Normally, childbirth begins exactly when all the developmental processes of the fetus are completed and it is ready for independent life. As with all natural processes, normal childbirth does not require any additional intervention. The main task of medical personnel during childbirth is to monitor the condition of the expectant mother and baby. But if something goes wrong, doctors will be able to provide the necessary assistance in time. Let's try to understand the causes of labor disorders and labor complications.

1. Incorrect position of the fetus

Usually, at the time of delivery, the baby is located in the womb of the mother longitudinally with its head down. If the child lies across, his progress along the birth canal becomes impossible. In this case, there is no presenting part of the fetus (head), which normally should press on the cervix during contractions, and in this case the cervix practically does not open, and the walls of the contracting uterus put pressure on the transversely located spine of the baby, which is fraught with severe birth injuries ... There is also an unstable, or oblique, incorrect position of the fetus - in this case, as the contractions intensify, it can also go into the transverse, which is dangerous for the baby, or into the longitudinal - then everything will go according to the usual scenario, without complications in childbirth.

Another option for the incorrect location of the fetus is when not the head is located below, but the buttocks or legs of the crumbs. In this case, childbirth through the natural birth canal may well pass safely and without any complications in childbirth. However, the breech process is certainly longer and more complicated. The risk of complications in childbirth with breech presentation increases the large weight of the fetus (more than 3600 g) or the mother's narrow pelvis. The gender of the baby is of great importance. Since in boys the genitals protrude significantly between the buttocks, with a "pelvic" birth for them, the risk of injury and development of genital disorders in the future significantly increases.

2. Anatomical features of the pelvis

Most often, in practice, there is a uniform narrowing of the pelvis, characterized by a symmetrical decrease in all sizes. In this case, four degrees of constriction are distinguished. In the first degree - a decrease in all sizes of the pelvis within 2 cm - in most cases, childbirth takes place naturally without any complications. The second degree is characterized by a decrease in all sizes by 2-4.5 cm. In this case, childbirth in a natural way is possible, however, the course of the birth process is more often complicated. The third degree involves a decrease in the size of the pelvis by 4.5-6 cm, and the fourth - by more than 6 cm (this is extremely rare). These degrees of narrowing of the pelvis are otherwise called an absolutely narrow pelvis, and in this case, birth through a natural birth canal is impossible.

3. Clinically narrow pelvis

The pelvis is called, which complicates childbirth or prevents its flow, regardless of its size. A clinically narrow pelvis is a concept that denotes a discrepancy between the actual dimensions of the walls of the birth canal and the head of the fetus. Such a discrepancy can develop with the correct shape and normal size of the pelvis, in the following cases:

• large fruit or large fetal head;
• post-term fetus (the head bones are denser and lack the ability to configure, that is, to adapt to the size of the pelvis);
• incorrect insertion of the fetal head, in which the transverse size of the head increases, for example, with the frontal and facial location in the birth canal (correct insertion of the head is occipital, this is its smallest size).

4. Large fetus and childbirth

Using the term "large fetus", we mean that the estimated weight of the baby at birth exceeds 3600 g. Of course, the larger the fetus, the more difficult it is for him and for the expectant mother during the second stage of labor associated with moving through the birth canal. With a weight of more than 4500 g, even a normal pelvis may be too narrow for a large fetus, and natural childbirth may be too risky for health. However, it is not the estimated weight of the fetus that is decisive for the prognosis of childbirth, but the estimated size of its head - the hardest and largest part of the baby's body. It often happens that with a large weight, a full-term fetus has a relatively small head. In this case, in the absence of other contraindications, natural childbirth is possible and not necessarily associated with the risk of complications. Despite, his bone structures are commensurate with the size of the mother's pelvis and the risk of injury during childbirth is low. On the contrary, if, at a normal weight, the fetus has too large (relative to the size of the mother's pelvis) head sizes, the prognosis for natural childbirth may be unfavorable.

Preparing for childbirth in advance. In order to learn how to relax, control emotions and be able to behave correctly during childbirth, you can read popular literature on preparation for childbirth (books, magazines for pregnant women) and enroll in special maternity schools that are organized at antenatal clinics, maternity hospitals or family clubs for parents and kids. Communication with specialists and other mothers, the opportunity to ask all your questions and to master the technique of self-pain relief during childbirth will help to cope with unaccountable fear and insure against the majority of abnormalities in labor and other complications of childbirth.

5. Multiple pregnancy

If a woman bears two or more babies, then such a load often turns out to be a serious test for her health, doubles (or triples - in proportion to the number of fetuses) and risks in childbirth. Natural childbirth is possible, but any, even the most insignificant "nuances" associated with the condition of mothers and babies, much more often provoke the development of complications during childbirth. The most common complications of childbirth in this case are premature labor, premature effusion of water, weakness of labor, placental abruption.

6. Features of the structure of the uterus

This, first of all, includes the unusual forms of the uterus: saddle-shaped, two-horned, one-horned, infantile. The irregular shape of the uterus often becomes the cause of the development of weak labor, oblique or transverse position of the fetus in childbirth, bleeding. Other unfavorable features of the structure of the uterus, affecting the development of birth complications, are septa (connective tissue cords) and septa in the uterine cavity, fibroids (globular growths of the uterine muscle) and postoperative. These formations impair the conduction of a nerve impulse in the muscles of the uterus, which can cause various disorders, mainly weakness or discoordination of labor. In the presence of septa and septa, the risk of birth trauma to the fetus significantly increases, and the main danger associated with the presence of a scar on the uterus is its rupture against the background of contractions or attempts.

