Intrauterine fetal hypoxia - causes, symptoms and consequences. Intrauterine fetal hypoxia - symptoms and consequences Chronic intrauterine fetal hypoxia treatment

Many people know about the dangers and consequences of intrauterine fetal hypoxia, so the fear of hearing such a diagnosis is completely justified. Any expectant mother may panic, imagining that her baby is not getting enough oxygen. But is it really that scary? What signs indicate fetal hypoxia and can this phenomenon be prevented?

Fetal hypoxia and its forms

During intrauterine development, the baby receives oxygen from the mother's blood through the placenta. If its supply is disrupted, then fetal hypoxia occurs, which negatively affects the formation and development of its organs and systems, as well as the general condition of the baby.

Quite often, oxygen starvation is associated with fetoplacental insufficiency - a phenomenon that characterizes the occurrence of disturbances in the structure and functioning of the placenta. As a result, feeding and breathing of the fetus is complicated.

Minor short-term hypoxia is usually not dangerous for the fetus. But prolonged or acute lack of oxygen can lead to irreversible consequences.
Alcohol consumption leads to the development of chronic fetal hypoxia

Hypoxia can occur throughout pregnancy:

in the first months, oxygen starvation usually causes disturbances in the formation of important organs in the fetus (most often the nervous system);
in the later stages, the lack of oxygen also adversely affects the development of the baby and often leads to the need for a caesarean section long before the scheduled date;
oxygen starvation can develop during childbirth. If hypoxia is prolonged, it poses a serious danger to the life and health of the child. In severe form, it is asphyxia, that is, suffocation of the fetus.

There are forms of hypoxia:

chronic - occurs when there is a prolonged lack of oxygen in the fetus. It can be provoked by severe toxicosis, dysfunction of the placenta, smoking and alcohol consumption by the mother, etc. Hypoxia develops gradually, increasing over time;
acute lack of oxygen occurs as a result of complications in late pregnancy and during childbirth. Oxygen starvation occurs abruptly and develops quickly. Treatment is most often impossible. An urgent delivery is required.

Reasons for the development of pathology

The causes of chronic hypoxia include:

fetoplacental insufficiency (impaired functioning of the placenta);
intrauterine infections and fetal malformations;
multiple pregnancy;
smoking and drinking alcohol;
acute and chronic diseases of the internal organs of the mother;
low hemoglobin in a pregnant woman;
diabetes;
severe toxicosis;
experiencing stress;
incorrect presentation of the fetus.

Umbilical cord entanglement can provoke acute fetal hypoxia

Acute hypoxia can lead to:

increased uterine tone;
placental abruption;
uterine rupture;
umbilical cord entanglement;
weak labor activity;
rapid birth.

Symptoms and diagnosis

It is extremely difficult to detect hypoxia in the first months of pregnancy. Only a few objective factors (low hemoglobin, diabetes mellitus, smoking, etc.) can suggest its presence.

A reliable diagnosis can be made after 18 weeks of pregnancy, when the fetus begins to move in the uterus. The greatest suspicions are caused by changes in his motor activity, rapid or slow heartbeat.

The expectant mother needs to pay attention to the following manifestations:

prolonged absence of the baby's movements;
increased fetal activity (frequent movements);
change in the nature of the child’s motor activity. For example, the movements were rare, and then suddenly became more frequent. Or, on the contrary, the baby was actively moving, and then suddenly stopped.

In all of the above cases, you should immediately consult a doctor.
CTG is performed several times during the 3rd trimester of pregnancy and during childbirth

Diagnostic methods

Hypoxia is diagnosed using the following methods:

Ultrasound - performed after 18 weeks of pregnancy;
CTG (cardiotocography) - performed after 30 weeks of pregnancy and during childbirth and consists of recording and analyzing the fetal heart rate during movement, rest, and contractions;
Doppler testing is a type of ultrasound diagnostics and is performed after 18 weeks of pregnancy upon the direction of a doctor. The intensity of blood flow in the vessels of the fetus, uterus and placenta is assessed;
amnioscopy - performed in late stages (after 37 weeks) by inserting a special device - an amnioscope - through the cervix. The method allows you to assess the condition of amniotic fluid (quantity, color and the presence of impurities in it) and the amniotic sac.

Indicators that indicate oxygen deficiency:

the fetus is smaller in size and weight than normal for a given period of pregnancy, which indicates developmental delay;
polyhydramnios or oligohydramnios;
fetal heartbeat disturbance;
disruption of blood flow in the vessels of the uterus, placenta and umbilical cord;
The color of amniotic fluid is green and contains meconium (usually diagnosed during childbirth).

Consequences of fetal oxygen deprivation

Acute hypoxia is more dangerous because it develops rapidly. In the absence of measures to eliminate it, suffocation and fetal death are likely to occur.

Other dangerous consequences of acute oxygen deficiency include:

death of nerve cells and pathological changes in brain tissue, which leads to a lag in intellectual and speech development;
hemorrhage in various organs.

Consequences of chronic hypoxia:

miscarriage;
premature birth;
developmental delay before and after birth;
disruption of the baby's respiratory system;
diseases of the nervous system;
metabolic disorders in a child;
difficulties in adapting a newborn to living conditions.

Video: lecture on hypoxia and its consequences

Forecast of the consequences of oxygen starvation of a child

The consequences of hypoxia are diagnosed during childbirth using the Apgar scale. If the child’s condition is assessed from 4 to 6 points in the first minute and 8 points or more in the fifth minute, then this indicates moderate severity of oxygen deficiency. Lower scores may result in dire consequences.

