Modern methods of treatment of intrauterine fetal hypoxia. Intrauterine fetal hypoxia: signs, causes, treatment and prevention. How to avoid fetal hypoxia

26.06.2020

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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 during all nine months of pregnancy try to be fierce adherents of a healthy lifestyle. In most cases, this fact helps to endure a healthy baby, but not in all one hundred percent of cases. Quite often it also happens that, having come to the next appointment with a gynecologist, a woman hears the diagnosis "intrauterine fetal hypoxia." This diagnosis horrifies her, and all because most often future mothers know absolutely nothing about him. 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 a violation of its absorption by the tissues of the fetus.

In fact, this ailment 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 body of the fetus.

According to statistics, fetal hypoxia occurs in 10.5% of all pregnancies and childbirth.

Circulation of the fetus and newborn

In utero, the fetus receives nutrients and oxygen from the mother.

First two weeks
The embryo feeds on the outer layer of cells of the fetal egg, which does not have blood vessels. From the 10th day, enzymes are produced that dissolve the cells of the uterine mucosa - and a cavity filled with blood is formed. A fertilized egg is introduced into it - implantation occurs.

From 8 to 15-16 weeks
The cells of the membrane of the fetal egg divide, forming around the embryo elongated small outgrowths with cavities (villi) into which the vessels grow - the placenta is formed.

From 3-4 months
Placental circulation is gradually established and the functions of the placenta develop.

From 4-5 months
There is a full-fledged placental circulation, which has distinctive features from the circulation of a newborn baby.

Severe conditions that complicate the course of pregnancy in the second and third trimester. The causes are not fully understood, but it is believed that there is a genetic predisposition.

The future mother's blood pressure rises, all the vessels narrow, and small blood clots form in their lumen. Violations threaten the life of a pregnant woman, since her work of all organs and systems suffers. The same changes occur in the vessels of the placenta, so it does not cope with its functions: respiratory, nutritional, hormone production, and others.

Premature placental abruption

Long before childbirth, the integrity of the uteroplacental vessels is disrupted.

Exposure to adverse factors in the first trimester of pregnancy can lead to fetal death and miscarriage, the occurrence of gross congenital malformations. For example, anomalies of the intestines, nervous system, lungs.

The occurrence of hypoxia in the second and third trimesters leads to a delay in intrauterine development of the fetus, damage to internal organs and the nervous system. Therefore, the child may lag behind in mental and physical development from peers. Often has various diseases: cerebral palsy, disorders in the immune system, epilepsy.

Before use, you should consult with a specialist.

Fetal hypoxia - diagnosis and treatment by week of pregnancy, consequences for the brain, kidneys, lungs and other organs. Prevention

During pregnancy, any mother worries about the health of her unborn baby and wants him to swarm on time and strong. It often happens that at a scheduled appointment with a doctor, mommy hears such a word as “hypoxia”. What is "fetal hypoxia", how can it be avoided and how can it be cured?

Intrauterine fetal hypoxia- this is a lack of oxygen for the normal development of the fetus. Simply put, the baby inside the mother has nothing to breathe, more precisely, its still unformed organs have nowhere to get oxygen for formation, and if the organs are already formed, then there is no possibility for their normal functioning.

Hypoxia can occur both in the early stages of pregnancy and in its last weeks. It can also become an obstacle to the successful course of childbirth during labor. If you ask yourself why fetal hypoxia is dangerous, then it depends on the degree of hypoxia, its type: chronic or acute, the timing of diagnosis and compliance with the treatment prescribed by the doctor.

Sometimes, in the absence of monitoring a pregnant woman (if she is not registered), with untimely diagnosis and treatment of this pathology, prolonged oxygen starvation occurs - chronic fetal hypoxia. The consequences of chronic fetal hypoxia are: violations of the formation of organs of the fetus, development of the embryo.

At a later date, this pathology causes damage to the central nervous system, a violation of physical development, which is characterized by growth retardation, poor adaptation of the child to existence outside the womb. In children born after chronic hypoxia inside the womb, poor appetite, anxiety and disorders of the autonomic nervous system are observed.

Acute fetal hypoxia

This type of hypoxia can occur at any stage of pregnancy and during labor. In this case, the diagnosis will sound like “acute fetal hypoxia”. This diagnosis is not conducive to any therapeutic intervention. With such a diagnosis, the woman is immediately placed in an emergency operation to extract the fetus in order to save his life. Every minute counts here. Prolonged lack of oxygen leads to the death of brain cells, therefore, to fetal asphyxia. The severity of the consequences of acute hypoxia is assessed on the Apgar scale immediately in the delivery room.

In general, fetal hypoxia can lead to consequences that will not really affect his life and development, he will be able to outgrow them by 5-6 years of life. Or, after fetal hypoxia during pregnancy, the born baby will fight for life for a long time, since his organs have not received proper development in the womb and will need treatment throughout his life.