7. Multiple entanglement with the umbilical cord

Repeated entanglement with the umbilical cord leads to a significant shortening of its length and a deterioration in the blood supply to the fetus. In addition, numerous (more than three) loops of the umbilical cord interfere with the normal position of the fetus in the uterus and impede its movement, which disrupts the normal course of labor. If the baby is not able to make the necessary movements - for example, bend, unbend and turn the head, then birth trauma is inevitable even with the normal size of the pelvis and the fetus itself.

8. Change in the amount of water

Normally, by the end of pregnancy, the fetal bladder contains about 800-1500 ml of amniotic fluid. However, with some common diseases of the expectant mother, pathologies of pregnancy, the amount of water can change significantly. There is both pronounced lack of water and significant polyhydramnios. Both the condition is a deviation from the norm and can adversely affect the growth, development and the very process of giving birth to a baby.

Very often, with polyhydramnios (the amount of water exceeds 2 liters), premature rupture of amniotic fluid occurs. Due to the overstretching of the uterine wall with a large volume of water, weakness and discoordination (dysregulation) of the labor forces often develop. The moment of rupture of the fetal bladder is dangerous: amniotic fluid, poured out with polyhydramnios in a large and strong stream, often carries along the umbilical cord and small parts of the fetus - the fetus can be established in a transverse or oblique position.

9. Childbirth with oligohydramnios

Childbirth with low water (the amount of water is less than 800 ml) also have their own flow characteristics. The period of cervical dilatation is usually delayed, since there is no proper pressure of the fetal bladder. Primary and secondary weakness of the birth forces often develops. At the same time, contractions are painful from the very beginning, but unproductive. In the follow-up and early postpartum period (the first two hours after childbirth), bleeding develops more often.

10. Complications of pregnancy

In principle, any deviations from the normal course of pregnancy are fraught with the development of complications in childbirth, however, most often they are caused by three main pathologies of pregnancy: preeclampsia, placental insufficiency and impaired hemostasis.

Gestosis is called late pregnancy toxicosis, in which kidney function is impaired. This pathology of pregnancy is characterized by an increase in blood pressure - a symptom that is extremely dangerous for childbirth. Against the background of preeclampsia, premature placental abruption, bleeding during childbirth or the early postpartum period, and even eclampsia (convulsive syndrome, extremely dangerous for the life of a woman in labor) can develop.

With fetoplacental insufficiency, blood circulation in the vessels of the placenta is disturbed and, as a result, the supply of oxygen to the fetus. During childbirth, this can lead to oxygen starvation of the baby.

Violation of hemostasis, that is, a stable state of blood, during childbirth can provoke multiple bleeding or thrombosis - both types of clotting disorders, unfortunately, pose a threat to the life of the mother and baby.

11. Premature and late birth

There are two options for an untimely start - premature birth (up to the 36th week of pregnancy), which occurred significantly earlier than the natural term of the baby's maturity, and delayed labor with prolonged pregnancy, starting later than expected.

With premature birth, the development of the process often becomes too intense and childbirth proceeds in an "accelerated" mode. Such a high rate of the birth process is provided by excessively strong and frequent contractions of the uterus, significantly exceeding the natural resistance of the tissues of the birth canal. As a result of this "birth pressure", the fetus is literally pushed out of the mother's body, not having time to adapt to the abruptly changing environmental conditions (the pressure in the uterus, in the vagina and at the exit from the birth canal differs tenfold) and leaving significant destruction in the mother's birth canal ...

Tolerance is not just a pregnancy that lasts more than 40 weeks, as many mistakenly believe. With prolongation, the placenta and membranes "age" and gradually lose their ability to protect the baby and maintain his life in the mother's body. Aging of the placenta and membranes gradually leads to oxygen starvation of the fetus, a decrease in nutrition and metabolism, and a decrease in the amount of amniotic fluid. In such cases, incorrect insertion of the fetal head often develops due to the high density of the bones of the skull, weakness of labor against the background of oligohydramnios, lack of oxygen to the fetus in childbirth due to circulatory disorders in the placenta.

12. Biological immaturity of the birth canal

This term denotes the discrepancy between the state of the cervix and the walls of the vagina and the period of pregnancy. Normally, before childbirth, the cervix gradually shortens and begins to open slightly, the tissues of the vagina and cervix become soft and elastic. If during a full-term pregnancy and a mature fetus, the cervix remains tight and long, as in the middle of pregnancy, and the cervical canal is closed, even training contractions can feel extremely painful, and the opening of the cervix during childbirth takes much longer and more difficult, often accompanied by ruptures.

13. Physical fatigue of a woman in labor

This is the main and most common reason for the development of such complications in childbirth as weakness in labor. Childbirth is a significant burden and a serious test for the body of the expectant mother, and in order for them to pass safely, strength is needed. If, at the beginning of the process, a woman is physically exhausted (most often this is due to sleep disturbance at the end of pregnancy due to anxiety before childbirth, night "precursor" contractions or other physiological and everyday reasons), the body does not have enough energy to regulate and develop labor. In this case, the weakness of the labor forces develops - a complication in childbirth, in which the contractions practically do not intensify, and the opening occurs extremely slowly or does not increase at all. At the same time, childbirth becomes protracted, which threatens the development of fetal hypoxia and postpartum hemorrhage.

14. Chronic diseases of the mother

The presence of serious diseases in a woman in labor significantly increases the risk of complications during childbirth, since the body, weakened by a chronic ailment, is less resistant to stress. Doctors pay the most close attention to diseases of the kidneys and cardiovascular system, since if these organs are disrupted, the most dangerous complications of childbirth can develop, leading to bleeding in the mother and impaired fetal breathing. With endocrine diseases, characterized by a violation of the hormonal background, weakness of labor forces often develops or, on the contrary, a rapid and rapid course of labor.