In the first years of life, a baby may develop:

hyperactivity;
neurological diseases;
retardation in height, weight and development of cognitive processes;
mental disorders, etc.

For treatment, special massage, physical exercise, and medications are prescribed. Most often, with careful monitoring and proper treatment, the child's health improves during the first year of life.

How is hypoxia treated?

Depending on the degree and causes of hypoxia, treatment can be carried out both in a hospital and on an outpatient basis. Measures are being taken to improve blood circulation in the placenta, reduce the tone of the uterus, and enhance metabolic processes.

The expectant mother needs to make adjustments to her lifestyle:

reduce emotional stress and physical stress (work less intensively, take breaks more often);
spend 2–3 hours every day outdoors;
It is recommended to do breathing exercises, yoga, water aerobics, and swimming.

If the measures taken are ineffective and hypoxia persists, then early delivery is indicated (for a period of more than 28 weeks).

For prolonged hypoxia, medications are prescribed:

vitamins E, C, B6;
Eufillin;
Ginipral et al.

In a situation of acute oxygen deficiency, glucose, insulin, calcium gluconate, etc. are often administered, and oxygen inhalations are performed using a mask.

Photo gallery: drugs for the treatment of oxygen deficiency in the fetus

Curantil is a drug used to improve blood circulation Actovegin is a drug with an antihypoxic effect that activates the delivery and absorption of oxygen and glucose by the cells of various organs and tissues Trental improves blood microcirculation
Ginipral - a drug for relaxing the myometrial muscle tissue and reducing pressure in the uterine cavity
No-Spa is used to relax the smooth muscles of the uterus

One of the most pressing problems in obstetrics and neonatology remains fetal hypoxia during pregnancy. According to some data, its frequency among the total number of births varies between 4 and 6%, according to others - reaches 10.5%.

Pathology associated with hypoxia, that is, a lack of oxygen, is dangerous not only in the prenatal period, but also subsequently leads to serious consequences in children. In 63% of the associated pathological changes in the body develop in the prenatal period, on average in 21% - in the intranatal period and in 5-6% - already in the newborn period. How to determine fetal hypoxia and can it be avoided?

How dangerous is the pathology?

This pathological condition, often complicating pregnancy and childbirth, is the most common cause of fetal mortality and child morbidity in infancy.

Oxygen deficiency during different periods of pregnancy and childbirth is characterized by the development of different pathologies and different consequences. For example, during the period of organ formation, a slowdown in the development of the embryo and the formation of developmental anomalies is possible, during the period of tissue differentiation of organs - a delay in further development, developmental pathology or damage to the central nervous system (60-80%), disruption of the adaptation mechanisms of the fetus and newborns, increasing the incidence of the latter.

Severe intrauterine fetal hypoxia can also be the cause of stillbirth or death of newborns in the early postpartum period (in 23%), disturbances or delays in intellectual and/or psychomotor development in newborns. In addition, they have lesions of the heart and blood vessels (in 78%), central nervous (in 98% or more) and urinary (in 70%) systems, and severe eye diseases.

What is fetal hypoxia?

The term “fetal hypoxia” is used to refer to a set of changes in its body that arise as a result of insufficient oxygen supply to its organs and tissues or inadequate absorption (utilization) of oxygen by them.

This is not an independent disease or a primary nosological form, but a condition that is the result of pathological processes of various nature in the “mother-placenta-fetus” system and complicating the intrauterine development of the latter.

Even in the case of an uncomplicated, physiologically proceeding pregnancy, the supply of oxygen to the fetus is significantly lower compared to adults. But compensatory-adaptive mechanisms (increased heart rate, large minute volume of blood, significant oxygen capacity of the blood, etc.) at any stage of development ensure its resistance to this deficiency, bringing the oxygen supply to full compliance with the needs for it.

Disorder of compensatory mechanisms leads to a hypoxic state, which, depending on the duration, is divided into:

Chronic, developing as a result of oxygen deficiency over a long period of time during a complicated pregnancy. Chronic intrauterine fetal hypoxia is associated mainly with morphological and functional changes in the placenta, which usually arise as a result of disruption of its blood supply due to inflammatory, degenerative and other types of damage.
Subacute, which is characterized by a decrease in the degree of adaptation of the fetus and develops 1-2 days before the onset of labor.
Acute, occurring already during childbirth. Acute fetal hypoxia very rarely develops during pregnancy. An unfavorable factor in terms of prognosis is its often observed development against the background of existing chronic hypoxia.

Causes and forms of hypoxia

Understanding the numerous causes and mechanisms of development makes it possible to understand how to avoid fetal hypoxia during pregnancy. All causal factors are conditionally grouped into three groups:

diseases and disorders in the body of a pregnant woman leading to oxygen deficiency - pathology in the cardiovascular and pulmonary systems, compression syndrome of the inferior vena cava, poisoning or intoxication of the body, anemia, blood loss or shock for various reasons, complications of pregnancy or childbirth, accompanied by excess in a woman’s body carbon dioxide or oxygen deficiency;
disorders in the fetal-placental system that develop with post-term pregnancy, abnormal placental location or thrombosis of the placental vessels, false umbilical cord node or thrombosis of the latter, fetal hypoxia during childbirth as a result of premature abruption of the normal placenta, abnormalities in labor, entanglement of the umbilical cord, tension or prolapse last;
pathology in the fetus - infection, the presence of congenital malformations, hemolytic disease, anemia, prolonged compression of the head during childbirth.

