Prevention of the occurrence of oxygen starvation of the fetus and other pathologies of pregnancy is its correct planning.
How to avoid? If you undergo examination and treat all existing diseases before conception, the risk of hypoxia will significantly decrease.
Another important point in the prevention of hypoxia is maintaining a healthy lifestyle for parents before conception and during pregnancy.
A pregnant woman must give up smoking, alcohol, eat right, get plenty of rest, maintain physical activity, but not overwork. You need to avoid stress and anxiety. The health of the unborn child directly depends on the health of the mother.
If a woman has incurable chronic diseases, then she needs to inform the doctor about this so that he knows about possible problems during pregnancy and can take the necessary actions to eliminate them in a timely manner.
Long walks in the fresh air, breathing exercises, and ventilation of the room where the woman is are good for preventing hypoxia. After all, in order for the baby inside the womb to receive a sufficient amount of oxygen, the woman needs to inhale more of this gas.
In urban environments, this is not always possible, because the air in cities is saturated with carbon dioxide, an oxygen antagonist. Therefore, it is better to walk in city parks, near water bodies, and go outside the city.
Aqua gymnastics has proven itself positively. This is the safest sport for pregnant women. Water will help you relax and relieve tension, tones and lifts your spirits. Exercises in water will help improve blood circulation, the functioning of all organs and systems of the body, and improve metabolism.
Exercises in the pool train the respiratory and cardiovascular systems, saturate the blood with oxygen, which serves as a good prevention of hypoxia. Also, exercises will help relieve stress from the spine, which is very important during pregnancy, and train many muscles, including the back, abs, and hips.
To detect hypoxia in a timely manner, it is important to take all prescribed tests on time, monitor the health status of the pregnant woman and consult a doctor.
Consequences
What does this lead to in the future?
In the absence of timely diagnosis and adequate treatment, prolonged oxygen starvation can lead to the following consequences:
- In the first trimester, pregnancy slows down and fades;
- Incorrect formation of the child’s systems and organs;
- Fetal development and growth retardation;
- CNS lesions;
- Decreased function of newborn adaptation to the environment.
In our next material you will find
Acute form
The onset of an acute form of oxygen starvation occurs suddenly and develops rapidly. Development occurs over several hours.
You can suspect hypoxia that has occurred during the process of delivery:
- If the amniotic fluid is greenish in color, it is cloudy with an admixture of baby feces - meconium.
- If the child's heart rate first increases sharply (up to 170 beats per minute and above), and then decreases (up to 120 beats per minute and below).
If there is a severe deficiency of oxygen in the fetal blood, the child’s circulatory system redistributes oxygen so that it reaches the most important organs. In this case, intestinal function decreases, and feces are released into the amniotic fluid. In the normal course, the baby has a bowel movement for the first time after birth.
The rhythm becomes weak, the heartbeat is muffled, arrhythmic.
Causes
The most common causes of acute oxygen deficiency in the fetus during labor can be:
- Premature placental abruption
- Uterine rupture occurs during childbirth
- Difficult birth with difficult delivery of the baby
- Cord clamping
- Prolonged labor, low labor activity.
Most often occurs with preeclampsia - long-term high blood pressure in a woman
With pathological changes in the walls of the uterus or through mechanical damage). In this case, the fetus along with the placenta will enter the mother’s abdominal cavity and die within a few minutes.
The baby's head is compressed for a long time, especially if the baby is heavy
It is most often caused by repeated entanglement of the umbilical cord, especially around the baby's neck. In this case, asphyxia may develop.
Treatment
Treatment of acute hypoxia depends on the causes of its occurrence. In any case, urgent medical intervention is required, usually surgery.
If an acute form of the disorder occurs during pregnancy, it is necessary to urgently take the pregnant woman to the hospital.
To improve her condition, you can use intravenous administration of glucose, vitamins, and means to stimulate respiratory function.
In case of acute fetal hypoxia that occurs during childbirth, it is necessary:
- If possible, eliminate the cause that caused this condition
- Provide the necessary resuscitation measures for the newborn immediately after birth.
For example, to induce labor if it is protracted, or to perform an emergency operation.
In an infant with acute hypoxia, asphyxia usually occurs - lack of breathing. Oxygen starvation causes the accumulation of carbon dioxide in the organs and tissues of the newborn, slowing down breathing and heartbeat until they stop.
Subsequently, the child is monitored by specialists, and examinations are prescribed to detect damaged organs, systems, and tissues due to oxygen deficiency.
Consequences
Acute development of hypoxia if emergency assistance is not provided can lead to the death of a child.
The consequences of acute oxygen deprivation that occurs during childbirth are assessed using the Apgar scale. The lower the scores on this scale, the greater the likelihood of pathologies and health problems in the newborn.
The consequences of oxygen starvation can be expressed by the following pathologies:
- Lesions of the central nervous system of the child's body
- Ischemic diseases of organs and tissues
- Hemorrhages in various organs
- Increased risk of sudden infant death
Lack of oxygen leads to the death of nerve cells, which, as is known, are not restored.
Who suffered due to oxygen deficiency;
Prevention
It is impossible to predict the occurrence of acute hypoxia. However, you can take actions to reduce the risk of developing this pathology.
Prevention of acute oxygen deficiency consists of proper preparation for pregnancy and childbirth and avoidance of chronic hypoxia. Moderate physical activity and a healthy lifestyle reduce the risk of complications during childbirth, and, consequently, the occurrence of hypoxia.
It is important to choose an experienced obstetrician who will deliver the baby. Inform him about the progress of pregnancy, problems during its period, existing diseases that can cause complications during childbirth.
The doctor will help you make the right decision about the method of resolving labor or provide timely assistance if problematic situations arise.