15. Age of the expectant mother

Doctors pay more attention to older pregnant women, especially when a woman is preparing to become a mother for the first time. Obstetricians attribute such expectant mothers to a risk group for the development of various complications of childbirth - both from the woman herself and from the fetus. After all, unfortunately, the past years add to us not only knowledge, but also various health problems. There is another reason for the higher risk of complications in childbirth after 30 years - gradual changes in hormonal levels, characteristic of this age, often provoke. But, of course, the age of a woman in labor in itself is neither an indication of the inevitable development of complications in childbirth, nor a reason for any additional interventions in the process of childbirth.

16. Psychological unpreparedness for childbirth

Naturally, on the eve of childbirth and during them, every woman experiences strong anxiety, fear for herself and the child. However, if at the same time the expectant mother has no idea what exactly will happen to her in the process of childbirth, fear of the unknown joins these worries.

He can do a disservice to the expectant mother. After all, it is the state of panic, overexcitation of the nervous system of a woman in labor that leads to the development of various complications during childbirth, first of all - discoordination of contractions. As a result of "nervous breakdowns", the signals that coordinate labor activity arrive unevenly, can weaken or, on the contrary, sharply increase. Due to the violation of the nervous regulation of labor, contractions become painful and unproductive. Unfortunately, such contractions often negatively affect not only the well-being of the expectant mother, but also the health of the baby: frequent intense contractions of the uterus prevent normal blood flow in the placenta, which is necessary for the crumbs to breathe, and he begins to suffer from a lack of oxygen. Therefore, along with a thorough medical examination during planning and during the course of pregnancy, doctors recommend that all expectant mothers, without exception, take care of the psychological and practical preparation for childbirth in advance.

It is the psychological unpreparedness of the expectant mother for childbirth that is considered the most common cause of the development of complications in childbirth.

& nbsp & nbspTo give birth without various complications, you need to prepare well for them. Let's consider the most common childbirth problems and tell you about the methods for solving them.

& nbsp & nbspThe most common childbirth problems are:

Perineal rupture

& nbsp & nbspWhat is the reason for the rupture of the perineum? There are many reasons: for example, weak muscles in the perineum or too narrow vagina, inelastic perineum, scar changes after trauma in previous births. Perineal rupture can also occur if labor is too fast or the baby is very large.

& nbsp & nbspWhat to do in this situation? There are the following recommendations:

& nbsp & nbsp 1 ... Get tested regularly for infections and do not waste time with their treatment. The fact is that tissue extensibility decreases with fungal and infectious diseases. See your doctor at the antenatal clinic. The doctor will notice a predisposition to rupture even before childbirth and will definitely prescribe special procedures that will help prevent them.

& nbsp & nbsp 2 In general, tissue tone largely depends on heredity and decreases with age. But there are some steps you can take to tone your tissues. To do this, in the 3rd trimester of pregnancy, you should definitely include vegetable oils in your diet - olive, linseed, sesame, pumpkin.

& nbsp & nbsp 3 ... Even late in pregnancy, continue to lead an active lifestyle - move more, walk, exercise, attend pool classes for pregnant women.

& nbsp & nbsp 4 ... To make the skin more elastic, massage the perineum yourself. For this, you should use any vegetable oil or cosmetic oil. It is necessary to massage the perineum according to the following schedule: in the 1st and 2nd trimesters - once every 5 to 10 days, in the 3rd trimester - once every 3 to 5 days. From the 36th week of pregnancy, start massaging every other day, and from the 38th week - daily.

& nbsp & nbsp How to massage the perineum

& nbsp & nbspWash your hands thoroughly, lubricate the crotch area well with oil. Then insert your finger into the vagina by 2 - 3 cm, having also lubricated it beforehand. For a minute, gently press on the back of the vagina (closest to the intestines) so that you feel the muscle tension, then release. Relax the muscles and move your finger into the vagina, gently moving down to the perineum towards the anus. Initially, the vaginal muscles will be a little tense, but over time you will master the technique and learn to relax. Do the massage for about 3 to 5 minutes.

& nbsp & nbsp 5 ... In order to avoid tissue rupture, strictly follow the instructions of your obstetrician during labor. Usually, noticing the threat of rupture directly during childbirth, the doctor performs a perineal incision (episiotomy). Such incisions heal much better than if they ruptured spontaneously.

& nbsp & nbsp 6 ... Remember that the most important thing is the right attitude. It is scientifically proven that a woman who is very much expecting a baby has fewer problems during childbirth. Therefore, tune in to work, fully activate the entire body, do not think about pain, but clearly track it. You should be aware of everything that is happening to you and describe how you feel. Don't take everything that happens as a tragedy. If the doctor prescribes any procedures or medications, then this is required by the situation.

Ruptured cervix and pubic symphysis

& nbsp & nbspRush labor, large fetus, cicatricial changes (after surgery or postpartum), various inflammations - all these are causes of rupture of the cervix and pubic space. But the most common reason is early attempts, when the uterine pharynx is not yet sufficiently open.

& nbsp & nbspIn this situation, during childbirth, it is very important to inform the doctor about the appearance of attempts, so that he can assess the size of the opening of the throat and decide whether you can start pushing or not. In general, so that there are no troubles, doctors must take into account all the factors and, on the basis of this, are already taking appropriate measures.

Discrepancy or rupture of the pubic articulation

& nbsp & nbspDiscrepancy or rupture of the pubic articulation most often occurs due to the fact that some softening of the ligaments occurs during pregnancy. Also, a narrow pelvis, a large fetus, the use of obstetric forceps during childbirth can lead to a discrepancy of the pubic articulation.