Forms of hypoxia in accordance with the mechanisms of its development

Arterial-hypoxemic

Which include:

hypoxic, resulting from a disruption in the supply of oxygen to the uteroplacental bloodstream;
transplacental - the result of a circulatory disorder in the placenta or in the feto-placental system and a disorder of the gas exchange function of the placenta.

Hemic

Associated with anemia due to blood loss or hemolytic syndrome, as well as a decrease in the oxygen affinity of fetal hemoglobin.

Ischemic

Developing due to:

low cardiac output due to cardiac and vascular abnormalities, insufficient contractility of the heart muscle or severe cardiac arrhythmias;
increased resistance in blood vessels (mechanical compression, thrombosis of the uterine arteries, etc.), including due to disturbances in the properties of blood.

Mixed

Representing a combination of two or more mechanisms of oxygen deficiency.

In practice, arterial-hypoxemic and mixed forms are most often encountered.

Oxygen deficiency is the main factor in the mechanism of development of metabolic disorders, organ functioning and, ultimately, the development of a terminal condition. A decrease in the degree of oxygen saturation of the blood leads to disruption of its respiratory function and the development of an acidic environment. Changed conditions cause disruption of many parameters of constancy and self-regulation of the internal environment of the body.

Initially, the universal compensatory reaction is aimed at protecting vital systems and organs and preserving their function. This occurs by stimulating the hormonal function of the adrenal glands and increasing their secretion of catecholamines, as a result of which the fetal heart rate initially increases during hypoxia. In addition, centralization of blood circulation (redistribution of blood) develops due to vascular spasm in individual organs that are not vital (lungs, intestines, spleen, kidneys, skin).

All this helps to improve blood circulation in vital organs (heart, brain, adrenal glands, placenta) and, accordingly, to increase the delivery of oxygen to them by reducing its delivery to “less important” organs and tissues, which leads to the development of metabolic acidosis (acid Wednesday) in the latter.

Significant and prolonged hypoxia causes depletion of compensatory mechanisms, inhibition of the function of the adrenal cortex, and a decrease in the content of catecholamines and cortisol in the blood. This causes a deterioration in the endocrine regulation of the function of vital centers, a decrease in the heart rate and a decrease in blood pressure, a slowdown in the speed of blood flow, stagnation of blood in the veins and its accumulation in the portal vein system.

Such disorders are accompanied by changes in blood viscosity and its fluid properties, microcirculation disorders, impaired gas exchange in them, decreased pH, increased permeability of the walls of small vessels, tissue swelling, etc.

Pronounced changes in macrodynamics and microdynamics, accompanied by metabolic disorders, cause tissue ischemia and even necrosis, primarily in the brain, as well as small and sometimes massive hemorrhages in it and in other organs, dysfunction of the respiratory and cardiovascular centers of the brain and etc.

Consequences of hypoxia in a child after birth

The severity and duration of persistence of these consequences depend on the degree and duration of hypoxia. Depending on its intensity, there are:

mild degree, or functional hypoxia - there are only hemodynamic disorders;
deep, which is accompanied by a reversible disruption of all types of metabolism;
severe, or destructive, in which irreversible damage develops at the cellular level.

Clinical picture and diagnosis

Clinical signs and subjective symptoms of fetal hypoxia during pregnancy are very scarce and difficult to recognize. This requires listening to the heartbeat by a gynecologist using a stethoscope.

As a result of auscultation of heartbeats, the assumption of the presence of a pathological condition may arise when there is a deviation from the norm (increase or, conversely, decrease) in the number of heartbeats. In these cases, additional (instrumental and diagnostic) studies are necessary.

Is it possible for a pregnant woman to independently determine fetal hypoxia?

A general understanding of the mechanisms of this condition helps a woman understand that a lack of oxygen supply or utilization by the fetus necessarily leads to a change in the nature of its motor activity. This can be recognized by correctly assessing your sensations during fetal movements.

How does the fetus behave during hypoxia?

At the initial stages of the pathological condition, a pregnant woman notices an increase in the frequency and intensity of movements. In the case of a long-term lack of oxygen or its progression, the degree of motor activity decreases until the complete cessation of movements.

A decrease in the number of movements to 3 or less over the course of one hour is a clear sign of hypoxic suffering and is a direct indication for immediate additional research to decide on the choice of further pregnancy management tactics.

Instrumental and diagnostic signs of fetal hypoxia in later stages, sometimes at earlier stages, are detected through such indirect methods as echography, cardiotocography, blood flow in the vessels of the uteroplacental-fetal system, determination of the fetal biophysical profile, oxygen and carbon dioxide pressure, acid-base state and lactic acid content in a woman’s blood, biochemical study of amniotic fluid, levels of certain hormones, etc.

The most accurate and informative methods in late pregnancy (in the third trimester) are cardiotocography, ultrasound scanning and Doppler.

The initial signs of oxygen “starvation” during cardiotocography are:

an increase in heart rate to 170 beats per minute or a decrease to 100 beats;
a decrease in the degree of variability of the heart rhythm (rhythm variability), which is normally 5-25 beats per minute (indicates the normal regulation of heart function by the sympathetic and parasympathetic systems);
short-term monotonous nature of the heart rhythm, constituting no more than 50% of the recording;
reduced response to functional tests;
cardiotocogram score ranging from 5 to 7 points.