Causes of fetal hypoxia

There can be many reasons for hypoxia. Intrauterine chronic hypoxia can be caused by the following reasons:

mother's diseases (respiratory tract diseases, cardiovascular system, blood diseases);
diseases of the fetus itself (Rhesus conflict, infections, congenital malformations, intracranial trauma);
impaired blood flow due to prolapse of the umbilical cord, pressing the umbilical cord in breech presentation, entanglement of the umbilical cord around the limbs;
severe and prolonged toxicosis is unpleasant and difficult for the mother, and this can affect the baby with hypoxia;
with polyhydramnios or multiple pregnancies, babies may not have enough oxygen for normal existence and development, then additional measures should be taken to help them;
overwearing can also cause oxygen starvation of the fetus;
in addition, all pregnant women are told daily not to get upset, think only about the good and avoid stressful situations. Firstly, the baby himself tenses up when the mother is upset, and, secondly, during stress, the mother breathes less often, which disrupts the flow of the right amount of oxygen to the fetus;
acute hypoxia occurs with tight multiple entanglement of the umbilical neck of the fetus;
premature detachment of the placenta, fleeting labor or vice versa protracted, knots on the umbilical cord, which prevent the flow of blood to the fetus, uterine rupture and much more;
the use of an anesthetic during the birth process can also cause acute hypoxia; →
prolonged stay of the fetal head in the pelvic area leads to oxygen starvation.

Hypoxia of the fetus and newborn

The above reasons are associated not only with fetal hypoxia, but also with asphyxia of the newborn. A newborn baby is considered in the first week after birth. During this period, all organs actively begin to work, which are reconfigured to work independently, without the help of the mother's body. So, if a child had intrauterine hypoxia, then it is likely that the same problem may arise in the first days of life.

The fact is that, with a lack of oxygen in the womb, the child tried to compensate for it by breathing through an open glottis. Amniotic fluid, mucus, blood could get there, which after birth will lead to blockage of the respiratory organs, and suffocation will occur - asphyxia of the newborn. That is why every second supervision is necessary for such children in the first days of life.

Hypoxia and fetal hypotrophy

We figured out what hypoxia is, and malnutrition is a lack of nutrition and underdevelopment of the fetus. This may be due to the same lack of oxygen, which is so necessary in the development of each organ, with the lack of proper nutrition. In most cases, malnutrition is a consequence of untreated or unnoticed hypoxia.

Fetal hypoxia: signs

In the first stages of pregnancy, it is impossible to determine fetal hypoxia without a Doppler examination (intrauterine examination of the fetal heartbeat) and ultrasound, since the fetus is not yet fully formed and cannot “tell” you that something does not suit him in your lifestyle and your condition.

Here, the diagnosis of fetal hypoxia comes to the rescue thanks to frequent and unscheduled examinations. Indicators for them can be your chronic diseases (diabetes, bronchitis, persistent cough, and others), your general condition, if you work in a stuffy room, and no one will release you from work there if there are certain contraindications.

In the later stages of pregnancy, the mother should monitor. When asked by a doctor about fetal movements, you get an answer on how to determine fetal hypoxia on your own. " Method 10”- this is the name of the assistant to identify signs of intrauterine fetal hypoxia.

Mom, waking up in the morning, saying hello to the baby, begins to count his movements. At least 10 episodes must occur per day. That is, you felt a stir for 2 minutes - the first series, then another minute - the second series, and so on.

Some doctors believe that increased fetal movements and hiccups are also symptoms of fetal hypoxia. But in fact, this can be a second indicator of excitement: mom unsuccessfully lay down (on her back, for example, which is unacceptable during pregnancy) or walked very quickly and now she also lacks air. If these phenomena quickly pass in the baby, then there is no reason to worry. But a decrease in the number of movements is already the most important symptom of intrauterine fetal hypoxia.

The development of acute fetal hypoxia is evidenced by turbid amniotic fluid, which is determined by their analysis.

How to recognize fetal hypoxia

First method about the detection of oxygen starvation was indicated above. The remaining methods are associated with an examination of a pregnant woman by a gynecologist at a scheduled or unscheduled examination.

The doctor, listening to the fetal heartbeat, pays attention to its frequency. If it is below the norm, then there is a need to conduct an additional examination. Listening to the fetal heartbeat with a statoscope through the mother's abdominal cavity begins in the second half of pregnancy.

More accurately traced the heart rhythm with the help of CTG (cardiotocography). This is an ECG for the fetus.

Signs of fetal hypoxia according to CTG are:

absence or decrease in the number of heart beats;
the presence of increased heart rate with involuntary contractions of the uterus and with fetal movements. The absence of such an increase indicates fetal tension and exhausted adaptive reactions.

And the third way is research with doppler ultrasound- intrauterine ultrasound, which allows you to examine the blood flow in the uterine arteries.

Also, a routine ultrasound examination can tell the doctor about the development of hypoxia - these may be disturbances in the development of the placenta, its premature maturation, too thick or thin walls.

Ordering some blood tests: hormonal and biochemical tests make it possible to detect the presence of enzymes in a higher concentration, fat oxidation products and other trace elements that indicate the development of such a pathology as fetal hypoxia.

Treatment of intrauterine fetal hypoxia

Having heard the diagnosis of “fetal hypoxia”, mommy becomes scared and the first thing that worries her is what should she do with fetal hypoxia. The main thing is to remain calm and follow the recommendations of the doctor. The calmness of the mother is the guarantee of the health of the child, not only already born, but also in her tummy.

If fetal hypoxia is diagnosed in time, and there are no indications for immediate surgery, then fetal hypoxia is treated. First of all, in the treatment of fetal hypoxia during pregnancy, they try to get rid of the mother’s illness as much as possible, which led to the onset of oxygen starvation (if it is revealed that it is she who is the cause of this).

Depending on the severity, treatment can take place in a hospital or on an outpatient basis. Rest and bed rest, taking medicines prescribed by a doctor that help to improve the supply of oxygen to the fetus, drinking oxygen-rich water are the main directions for the treatment of intrauterine fetal hypoxia.