& nbsp & nbspIn this case, the doctor will decide to do a caesarean section. Especially if this is not the first birth.

Postpartum hemorrhoids

& nbsp & nbspEven if hemorrhoids do not bother you during pregnancy, they can sharply worsen after childbirth.

& nbsp & nbspThe reasons for such a complication, in addition to stagnation of blood in the veins of the small pelvis, can be an unbalanced diet, constipation, a sedentary lifestyle.

& nbsp & nbspTake care of your health during pregnancy - move more, try to eat right. And at the first sign of a problem, see your doctor. Watch for regularity of stools, avoid constipation. To do this, you need to include in the diet more fiber-rich foods: raw vegetables and fruits, legumes, dried fruits, whole grain bread.

Retinal disinsertion

& nbsp & nbspThe cause of retinal detachment is intense stress during childbirth. Women with severe myopia are at risk, but sometimes retinal detachment can occur in those who have not had vision problems.

& nbsp & nbspTo avoid this problem, regularly during pregnancy undergo an examination by an ophthalmologist. If at one of these consultations the doctor discovers thinning and tearing of the retina, then he will carry out special prophylaxis - laser coagulation.

Phlebeurysm

& nbsp & nbspWith a high load, which is associated with the growth of the uterus, there is a sharp increase in pressure in the veins and damage to the valve apparatus. The main reasons for the development of this disease are sedentary work or prolonged standing on their feet, lifting weights, a sedentary lifestyle, wearing high-heeled shoes.

Update: November 2018

The birth of a long-awaited baby is a joyful event, but by no means in all cases childbirth ends successfully not only for the mother, but also for the child. One of these complications is fetal asphyxiation, which arose during childbirth. This complication is diagnosed in 4 - 6% of newly born children, and according to some authors, the frequency of newborn asphyxia is 6 - 15%.

Definition of newborn asphyxia

Translated from Latin, asphyxiation means suffocation, that is, lack of oxygen. Asphyxia of newborns is a pathological condition in which gas exchange in the body of a newborn is disturbed, which is accompanied by a lack of oxygen in the tissues of the child and his blood and the accumulation of carbon dioxide.

As a result, a newborn who was born with signs of live birth either cannot breathe on its own in the first minute after birth, or he has separate, superficial, convulsive and irregular respiratory movements against the background of an existing heartbeat. Such children are immediately given resuscitation measures, and the prognosis (possible consequences) for this pathology depends on the severity of asphyxia, the timeliness and quality of resuscitation.

Classification of newborn asphyxia

By the time of occurrence, there are 2 forms of asphyxia:

• primary - develops immediately after the birth of the baby;
• secondary - it is diagnosed within the first days after childbirth (that is, at first the child breathed independently and actively, and then suffocation occurred).

According to the severity (clinical manifestations), there are:

• mild asphyxia;
• moderate asphyxia;
• severe asphyxia.

Factors provoking the development of asphyxia

This pathological condition does not belong to independent diseases, but is only a manifestation of complications of the course of pregnancy, diseases of the woman and the fetus. The causes of asphyxia include:

Fruit factors

• ) The child has;
• Rh-conflict pregnancy;
• anomalies in the development of the organs of the bronchopulmonary system;
• intrauterine infections;
• prematurity;
• intrauterine growth retardation;
• blockage of the airways (mucus, amniotic fluid, meconium) or aspiration asphyxia;
• malformations of the heart and brain of the fetus.

Maternal factors

• severe, occurring against a background of high blood pressure and severe edema;
• decompensated extragenital pathology (cardiovascular diseases, diseases of the pulmonary system);
• pregnant women;
• endocrine pathology (, ovarian dysfunction);
• shock of a woman during childbirth;
• disturbed ecology;
• bad habits (smoking, alcohol abuse, drug use);
• inadequate and inadequate nutrition;
• taking medications that are contraindicated during gestation;
• infectious diseases.

Factors contributing to the development of disorders in the uteroplacental circle:

• post-term pregnancy;
• premature aging of the placenta;
• premature placental abruption;
• pathology of the umbilical cord (cord entanglement, true and false nodes);
• permanent threat of interruption;
• and bleeding associated with it;
• multiple pregnancy;
• excess or lack of amniotic fluid;
• anomalies of labor forces (and discoordination, rapid and impetuous labor);
• injecting drugs less than 4 hours before the completion of labor;
• general anesthesia of a woman;
• rupture of the uterus;

Secondary asphyxia is provoked by the following diseases and pathology in a newborn

• impaired cerebral circulation in a child due to residual effects of damage to the brain and lungs during childbirth;
• heart defects not identified and not immediately manifested at birth;
• aspiration of milk or mixture after the feeding procedure or poor-quality sanitation of the stomach immediately after birth;
• respiratory distress syndrome due to pneumopathies:
  • the presence of hyaline membranes;
  • edematous hemorrhagic syndrome;
  • pulmonary hemorrhage;
  • atelectasis in the lungs.

The mechanism of development of asphyxia

No matter what caused the lack of oxygen in the body of a newly born child, in any case, metabolic processes, hemodynamics and microcirculation are rebuilt.

The severity of the pathology depends on how long and intense the hypoxia was. As a result of metabolic and hemodynamic rearrangements, acidosis develops, which is accompanied by a lack of glucose, azotemia and hyperkalemia (later hypokalemia).

With acute hypoxia, the volume of circulating blood increases, and with chronic and subsequent asphyxia, the volume of blood decreases. As a result, the blood thickens, its viscosity increases, and the aggregation of platelets and erythrocytes increases.