Calm, just calm! Fetal defense mechanisms
Despite the fact that fetal hypoxia is a fairly common diagnosis, there is no need to worry ahead of time. Oxygen starvation is of course very harmful to the child, but there is no need to panic ahead of time. After all, nature provides for compensatory and adaptive reactions of the fetus. They are expressed by the following physiological features:
- Increased heart rate to 130-160 beats per minute,
- Blood contains a lot of fetal hemoglobin, up to 70% of the total volume,
- There is a significant oxygen capacity of the blood,
- the fetal cardiovascular system is designed in such a way that almost all organs receive mixed blood
This ensures a slower decrease in the oxygen level in the blood during hypoxia.
When oxygen starvation occurs, the stroke volume of the heart increases, the heart rate and the volume of circulating blood increase, the blood supply changes so that the bulk of the blood flows to vital organs - the brain, heart, lungs - and blood circulation in the skin, muscles, and intestines decreases.
The stress that occurs in the fetus during hypoxia activates the body's systems and causes the release of glucocorticosteroids, which increase the stability of cell membranes.
Thus, during the first stage of hypoxia, the fetus is quite capable of maintaining the required level of oxygen in the tissues. And only with prolonged oxygen deficiency, the fetus’s adaptive mechanisms are exhausted and decompensation develops, which means oxygen starvation of the cells occurs.
The main thing for a pregnant woman is to remain calm and not give in to emotions. After all, the health of both mother and child depends on the emotional state.
It is important to study all available information on hypoxia during pregnancy, know its symptoms and be prepared for the occurrence of this problem. Then it will be possible to identify the violation in time and eliminate it before serious consequences occur.
Video about prevention methods
From the following video you will learn how you can increase the flow of oxygen to your baby.
Intrauterine fetal hypoxia is a deficiency of oxygen necessary for the embryo to properly form and develop organs and tissues. This pathology can lead to serious consequences for the health and life of both the baby and the mother, and therefore it is important to diagnose and begin treatment in a timely manner.
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Types of intrauterine hypoxia
The disease is classified according to two factors - the duration of hypoxia and the stage of severity of the main symptoms.
First group:
- Chronic fetal hypoxia is a long-term deficiency of oxygen supply to the tissues of the embryo due to maternal illness or placental disorders.
- Acute hypoxia is a sharp and pronounced lack of oxygen. This type of disease can develop during placental abruption, childbirth and other pathological situations.
Classification of hypoxia in accordance with the clinical picture of the disease:
- Threatening - symptoms of oxygen deficiency are not observed, but conditions develop that are provoking factors (post-term pregnancy, premature aging of the placenta, etc.). Prevention of hypoxia is necessary.
- Once it has begun, the clinical picture of oxygen starvation is clearly expressed, which requires immediate initiation of treatment.
Degrees of chronic hypoxia
Intrauterine hypoxia in the embryo most often develops in the second and third trimester, when the fetal need for oxygen sharply increases. Under the influence of a damaging factor, adaptive mechanisms are activated for a certain time. They protect the organs and tissues of the fetus without stopping the normal development process. With prolonged hypoxia, the protective ability decreases and the disease begins to progress.
There are the following degrees of chronic lack of oxygen in the fetus:
- Compensated. Develops at the first stages of oxygen deficiency. During this period, the work of the adrenal cortex increases, affecting the amount of hormones. Thus, heart rate, vascular tone, blood volume, as well as red blood cells and hemoglobin increase. All these changes contribute to faster movement and oxygenation of cells. At this stage, the main symptom is more intense fetal movements. During the first stage, the uterus and placenta are able to cope with the negative effects of oxygen deficiency and ensure the normal development of the embryo. If the mother’s condition is restored in a timely manner, pregnancy proceeds as usual.
- Partially compensated. The protective functions of the fetus restructure the body’s functioning to provide oxygen to vital organs (heart, brain and spinal cord). As a result, the remaining tissues are exposed to insufficient blood supply, ischemia occurs. For example, such a process in the intestines leads to the opening of the anus and the release of meconium into the amniotic fluid. At this stage, the protective capabilities of the uterus and placenta are almost exhausted. Urgent treatment is necessary, since the risk of disruption in the formation of many organs of the embryo is significantly high.
- Decompensated. There is a disruption in the functioning of the body. The adrenal cortex can no longer produce cortisol even in a minimal amount. The heart rate decreases, the fetus becomes inactive, and movements practically disappear. Continued oxygen deprivation leads to minor hemorrhages in the brain and other organs, and blood clots may form. Due to the accumulation of carbon dioxide in the blood, the baby tries to breathe through the glottis, which leads to mucus, water and meconium entering the lungs. This is a direct path to asphyxia during childbirth when trying to take the first breath.
Scheme of fetal hypoxia
Causes
The developmental mechanisms and factors that lead to oxygen deficiency can be quite diverse and are grouped into several categories.
Diseases and conditions of the mother
The first group of factors relates to diseases and lifestyle of a pregnant woman:
- decreased hemoglobin;
- systemic diseases (for example, diabetes mellitus);
- severe blood loss;
- diseases of the heart, kidneys, lungs and bronchi, infectious lesions;
- smoking, staying in rooms with polluted air;
- toxic damage to the body;
- low birth weight, narrow pelvis;
- sedentary lifestyle.
Disturbance of uteroplacental blood flow
- post-term pregnancy;
- high risk of rapid labor;
- various complications and pathologies during pregnancy (preeclampsia and others);
- structural and functional disorders of the placenta and umbilical cord;
- placenta previa or improper placement in the uterus;
- twisting or prolapse of the umbilical cord;
- complications during childbirth.
Features of the course and complications of this pregnancy
Intrauterine fetal hypoxia can cause the following problems during pregnancy:
- Threat of interruption. It occurs both as a result of stress and severe overwork of a woman, and in connection with various diseases of the mother and disturbances in the development of blood flow between the uterus and placenta.
- Increased uterine tone. Long-lasting and frequent contractions of muscle tissue occur long before the baby is born. As a result, the flow of arterial blood to the embryo is disrupted.
- Multiple pregnancy. It is harder for the uterus and placenta to provide oxygen to several embryos.