With severe oxygen deficiency, the following are observed:

significant (more than 170 beats per minute) tachycardia or bradycardia of less than 100 beats per minute;
a pronounced decrease in rhythm variability;
monotony of heart rate, accounting for more than 50% of the recording;
a paradoxical response to functional tests and a late (after 10-30 seconds) reaction in the form of a decrease in the fetal heart rate in response to its movement (during a non-stress test);
The cardiotocogram score is 4 points and below.

In diagnosis, Doppler examination of blood circulation in the vessels of the brain and the fetal aorta is of great importance. This technique detects intrauterine hypoxia in pregnant women at an earlier stage, compared to cardiotocography, and allows them to be recommended for constant careful monitoring and treatment.

Hypoxia during childbirth is also manifested by cardiac dysfunction. The most accessible diagnostic methods during this period are auscultation and cardiotocography.

Diagnostic symptoms in the first stage of labor include:

Initial signs (regardless of presentation) are bradycardia of about 100 beats per minute, periodically occurring monotonous heart rhythm, response to contractions, expressed in a late decrease in heart rate to 70 beats.
Pronounced signs are bradycardia, reaching 80 beats per minute with cephalic presentation or tachycardia (up to 200 beats) with pelvic presentation, persistent arrhythmia and monotony of heart rhythm independent of presentation. In addition, responses to contractions, expressed in long-term late decreases in rhythm frequency in the form of W-shaped complexes in the case of cephalic presentation, and a combination of its increase and decrease (up to 80 beats per minute) - in breech presentation.

In the second stage of labor:

Initial signs are bradycardia up to 90 beats or an increase in contraction frequency (tachycardia) up to 200 beats per minute, periodically occurring monotonous heart rhythm, after pushing - a later decrease in heart rate to 60 beats per minute.
Pronounced signs are bradycardia up to 80 or tachycardia over 190 beats per minute, persistent monotonous rhythm, rhythm disturbance, late and prolonged slowdown of the rhythm (up to 50 beats) with cephalic or pelvic presentation, with W-shaped complexes with cephalic presentation.

In addition, the presence of meconium in the amniotic fluid speaks in favor of a threatening situation (but only with cephalic presentation). It may take the form of individual suspended fragments (in initial signs) or a dirty emulsion (in severe cases). However, its presence can be the result not only of acute hypoxia, but also of long-term or short-term oxygen deficiency that occurred before the onset of labor. Birth is possible without asphyxia if hypoxic episodes do not recur.

An unfavorable sign during the first and second stages of labor, in contrast to the prenatal period, is the occurrence of pronounced regular motor and/or respiratory activity of the fetus, which leads to severe aspiration syndrome.

Treatment and prevention of fetal hypoxia

The treatment program consists of correcting the treatment of concomitant pathology (if any), normalizing blood circulation in the placenta, improving the delivery of oxygen and energy components to the fetus, measures to increase its adaptive capabilities and the course of metabolic processes, as well as increasing resistance to oxygen deficiency.

Direct treatment of fetal hypoxia is carried out using methods and drugs that promote:

Relaxation of the myometrium.
Dilatation of uteroplacental vessels.
Improving the rheological characteristics of blood.
Stimulation of metabolism in the myometrium and placenta.

For these purposes, bed rest is prescribed, the woman breathes a mixture of oxygen and air for 1 hour up to two times a day, takes a protein-oxygen cocktail, and hyperbaric oxygenation - if the pregnant woman has cardiovascular insufficiency.

Medicines used include Sigetin, Efillin, Curantyl, Trental, anticoagulants (Heparin), Methionine, folic acid, high doses of vitamin “B 12”, Cocarboxylase, Lipostabil, Haloscorbin, antioxidants (vitamins “E” and “C”, glutamic acid) .

In case of acute hypoxia, chronic hypoxia at 28-32 weeks in the absence of the required result from the treatment, deterioration of the biophysical profile and cardiotocogram, the presence of oligohydramnios, the appearance of meconium in the amniotic fluid, emergency delivery is indicated regardless of the gestational age.

During the labor period, as preparation for surgical () or obstetric (perineo- or episiotomy, application of obstetric forceps, vacuum extraction, extraction by the pelvic end) resolution of labor, breathing with humidified oxygen, intravenous administration of glucose, Euphyllin, Cocarboxylase and ascorbic acid, Sigetin are used.

Prevention consists of early prenatal diagnosis, treatment of concomitant diseases (cardiovascular and pulmonary pathology, diabetes mellitus, etc.), identification, thorough examination, as well as timely hospitalization and treatment of women at risk.

The course of pregnancy may be accompanied by fetal hypoxia, which is characterized by oxygen starvation and intrauterine pathologies of the embryo. The condition is extremely dangerous; for example, among potential complications, doctors do not exclude the development of newborn asphyxia and incurable congenital diseases. To prevent oxygen starvation of the fetus during pregnancy, it is important to visit a gynecologist more often and monitor blood hemoglobin levels.

What is fetal hypoxia

If oxygen reaches the tissues and internal organs of the fetus in insufficient quantities and with a delay, intrauterine hypoxia progresses, which is first of all accompanied by extensive damage to the central nervous system. The pathology progresses at different stages of pregnancy, while slowing down the development of the embryo and causing extensive defects. With this kind of anomaly, the main goal of the doctor and the expectant mother is to restore the normal flow of uteroplacental blood flow, ensure complete blood supply to the placenta, and prevent oxygen deficiency.