All these processes lead to a disorder of microcirculation in vital organs (brain, heart, kidneys and adrenal glands, liver). Microcirculation disorders cause edema, hemorrhages and ischemic foci, which leads to hemodynamic disturbances, disorders of the functioning of the cardiovascular system, and, as a consequence, all other systems and organs.

Clinical picture

The main symptom of asphyxia in newborns is breathing disorder, which entails a malfunction of the cardiovascular system and hemodynamics, and also disrupts neuromuscular conduction and the severity of reflexes.

To assess the severity of the pathology, neonatologists use the Apgar score of the newborn, which is carried out in the first and fifth minutes of the child's life. Each feature is estimated at 0 - 1 - 2 points. A healthy newborn gets 8 - 10 points on Apgar in the first minute.

The degree of asphyxia of newborns

Light asphyxia

With mild asphyxia, the Apgar score for a newborn is 6 - 7. The child takes the first breath during the first minute, but there is a weakening of breathing, a slight acrocyanosis (cyanosis in the area of ​​the nose and lips) and a decrease in muscle tone.

Moderate asphyxia

The Apgar score is 4 - 5 points. There is a significant weakening of breathing, its disturbances and irregularities are possible. Heartbeats are rare, less than 100 per minute, cyanosis of the face, hands and feet is observed. Physical activity increases, muscular dystonia develops with a predominance of hypertonia. Tremor of the chin, arms and legs is possible. Reflexes can be either decreased or increased.

Severe asphyxia

The condition of the newborn is severe, the Apgar score in the first minute does not exceed 1 - 3. The child does not make breathing movements or makes separate breaths. Heartbeats less than 100 per minute, pronounced, deaf and arrhythmic heart sounds. A cry in a newborn is absent, muscle tone is significantly reduced or muscle atony is observed. The skin is very pale, the umbilical cord does not pulsate, reflexes are not detected. Eye symptoms appear: nystagmus and floating eyeballs, the development of seizures and cerebral edema, DIC syndrome (violation of blood viscosity and increased platelet aggregation) is possible. Hemorrhagic syndrome (multiple hemorrhages on the skin) increases.

Clinical death

A similar diagnosis is made when evaluating all Apgar indicators at zero points. The condition is extremely serious and requires immediate resuscitation measures.

Diagnostics

When making a diagnosis: "Asphyxia of a newborn", the obstetric history data, how the childbirth proceeded, the Apgar score of the child at the first and fifth minutes, and clinical and laboratory studies are taken into account.

Determination of laboratory parameters:

• pH level, pO2, pCO2 (study of blood obtained from the umbilical vein);
• determination of the deficiency of bases;
• the level of urea and creatinine, urine output per minute and per day (work of the urinary system);
• the level of electrolytes, acid-base state, blood glucose;
• ALT, AST, bilirubin levels and blood clotting factors (liver function).

Additional methods:

• assessment of the work of the cardiovascular system (ECG, blood pressure control, pulse, chest x-ray);
• assessment of the neurological status and the brain (neurosonography, encephalography, CT and NMR).

Treatment

All newborns born in a state of asphyxia are given immediate resuscitation measures. The further prognosis depends on the timeliness and adequacy of the treatment of asphyxia. Resuscitation of newborns is carried out according to the ABC system (developed in America).

Primary care for a newborn

Principle A

• ensure the correct position of the child (lower your head, placing a roller under the shoulder girdle and tilt it back slightly);
• suck mucus and amniotic fluid from the mouth and nose, sometimes from the trachea (with aspiration of amniotic fluid);
• intubate the trachea and scan the lower airways.

Principle B

• carry out tactile stimulation - a slap on the child's heels (if there is no cry for 10-15 seconds after birth, the newborn is placed on the resuscitation table);
• oxygen supply by jet;
• the implementation of auxiliary or artificial ventilation of the lungs (Ambu bag, oxygen mask or endotracheal tube).

Principle C

• performing an indirect heart massage;
• administration of drugs.

The decision on the termination of resuscitation measures is carried out after 15 - 20 minutes if the newborn does not respond to resuscitation actions (there is no breathing and persistent bradycardia persists). The termination of resuscitation is due to the high likelihood of brain damage.

Administration of drugs

A cocarboxylase diluted with 10 ml of 15% glucose is injected into the umbilical vein against the background of artificial ventilation (mask or endotracheal tube). Also, 5% sodium hydrogen carbonate is injected intravenously to correct metabolic acidosis, 10% calcium gluconate and hydrocortisone to restore vascular tone. If bradycardia appears, 0.1% atropine sulfate is injected into the umbilical vein.

If the heart rate is less than 80 per minute, chest compressions are performed with mandatory continuation of mechanical ventilation. 0.01% -adrenaline is injected through the endotracheal tube (possibly into the umbilical vein). As soon as the heart rate has reached 80 beats, the cardiac massage stops, mechanical ventilation is continued until the heart rate reaches 100 beats and spontaneous breathing appears.

Further treatment and follow-up

After the provision of primary resuscitation care and restoration of cardiac and respiratory activity, the newborn is transferred to the intensive care unit (ICU). In the PIT, further therapy for asphyxia of the acute period is carried out:

Special care and feeding

The child is placed in an incubator, where constant heating is carried out. At the same time, craniocerebral hypothermia is performed - the head of the newborn is cooled, which prevents. Feeding of children with mild and moderate asphyxia begins no earlier than 16 hours later, and after severe asphyxia, feeding is allowed every other day. The baby is fed through a tube or bottle. The attachment to the breast depends on the condition of the child.

