

· a test with physical activity consists of changing the gas composition of the blood and air.

· Thermal tests: hot compress or cold to the abdomen.

· Administration of atropine or oxytocin.

These tests allow us to identify the compensatory capabilities of the fetus before hypoxia develops.

· Stress-free test - the reaction of the fetal heartbeat to its own movements. Normally, the fetus should increase its heart rate by 10-12 beats per minute. If the fetus does not respond, then it is hypoxia. The heartbeat should also respond to contractions, which can be studied using a cardiotocograph: an ultrasound effect is used (records heartbeats and contractions), sums up the heartbeat and produces a tape. The contractile activity of the uterus (tocogram) is also recorded. Deceleration is a slowing of the heartbeat during a contraction. Early bradycardia coincides with the time of contraction, usually appears in the second stage of labor, when the head passes the narrow part. Late deceleration - bradycardia after a contraction - is a sign of late hypoxia.

· Electrocardiography and phonography of the fetal heartbeat: very complex decoding, that is, a computer is needed for processing.

In the first stage of labor, the heartbeat increases in response to contractions; in the second period, a short-term decrease in heart rate is possible due to pressing of the head. With cephalic presentation up to 80 beats per minute, with breech presentation even tachycardia up to 180 beats per minute can be considered normal, which is due to the peculiarities of the location of the head in the fundus.

· Physical activity. 5 movements in 30 minutes is the norm, in the 1st period - 1-3 movements, in the second period the fetus does not normally move.

· Examination of amniotic fluid for meconium - amnioscopy (you can tell whether there is meconium or not) or evaluate leaking water (if there is no amniotic sac).

· Amniocentesis is usually used for maternal or fetal indications: genetic pathology, hemolytic disease of the newborn. The bladder is punctured. The most common procedure is transabdominal amniocentesis, which involves inserting a needle into the amniotic cavity. For amniocentesis, the location of the placenta along the anterior wall must be excluded. Transvaginal, suprapubic amniocentesis is used mainly in the early stages.

· Determination of acid-base balance. It can be done when examining amniotic fluid, or examining blood from the presenting part of the fetus (therefore, it is done only during childbirth, when there is no bladder).

STUDY OF UROPLACENTAL CIRCULATION.

1. Determination of the level of placental hormones in urine: one can judge the state of the placental blood circulation and indirectly the condition of the fetus. Estriol, pregnanediol (progesterone metabolite), thermostable alkaline phosphatase in the mother's blood are determined.

2. Isotope methods (more scientific method).

3. Ultrasound: determine the size, structure of the placenta, hypotrophy during chronic hypoxia.

Prevention and treatment are carried out using the same methods.

TREATMENT. Treatment should consist of eliminating the cause of hypoxia, as well as treating hypoxia itself (drug pathogenetic therapy and early delivery).

PATHOGENETIC DRUG THERAPY:

1 gr.

1. Oxygen therapy is carried out using pure oxygen, an oxygen-air mixture (oxygen is 60%), inhalation for 10-15 minutes.

2. Hyperbaric oxygenation. You can even carry out childbirth in an HBOT chamber.

2 gr. Drugs aimed at improving placental blood circulation.

1. Vasodilators: aminophylline, trental, chimes (the last 2 improve the rheological properties of the blood as deaggregants), you can also prescribe rheopolyglucin.

2. Estrogens - enhance uteroplacental blood circulation: natural estrogens - folliculin, artificial - sinestrol. Sigetin is a drug with estrogen-like action.

3. Tocolytics - beta-adrenergic agonists: partusisten, bricanil, salbutamol, ritodrine, alupent.

3 gr. Drugs that increase fetal resistance to oxygen deficiency. - antihypoxants - seduxen, etimizol, sodium hydroxybutyrate, bufenin, piracetam, droperidol.

4 gr. Drugs aimed at enhancing metabolic processes in the fetus: glucose, vitamin C, group B, calcium gluconate, calcium chloride, unithiol, cocarboxylase, cytochrome C, etc.

5 gr. Means to combat metabolic acidosis. Sodium bicarbonate controls acid-base balance as it can easily lead to imbalance. There are women of small, medium, large body weight. Depending on this, different amounts of soda are administered: 100-150-200 ml intravenously by drip and then 40 ml of 40% glucose intravenously.

Speedy delivery. Methods depend on the condition of the mother’s body.

During pregnancy and in the first trimester of labor, a cesarean section is used, in the second period - obstetric forceps for cephalic presentation, and for pelvic presentation - extraction of the fetus by the pelvic end.

Asphyxia of the newborn is a syndrome characterized by the absence of breathing or occasional irregular breathing that is ineffective in the presence of cardiac activity.

Asphyxia is not a very appropriate term, since translated from Latin it means “without a pulse.” Therefore, the modern name for newborn asphyxia is neonatal depression (WHO term).