Fetal hypoxia during childbirth

During labor, the obstetrician-gynecologist who takes delivery periodically listens to the baby's heartbeat. So here the symptoms of hypoxia are tachycardia, fetal bradycardia, as well as the appearance of dull tones and arrhythmias in the fetal heartbeat.

The degree of bradycardia and tachycardia in different periods of labor may be different. In the first period, hypoxia is evidenced by bradycardia up to 100 beats per minute, and in the second it is already 98 beats.

In response to a contraction, with the development of hypoxia in labor, with the help of a radiotocograph, one can observe a decrease in heart beats up to 50 per minute.

The consequence of hypoxia during labor the child may swallow amniotic fluid, which further leads to disruption of the respiratory organs of the newborn.

How to avoid fetal hypoxia

To avoid hypoxia and the consequences of intrauterine hypoxia, you should lead a healthy lifestyle for two. First of all, you should get rid of all bad habits, especially smoking, and walk more in the fresh air away from roads and highways.

No one cancels a visit to a doctor during pregnancy, he will always be able to diagnose this pathology on time.

The diet should be balanced. Products containing iron must be present in your menu.

During the first examination, when you first register, talk about all chronic diseases (in principle, this is in the questionnaire when the pregnant woman is filled out), and at subsequent visits, talk about respiratory diseases, if they appear.

By agreement with the doctor, breathing exercises can be performed to prevent fetal hypoxia.

Remember to get enough rest and sleep. Tips on how to avoid fetal hypoxia during pregnancy will help you easily endure a happy period of pregnancy, endure and give birth to a strong baby or baby.

During pregnancy, a mother should think not only about the baby, but also about herself, because the well-being of her unborn child depends on the state of her health. Wrong lifestyle and habits become the causes of fetal hypoxia during pregnancy.

Remember, everything that happens to you, one way or another is reflected in the baby. Take care of yourself and keep a close eye on the little miracle churning in your tummy.

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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 stronger 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 being carried out - to assess the risks of development hypoxia fetus:

The pregnant woman is interrogated: the age (late or young in the primiparous), the state of health and past diseases, the outcomes and course of previous pregnancies, the presence of bad habits and other factors are specified.
During the examination, the presence or absence of uterine tone is assessed.
The circumference of the abdomen is measured, then the data is compared with the weight and height of the pregnant woman.
The results of studies evaluating the state of the fetus and uteroplacental blood flow are analyzed.

An accurate diagnosis can be made through such examination methods as:

dopplerometry;
cardiotocography;
study of amniotic fluid;
ultrasound procedure;
amnioscopy.

Listening to the fetal heartbeat

It is performed through the anterior wall of the abdomen, starting from the 18-20th week of pregnancy. Fine heart rate (HR) in the fetus 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 stomach - at the point of best listening, which depends on the position of the fetus in the uterine cavity (head, pelvic, transverse).

Cardiotocography (CTG)

It makes it possible to simultaneously record and analyze the fetal heartbeat and uterine contractions.

CTG during pregnancy
With 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 - upon admission of a woman in labor to the maternity ward, after the discharge of amniotic fluid, before labor induction in case of weak labor activity and every three hours of childbirth.

The results of CTG are variable and depend on many factors. For example, if in the morning they were within the normal range, then deviations may occur in the evening. Therefore, the study is carried out as often as necessary.

Indications for CTG for women at risk:

From the side of the mother: Rh-negative blood, a history of premature birth, reduced or increased fetal activity, serious diseases (diabetes mellitus, diseases of the cardiovascular system, and others).
Changes in the fetus detected 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 course of this pregnancy: placenta previa, abnormal position of the fetus, multiple pregnancy, overgestation, preeclampsia.

Most often, cardiotocographs record a graph and independently process the data. The doctor makes a decision after receiving them.

There are technologies for conducting CTG-online remotely: the sensor is attached to the skin of the anterior wall of the expectant mother's abdomen, and the signal is transmitted to a smartphone connected to the Internet. The information is received on the Internet portal and processed, and then the results are sent to the doctor for decision making.

There are two types of CTG:

Indirect (external) - carried out with a whole fetal bladder. Sensors are attached to the skin of the anterior wall of the abdomen at the points of best listening to the fetal heartbeats.
Direct (internal) - rarely used, during childbirth in violation of the integrity of the fetal bladder. The sensor for recording the heart rate is attached to the presenting part of the fetus, the catheter for recording the tone is inserted into the uterine cavity.

Duration of CTG recording:

During pregnancy - about 40-60 minutes, when receiving normal indicators - 15-20 minutes.
During childbirth - 20 minutes and / or five contractions.

How is CTG performed?

During the study, the woman is in a sitting or lying position.
The doctor gives the future mother a device with a button, which she presses when she feels the movements of the fetus.

On a note!
It is not recommended to conduct CTG on an empty stomach, within 1.5-2 hours after eating, or one hour after the administration of 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. It is used for additional diagnostics when a non-stress test showed deviations from the norm.

The most commonly used stress test options are:

Oxytocin test: oxytocin is injected and contractions are induced, then the response of the fetal heart rate to uterine muscle contractions is observed.
Mammary test: a woman scrolls 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 is displaced: the head or pelvis is located closer to the entrance to the uterus for natural childbirth.