Prevention of cerebral edema

Albumin, plasma and cryoplasma, and mannitol are injected intravenously through the umbilical catheter. Also, drugs are prescribed to improve the blood supply to the brain (cavinton, cinnarizine, vinpocetine, sermion) and antihypoxants (vitamin E, ascorbic acid, cytochrome C, aevit). Hemostatic drugs (dicinone, rutin, vicasol) are also prescribed.

Oxygen therapy

The supply of humidified and warmed oxygen continues.

Symptomatic treatment

Therapy is carried out aimed at preventing seizures and hydrocephalic syndrome. Anticonvulsants are prescribed (GHB, phenobarbital, relanium).

Correction of metabolic disorders

The intravenous administration of sodium bicarbonate continues. Infusion therapy is carried out with saline solutions (saline and 10% glucose).

Newborn monitoring

Twice a day, the child is weighed, the neurological and somatic status and the presence of positive dynamics are assessed, the inflowed and released fluid (diuresis) is monitored. The devices record heart rate, blood pressure, respiratory rate, central venous pressure. From laboratory tests, a general blood test with and platelets, acid-base state and electrolytes, blood biochemistry (glucose, bilirubin, AST, ALT, urea and creatinine) are determined daily. Blood clotting and tank indicators are also assessed. cultures from the oropharynx and rectum. Shown are chest and abdominal x-ray, ultrasound of the brain, ultrasound of the abdominal organs.

Consequences

Asphyxia of newborns rarely goes away without consequences. To one degree or another, the lack of oxygen in a child during and after childbirth affects all vital organs and systems. Particularly dangerous is severe asphyxia, which always occurs with multiple organ failure. The prognosis for a baby's life depends on the degree of Apgar score. In the case of an increase in the score at the fifth minute of life, the prognosis for the child is favorable. In addition, the severity and frequency of the consequences depend on the adequacy and timeliness of the provision of resuscitation measures and further therapy, as well as on the severity of asphyxia.

The frequency of complications after suffering from hypoxic conditions:

• at the I degree of encephalopathy after hypoxia / asphyxia of newborns - the development of the child does not differ from the development of a healthy newborn;
• at the II degree of hypoxic encephalopathy - 25 - 30% of children later have neurological disorders;
• with grade III hypoxic encephalopathy, half of the children die during the first week of life, and the rest in 75 - 100% have severe neurological complications with convulsions and increased muscle tone (late mental retardation).

After suffering asphyxia during childbirth, the consequences can be early and late.

Early complications

Early complications are spoken of when they appeared during the first 24 hours of a baby's life and, in fact, are manifestations of a difficult course of childbirth:

• cerebral hemorrhage;
• convulsions;
• and hand tremor (first small, then large);
• apnea attacks (respiratory arrest);
• meconium aspiration syndrome and, as a result, the formation of atelectasis;
• transient pulmonary hypertension;
• due to the development of hypovolemic shock and thickening of the blood, the formation of polycythemic syndrome (a large number of red blood cells);
• thrombosis (blood clotting disorder, decreased vascular tone);
• cardiac arrhythmias, the development of posthypoxic cardiopathy;
• disorders of the urinary system (oliguria, thrombosis of the renal vessels, edema of the interstitium of the kidneys);
• gastrointestinal disorders (and intestinal paresis, dysfunction of the digestive tract).

Late complications

Late complications are diagnosed after three days of the child's life and later. Late complications can be infectious and neurological in origin. The neurological consequences that appeared as a result of the transferred hypoxia of the brain and posthypoxic encephalopathy include:

• Hyperexcitability syndrome

The child has signs of increased excitability, pronounced reflexes (hyperreflexia), dilated pupils,. There are no convulsions.

• Reduced excitability syndrome

Reflexes are poorly expressed, the child is lethargic and adynamic, muscle tone is low, dilated pupils, a tendency to lethargy, there is a symptom of "puppet" eyes, breathing periodically slows down and stops (bradypnea alternating with apnea), rare pulse, weak sucking reflex.

• Convulsive syndrome

Characterized by tonic (tension and rigidity of the muscles of the body and limbs) and clonic (rhythmic contractions in the form of twitching of individual muscles of the arms and legs, face and eyes) convulsions. Opercular paroxysms also appear in the form of grimaces, gaze spasms, attacks of unmotivated sucking, chewing and protruding tongue, floating eyeballs. Possible attacks of cyanosis with apnea, rare pulse, increased salivation and sudden pallor.

• Hypertensive-hydrocephalic syndrome

The child throws back his head, fontanelles bulge, cranial sutures diverge, head circumference increases, constant convulsive readiness, loss of cranial nerve functions (strabismus and nystagmus are noted, smooth nasolabial folds, etc.).

• Syndrome of vegetative-visceral disorders

Characterized by vomiting and persistent regurgitation, disorders of intestinal motor function (constipation and diarrhea), marbling of the skin (spasm of blood vessels), bradycardia and infrequent breathing.

• Movement Disorders Syndrome

Residual neurological disorders (paresis and paralysis, muscle dystonia) are characteristic.

• Subarachnoid hemorrhage
• Intraventricular hemorrhage and hemorrhage around the ventricles.

Possible infectious complications (due to weakened immunity after suffering multiple organ failure):

• development ;
• damage to the dura mater ();
• the development of sepsis;
• intestinal infection (necrotizing colitis).

Question answer

Question:
Does a child who has suffered asphyxia during labor need special care after discharge?

Answer: Yes, sure. Such children need especially careful supervision and care. Pediatricians, as a rule, prescribe special gymnastics and massage, which normalize anxiety, reflexes in the baby and prevent the development of seizures. The child needs to ensure maximum rest, giving preference to breastfeeding.

Question:
When is discharged from the hospital after asphyxiation of a newborn?