The etiology and pathogenesis are the same as with GVP, since asphyxia begins with GVP (in 70-80% of cases).

DIAGNOSTICS.

1. Assessment of the newborn’s condition according to a number of parameters: Apgar scale (1910, Virginia Apgar). Signs according to the 0-1-2 point system: state of heartbeat, breathing, skin, muscle tone, reflex excitability. Ideal score 10, norm 8-10. There are moderate (6-5 points) and severe (4-1 points) degrees of asphyxia. 0 points – this is a stillbirth.

2. You can characterize asphyxia of a newborn visually: blue asphyxia (6-5 points), white asphyxia (1-4 points).

TREATMENT.

Resuscitation measures.

Principles:

restoration of independent adequate breathing and elimination of hypoxia

elimination of disturbances of central and peripheral hemodynamics

· correction of metabolic disorders

· correction of energy balance

SEQUENCE OF RESUSCITATION MEASURES FOR MODERATE ASPHYXIA:

Respiratory resuscitation:

· clearing the airways (suction bulb, electric suction). Normally, the bronchi contain embryonic fluid that is expelled during childbirth.

· respiratory resuscitation in a special room - at the same time the following is done: warming the child, mechanical ventilation (mask oxygen) since breathing at this level of severity is superficial, but there is. 30-40 breaths per minute.

· Resuscitation solutions are injected into the umbilical cord vessels: glucose 10% 5 ml per 1 kg of weight, cocarboxylase 8 mg/kg; vitamin C 5% 1-2 ml depending on weight; calcium gluconate 1 ml/kg; sodium bicarbonate under the control of acid-correcting reaction 2-4 ml/kg, etimizol 1.5% 0.3 ml. If the measures are ineffective, we expand them to the scope of treatment of severe asphyxia of newborns.

SEQUENCE OF RESUSCITATION MEASURES FOR SEVERE INFANT ASPHYXIA.

1. Restore the patency of the upper respiratory tract.

2. Warming the baby.

3. Intubation because breathing is very shallow or non-existent. Ventilation using breathing devices - VITA, VLADA, Johnson and Johnson.

4. Intravenous medications, see above, add to this hydrocortisone 5 mg per kg of weight, or prednisolone 1 mg per kg.

5. If the measures are ineffective and in the presence of bradycardia, arrhythmia, or cardiac arrest, external cardiac massage should be performed: rhythmic pressure with the index and middle fingers of the right hand on the sternum in the middle third (at the level of the nipples) with a frequency of 100-140 times per minute, to a depth of 1 -2 cm. If this is ineffective, intravenous administration of adrenaline hydrochloride 0.1 ml per kg of weight. If there is no effect, intracardiac adrenaline.

RESUSCITATION OF A NEWBORN IS STOPPED:

1. if cardiac activity does not recover within 8-10 minutes.

2. The heartbeat is effective, but breathing is not restored after 15-20 minutes on mechanical ventilation (since if breathing is not restored, then there is severe brain damage).

The issue is resolved legally. All resuscitation measures do not guarantee against the development of post-hypoxic conditions: mental, physical retardation, childhood disability.

Diagnosis of fetal hypoxia

“If there are signs of fetal hypoxia, it is necessary to do an ultrasound,” warned obstetrician-gynecologist Evgeny Petreikov. — An ultrasound examination of the biophysical profile is prescribed, during which the heartbeat, respiratory movements, and weight of the fetus are clarified. They also evaluate the amniotic fluid index.”

If the volume of amniotic fluid is abnormal, this may indicate pathology. Chronic oxygen starvation during intrauterine development is indicated by oligohydramnios. If the amniotic fluid is more than normal, this indicates the presence of infection.

Dopplerography allows you to measure the volume of blood inflow and outflow to the placenta. In this study, doctors pay attention to the general blood supply to the uterus and in particular to the blood supply to the blood vessels of the unborn baby’s brain.

“If violations are detected, studies must be performed regularly,” continued Evgeniy Petreikov, “every week. It is important to establish whether a pathological process is developing in order to decide on treatment tactics.”

Therapeutic tactics of hypoxia

If fetal hypoxia occurs during the period of pushing or during contractions (decrease in heartbeat), a decision is made to complete the labor as soon as possible: a cesarean section or the application of obstetric forceps (in the case of labor stimulation with oxytocin, the administration of the drug is stopped). After the birth of the child, immediate medical care begins:

• clearing the respiratory tract from mucus, meconium and water (suction with a special aspirator);
• supplying a mixture of oxygen with air or pure humidified oxygen through a mask, nasal catheter or mechanical ventilation device (in case of severe hypoxia, the newborn is placed in an incubator, intubated and mechanical ventilation is started);
• heating the baby with radiant heat (on a special changing table), and in case of severe hypoxia, placing the baby in an incubator;
• administration of drugs that stimulate blood circulation and increase blood pressure (camphor, dopamine) and drugs that stimulate the respiratory center (etimizole);
• intravenous infusions solution, sodium bicarbonate (neutralization of carbon dioxide in the blood), glucose to restore the reduced volume of the vascular bed;
• transfusion of blood products if necessary (hemolytic disease of the newborn);
• prescribing antibiotics to prevent pulmonary infections in case of severe hypoxia or intrauterine infection of the fetus, as well as in respiratory distress syndrome during premature birth;
• prescription of anticonvulsants (phenobarbital, phenazepam);
• To reduce intracranial pressure, administration of diacarb and veroshpiron (diuretics with the effect of reducing cerebrospinal fluid production) is indicated.