Signs of hypoxia on CTG

Assessed on the Savelyeva scale (1984)

Assessment of the state of the fetus by points

8-10 points - the normal state of the fetus.
5-7 points - there are initial manifestations of hypoxia. A repeated non-stress test is carried out during the day. 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 villi of the placenta.

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, which emits more powerful radiation, which is reflected from a moving object, in this case, blood flow. During the study, the woman is in a position lying on her side or back. Previously, a special gel is applied to the skin of the anterior abdominal wall - for better glide of the sensor.

The study is conducted for all women with a normal pregnancy at 30-32 weeks and before childbirth. Perform more frequently if necessary.

Indications for dopplerometry for women at risk:

From the side of the mother: serious diseases - for example, the cardiovascular system, kidneys, diabetes mellitus and others.
On the part of the fetus: intrauterine growth retardation, a decrease or increase in motor activity.
Condition or complications of the current pregnancy: premature birth, preeclampsia, and others.

Doppler indicators are evaluated by indices, the norms of which depend on the gestational age. The doctor determines the change in blood flow according to special tables.

Violations of the utero-placental-fetal blood flow according to Medvedev

I degree:
BUT- blood flow is disturbed in the vessels between the uterus and the placenta, but remains at normal levels in the vessels between the fetus and the placenta.
IN- the blood flow in the vessels between the fetus and the placenta is disturbed, but remains between the uterus and the placenta.

II degree: the blood flow is disturbed simultaneously in the vessels of the uterus, placenta and fetus, but the values do not reach critical ones.

III degree: the blood flow in the vessels between the fetus and the placenta is disturbed to critical values, while the blood flow in the vessels between the uterus and the placenta is disturbed or maintained.

Ultrasound examination (ultrasound)

The most common, safe and highly informative method of examination during pregnancy for the fetus and expectant mother.

It is carried out for all women on terms in accordance with the recommendations for a screening study during pregnancy:

The first screening is at 11-13 weeks;
The second - at 20-21 weeks;
The third - at 30-34 weeks.

The principle of operation of the ultrasound machine is based on the fact that the ultrasonic waves sent by the sensor are reflected from the organs under study. Then they are transmitted to the monitor in the form of images that are analyzed by the doctor. During the study, the woman is in the supine position.

The procedure is carried out without prior preparation using two types of sensors:

Transvaginal (a probe is inserted into the vagina) - most often used in the first trimester. Before the examination, the doctor puts on a condom on the ultrasound probe.
Abdominal (they drive a sensor along 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 probe.

Signs of fetal hypoxia on ultrasound

They are assessed depending on the duration of pregnancy. Changes or diseases that could lead to the development of fetal hypoxia are also detected.

In the early stages, the place of attachment of the fetal egg is determined and its formation is assessed.

At a later date

Assessing the condition of the placenta

The structure, thickness, place of attachment, presence or absence of detachment, 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 gestational age. With a change in the direction of increase, we are talking about polyhydramnios, with a decrease - about oligohydramnios.
Attention is drawn to the composition of amniotic fluid: normally, up to 28 weeks, they are transparent and colorless. As the period of water increases, they become cloudy and inclusions appear in them in the form of white flakes - due to the ingress of the separated sebaceous glands of the fetus (fat droplets), vellus hair, desquamation of skin cells and some other substances into them. The appearance of meconium (original stool) is a sign of hypoxia, dirty water, intrauterine infection.

The dimensions of the fetus are determined: head, trunk and limbs.
The data obtained are compared with normal values in accordance with the expected gestational age. On this basis, a conclusion is made. With hypoxia, there is an intrauterine growth retardation of the fetus.

The condition of the internal organs is assessed- to detect developmental anomalies in the fetus.

The position of the child is determined: head, transverse, pelvic.

The structure of the umbilical cord and the location of its loops are assessed- to detect developmental anomalies and possible compression during childbirth.

Amnioscopy

Through the vagina, an optical endoscopic device is inserted into the cervical canal, with the help of which the lower pole of the fetal bladder is examined.

Indications for amnioscopy

Suspicion of post-term pregnancy, acute or chronic hypoxia.
Rh incompatibility between mother and fetus.
Previous pregnancies ended in premature birth or miscarriage, severe gestosis (toxicosis).

The condition of the fetus and the likelihood of hypoxia is assessed by color, transparency and amount of amniotic fluid.

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 tissues of the fetus.

In the case of a minor form of this pathology, therapy is not provided. If it concerns a severe form of oxygen starvation, then all the efforts of specialists are directed to improving the uteroplacental circulation, as well as to restoring the metabolic processes of the fetus. In addition to numerous medications, the expectant mother can also be prescribed aqua gymnastics along with special breathing exercises. Childbirth in the presence of this pathology is accepted with mandatory cardiomonitoring, which makes it possible to monitor the general condition of the fetus. In very severe cases, an emergency delivery may be necessary, which is carried out by caesarean section.

Treatment of fetal hypoxia without medication

It is aimed at improving the supply of oxygen to the tissues of the mother and fetus.

Reducing physical and emotional stress, compliance with dosed bed rest
It is indicated for existing hypoxia and fetal developmental delay. Helps reduce vascular tone and improves blood flow to the uterus.

Complete nutrition
It is important for the expectant mother's body to receive all the necessary nutrients.

Hyperbaric oxygen therapy during pregnancy
Oxygen will be used at a pressure that exceeds atmospheric pressure. The procedure is carried out in special medical pressure chambers.