Symptoms

Increased activity of the uterus (hypertonicity) makes the expectant mother think about problems with the child, and their nature can be determined by diagnosing intrauterine pathology. For an adult organism, anemia in pregnant women is accompanied by a decrease in vitality and increased weakness. However, radical changes are more prevalent in the prenatal period: in mild cases, to detect hypoxia, it is necessary to pay attention to the increased activity of the fetus, and in complicated clinical pictures, the baby behaves passively, less often reminds of himself with jerks.

Acute fetal hypoxia

The disease has two stages - acute and chronic. In the first case, we are talking about a sudden course of the pathological process, which is preceded by weak labor, uterine rupture, prolonged labor, premature placental abruption, and entanglement of the umbilical cord. Pregnancy is under threat, the baby’s health suffers, and the pathology is accompanied by a sharp reduction in its motor functions. There is an urgent need for correct diagnosis of the acute stage of a characteristic illness, otherwise the brain cells, without receiving nutrition, die on a large scale.

Chronic

The disease is accompanied by oxygen starvation, and in its chronic form it is prone to a sluggish state. To monitor cardiac activity, cardiac monitoring of pregnant women is necessary, which is recommended by a gynecologist during an unscheduled visit to the expectant mother. If oxygen starvation develops slowly and fetal vital signs remain at a satisfactory level, radical action and conservative treatment are not required. A pregnant woman with a chronic disease (CVGP) is observed by a doctor, classifying her as a risk group for pathological childbirth.

Signs of fetal hypoxia in later stages

The disease is accompanied by impaired activity of the baby and irregularities in the fetal heart rate. Based on the general condition of the expectant mother, it is difficult to draw a conclusion about a progressive pathology, but the child’s behavior changes noticeably. For example, you should carefully monitor the baby's movements when his two-minute activity is replaced by a two-hour resting stage. This is the first symptom to suspect hypoxia, potential intrauterine growth retardation. With this type of disorder, other signs of pathology are observed in the later stages:

attacks of tachycardia (states of increased heart rate, increased contraction frequency);
impaired tone in the vessels of the brain;
severe symptoms of bradycardia;
monotony of heart rate;
discomfort with noticeable contractions of the uterus;
decreased heart rate variability;
weakening of the reaction to functional tests.

If a health problem is not resolved in a timely manner, by the 35-36th obstetric week of pregnancy it becomes chronic. In this clinical picture, meconium enters the amniotic fluid, and placental abruption and water leakage begin. All this time, the woman has been bothered by symptoms of dyspepsia, frequent nausea and depression. In the event of pathologies of this kind, the first step is to determine the etiology of the pathological process.

Causes

Hypoxia during pregnancy requires emergency medical measures and timely response from the gynecologist. The first step is to determine the main pathogenic factor that provoked the respiratory failure of the embryo and lack of oxygen. A progressive health problem occurs when:

extensive pathologies of the placenta;
diseases of the respiratory system;
insufficient supply of tissues and internal organs with oxygen;
circulatory insufficiency of the placenta;
violation of the integrity of the umbilical cord vessels;
pregnancy complications;
slowing the baby's heartbeat;
lack of blood hemoglobin;
intrauterine infections;
severe intoxications.

Consequences for the child

Pathology associated with blood flow deficiency negatively affects the child’s health from the first days of his life. If you do not get rid of progressive hypoxia during pregnancy, the difficulties will only begin after the birth of a new person. In addition to extensive pathologies of the respiratory tract, potential complications may include:

asphyxia of newborns;
posthypoxic pneumopathy;
heart defects;
pulmonary hypertension;
ischemic endocardial necrosis;
more frequent seizures;
perinatal encephalopathy;
increased swelling of the brain;
renal failure;
areflexia.

Consequences of hypoxia during childbirth

If chronic hypoxia predominates, labor may end in an emergency cesarean section. This is not the only disease accompanied by pathological blood flow. Therefore, the woman must remain under medical supervision so that the birth ends without death for the newborn. A potential threat during labor may be:

premature birth;
acute hypoxia during childbirth;
risk of antenatal fetal death.

How to determine fetal hypoxia

With minor hypoxia, there are no alarming symptoms, and the expectant mother feels great. The need for laboratory and clinical examination of a pregnant woman arises if the fetus slows down its activity. This is an early stage of pathology, with timely correction of which the general condition can be stabilized at the “satisfactory” level. The following procedures and measures are carried out for diagnosis:

Ultrasound of the fetus, according to the stage of pregnancy;
fetal blood test;
cardiotocography;
auscultatory assessment of fetal heartbeats to identify heart rate;
collection of anamnesis data.

Treatment

Effective treatment of intrauterine hypoxia can be prescribed by the attending physician individually for each clinical picture. Taking pills on your own is dangerous for the health of the fetus, even with the initial symptoms of a characteristic illness. The consequences may be irreversible and fatal. To avoid such a tragic fate for the fetus, the general recommendations of a specialist are as follows:

it is recommended to maintain bed rest, eat right, and remain under strict medical supervision;
therapy is required to reduce uterine tone with the participation of Papaverine, Drotaverine, Eufillin, Hexoprenaline, Terbutaline;
to reduce intravascular coagulation of uterine vessels, Dipyridamole, Dextran, Pentoxifylline are prescribed;
to improve the cellular permeability of placental vessels, increase oxygen flows and accelerate metabolism, essential phospholipids, glucose, vitamins E, C, B6 are prescribed;
intrapartum hypoxia that occurs due to umbilical cord pathologies is an indication for cesarean section.