Diseases and conditions of the fetus
Causes of hypoxia:
- infections;
- malformations of organs and systems;
- intracranial hematoma;
- incompatibility of the blood of the embryo and mother;
- breech presentation.
Signs of hypoxia
In the first months of pregnancy, it is possible to determine oxygen deficiency for the fetus only through instrumental diagnostic methods. Indications for such studies may include illness of the mother, as well as the presence of factors from the list above. Therefore, it is so important to visit the doctor on time and tell about all the atypical and typical symptoms of pregnancy that concern you. Perhaps one of them will prompt the doctor to think that there is a risk of pathology and fetal hypoxia.
At later stages, the mother needs to carefully monitor the baby’s movements. Some doctors believe that hiccups and increased movements may also indicate hypoxia. But the cause of such symptoms may be the incorrect position of the fetus in the uterus or stress of the mother. If such signs pass quickly, then there is no reason to worry.
A decrease in the number of waves of movements during the day is the main alarming indicator, when it appears, you should immediately consult a doctor for a more thorough diagnosis.
Diagnostics
It is possible to detect the onset of hypoxia during a routine examination of a pregnant woman - poor tests (low hemoglobin is the first symptom of oxygen deficiency in the mother's blood) or a woman's complaints about decreased fetal activity. After which a more thorough examination takes place in order to recognize the presence of oxygen starvation in the embryo.
The first step is to interview the expectant mother:
- woman's age;
- medical history;
- current condition, presence of non-standard symptoms;
- previous pregnancies - course and outcome;
- bad habits, lifestyle;
- working conditions.
Cardiotocography
The method allows you to calculate the heartbeat of the fetus, as well as monitor its activity, and record the influence of the mother’s movements on the baby.
Operating principle of the CTG device
Study results for a healthy fetus:
- heart contractions from 120 to 160 beats per minute;
- the heartbeat increases with the activity of the embryo or sudden movement of the pregnant woman;
- there is no slowdown in heart rate.
In case of fetal hypoxia, the results of cardiotocography will have the following features:
- very slow or, conversely, accelerated heartbeat;
- reduced motor activity of the embryo;
- There is a frequent decrease in heart rate.
Doppler
One of the types of ultrasound diagnostics, which evaluates blood vessels and the state of blood flow in the uterus, placenta and umbilical cord. The result of the study is a Dopplerogram, constructed based on an analysis of the frequency difference between the sent and reflected signals from moving red blood cells. Diagnosis by this method is most informative at 21-22 weeks of pregnancy.
Doppler
Amnioscopy
This method is used exclusively from the 37th week of pregnancy, as there is a high risk of premature birth. The woman is placed in a gynecological chair, the external and internal genital organs are treated with an antiseptic. An amnioscope is inserted through the cervix into the uterus, with its help the doctor examines the state of the amniotic fluid and the presence of impurities in it.
Counting fetal movements
This is rather a method of primary diagnosis, on the basis of which a pregnant woman seeks a more thorough examination of the body. It is used from 25 weeks. The woman lies on her side and counts the baby's movements. Normally, there should be at least 10 movements within an hour.
There is also a Pearson test. In which you need to observe from the moment you wake up until the moment you sleep. For example, let's take the period from 9 am to 9 pm. If during this period you feel less than 10 sessions of movements (they can last a couple of minutes), then you need to consult a doctor.
Ultrasound examination (ultrasound)
Ultrasound can be used to diagnose hypoxia after 20 weeks of pregnancy. At this time, it is possible to examine the arteries in the uterus and identify disturbances in the blood flow to the placenta at an early stage. And ultrasound is also used to determine the structure of the placenta and the level of amniotic fluid.
Ultrasound during pregnancy
Treatment methods
The causes and consequences of hypoxia are quite diverse. In this regard, treatment is selected purely individually, depending on the degree of pathology, concomitant conditions, gestational age and other factors.
Treatment of fetal hypoxia without medications
This technique is aimed at improving blood flow between mother and fetus and is used in the early stages of hypoxia or as part of complex treatment:
- Reducing physical activity, emotional stress, dosed bed rest. These measures lead to a decrease in vascular tone, which stabilizes blood flow to the fetus.
- Complete nutrition.
- Oxygen therapy. Inhale a 50% air mixture a couple of times a day. Sometimes oxygen cocktails of 200 ml can be used 10 minutes before meals or 2 hours after.
- Hyperbaric oxygenation. A pregnant woman is placed in a special pressure chamber in which she breathes a gas mixture under pressure above atmospheric pressure. Thus, the level of oxygen access to tissues and organs improves.
Hyperbaric chamber for pregnant women
Drug treatment
Medicines for hypoxia are divided into several groups depending on the condition of the pregnant woman and the characteristics of the course of the pathology:
- Treatment of the underlying disease of the mother or fetus (diabetes mellitus and others).
- Normalization of blood circulation between mother and embryo (Actovegin, vitamins E and C, amino acids).
- Preparations for relaxing the muscles of the uterus - Ginipral, Magnesium B6, No-shpa, Papaverine.
- To improve blood clotting - Trental, Curantil.
Magne B6 (515 rubles) Actovegin (1048 rubles) Ginipral (245 rubles) Chimes (509 rubles) No-shpa (50 rubles) Vitamin E (123 rubles)
Fetal hypoxia: hospital treatment
Some factors leading to hypoxia may require the pregnant woman to be in the hospital under constant monitoring.
Treatment in a hospital occurs in the following cases:
- If there is a need to administer drugs intramuscularly.
- Intoxication of a pregnant woman as a result of infections, poisoning. Constant monitoring of the condition of the woman and fetus is important, as well as replenishment of fluid losses in the body by administering intravenous solutions (glucose, sodium bicarbonate, and others).
- Placental abruption. In a hospital setting, the condition of the mother, placenta and fetus is monitored. If treatment does not help, then in case of detachment in a significant area and severe bleeding, a cesarean section or cleansing is performed, depending on the stage of pregnancy.