When breathing with a gas mixture under pressure, oxygen delivery to the tissues is artificially improved. Indications for the appointment of the procedure are already developing fetal hypoxia and all the conditions that can lead to it. For example, chronic diseases of the mother (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% of the 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 a meal or 2 hours after a meal.

Medical treatment

It has several directions:

Treatment of the underlying disease of the mother 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 fluidity and blood clotting.
Improvement of metabolism in the uterus and placenta.
Complex prescribing of drugs, taking into account one or more reasons and individual tolerability of drugs by the expectant mother.

Fetal hypoxia: hospital treatment

It is carried out with pronounced changes in the uteroplacental blood flow and a lack of oxygen supply to the fetus. Medicines can be prescribed both in the form of injections and tablets.

Drug group	Representatives	Mechanism of action	Application
Improvement of uteroplacental blood flow
Estrogens	The most commonly used is Sigetin, which has a weak estrogen-like effect. Less often - Follikulin, Sinestrol.	Increase the permeability of the placenta, facilitating the transfer of nutrients and glucose from mother to fetus. Improve metabolism in the endometrium (the lining of the uterus).	Sigetin is administered intravenously, 2-4 ml per 20 ml of 40% glucose solution. If necessary, the drug in the same dose is re-introduced with an interval of 30 minutes (no more than 5 times!). It is not prescribed during childbirth and uterine bleeding. The best effect is achieved with complex use 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 (Kurantil), Xanthinol nicotinate (Nicotinic acid), Pentoxifylline (Trental)	They inhibit the formation and adhesion of platelets (blood elements involved in clotting). Reduce the amount of fibrinogen - the protein-base of a blood clot (thrombus). Reduce blood viscosity. Improve blood flow in small vessels. Promote the supply of oxygen to the tissues. Moderately dilate small vessels.	Dipyridamole is prescribed 1-2 tablets three times a day. It is used in combination with acetylsalicylic acid. Pentoxifylline - intravenously drip for 7 days in 0.9% saline or 5% glucose solution, then - inside 1 tablet 3 times a day. Xanthinol nicotinate - first intramuscularly, 2 ml for several days, then - 1 tablet orally 3 times a day. The general course of treatment is 2-3 weeks. If necessary, some drugs are used for a longer time, under the control of blood clotting indicators, once every two weeks: fibrinogen, thrombin time, and others.
Drugs that lower the tone of the muscles of the uterus
Tocolytics - to prevent the development of preterm labor	Ginipral, Atosiban (Tractocil), Nifedipine	Reduce the tone and intensity of contraction of the muscles of the uterus. Suppresses premature labor pains, including those caused by oxytocin (the hormone that causes contractions). Ginipral has side effect: causes an increase in heart rate (tachycardia). Therefore, it is used in conjunction with drugs that normalize the heart rhythm (for example, Verapamil).	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. 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 is prescribed from the 16th week of pregnancy, 1 tablet 2-3 times a day. The duration of use is determined by the doctor. Atosiban is administered intravenously by drip, slowly, in three stages over 48 hours. Causes fewer side effects, is used from 24 to 33 weeks of pregnancy.
Antispasmodics	No-shpa, Drotaverine, Papaverine	Suppress contractions of the muscles of the uterus, stomach and intestines, urinary tract. Expand blood vessels and improve blood flow.	In the acute period, one of the drugs is administered intramuscularly for several days. Then he recommends the use of 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. because they can soften the cervix, causing it to dilate prematurely.
Magnesium preparations	Magnesium B6, Magnesium sulfate	Reduce the ability of the muscles of the uterus to contract; Increase blood flow in the vessels of the uterus; Reduce vasospasm; Improve the functioning of brain cells in the fetus and mother; Contribute to lowering blood pressure in the mother; Protect fetal brain tissue from damage: reduce the incidence of cerebral palsy and hemorrhages in the ventricles of the brain during premature birth; Pyridoxine (vitamin B 6) improves protein production.	In preeclampsia and eclampsia, magnesium sulfate is administered intravenously to lower blood pressure, slowly, according to the scheme - in order to avoid overdose. With an increased tone of the uterus and the threat of premature birth, magnesium B6 is prescribed orally, 1 tablet twice a day. The course is 2-3 weeks, if necessary - longer.
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	Vitamins E and C; Amino acids are components for the formation of protein.	They affect all metabolic processes occurring in cells: respiration, energy generation, protein synthesis, and others. They improve the delivery, as well as the absorption of oxygen and glucose by tissues. Prevent the destruction of red blood cells.	Actovegin initially administered intravenously, 4-5 ml per 200-400 ml of glucose solution, every other day. Course - 10 days. Then - one dragee three times a day. Course - 2 weeks. Vitamin E- 1 capsule per day (400 IU / 400 mg) orally during or after meals. Course - 2-3 weeks. Amino acid solutions- 400 ml intravenously, every other day. Course - 5-10 infusions.
Neuroprotectors- drugs that prevent damage to nerve cells in the fetus	Instenon is the most effective drug with minor and unexpressed side effects.	Improves blood circulation in the vessels of the brain; Increases the absorption of oxygen and glucose by the nervous tissue, improves the transmission of a nerve impulse along the nerve fibers; Improves the work of the heart muscle; Expands small vessels.	Instenon is initially prescribed 2 ml per 200 ml of 0.9% saline sodium chloride solution 1 time per day. Course - 5 intravenous infusions daily or every other day. Then - inside 1-2 tablets 3 times a day. Course - 5-6 weeks.