Medications

To prevent complications after childbirth, therapy for chronic hypoxia includes a number of medications to reduce the tone of the uterus, reduce blood clotting, improve cellular permeability, and stimulate metabolism. If the causes of fetal hypoxia are known, the following medications have proven themselves in obstetrics:

Chimes. If you take 1 tablet three times a day, blood flow and blood supply in the mother-fetus system improves.
Actovegin. If symptoms of impaired metabolism appear, it is recommended to take 1 tablet three times a day. Additionally, it is recommended to take vitamin E and C.
Suppositories with Papaverine. If the disease manifests itself in the form of hypertension, the medication can be used as suppositories or injections.

Forecast

If a child suffers from oxygen starvation while still in the womb, such a pathological process can negatively affect the baby’s health from the first days of his birth. When treatment is started in a timely manner, a new person is born healthy and strong. If the threat is not recognized in time, it manifests itself as congenital heart defects, impaired intracranial pressure, and sudden infant death syndrome. The clinical outcome depends entirely on the vigilance of the expectant mother and her willingness to cooperate with doctors.

Prevention of fetal hypoxia during pregnancy

To prevent oxygen starvation during pregnancy, it is important to take timely precautions, preferably even when planning a pregnancy. Other preventive measures are presented below:

healthy and nutritious nutrition;
exclusion from life of bad habits and other provoking factors;
timely registration in the residential complex;
scheduled ultrasound every trimester;
moderate physical activity;
regular breathing exercises;
compliance with the regime and daily routine.

Video

We all know that during pregnancy, a woman's thoughts rush in one direction. She dreams of a future baby, of a happy life together, she already cares about his condition and comfort and wants the baby to be born strong, healthy and on time.

In order for the fetus to develop fully during pregnancy and the birth to take place safely, all processes in both organisms - the child's and the mother's - must proceed normally, as expected. Any violation can affect the baby's condition. And such a situation can arise for many reasons. Often pregnant women are diagnosed with fetal hypoxia. And this is a serious reason to think and act.

What's happening?

The word "hypoxia" means lack of oxygen. That is, when we talk about fetal hypoxia, this means that the baby does not receive enough oxygen from the mother’s body, and oxygen starvation of the fetus occurs, as doctors say. This condition can develop during pregnancy (and then a diagnosis of chronic hypoxia is made) or directly during childbirth (we are talking about acute hypoxia).

What happens when there is not enough oxygen? Of course, the baby begins to choke. But not right away. First, a number of disorders occur in his small body, the consequences of which, if hypoxia is not detected and therapeutic measures are not taken on time, can be irreversible.

Lack of oxygen in the early stages of pregnancy (when the formation and formation of organs and systems occurs) can provoke a disruption in the development of the embryo, including anomalies and injuries. And in the later stages, the child’s central nervous system and physical development suffer: growth is delayed, the newborn adapts less well to the new environment, and may have physical and mental abnormalities. Children born with hypoxia have disorders of the autonomic nervous system, muscle hypertonicity, the baby is restless, capricious, eats and sleeps poorly. Such a child should be under constant supervision of a neurologist.

When the fetus experiences a lack of oxygen, all its organs and systems begin to work in increased mode, trying to obtain the vital gas. This is possible due to the increased compensatory capabilities of the small organism. The woman feels this activation through the increased mobility of the baby. But this may not last long. And if the normal supply of oxygen is not restored and the metabolism is not normalized in time, depression soon sets in - the child becomes quiet, because without oxygen he can no longer move. The consequences of this condition may be irreversible. Therefore, if after suddenly increased activity your baby suddenly freezes (you feel no more than 3 movements per hour), you should consult a doctor immediately! Hypoxia can be detected most reliably through additional studies: cardiotocography and Doppler.

Why does this happen?

Oxygen is supplied to all our organs and systems along with blood. Transports oxygen, and without iron it is not produced. That is, with (iron deficiency), the production of hemoglobin and, accordingly, the flow of oxygen into the blood and further throughout the body naturally decreases. However, a lack of iron in the mother's blood is not the only cause of hypoxia.

During pregnancy, the volume of circulating blood in the mother’s body increases significantly, because through the placenta it nourishes the fetus. If the uteroplacental exchange deteriorates, the embryo cannot receive the required amount of all nutrients, including oxygen, supplied to it with maternal blood. Metabolic disorders between mother and fetus occur with placental insufficiency. It also blocks the flow of oxygen to the fetus during pregnancy, since nicotine constricts blood vessels and blood circulation is impaired. It is also known that tobacco smoke penetrates to the embryo through the placenta, and it ends up in a smoke screen - how can you not suffocate... It does not have the best effect on blood vessels and...

In general, the development of hypoxia can be provoked by a number of diseases (especially chronic diseases of women) and disorders in the organisms of the fetus and mother and in the placenta:

cardiovascular diseases of a pregnant woman;
anemia;
pulmonary diseases (respiratory tract);
deep;
gestosis;
post-maturity;
polyhydramnios;
multiple births;
violations during;
threat ;
pathology of the placenta and umbilical cord;
anomalies of labor;
intrauterine infections, intoxication;
hemolytic disease of the fetus;
prolonged compression of the head during childbirth and others.