- Infectious diseases of viral or bacterial origin. In this case, antibiotics (Cefazolin, Acyclovir) may be prescribed.
Acyclovir (343 rubles) Cefazolin (24 rubles)
Possible consequences
Intrauterine fetal hypoxia, even to a mild degree, can subsequently lead to unpleasant consequences for the child and mother. First of all, the fetus suffers, since oxygen deficiency negatively affects the development of its organs and systems. Severe degrees of oxygen starvation lead to premature birth and death of the embryo. In this case, the woman in labor often experiences bleeding, and in the later stages, difficult labor. In the most difficult situations, a woman may have further problems conceiving again.
If a baby with intrauterine hypoxia survives the first month after birth safely, then pathological changes in his future life are minimal.
Chronic
The consequences for a child with chronic hypoxia are as follows:
- short stature and underweight;
- low hemoglobin;
- weak immunity (susceptibility to viral infections);
- hyperactivity in older age;
- poor thermoregulation after childbirth.
Acute
With this form of hypoxia, the following consequences can be observed:
- intestinal necrosis;
- high risk of sudden infant death syndrome;
- pneumonia;
- serious damage to the central nervous system;
- development .
How to avoid fetal hypoxia?
It is easier to learn to prevent the risk of developing oxygen starvation of the fetus than to deal with the consequences in the future. There are various preventive measures both before pregnancy (during the period of planning and preparation) and during its course. If a woman takes a responsible attitude to this issue, the risk of hypoxia is significantly reduced.
Prevention before pregnancy
The main aspects of preparing a woman for pregnancy are giving up bad habits (smoking, drugs, alcohol) and examining the body for the presence of diseases. Treating existing ailments before fertilization will help minimize their impact on fetal development.
During pregnancy
To avoid hypoxia, the expectant mother must adhere to the following rules:
- register before 12 weeks and strictly follow the schedule of required studies;
- visit a doctor in the absence of pathologies once every one and a half months in the first trimester and once every 4 weeks in the second and third;
- maintain a daily routine (sleep at least 8 hours);
- good nutrition;
- taking vitamin complexes for pregnant women, especially important are folic acid (has a beneficial effect on iron absorption) and magnesium (responsible for the formation of blood vessels);
- walks in the open air;
- healthy lifestyle.
Fetal hypoxia is an intrauterine syndrome characterized by multiple disorders of internal organs and systems caused by oxygen starvation of the fetus. Perinatal hypoxia is one of the most common obstetric pathologies in Russia: up to 10.5% of newborns suffer from certain manifestations of oxygen starvation.
Source: mamitips.com
Causes and risk factors
Fetal hypoxia is a manifestation of various pathological processes in the body of the mother or unborn child. The risk group includes women suffering from anemia and diabetes, severe forms of gestosis, acute and chronic diseases of the respiratory and cardiovascular systems. Contact with toxic substances, living in an ecologically unfavorable area, and bad habits of the mother also negatively affect placental circulation.
On the part of the fetus, the following factors provoke hypoxia are identified:
- malformations and anomalies of development;
- intrauterine infections (toxoplasmosis, herpes, chlamydia, mycoplasmosis);
- prolonged compression of the head during childbirth;
- hemolytic disease in Rhesus conflict.
Insufficient oxygen supply to the fetal tissues triggers a cascade of pathological processes that provoke the appearance of congenital pathologies and a general retardation of the child in mental and physical development.
Oxygen starvation of the fetus also occurs when there are disturbances in placental blood flow associated with complications of pregnancy and childbirth:
- fetoplacental insufficiency;
- abnormalities in the structure of the umbilical cord;
- repeated entanglement of the umbilical cord around the baby’s neck;
- post-maturity;
- prolapse or compression of the umbilical cord;
- prolonged or rapid labor;
- threat of premature birth.
Source: dobrenok.com
Forms
Depending on the duration of the course, two forms of fetal hypoxia are distinguished - acute and chronic. Acute hypoxic conditions usually develop as a result of pathological childbirth, less often - during pregnancy in the case of placental abruption and uterine rupture. Rapidly increasing depression of the functions of vital organs poses a threat to the child’s life.
Chronic fetal hypoxia during pregnancy develops over a period of time. Insufficient oxygen supply to the fetal tissues triggers a cascade of pathological processes that provoke the appearance of congenital pathologies and a general retardation of the child in mental and physical development. The body's first reaction to oxygen deficiency is centralization and redistribution of blood flow in favor of the brain, creating the preconditions for ischemic changes in tissues. The reactive release of vasoactive adrenal hormones in the early stages of hypoxia leads to gradual depletion of the medulla and cortex and secretory failure, followed by the development of bradycardia and arterial hypotension. Reduced tone of precapillaries and arterioles contributes to the expansion of peripheral vessels and the appearance of capillary circulation disorders, which are expressed in slowing blood flow, increasing blood viscosity and reducing the intensity of gas exchange. Violation of the trophism of vascular walls increases the permeability of cell walls, creating conditions for the development of hemoconcentration, hypovolemia, internal hemorrhages and tissue edema. The accumulation of under-oxidized metabolic products causes respiratory metabolic acidosis and activates lipid peroxidation, during which toxic free radicals are released.
With timely completion of planned diagnostic procedures during pregnancy, there is a chance to save the fetus and minimize damage to the child’s health.
The severity of pathological changes in chronic perinatal hypoxia depends on the duration and intensity of oxygen deficiency, as well as on the adaptive capabilities of the body. In obstetric practice, compensated, subcompensated and decompensated hypoxic conditions are distinguished. Compensated fetal hypoxia during pregnancy does not cause serious damage to the child’s health, but the probability of giving birth to absolutely healthy children after hypoxia suffered in utero is estimated at 4%.
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Diagnosis of fetal hypoxia
Each expectant mother can suspect the initial stage of this condition on her own, since she is characterized by very restless behavior of the fetus. The more this pathology develops, the weaker the fetus begins to move. As a result, the woman goes to a specialist doctor.