Poisoning, vomiting, diarrhea, intoxication in infectious diseases

The lost fluid is replenished by intravenous administration of solutions to restore acid-base balance: glucose, rheopolyglucin, sodium bicarbonate and others.

Premature placental abruption

With a slight detachment in a small area and the well-being of the expectant mother, the observation is carried out in a hospital:

The state of the fetus, mother and placenta is monitored in dynamics. Studies are being carried out: CTG, dopplerometry, ultrasound and others.
Treatment is prescribed: uterine muscle contractions are suppressed, hemostatic agents (Decinon, Vikasol), antispasmodics (No-shpa, Papaverine), drugs to improve metabolism and protect the fetus from lack of oxygen are prescribed.

Detachment over a large area with the development of massive bleeding or the appearance of minor repeated bleeding from the birth canal

Regardless of the mother's well-being, an urgent delivery is performed, a caesarean section is preferable. Induction of labor in placental abruption is contraindicated.

With massive bleeding of the mother, a donor red blood cell mass (a suspension of red blood cells obtained from human blood) and plasma (the liquid part of the blood) is injected 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 gestational age. 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 II and III 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 elements of inflammation are retained in the membrane.

Indications for urgent delivery with fetal hypoxia

Lack of effect from the treatment.
Deterioration of indicators on studies: CTC, dopplerography and others.
The appearance of meconium in the amniotic fluid, the increase in oligohydramnios or polyhydramnios.

Preference should be given to caesarean section, but it is also possible to use obstetric forceps, depending on the condition of the fetus and mother.

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 administration, suppositories for injection into the rectum.

Hypoxia during childbirth - asphyxia of the newborn

Resuscitation activities are carried out in the delivery room.

The order in which the steps are performed 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.

After birth and crossing the umbilical cord, the child is transferred to a heated table, wiped with dry heated diapers to avoid hypothermia and increased hypoxia.

Restores airway patency: mucus and amniotic fluid are sucked out from the mouth and nose of the child with the help of a rubber pear or electric suction. Then, if necessary, the neonatologist or obstetrician-gynecologist flushes the child's airways with saline from meconium and amniotic fluid using an electric pump and a laryngoscope (a medical instrument with a light).

With no or irregular breathing a tube is inserted into the child's airways to supply an air-oxygen mixture - intubation. Artificial ventilation of the lungs begins with the help of a special balloon, if necessary, with simultaneous chest compressions.

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 terminating neonatal resuscitation:

Lack of heart work for 8-10 minutes.
There is cardiac activity, but breathing is not restored within 15-20 minutes.

Fetal hypoxia during childbirth (newborn asphyxia): rehabilitation by hypothermia - video

Consequences

The severity and frequency of complications of oxygen deficiency for the fetus depend on the duration of pregnancy, the duration and strength of exposure to damaging factors (the degree of hypoxia).

Chronic fetal hypoxia: consequences

In the first trimester the laying of organs and tissues is disturbed, which leads to the formation of congenital malformations. Changes incompatible with life lead to intrauterine death of the fetus and miscarriage in the early stages. With the further development of pregnancy, a child is most often born with various congenital malformations. For example, with anomalies in the development of the brain, kidneys, lungs, etc.

In the second and third trimesters
There is a delay in intrauterine development of the fetus: insufficiency of weight and / or growth.

Perhaps the beginning of the development of labor activity much earlier than the expected date - the birth of a premature baby.

Often there are foci of hemorrhage in various organs and ischemia (areas of tissue experiencing a pronounced decrease in blood flow), necrosis develops (areas of tissue death), there is immaturity of organs and systems. Without a trace, such changes do not pass, 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 convulsions), cerebral palsy (damage to one or more parts of the brain), mental retardation, impaired maturation of the nervous system after birth and other diseases.
internal organs - after birth, the child does not adapt well to new conditions of life 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 disturbed.

Often, the condition of such children at birth is severe, requiring treatment in the conditions of resuscitation of newborns from the first minutes of life. In the future, these children need a long recovery period and treatment from specialized specialists - for example, a neuropathologist.

Consequences of acute fetal hypoxia

Develop depending on the severity of the impact of the cause:

Maybe thickening of the blood and 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 sections 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 detachment of the placenta. Consequences for the child: birth in a state of hemorrhagic shock (bleeding), in which the work of all organs and systems suffers. Consequences for the mother: Couveler's uterus (soaking with blood) and the development of DIC (increased tendency to bleed). Both the fetus and the mother may die.
If the airways are not cleared in time from amniotic fluid and meconium, the death of a child due to asphyxia and the development of pneumonia in the first days of life is 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 slight exacerbation of the disease during pregnancy can lead to a violation of the general condition of the expectant mother and harm the fetus.
Give up bad habits: smoking, alcohol abuse, drug use.

During the onset of pregnancy:

Registration up to 12 weeks of pregnancy with the implementation of all necessary studies according to the terms of pregnancy.
A visit to an obstetrician-gynecologist in a antenatal clinic according to the recommended terms: with a normal pregnancy in the first trimester - once a month, in the second and third trimesters - once every two to three weeks.
Compliance with the regime of wakefulness and rest: night sleep for at least 7-8 hours.
Complete nutrition with foods that contain sufficient vitamins, minerals, proteins and fats.
Taking vitamin preparations that are involved in all body processes. The most important for the expectant mother is folic acid (vitamin B 9). It promotes the absorption of iron, is necessary for the development of all organs and systems in the fetus, significantly reduces the likelihood of the formation of malformations of the nervous system.