Answer: You should forget about early discharge (2 - 3 days). The baby will be in the maternity ward for at least a week (an incubator is required). If necessary, the baby and mother are transferred to the children's department, where the treatment can last up to a month.

Question:
Are newborns who have undergone asphyxia subject to dispensary observation?

Answer: Yes, all children who have suffered asphyxiation during childbirth are subject to mandatory dispensary registration with a pediatrician (neonatologist) and a neurologist.

Question:
What consequences of asphyxia are possible in a child at an older age?

Answer: Such children are prone to colds due to weakened immunity, they have reduced school performance, reactions to some situations are unpredictable and often inadequate, psychomotor developmental delay, speech lag are possible. After severe asphyxia, epilepsy, convulsive syndrome often develop, oligophrenia is not excluded, and paresis and paralysis.

Reading time: 8 minutes

The woman's body after childbirth will no longer be the same as before, there may even be health problems. To prevent this from happening, it is important to be observed by a gynecologist, to respond in a timely manner to the first alarming symptoms. Not only the external curves of the figure change, but also the internal health of the woman after childbirth, and there is a number of confirmations of this. It is especially dangerous if labor was accompanied by pathologies. In this case, the consequences for women's health can be reminiscent of themselves for a lifetime. It is necessary to talk about such unpleasant moments in more detail.

What is childbirth

This is a natural process of the female body, as a result of which new life is born. Simply put, this is the logical conclusion of pregnancy with the long-awaited replenishment of a happy family. Physiologically, in the female body, the fetus and placenta are expelled from the uterus through the birth canal (through the cervical canal and vagina). Natural childbirth is accompanied not only by recurrent pain and specific secretions, more serious health problems are possible. Such moments are discussed with the obstetrician-gynecologist on an individual basis.

What childbirth is considered complicated

If in the process of labor activity there are certain difficulties on the part of the mother or child, such childbirth in the extensive obstetric practice is considered complicated. The reasons why the pathological process progresses are revealed even during pregnancy or come as a surprise when a newborn is born. In any case, such pathologies require high professionalism and timely coordinated actions on the part of a team of specialists. The health problem can be conditionally classified as follows, the following reasons for pathological childbirth can be distinguished:

• premature birth (a history of miscarriages and abortions, multiple pregnancies, cervical insufficiency and other pathologies of this important organ of the reproductive system);
• weak labor activity (obesity of the expectant mother, a large fetus or its abnormal presentation in the womb, overwork of a woman in labor during labor, previous inflammatory processes);
• ruptures of soft tissues (severe tears of the perineum, vaginal walls, cervix against the background of a large fetus, its incorrect presentation in the womb, serious medical errors);
• a long anhydrous period (accession of a secondary infection during pregnancy, weakness of labor);
• oxygen starvation or fetal hypoxia (premature placental abruption, excessive fetal pressure of the abdominal wall, entwining an unborn baby with an umbilical cord with the need for an emergency caesarean section).

The anatomical features of the female body can provoke complications during childbirth in women, among which the naturally narrow pelvis takes the leading place. To avoid the development of such a pathology and serious consequences for childbirth, the leading gynecologist individually determines the ratio of the size of the pelvic ring to the size of the baby's head. If there are visible differences, a planned caesarean section may be required. In this way, the risk of unpleasant consequences for the mother and child can be minimized.

Woman after childbirth

Immediately after the completion of labor, the fairer sex feels devastated and overwhelmed, wants to sleep badly. So she enters the postpartum period, which can last from 6 to 8 weeks. All internal organs, except for the mammary glands and the hormonal system, gradually return to normal, restore their usual functions.

Immediately after childbirth, the uterus weighs up to 1 kg, but gradually it shrinks and decreases in size, reaching up to 500 g in weight. It is important to clarify that during breastfeeding, painful sensations in the lower abdomen may periodically occur. This is normal: the uterus contracts, intense oxytocin production prevails, causing especially strong contractions of the uterus. But these are not the only changes that a recently given birth woman notices in her own body:

1. For 5 - 6 weeks, among the consequences, it is required to highlight spotting (lochia).
2. Six months after giving birth, there may be no stable menstruation, or an irregular menstrual cycle predominates.
3. After delivery, the vagina gradually decreases in size, but it does not always return to its prenatal shape.
4. The mammary glands are enlarged, since during breastfeeding breast milk predominates in them, the concentration of prolactin increases.
5. In the first days after childbirth, colostrum is excreted from the breast, after a few days the milk acquires the fat content required for the satiety of the newborn.
6. Among the dangerous consequences, there may be no urge to urinate, which is normal for the first 2 to 3 days, but not longer.
7. If a cesarean section was performed, fresh stitches for the first 2 - 3 weeks continue to hurt, regularly remind of themselves with extremely unpleasant sensations.

In the psychological state, radical changes are also observed, which can be conditionally called "from one extreme to another." At first, this feeling of euphoria from the long-awaited motherhood, but then joy fades into the background, lingering bouts of blues and apathy begin to disturb. This is how postpartum depression begins, from which some women cannot get out without the help and participation of a certified psychotherapist.

Consequences of childbirth in women

A woman does not always feel comfortable and calm after the birth of a baby; certain difficulties with health may appear. The consequences of childbirth can be pathological in nature, cause an urgent hospitalization of a recent woman in labor. Do not ignore the prevailing problem if a woman has such changes in the body:

1. Since the volume of blood after the birth of a child in the female body decreases, at first signs of arrhythmia, tachycardia, angina pectoris may prevail.
2. There is a high risk of blood clots forming and the subsequent development of thrombosis in a woman's body.
3. In the postpartum period, intestinal motility is disturbed, and one of the consequences of such dysfunction is the development of chronic constipation.
4. It is possible that hemorrhoids appear and increase in size, which must be shown to the proctologist on an individual basis.
5. After childbirth, bleeding may open, which not only provokes iron deficiency anemia, but also becomes a real threat to the life of a newly-made mom.
6. Complications of childbirth are accompanied by a sharp rise in temperature, which indicates an infectious or inflammatory process in a woman's body.
7. If traces of specific discharge with an unpleasant odor appear on the underwear, this is a sign of thrush, with the treatment of which it is advisable not to delay.