A comprehensive examination of the expectant mother is carried out to assess the risks of development hypoxia fetus:
- The pregnant woman is interviewed: her age (late or young for a primigravida), her state of health and past illnesses, the outcomes and course of previous pregnancies, the presence of bad habits and other factors are clarified.
- During the examination, the presence or absence of uterine tone is assessed.
- The abdominal circumference is measured, then the data is compared with the weight and height of the pregnant woman.
- The results of studies assessing the condition of the fetus and uteroplacental blood flow are analyzed.
- Doppler;
- cardiotocography;
- study of amniotic fluid;
- ultrasonography;
- amnioscopy.
Listening to the fetal heartbeat
It is performed through the anterior wall of the abdomen, starting from 18-20 weeks of pregnancy. Fine heart rate (HR) in the fetus it is 140-160 beats/min.
Used obstetric stethoscope- a small tube with wide funnels at both ends. The doctor applies a wide funnel to the mother's abdomen - at the point of best listening, which depends on the position of the fetus in the uterine cavity (cephalic, pelvic, transverse).
Cardiotocography (CTG)
Makes it possible to simultaneously record and analyze the fetal heartbeat and uterine contractions.
CTG during pregnancy
In case of a normal pregnancy after 32-33 weeks, according to the recommendations, it is performed for all women once every 7-10 days.
CTG during childbirth
Execution is determined individually. General recommendations - when a woman in labor enters the maternity ward, after the discharge of amniotic fluid, before induction of labor in case of weak labor, and every three hours of labor.
CTG results are variable and depend on many factors. For example, if in the morning they were within the normal range, then in the evening deviations may occur. Therefore, the study is carried out as often as necessary.
Indications for CTG for women at risk:
- On the mother's side: Rh-negative blood, a history of premature birth, decreased or increased activity of the fetus, serious diseases (diabetes mellitus, diseases of the cardiovascular system and others).
- Changes in the fetus identified by ultrasound: impaired blood flow in the placenta, discrepancy between the size of the fetus and the gestational age, abnormalities of the placenta and/or umbilical cord, changes in the quality or quantity of amniotic fluid, intrauterine growth retardation, decreased fetal activity.
- Complications of the current pregnancy: placenta previa, abnormal fetal position, multiple pregnancy, post-term pregnancy, preeclampsia.
There are technologies for conducting CTG online remotely: The sensor is attached to the skin of the front wall of the expectant mother's abdomen, and the signal is transmitted to a smartphone connected to the Internet. The information is sent to the Internet portal and processed, and then the results are forwarded to the doctor for decision-making.
There are two types of CTG:
- Indirect (external) - performed when the amniotic sac is intact. The sensors are attached to the skin of the anterior abdominal wall at the points of best listening to the fetal heartbeat.
- Direct (internal) - rarely used during childbirth when the integrity of the amniotic sac is broken. A sensor for recording heart rate is attached to the presenting part of the fetus, and a catheter for recording tone is inserted into the uterine cavity.
- During pregnancy - about 40-60 minutes, when normal indicators are obtained - 15-20 minutes.
- During labor - 20 minutes and/or five contractions.
- During the examination, the woman is in a sitting or lying position.
- The doctor gives the expectant mother a device with a button, which she presses when she feels the movements of the fetus.
It is not recommended to perform CTG on an empty stomach, within 1.5-2 hours after eating or one hour after administering glucose. If the necessary conditions are not met, the results of the study may be distorted.
CTG options
The non-stress test is carried out in natural conditions.
Stress test - the birth process is simulated. Used for additional diagnostics when a non-stress test shows deviations from the norm.
The most commonly used stress test options are:
- Oxytocin test: Oxytocin is administered to induce contractions, then the fetal heart rate response to uterine muscle contractions is observed.
- Mammary test: a woman rolls her nipples with her fingers until contractions appear.
- Acoustic test: the fetal heart rate is recorded in response to a sound stimulus.
- The presenting part of the fetus shifts: the head or pelvis is located closer to the entrance to the uterus for natural birth.
Evaluated according to the Savelyeva scale (1984)
Assessment of fetal condition by points
- 8-10 points - normal condition of the fetus.
- 5-7 points - there are initial manifestations of hypoxia. A repeated non-stress test is performed within 24 hours. If the indicators have not changed, then a stress test is performed or additional research methods are carried out.
- 4 points or less - serious changes in the condition of the fetus, which require a solution to the issue of urgent delivery or adequate treatment to improve the condition of the mother and fetus.
Doppler
Blood flow is measured in the vessels of the fetus, placenta and the space between the placental villi.
The study can be carried out from 20-24 weeks of pregnancy, but the most reliable results are obtained from the thirtieth week. The procedure is harmless to the fetus and mother.
A special ultrasound sensor is used that emits more powerful radiation that is reflected from a moving object, in this case the bloodstream. During the study, the woman is in a lying position on her side or back. A special gel is first applied to the skin of the anterior abdominal wall for better glide of the sensor.
The study is carried out for all women during a normal pregnancy at 30-32 weeks and before childbirth. Perform more often if necessary.
Indications for Doppler testing for women at risk:
- On the mother's side: serious diseases - for example, cardiovascular system, kidneys, diabetes mellitus and others.
- From the fetus: intrauterine growth retardation, decreased or increased motor activity.
- Condition or complications of the current pregnancy: premature birth, gestosis and others.
Disturbances of utero-placental-fetal blood flow according to Medvedev
I degree:
A- blood flow in the vessels between the uterus and the placenta is disrupted, but remains at normal levels in the vessels between the fetus and the placenta.
IN- blood flow in the vessels between the fetus and the placenta is disrupted, but is maintained between the uterus and the placenta.
II degree: blood flow is disrupted simultaneously in the vessels of the uterus, placenta and fetus, but the values do not reach critical values.
III degree: the blood flow in the vessels between the fetus and the placenta is disrupted to critical values, while the blood flow in the vessels between the uterus and the placenta is disrupted or maintained.