Intrauterine fetal hypoxia is a deficiency of oxygen necessary for the embryo for the proper formation and development of 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 start treatment in a timely manner.

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Types of intrauterine hypoxia

The classification of the disease is carried out according to two factors - the duration of hypoxia and the stage of severity of the main symptoms.

First group:

Chronic fetal hypoxia is a prolonged deficiency of oxygen supply to the tissues of the embryo due to maternal diseases or placental disorders.
Acute hypoxia is a sharp and pronounced lack of oxygen. This type of disease can develop with placental abruption, birth baby and other pathological situations.

Classification of hypoxia in accordance with the clinical picture of the manifestation of the disease:

Threatening - symptoms of oxygen deficiency are not observed, but conditions develop that are provoking factors (pregnancy prolongation, premature aging of the placenta, etc.). Prevention of hypoxia is necessary.
Started - the clinical picture of oxygen starvation is clearly expressed, which requires the immediate start of treatment.

Degrees of chronic hypoxia

Intrauterine hypoxia in the embryo most often develops in the second and third trimester, when the fetal oxygen demand increases sharply. Under the influence of a damaging factor, adaptive mechanisms are triggered 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 first oxygen deficiency. During this period, the work of the adrenal cortex, which affects the amount of hormones, increases. Thus, the heart rate, vascular tone, blood volume, as well as red blood cells and hemoglobin increase. All these changes contribute to faster movement and saturation of cells with oxygen. At this stage, the main symptom is more intense fetal movements. At 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. With the timely recovery of the mother's condition, the pregnancy proceeds normally.
Partially compensated. The protective functions of the fetus restructure the work of the body 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 intestine 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 needed, since the risk of disruption in the formation of many organs of the embryo is significantly high.
Decompensated. There is a breakdown in the work of the body. The adrenal cortex can no longer produce cortisol even in a minimal amount. The heart rate decreases, the fetus becomes inactive, movements practically disappear. Continued oxygen starvation leads to minor hemorrhages in the brain and other organs, blood clots can 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 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 refers to the diseases and lifestyle of a pregnant woman:

low 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.

Violation of the uteroplacental blood flow

delayed pregnancy;
high risk of rapid delivery;
a variety of complications and pathologies during pregnancy (preeclampsia and others);
structural and functional disorders of the placenta and umbilical cord;
placenta previa or its incorrect attachment 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 disorders in the development of blood flow between the uterus and the placenta.
Increased tone of the uterus. There are prolonged and frequent contractions of muscle tissue long before the date of birth of the baby. As a result, arterial blood flow to the embryo is disrupted.
Multiple pregnancy. It is more difficult 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;
pelvic presentation.

Signs of hypoxia

In the first months of pregnancy, it is possible to determine the oxygen deficiency for the fetus only by instrumental diagnostic methods. Indications for such studies may be maternal illness, as well as the presence of factors from the list above. Therefore, it is so important to visit the doctor on time and talk about all the atypical and typical symptoms of pregnancy that concern you. Perhaps it is one of them that will lead the doctor to the idea that there is a risk of pathology and fetal hypoxia.

At a later date, the mother needs to carefully monitor the movements of the baby. Some doctors believe that hiccups and increased movement may also indicate hypoxia. But the cause of such symptoms may be the incorrect position of the fetus in the uterus or the stress of the mother. If these symptoms 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 identify 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 a decrease in fetal activity. After that, 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 state, the presence of non-standard symptoms;
previous pregnancies - course and outcome;
bad habits, lifestyle;
working conditions.

Cardiotocography

The method allows you to calculate the heart rate of the fetus, as well as monitor its activity, record the influence of the mother's movements on the baby.

The principle of operation of the CTG apparatus

Research results for a healthy fetus:

contractions of the heart from 120 to 160 beats per minute;
the heartbeat increases with the activity of the embryo or a sharp movement of the pregnant woman;
no slowdown in heart rate.

With 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, in which the vessels and the state of blood flow in the uterus, placenta and umbilical cord are evaluated. The result of the study is a Dopplerogram built on the basis of an analysis of the frequency difference between the sent and reflected signals from moving blood erythrocytes. Diagnosis by this method is most informative at the period of 21-22 weeks of pregnancy.

Doppler

Amnioscopy

This method is used exclusively from the 37th week of pregnancy, so there is a high risk of premature birth. The woman is located in the 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 condition of the amniotic fluid, the presence of impurities in them.

Counting fetal movements

It is rather a method of primary diagnosis, on the basis of which a pregnant woman seeks a more thorough examination of the body. It has been used since 25 weeks. The woman lies on her side and counts the movements of the baby. Normally, there should be at least 10 movements within an hour.

There is also a Pearson test. At which it is necessary to observe from the moment of awakening until the moment of sleep. For example, let's take the period from 9 am to 9 pm. If during this period you felt less than 10 sessions of movements (they can last for a couple of minutes), then you need to consult a doctor.

Ultrasound examination (ultrasound)

To diagnose hypoxia, ultrasound can be used after 20 weeks of pregnancy. At this time, it is possible to examine the arteries in the uterus and identify disturbances in the work of blood flow with the placenta at an early stage. And also ultrasound is 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 medication

This technique is aimed at improving blood flow between the mother and fetus, is used in the early stages of hypoxia or as part of complex treatment:

Decreased physical activity, emotional stress, dosed bed rest. These measures lead to a decrease in the tone in the vessels, which stabilizes the blood flow to the fetus.
Complete nutrition.
Therapy with oxygen. Inhalation of 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 at a pressure above atmospheric. Thus, the level of oxygen access to tissues and organs improves.