Diseases

If the general condition after childbirth is satisfactory, and the young mother is experiencing a sharp deterioration in general health, it is high time to contact the local gynecologist. Otherwise, immediate hospitalization may be required, followed by medication and temporary cessation of breastfeeding. Here are the diseases of the female body of a gynecological nature we are talking about:

• postpartum endometritis;
• inflammation of the postpartum sutures;
• cystitis and other infectious processes of the urinary tract;
• mastopathy, mastitis;
• chronic pyelonephritis;
• accession of a secondary infection;
• non-infectious diseases (joints, skin).

The consequences of rapid childbirth for the baby

It is important not to ignore the prerequisites for childbirth, since the delay of the expectant mother can significantly harm the newborn, complicate the process of labor. With rapid childbirth, the potential consequences for a new person are:

• oxygen starvation (hypoxia), which contributes not only to extensive brain pathologies;
• anoxia, as one of the varieties of hypoxia, which is accompanied by extensive death of brain cells;
• intoxication of a newborn with medications that are involved in an emergency delivery or cesarean section;
• infection of the child during its passage through the birth canal;
• syndrome of sudden death of the newborn, which occurs in the first days of a baby's life.

The consequences of a difficult birth for a child

With complicated labor, the newborn may not survive or die suddenly in the first hours of his life. This is dangerous, therefore, doctors should be especially vigilant about such clinical pictures, and timely arrange for the preservation of expectant mothers from the risk group. Difficult childbirth is a prerequisite for extensive pathologies of the newborn organism. Alternatively, these conditions can be:

• swelling of the brain;
• hydrocephalus;
• Down syndrome;
• congenital heart defects;
• complete muscle atrophy;
• delay in the physical and mental state in the future.

Diseases that progress during childbirth, or become an extremely unpleasant consequence of a birth trauma, are considered incurable. Almost always, such a child receives the status of a disabled person already in the first year of life, is in dire need of parental care and attention, and later becomes independent (if at all). Such complications of childbirth do not lend themselves to successful correction only by medication.

Recovery after a difficult birth

If labor was complicated, the young mother and child are not discharged from the maternity ward after 2 to 3 days. The doctor observes the woman in labor for a week, after which he gives individual recommendations in terms of the postpartum period. It is important to understand that it will last much longer than the time after a natural delivery. Here are valuable recommendations from competent professionals to avoid dire consequences for women's health:

1. The first step is bed rest and complete rest of the woman in labor, it is important to reduce the intensity of exposure to external stimuli.
2. It is important to set up breastfeeding in order to establish invisible contact with the newborn baby.
3. It is required to avoid physical activity until the body is fully recovered (this also applies to sports, especially after a cesarean section).
4. If bleeding has opened, it is important to call an ambulance, since a woman may even die from profuse blood loss.
5. At first, it is required to wear sanitary pads, control the volume of blood secreted, and avoid hemorrhage.
6. Kegel exercises will not be superfluous, which only strengthen the muscles of the pelvic floor, help restore the size of the vagina.
7. Tablets, creams, ointments and other medications should only be used as directed by a physician after childbirth.

Video

Contents Complications during childbirth Fetal hypoxia Symptoms of acute hypoxia Causes of occurrence Identification of possible complications - diagnosis Treatment of acute fetal hypoxia Consequences of past failure Complications during childbirth During preparation for childbirth, a woman should realistically assess all possible risks. Someone gets in the way of being informed and creates unnecessary fears, someone does not adhere to the rule - "informed, then armed." During pregnancy, the doctor calculates the possible complications. Therefore, to. ... ...

Contents Fetal presentation Causes of breech presentation of the fetus: Varieties of breech presentation Diagnosis of fetal position Pregnancy progress with breech presentation Which childbirth to choose? Fetal presentation A woman who is planning a pregnancy or is already in an interesting position probably knows that the normal position of the fetus before childbirth is head down. That is, towards the birth canal. However, in 4% of all pregnancies, the inverted position occurs. ... ... ...

What is the reason for arrhythmia during pregnancy? Forms of arrhythmia during pregnancy Arrhythmia in the fetus, which was found during pregnancy What to do if a pregnant woman is diagnosed with arrhythmia? During the period of bearing a child, a woman becomes more susceptible to various diseases. In addition, pregnancy itself is a serious burden for the body. In addition to toxicosis, other unpleasant phenomena may occur, for example, rhythm disturbances. ... ... ...

Having learned about an interesting "situation", many modern women buy up the entire range of literature on pregnancy at the nearest kiosk, discuss what they read with friends who are "in the subject", listen to advice from relatives and friends. But in the end it turns out that they do not have reliable information, but a complete set of legends and myths about pregnancy and childbirth. In our article, we will cover the most. ... ... ...

Contents Childbirth and fearParticipation of relativesEnjoy the situationHelp from specialistsDo not be afraid, because ... Childbirth and fear No matter how much a woman wants a baby, no matter how safely she endures the period of pregnancy, fear begins to attack by the end of the pregnancy and the approach of the birth itself. Scary stories about the painfulness of the childbirth process, read once or heard from, come to mind. ... ... ...