Thus, hypoxia should be considered as a condition caused by a complex of changes in the body of the mother and child.

How to treat?

If a pregnant woman is diagnosed with hypoxia, she may be hospitalized in a hospital to ensure complete rest and provide the necessary treatment. Although it is quite possible that treatment can be done at home with a visit to a clinic or hospital. The doctor must find out what disease caused the development of hypoxia and prescribe appropriate treatment.

Therapy is carried out comprehensively. However, if no positive dynamics are observed and the condition of the fetus worsens, the issue of performing a cesarean section is considered (but this is only for a period of at least 3 months).

How to prevent it?

Approximately 10.5 percent of women are diagnosed with fetal hypoxia. However, in order not to be on their list, you just need to adhere to a certain lifestyle during pregnancy.

The most important thing is not to smoke or drink alcohol. If possible, breathe only clean air. That is, if you live in a very gas-polluted area, move to a cleaner area for this time. Ventilate the room in which you live as often as possible. Spend every day outdoors, but don’t forget about proper rest.

Nutrition and prevention of iron deficiency anemia are of paramount importance.

Of course, even a healthy lifestyle and good nutrition cannot be a 100% guarantee that hypoxia will not develop during pregnancy. But it will significantly increase your chances of preventing it. In addition, regular examinations by a gynecologist and consultations with a doctor will help to identify something wrong in time.

Acute fetal hypoxia

A few more words about the lack of oxygen experienced by the child directly during childbirth - acute fetal hypoxia. This condition can arise for a number of reasons: a very rapid or very prolonged labor, when the baby stuck in the birth canal simply cannot breathe; entanglement of the fetus with the umbilical cord; premature placental abruption. All this leads to fetal asphyxia (suffocation).

If acute hypoxia develops, the doctor delivering the baby monitors the condition of the fetus, in particular, conducts cardiac monitoring, tracking cardiac activity. A prerequisite for this may be cloudy greenish waters: this means that meconium has entered them. This criterion can be taken into account only in case of cephalic presentation of the fetus. In addition, acute hypoxia can be judged by tests of amniotic fluid and fetal blood tests (based on pH level).

A prolonged increasing state of hypoxia during childbirth is an indication for an emergency cesarean section.

But it should be understood that even acute hypoxia has its roots in the period of gestation. And if the violations and changes that arise at this time are identified in advance, then many troubles can be avoided.

Especially for- Elena Kichak

During intrauterine development, the fetus urgently needs nutrients and oxygen. Access to them is an important condition and guarantee of the child’s health. Lack of oxygen or, scientifically, hypoxia is a serious disorder, dangerous due to possible complications and adverse consequences.

What is intrauterine fetal hypoxia

During intrauterine development, by the beginning of the 2nd trimester, the placenta is formed - the connection between the maternal body and the fetus. Thanks to the umbilical cord, blood enriched with oxygen and nutrients enters the child's body. For intensively growing and multiplying cells, a sufficient amount of oxygen is an important factor ensuring metabolism at the proper level.

Under normal conditions, there are enough nutrients and oxygen to provide the fetus with everything it needs. The adequacy of the mother-placenta-fetus system is of great importance during the 2nd and 3rd trimester, since at this time the development and maturation of the central nervous system occurs. But, with various disorders, hypoxia occurs - a state of acute or chronic lack of oxygen. Without the required amount of this gas in the fetal blood, biochemical processes are disrupted. Brain cells are most sensitive to this pathology. This explains mainly neurological disorders in children resulting from intrauterine fetal hypoxia.

Damage to the central nervous system can lead to the death of nerve cells, which are not known to regenerate. As a result of such damage, severe defects arise, manifested as epilepsy, cerebral palsy, and mental retardation.

Less serious, but no less significant, disorders are also associated with intrauterine hypoxia. Minimal brain dysfunction, hyperactive child syndrome, perinatal encephalopathy are pathologies directly related to lack of oxygen.

Severe acute fetal hypoxia can lead to the death of the child.

Classification of intrauterine fetal hypoxia

For reasons, fetal hypoxia is divided into:

associated with the mother’s body;
associated with pathologies of the placenta and umbilical cord;
associated with the fetal body.

Based on the body’s ability to compensate for disturbances that occur during hypoxia:

compensated hypoxia;
subcompensated hypoxia;
decompensated hypoxia.

By time:

chronic hypoxia - more often occurs during pregnancy;
acute hypoxia - often occurs due to obstetric pathology during childbirth.

Causes of intrauterine fetal hypoxia

Causes of fetal hypoxia associated with the mother’s body

Carbon monoxide coming from smoke binds tightly to hemoglobin molecules, a protein that carries oxygen in the blood. From the outside, this can be imagined as trying to get into a crowded bus during rush hour. If normally each passenger is one molecule of oxygen, then in the blood of a smoking woman, figuratively speaking, places are occupied by carbon monoxide. Everyone will reach the final stop, but not those who are needed. Only part of the required oxygen will reach the fetus.

Children of smoking mothers are often born with developmental abnormalities. They are developmentally delayed, begin to speak and walk later, and suffer from the effects of hypoxia and the toxic effects of tobacco smoke.

Mother's illnesses also affect the baby's oxygen supply. Cardiovascular pathologies, lung diseases, and anemia can cause acute and chronic hypoxia. For example, pneumonia during pregnancy sharply reduces the area of effective gas exchange. Absorbing less oxygen from the air, the mother’s body is not able to deliver the required amount to the fetus.