Ultrasound examination (ultrasound)
The most common, safe and highly informative method of examination during pregnancy for the fetus and the expectant mother.
It is carried out for all women at term in accordance with the recommendations for screening studies during pregnancy:
- The first screening is at 11-13 weeks;
- The second - at 20-21 weeks;
- The third is at 30-34 weeks.
The procedure is carried out without preliminary preparation using two types of sensors:
- Transvaginal (the sensor is inserted into the vagina) - most often used in the first trimester. Before the examination, the doctor puts a condom on the ultrasound sensor.
- Abdominal (the sensor is moved over the skin of the abdomen) - usually used from the second trimester. Before the examination, a special gel is applied to the skin to improve the glide of the sensor.
Rated depending on the duration of pregnancy. Changes or diseases that could lead to the development of fetal hypoxia are also identified.
In the early stages, the place of attachment of the fertilized egg is determined and its formation is assessed.
In the later stages
The condition of the placenta is assessed
The structure, thickness, place of attachment, presence or absence of detachment, and degree of maturity are determined.
Amniotic fluid is examined:
- The amount is determined by the amniotic fluid index (AFI), which has a wide range depending on the stage of pregnancy. When there is an increase, we are talking about polyhydramnios, and when it decreases, we are talking about oligohydramnios.
- Attention is drawn to the composition of amniotic fluid: normally up to 28 weeks it is transparent and colorless. As the period increases, the waters become cloudy and inclusions appear in them in the form of white flakes - due to the ingress of discharge from the sebaceous glands of the fetus (droplets of fat), vellus hair, desquamation of skin cells and some other substances. The appearance of meconium (original stool) is a sign of hypoxia, dirty water, and intrauterine infection.
The obtained data are compared with normal values in accordance with the expected gestational age. On this basis a conclusion is made. With hypoxia, there is intrauterine growth retardation of the fetus.
The condition of internal organs is assessed- to identify developmental abnormalities in the fetus.
The position of the child is determined: cephalic, transverse, pelvic.
The structure of the umbilical cord and the location of its loops are assessed- to identify developmental anomalies and possible compression during childbirth.
Amnioscopy
An optical endoscopic device is inserted through the vagina into the cervical canal, with the help of which the lower pole of the amniotic sac is examined.
Indications for amnioscopy
- Suspicion of post-term pregnancy, acute or chronic hypoxia.
- Incompatibility of the Rh factor of mother and fetus.
- Previous pregnancies ended in premature birth or miscarriage, severe gestosis (toxicosis).
Fetal hypoxia: treatment
There is no standard approach, since much depends on the individuality of the mother’s body and the reasons that led to insufficient oxygen supply to the fetal tissues.
In the case of a minor form of this pathology, therapy is not provided. If it comes to a severe form of oxygen starvation, then all the efforts of specialists are aimed at improving uteroplacental circulation, as well as restoring the metabolic processes of the fetus. In addition to numerous medications, the expectant mother may also be prescribed aqua gymnastics along with special breathing exercises. Childbirth in the presence of this pathology is accepted with mandatory cardiac monitoring, which makes it possible to monitor the general condition of the fetus. In very severe cases, emergency delivery may be necessary, which is performed by caesarean section.
Treatment of fetal hypoxia without medications
Aimed at improving the supply of oxygen to the tissues of the mother and fetus.
Reducing physical and emotional stress, maintaining dosed bed rest
Indicated for existing hypoxia and fetal developmental delay. Helps reduce vascular tone and improves blood flow to the uterus.
Nutritious food
It is important for the expectant mother’s body to receive all the necessary nutrients.
Hyperbaric oxygen therapy during pregnancy
Oxygen is used under pressure that exceeds atmospheric pressure. The procedure is carried out in special medical pressure chambers.
When breathing a gas mixture under pressure, oxygen delivery to tissues is artificially improved. Indications for the procedure are already developed fetal hypoxia and all conditions that can lead to it. For example, chronic maternal diseases (diabetes mellitus, iron deficiency anemia), increased uterine tone and others.
Oxygen therapy during pregnancy
The supply of oxygen to the mother’s body is improved by inhaling 40-60% oxygen-air mixture 1-2 times a day. It is also recommended to take an oxygen cocktail or foam for 10 minutes, 150-200 ml, 1.5 hours before meals or 2 hours after meals.
Drug treatment
Has several directions:
- Treatment of the mother's underlying disease by doctors of related specialties - for example, diabetes, respiratory diseases.
- Normalization of blood flow in the “mother - placenta - fetus” system.
- Relaxation of the muscles of the uterus.
- Normalization of blood fluidity and clotting.
- Improving metabolism in the uterus and placenta.
- Complex prescription of medications, taking into account one or more causes and the individual tolerance of drugs by the expectant mother.
Fetal hypoxia: hospital treatment
It is carried out when there are pronounced changes in the uteroplacental blood flow and a lack of oxygen supply to the fetus. Medicines can be prescribed either in the form of injections or tablets.