Treatment of fetal hypoxia

Oxygen starvation is a condition that develops in response to a pathological process in the mother’s body while carrying a child. Despite its danger, it is not a disease in itself. And it is impossible to cure it in any way.

In the chronic form, the doctor can only monitor the condition of the expectant mother, the characteristics of the course of pregnancy, perform tests, and prescribe the necessary examinations. These measures can reduce the risk of complications. When preeclampsia is detected, the doctor’s task is to prevent its transition from mild to moderate and severe. For hypertension - select a safe and effective therapy to control a woman’s blood pressure.

“If a woman does not have preeclampsia or placental abruption, our task is to bring the pregnancy to 34 weeks, when the fetus is fully viable,” said Evgeniy Petreikov. — Today we can talk about partial viability of the fetus after 22 weeks. But after 34 weeks the chances of survival are much higher.”

With developmental delay, a baby who experienced oxygen starvation during intrauterine development will weigh less than a healthy baby. Its weight at birth can be 1700-1800 grams. And this body weight, according to the specialist, is sufficient for birth. If acute hypoxia is detected or pregnancy complications become fatal, an urgent cesarean section is required. Only in this way can the life of the child, and often the mother, be saved.

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Signs of hypoxia. Apgar score

The baby's condition is assessed immediately after birth, in the first minute and 5 minutes later. For this purpose, a scale developed by Virginia Apgar is used, taking into account and summing up the following indicators, each of which is scored from 0 to 2 points:

• skin coloring;
• breathing rate;
• reflex activity;
• heart rate;
• muscle tone.

Based on the score obtained, the absence or presence of hypoxia and its degree are determined:

• norm – number of points 8-10;
• mild hypoxia – 6-7 points;
• moderate hypoxia – 4-5 points;
• severe hypoxia – 0-3 points.

Mild hypoxia is detected in almost all newborns in the first minute of life and disappears within 5 minutes on its own.

Moderate hypoxia in a newborn requires certain treatment; the child’s condition returns to normal after a few days. In case of severe hypoxia or asphyxia, immediate resuscitation measures are carried out, complex treatment and further monitoring of the child are prescribed.

The clinical picture of neonatal hypoxia is usually pronounced and the diagnosis is established immediately after the birth of the child. Signs of this condition include tachycardia, with gradual replacement by bradycardia (less than 100 beats per minute), irregular heartbeat, auscultation of heart murmurs, pallor of the skin and cyanosis of the nasolabial triangle and extremities.

Irregular breathing or its absence is noted, motor activity is reduced or absent (the child is lethargic or does not move), and the presence of meconium (green water) in the amniotic fluid. Blood clotting rates increase, which leads to thrombosis in the vessels and hemorrhage in the tissue.

Subsequently, if hypoxia was missed in the first minutes of the child’s life, the following signs are added:

• constant drowsiness;
• restless sleep, trembling;
• marbled skin tone of the extremities;
• the child freezes quickly (when bathing, changing clothes);
• restless, capricious behavior, causeless crying;
• trembling of the facial muscles while crying or at rest.

Hypoxic encephalopathy

Hypoxia in a newborn leads to the development of hypoxic encephalopathy (brain damage), which is divided into degrees of severity:

mild – drowsiness or agitation of the newborn, disappearing after 5-7 days;

moderate - in addition to drowsiness and/or agitation, there is crying for no reason, convulsions, aversion to being carried, rapid freezing;

severe - severe drowsiness and lethargy, development of psychomotor agitation or coma with ongoing convulsions.

Prevention of fetal hypoxia

In modern life it is difficult to pay enough attention to your health. But when planning a pregnancy, you should take care of yourself and undergo a medical examination to identify hidden chronic diseases. Therapy, correctly selected before conception, significantly reduces the risk of complications during pregnancy.

And when a happy event has already happened, it is important to remember that the mother’s body is inextricably linked with the baby’s body. Stress and excessive activity of the expectant mother only harm the healthy course of pregnancy. During these important nine months, you need to devote more time to rest and walks in the fresh air. You need to eat right, include fresh foods rich in nutrients in your diet.

The expectant mother needs to take vitamins, especially group B, which are necessary already at the stage of planning and preparing the body for conception. Combined with a healthy lifestyle and control of chronic diseases, this significantly increases the chances of a healthy pregnancy.