Pressure chamber for pregnant women

Medical treatment

Medications 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) Curantil (509 rubles) No-shpa (50 rubles) Vitamin E (123 rubles)

Fetal hypoxia: hospital treatment

Some factors leading to hypoxia may require a pregnant woman to be in the hospital under constant supervision.

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. It is important to constantly monitor the condition of the woman and the fetus, as well as replenish fluid losses in the body by administering intravenous solutions (glucose, sodium bicarbonate, and others).
Placental abruption. In a hospital, 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 caesarean section or cleaning is performed, depending on the duration 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 hypoxia of the fetus, even in a mild degree, can later 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. Serious degrees of oxygen starvation lead to premature birth and death of the embryo. In this case, the woman in labor often has bleeding, and in the later stages - a difficult birth. In the most difficult situations, a woman may have further problems with re-conception.

If a baby with intrauterine hypoxia survived safely the first month after birth, then pathological changes in his future life are minimal.

Chronic

The consequences for a child with a chronic form of hypoxia are as follows:

short stature and underweight;
low hemoglobin;
weak immunity (predisposition 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 how to prevent the risk of fetal oxygen starvation than to deal with the consequences in the future. There are various preventive measures both before the onset of pregnancy (during the planning and preparation period) and during its course. With a responsible attitude of a woman to this issue, the risk of hypoxia is significantly reduced.

Prevention before pregnancy

The main aspects of preparing a woman for pregnancy is to give up bad habits (smoking, drugs, alcohol) and examine the body for 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 up to 12 weeks and strictly follow the schedule of required studies;
visit the doctor in the absence of pathologies once a month and a half in the first trimester and once every 4 weeks in the second and third;
observe the regime of the day (sleep at least 8 hours);
complete nutrition;
taking vitamin complexes for pregnant women, folic acid is especially important (it has a beneficial effect on the absorption of iron) and magnesium (responsible for the formation of blood vessels);
walks in the open air;
healthy lifestyle.

In the process of intrauterine development, the fetus is in dire need of nutrients and oxygen. Access to them is an important condition and guarantee of the health of the child. Lack of oxygen or, scientifically, hypoxia is a serious violation, dangerous with possible complications and adverse consequences.

What is intrauterine fetal hypoxia

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

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

Damage to the central nervous system can lead to the death of nerve cells, which, as you know, do not recover. As a result of such damage, gross defects occur, manifested as epilepsy, cerebral palsy, mental retardation.

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

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

Classification of intrauterine fetal hypoxia

For reasons, fetal hypoxia is divided into:

associated with the mother's body;
associated with pathologies of the placenta and umbilical cord;
associated with the fetus.

According to the body's ability to compensate for disorders that occur during hypoxia:

compensated hypoxia;
subcompensated hypoxia;
decompensated hypoxia.

By time:

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

Causes of intrauterine fetal hypoxia

Causes of fetal hypoxia associated with the mother's body

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

Children of smoking mothers are often born with developmental anomalies. They lag behind in development, start talking and walking later, suffer from the effects of hypoxia and the toxic effects of tobacco smoke.

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

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

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

Causes of fetal hypoxia associated with the placenta and umbilical cord

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

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

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

Causes of intrauterine hypoxia associated with the fetal body

Symptoms of fetal hypoxia

Signs of fetal hypoxia: at first, a lack of oxygen excites the motor center of the child's brain. Clinically, this is manifested by an increase in the strength and frequency of movements, tachycardia (rapid heartbeat) in the fetus. With the breakdown of compensatory mechanisms and the accumulation of carbon dioxide in the blood, inhibition of motor activity and cardiac activity occurs. External manifestations - absence or decrease in the frequency and strength of movements, slowing of the fetal heartbeat (bradycardia). However, such symptoms are characteristic of acute hypoxia. In addition, the evaluation method is subjective. Studies have shown that the effectiveness of such diagnostics is very low. But, the absence of fetal movements for 12 hours is a reason to seek medical help.

Indirect signs of hypoxia at birth are cloudy green amniotic fluid due to the presence of meconium in them, cyanosis of the skin, low Apgar score.

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

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

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

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

Treatment of intrauterine fetal hypoxia

In chronic fetal hypoxia, treatment is aimed at improving uteroplacental blood flow. For this purpose, they correct violations of the blood coagulation system, treat anemia, and normalize the tone of blood vessels and uterus. Used drugs that improve metabolism. Vitamins and antioxidants prevent cell damage in the absence of oxygen.

Of great importance is physical activity, proper rest, elimination of stress and stress on the body. Recommended walks in the fresh air, gymnastics to prevent congestion in the pelvis. In severe cases, strict bed rest is prescribed. Nutrition is balanced, healthy, rich in vitamins and proteins.

Studies have shown that moderate chronic hypoxia is less dangerous. The child's body has time to adapt, to compensate for the lack of oxygen. Acute fetal hypoxia, which has arisen due to premature detachment of the placenta, entanglement, and other obstetric pathology, requires immediate operative delivery. The lack of oxygen can be alleviated with oxygen therapy.

The consequences of intrauterine fetal hypoxia

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

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

Prevention of fetal hypoxia

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

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