| Group of drugs | Representatives | Mechanism of action | Application |
| Improving uteroplacental blood flow | |||
| Estrogens | The most commonly used drug is Sigetin, which has a weak estrogen-like effect. Less commonly - Folliculin, Sinestrol. |
| Sigetin is administered intravenously at a dose of 2-4 ml per 20 ml of 40% glucose solution. If necessary, the drug in the same dose is re-administered at intervals of 30 minutes (no more than 5 times!). Not prescribed during childbirth and uterine bleeding. The best effect is achieved when used in combination with drugs that dilate blood vessels and improve blood flow. |
| Drugs that thin the blood, dilate blood vessels and improve blood flow | |||
| Antiplatelet agents or anticoagulants | Dipyridamole (Curantyl), Xanthinol nicotinate (Nicotinic acid), Pentoxifylline (Trental) |
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If necessary, some drugs are used for a longer period of time, under the control of blood clotting parameters, once every two weeks: fibrinogen, thrombin time and others. |
| Drugs that reduce uterine muscle tone | |||
| Tocolytics - to prevent the development of premature birth | Ginipral, Atosiban (Tractocil), Nifedipine |
| Ginipral is first administered intravenously by drip using an automatic infusion pump (liniomat) for 48 hours. Dose: 5 mg in 400 ml of 0.9% saline solution. Then, if acute contractions stop, the drug is prescribed one tablet every 3 or 4-6 hours. The duration of treatment is determined by the doctor. Nifedipine prescribed from the 16th week of pregnancy, 1 tablet 2-3 times a day. The duration of use is determined by the doctor. Atosiban administered intravenously, slowly, in three stages over 48 hours. Causes fewer side effects, used from 24 to 33 weeks of pregnancy. |
| Antispasmodics | No-shpa, Drotaverine, Papaverine |
| In the acute period, one of the drugs is prescribed intramuscularly for several days. Then he recommends using papaverine in the rectum in the form of suppositories twice a day. Course - 7-10 days. If necessary, courses of treatment are repeated. In the third trimester of pregnancy, antispasmodics are used with caution, as they can soften the cervix, leading to its premature dilatation. |
| Magnesium preparations | Magnesium B6, Magnesium sulfate |
| In case of preeclampsia and eclampsia, magnesium sulfate is administered intravenously to lower blood pressure, slowly, according to the scheme - to avoid overdose. With increased uterine tone and the threat of premature birth, magnesium B6 is prescribed orally, 1 tablet twice a day. The course is 2-3 weeks, longer if necessary. |
| Drugs to improve metabolism and increase the resistance of fetal tissues to oxygen deficiency | |||
| Antioxidants - protect against damage and improve metabolic processes in the tissues of the mother and fetus |
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| Neuroprotectors- drugs that prevent damage to nerve cells in the fetus | Instenon is the most effective drug with minor and unexpressed side effects. |
| Instenon is initially prescribed 2 ml per 200 ml of 0.9% physiological sodium chloride solution once a day. Course - 5 intravenous infusions daily or every other day. Then - 1-2 tablets orally 3 times a day. Course - 5-6 weeks. |
Poisoning, vomiting, diarrhea, intoxication due to infectious diseases
Lost fluid is replenished by administering intravenous solutions to restore acid-base balance: glucose, rheopolyglucin, sodium bicarbonate and others.
Premature placental abruption
If there is a slight detachment in a small area and the expectant mother is in good health, observation is carried out in a hospital setting:
- The condition of the fetus, mother and placenta is monitored over time. Studies are carried out: CTG, Doppler, ultrasound and others.
- Treatment is prescribed: contractions of the uterine muscles are suppressed, hemostatic agents (Decinon, Vikasol), antispasmodics (No-shpa, Papaverine), drugs to improve metabolism and protect the fetus from lack of oxygen are prescribed.
Regardless of the mother's well-being, urgent delivery is carried out, and a cesarean section is preferable. Induction of labor during placental abruption is contraindicated.
In case of massive bleeding of the mother, donor red blood cells (a suspension of red blood cells obtained from human blood) and plasma (the liquid part of the blood) are administered to replace the volume of lost blood and normalize its coagulation.
Infectious bacterial and/or viral diseases
For bacterial infections, antibiotics are prescribed depending on the pathogen that caused the development of the disease, according to the stage of pregnancy. The most commonly used are cephalosporins (Cefazolin, Ceftriaxone), penicillins (Ampicillin, Amoxiclav), macrolides (Erythromycin, Vilprafen).
For viral infections during pregnancy, Viferon is allowed to be used from the 16th week of pregnancy, Acyclovir - with caution, Genferon - from the 2nd and 3rd trimester.
To improve the functioning of the immune system in chronic infections, membrane plasmapheresis is recommended. During the procedure, the liquid part of the blood (plasma) is filtered through a special membrane with holes of different sizes, due to which large molecules containing toxins, allergens and other inflammatory elements are retained in the membrane.
Indications for urgent delivery in case of fetal hypoxia
- Lack of effect from the treatment.
- Deterioration of indicators on studies: CTC, Doppler ultrasound and others.
- The appearance of meconium in the amniotic fluid, increasing oligohydramnios or polyhydramnios.
Fetal hypoxia: treatment at home
It is carried out after the main treatment in a hospital or in the initial stages of hypoxia with unexpressed changes. A prerequisite: the ability to monitor the effectiveness of the treatment: CTG, ultrasound and others.
The same drugs are used as in the hospital, but they are prescribed in the form of tablets, capsules for oral use, and suppositories for insertion into the rectum.
Hypoxia during childbirth - asphyxia of the newborn
Resuscitation measures are being carried out in the delivery room.
The sequence of steps depends on two factors:
- The severity of asphyxia (suffocation) on the Apgar scale is used to assess the condition of the child only at birth.
- The effectiveness of the previous steps.
Airway patency is restored: mucus and amniotic fluid are sucked out from the baby’s mouth and nose using a rubber bulb or electric suction. Then, if necessary, the neonatologist or obstetrician-gynecologist flushes the baby's airways of meconium and amniotic fluid with saline using an electric pump and a laryngoscope (a medical instrument with a light).
Absent or irregular breathing A tube is inserted into the child's respiratory tract to supply an air-oxygen mixture - intubation. Artificial ventilation of the lungs begins using a special balloon, if necessary, with simultaneous indirect cardiac massage.
After stabilization of the general condition, the child is transferred from the delivery room to the neonatal intensive care unit for further treatment.
Indications for stopping neonatal resuscitation:
- No heart function for 8-10 minutes.
- There is cardiac activity, but breathing is not restored within 15-20 minutes.
Fetal hypoxia during childbirth (newborn asphyxia): rehabilitation using hypothermia - video
Consequences
The severity and frequency of complications of oxygen deficiency for the fetus depend on the duration of pregnancy, duration and strength of exposure to damaging factors (degree of hypoxia).