Anemia - a lack of hemoglobin and red blood cells that carry oxygen, is also a common cause of intrauterine hypoxia. However, the role of blood diseases in the development of hypoxia is very large.

Pregnancy against the background of chronic diseases is always the possibility of a number of complications, including fetal hypoxia.

Causes of fetal hypoxia associated with the placenta and umbilical cord

Feto-placental insufficiency is a disruption of the normal function of the mother-placenta-fetus system, which also leads to intrauterine hypoxia. The cause could be anything from anemia and infections to severe pregnancy complications.

From the placenta, blood enters the baby's body through the umbilical cord. The latter contains arteries and veins. Mechanical obstacles (torsions, kinks, compression, entanglements) reduce the permeability of blood through the umbilical cord and can lead to fetal hypoxia.

The most severe cause of fetal hypoxia is a serious complication of pregnancy called gestosis. Preeclampsia is based on a sharp increase in blood pressure due to vasospasm. Not only the blood supply to the fetus suffers, but also to the vital organs of the mother’s body. In developed countries, this pathology is the main cause of maternal and child mortality.

Causes of intrauterine hypoxia associated with the fetal body

Symptoms of fetal hypoxia

Signs of fetal hypoxia: initially, the lack of oxygen excites the motor center of the child’s brain. Clinically, this is manifested by increased strength and frequency of movements, tachycardia (rapid heartbeat) in the fetus. When compensatory mechanisms fail and carbon dioxide accumulates in the blood, motor activity and cardiac activity are inhibited. External manifestations are the absence or decrease in the frequency and strength of movements, slowing of the fetal heartbeat (bradycardia). However, such symptoms are characteristic of acute hypoxia. In addition, the evaluation method is subjective. Studies have shown that the effectiveness of such diagnostics is very low. But, the absence of fetal movements within 12 hours is a reason to seek medical help.

Indirect signs of hypoxia at birth are cloudy green amniotic fluid due to the presence of meconium in it, bluish skin, and a low Apgar score.

Chronic hypoxia is difficult to recognize without instrumental methods. To diagnose intrauterine fetal hypoxia, cardiotocography (a method of recording fetal heart rate and uterine tone) and ultrasound are used.

Diagnosis of fetal hypoxia: cardiotocography records the fetal heart rate and contraction of the uterine muscles. Normally, a child’s heart beats 120-160 beats per minute. Unstable or low fetal heart rate indicates hypoxia. Currently, the method is used in automated devices. They are called antenatal cardiac monitors. The equipment allows you to monitor the condition of the child before and during childbirth without human intervention.

For routine studies, fetal ultrasound with vascular Doppler scanning has become more widespread. The method allows you to determine the amount of blood flow through given vessels - arteries and veins of the umbilical cord, great vessels and the middle cerebral artery of the fetus. Slowing blood flow is a sign of hypoxia.

An indirect sign of fetal hypoxia on ultrasound is also considered to be a discrepancy between the weight and size of the fetus and the gestational age (intrauterine growth retardation).

Treatment of intrauterine fetal hypoxia

For chronic fetal hypoxia, treatment is aimed at improving uteroplacental blood flow. For this purpose, they correct disorders of the blood coagulation system, treat anemia, and normalize the tone of blood vessels and the uterus. Drugs that improve metabolism are used. Vitamins and antioxidants prevent cell damage due to lack of oxygen.

Physical activity, proper rest, and elimination of stress and strain on the body are of great importance. Walking in the fresh air and gymnastics are recommended to prevent congestion in the pelvis. In severe cases, strict bed rest is prescribed. The diet is balanced, healthy, rich in vitamins and proteins.

Studies have shown that moderate chronic hypoxia is less dangerous. The child’s body has time to adapt and compensate for the lack of oxygen. Acute fetal hypoxia, resulting from premature placental abruption, entanglement, or other obstetric pathology, requires immediate surgical delivery. The lack of oxygen can be alleviated with oxygen therapy.

Consequences of intrauterine fetal hypoxia

Chronic lack of oxygen contributes to intrauterine growth retardation. Statistical studies have shown a connection between hypoxia and sudden infant death syndrome. This pathology does not manifest itself and has no symptoms. But, due to dysfunction of the respiratory center, possible fatal disorders - in a dream, the child simply stops breathing. At an older age, mental retardation, attention deficit, and hyperactive child syndrome are possible.

Complications of acute fetal hypoxia are more severe. This is the main reason for transferring a child after birth to the intensive care unit. Damage to the central nervous system, which involves the death of neurons (brain cells), can lead to cerebral palsy, epilepsy, and mental defects. In severe cases, disability from childhood is possible. Such a child begins to walk at 3-4 years old and speak even later. Unfortunately, this is not uncommon. The consequences of hypoxia are difficult to treat.

Prevention of fetal hypoxia

Such serious pathologies are easier to prevent than to treat. A healthy lifestyle, a balanced nutritious diet, and sports are beneficial for the body of the expectant mother. Timely treatment of chronic diseases before pregnancy sharply reduces the incidence of obstetric complications.

Many women complain that during pregnancy they have to undergo frequent examinations and tests. This is a necessary measure - in recent decades, normal pregnancy has become a rare occurrence. But timely diagnosis and treatment is a guarantee that everything will be fine. It is necessary to strictly follow all doctor’s prescriptions and recommendations.

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