Chronic fetal hypoxia: consequences
In the first trimester The formation of organs and tissues is disrupted, which leads to the formation of congenital malformations. Changes incompatible with life lead to intrauterine fetal death and early miscarriage. With the further development of pregnancy, a child is most often born with various congenital defects. For example, with abnormalities in the development of the brain, kidneys, lungs, etc.
In the second and third trimesters
There is intrauterine growth restriction in the fetus: insufficient weight and/or height.
It is possible that labor may begin much earlier than expected - the birth of a premature baby.
Often there are areas of hemorrhage in various organs and ischemia (areas of tissue experiencing a pronounced decrease in blood flow), necrosis develops (areas of tissue death), and there is immaturity of organs and systems. Such changes do not pass without leaving a trace, and the consequences can persist throughout life.
Manifestations depend on the affected organ and/or tissue:
- Nervous system- possible development of epilepsy (sudden onset of seizures), cerebral palsy (damage to one or more parts of the brain), mental retardation, disruption of the maturation process of the nervous system after birth and other diseases.
- Internal organs - after birth, the child does not adapt well to new living conditions outside the womb. For example, physiological jaundice lasts longer, there is a tendency to respiratory diseases, the functioning of the immune system and other changes are disrupted.
Consequences of acute fetal hypoxia
They develop depending on the severity of the impact of the cause:
- Maybe thickening of the blood and a decrease in its volume, which leads to insufficient supply of oxygen and nutrients to the tissues. Against this background, hemorrhages, ischemia and necrosis of individual tissue areas in various organs occur. First of all, in the brain and adrenal cortex (they produce hormones that are responsible for almost all metabolic processes).
- Massive blood loss due to premature placental abruption. Consequences for the child: birth in a state of hemorrhagic shock (bleeding), in which the functioning of all organs and systems is affected. Consequences for the mother: Kuveler's uterus (soaked in blood) and the development of disseminated intravascular coagulation (increased tendency to bleed). Both the fetus and the mother may die.
- If the airways are not cleared in a timely manner from amniotic fluid and meconium, the child’s death due to asphyxia and the development of pneumonia in the first days of life are possible.
Prevention of fetal hypoxia
Long before pregnancy:
- Treat chronic diseases or achieve stable remission (disappearance or significant weakening of the signs of the disease). Since any minor exacerbation of the disease during pregnancy can lead to disruption of the general condition of the expectant mother and harm the fetus.
- Give up bad habits: smoking, alcohol abuse, drug use.
- Registration before 12 weeks of pregnancy with all necessary studies performed according to the timing of pregnancy.
- Visit an obstetrician-gynecologist in the antenatal clinic according to the recommended timing: for a normal pregnancy in the first trimester - once a month, in the second and third trimesters - once every two to three weeks.
- Maintaining a regime of wakefulness and rest: sleep at least 7-8 hours at night.
- Adequate nutrition with foods containing sufficient amounts of vitamins, minerals, proteins and fats.
- Taking vitamin preparations that are involved in all body processes. Folic acid (vitamin B 9) is most important for the expectant mother. It promotes the absorption of iron, is necessary for the development of all organs and systems in the fetus, and significantly reduces the likelihood of the formation of malformations of the nervous system.
Thank you
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Every expectant mother knows that the growth and development of the fetus in her womb directly depends on her general health during pregnancy. Since this fact is well known, almost all pregnant women try to be fierce adherents of a healthy lifestyle throughout the nine months of pregnancy. In most cases, this fact helps to bear a healthy baby, but not in all one hundred percent of cases. Quite often it happens that when a woman comes to her next appointment with a gynecologist, she hears a diagnosis of “intrauterine fetal hypoxia.” This diagnosis horrifies her, and all because, most often, expectant mothers know absolutely nothing about it. If you want to know as much information as possible about this pathology, then stay with us.
Hypoxia fetus (oxygen starvation) - a condition that develops during pregnancy and/or childbirth due to insufficient oxygen supply or disruption of its absorption by fetal tissues.
In fact, this disease is not independent, since it develops as a result of numerous pathological processes that can occur both in the body of a pregnant woman and in the placenta or in the fetus.
According to statistics, fetal hypoxia occurs in 10.5% of all pregnancies and births.
Blood circulation of the fetus and newborn
In utero, the fetus receives nutrients and oxygen from the mother.
First two weeks
The embryo is nourished by the outer layer of cells of the fertilized egg, which does not have blood vessels. From day 10, enzymes are produced that dissolve the cells of the uterine mucosa - and a cavity filled with blood is formed. The fertilized egg is introduced into it - implantation occurs.
From 8 to 15-16 weeks
The membrane cells of the fetal egg divide, forming elongated small outgrowths with cavities (villi) around the embryo, into which vessels grow - the placenta is formed.
From 3-4 months
Gradually, placental blood circulation is established and the functions of the placenta develop.
From 4-5 months
A complete placental blood circulation functions, which has distinctive features from the blood circulation of a newborn baby.
Severe conditions complicating the course of pregnancy in the second and third trimester. The reasons are not fully understood, but it is believed that there is a genetic predisposition.
The expectant mother's blood pressure increases, all blood vessels narrow, and small blood clots form in their lumens. Violations threaten the life of a pregnant woman, since the functioning of all organs and systems suffers. The same changes occur in the vessels of the placenta, so it cannot cope with its functions: respiratory, nutritional, hormone production and others.
Premature placental abruption
Long before birth, the integrity of the uteroplacental vessels is damaged.
Exposure to adverse factors in the first trimester of pregnancy can lead to fetal death and miscarriage, and the occurrence of severe congenital malformations. For example, abnormalities of the intestines, nervous system, lungs.
The occurrence of hypoxia in the second and third trimesters leads to delayed intrauterine development of the fetus, damage to internal organs and the nervous system. Therefore, the child may lag behind his peers in mental and physical development. He often has various diseases: cerebral palsy, disorders of the immune system, epilepsy.
Before use, you should consult a specialist.
