Incidents 

Problems arising during childbirth. Rupture of the cervix and pubic articulation. Physical fatigue of a woman in labor

It is not enough just to make a choice: you also need to prepare yourself to cope with the task that we undertake. For some reason, not everyone understands this. Some people think that home birth is just a holiday, just an easy and pleasant adventure. (After all, everyone who talked about this said that it was easy and joyful!) But besides the "holiday", there is also "work" that must be done in order for the child to be born safely.

Some families forget about it (or maybe no one told them about it, and they themselves did not guess?). They are preparing for the "holiday" and do not expect any complications, and then - if this happens to them - they are bitterly disappointed in the very idea of ​​home birth and become active opponents of all these "fashion trends."

This is what we will talk about today - about what complications can arise during home birth, how you can avoid them, and how to determine whether you can stay at home or need to go to the hospital.

Last summer, I had the opportunity to talk to the ambulance workers who sometimes make calls to women who have "not coped" with home births. I was given a whole bunch of situations that an ambulance team might face when they arrived on such a call. (Special thanks to paramedic L. - for compiling a list of complications.)

By the way, there is nothing surprising in the fact that these doctors have formed a persistent negative attitude towards home births: after all, they have seen ONLY such unpleasant situations, and they have NEVER seen successful home births - that's why they considered me ;-) "a desperate madcap." I was the first LIVING person for them who managed in some incredible way (and repeatedly!) To give birth at home and do without an ambulance ;-))) (and even survive while doing this).

So, let's consider all the situations described (and Irina Martynova will comment on them from the point of view of her vast experience).

I. Birth complications that are possible for any woman, including those examined in the antenatal clinic.

1. Sluggish or insufficient labor

- consequently, fetal hypoxia, subsequently - fetal asphyxia, leading to its death, and if timely medical care is not provided, to serious conditions and even death of the woman in labor.

(IM: Of course, this can happen if a woman is at home alone, without an obstetrician, and for some reason does not want to call an ambulance. But if a woman is preparing for a home birth with an obstetrician, then this situation will not arise.

Let's take a look at the possible options. There are 2 types of birth weakness - primary and secondary.

Primary is when weak contractions last for several days, but there is no normal opening dynamics. In such a situation, you must first determine whether childbirth has begun - maybe these are just harbingers, and there is nothing to worry about. If childbirth has begun, but there is no dynamics, then you need to establish the cause.

Maybe it's a flat bladder that prevents the baby from dropping - then the obstetrician should remove the bladder, and the birth will go normally. Maybe the reason is the woman's general fatigue, or low hemoglobin, or even some mental abnormality - but if a professional obstetrician watches a woman's condition during pregnancy, he will notice this not at the time of childbirth, but much earlier, and will convince such a woman the fact that home birth is contraindicated for her.

There is also a secondary weakness of labor activity - at the same time normal labor pains begin with progressive labor activity, a gradual opening of the birth canal occurs, but labor for some reason turns out to be protracted, and the woman gets tired of such labor.

Then she has a weakness, called secondary - there is a fading of labor. In such a situation, it is customary to stimulate childbirth. With home births, if the obstetrician believes that there is no danger to the mother and child, you can simply give the woman a good night's sleep so that she can gain strength. After that, she will have new good contractions, and she will be able to give birth normally.)

2. Premature placental abruption.

Due to insufficient supply of oxygen-enriched blood, it causes fetal hypoxia, up to asphyxia. But it is especially dangerous for a woman in labor, because is the cause of profuse uterine bleeding.

(IM: Yes, sometimes premature placental abruption occurs. The reasons may be different - trauma (mental or physical), chronic diseases and whatever. But this does not happen instantly - after the first signs of placental abruption appear, there is still time, to have time to call an ambulance.

If, with a small opening, spotting appears, any competent obstetrician will immediately send such a woman in labor to the hospital, without waiting for the situation to worsen. It is clear that such a woman should no longer have any home birth. If, in such a situation, she tries to give birth alone, without medical assistance, then this is not normal.)

3. Umbilical cord strangulation of the fetus

- hence, fetal hypoxia. With prolonged non-provision of medical care (surgery) - asphyxia and fetal death.

(IM: The umbilical cord entanglement is quite often found at the moment of birth - then it is necessary to immediately remove the loops suffocating the child, and act according to the circumstances - it depends on the degree of suffocation. In the mildest case, it is enough to immerse the child in cold water for a short time. In severe cases, mouth-to-mouth artificial respiration is done, chest massage - the obstetrician must know resuscitation techniques and be able to apply them at the right time.

When the obstetrician listens to the baby's heartbeat even before birth and feels that there are some malfunctions, it can be assumed that there is an entanglement. To avoid asphyxiation from entanglement or pressing, the obstetrician performs the so-called triad according to Nikolaev: this is a way of medication to combat intrauterine asphyxia.

The obstetrician will constantly monitor the heartbeat of the child who is in this condition, and by the time he is born, the obstetrician will prepare for all the necessary activities. He should have hot and cold water and suction devices on hand and should be prepared to apply all resuscitation procedures.)

4. Incomplete discharge of the placenta.

Causes severe bleeding, up to profuse. An urgent surgical intervention is required.

(IM: Of course, incomplete discharge of the placenta occurs during home childbirth. If a woman gives birth alone, she cannot determine for sure whether the placenta has completely come out. Therefore, in such a situation, one should not risk it - with any bleeding, one must surrender to the hospital.

But if an obstetrician is involved in childbirth, he will be able to detect in time that there are complications in the separation of the placenta. The obstetrician must not only know what measures are required, but also be able to do it. It is necessary to enter the uterus with your hand and as soon as possible to carry out the separation of the placenta. Old professional obstetricians, even in maternity hospitals, did it without anesthesia - they watched the woman's feelings.

After manual removal of the placenta, it is required to massage the uterus and check the walls. If done correctly, the uterus will contract well. In this case, it is necessary to conduct the early postpartum period, taking into account the contraction of the uterus - the obstetrician will use strong contractions so that there is no further blood loss. To compensate for the happened blood loss, it is enough to drink more liquid - if there are no symptoms of acute blood loss. If there are such symptoms (and the obstetrician sees it), then medical attention is required - you need to put a dropper.)

5. Insufficient contractile activity of the uterus

- therefore, bleeding dangerous for the health and life of the parturient woman.

(IM: To stop postpartum bleeding, oxytocin is needed, which is produced in the pituitary gland - and it is released due to the fact that the baby sucks at the breast. really does not contract well, then cold and heaviness is applied to the stomach (in maternity hospitals they use an ice pack) so that the uterus does not "dissolve".

There are special cases when it is already known in advance that the uterus will not contract normally. For example, asthmatics take special medications to relax their muscles. I had to take such childbirth: a woman with chronic asthma was taking such a drug. But in this case, you can cope with bleeding if you have been observed by a home obstetrician, and he knew in advance about this situation.

True, first you need to make sure that there are no ruptures of either the cervix or the vagina - in order to exclude other causes of bleeding. If there are gaps, they need to be sewn up - an obstetrician should be able to do this.

You need to understand that the protective functions of our body are always on the alert - and the work of the uterus is very wisely conceived. Childbirth is a natural act and the uterus "knows" how to behave after the baby is born. If a woman does not take any relaxing drugs, if there are no very strong hindrances to the natural mechanism of contraction of the uterus, then the law of nature will operate, which has always worked and works - otherwise we would all have died out.

Our reproductive function is based on the production of oxytocin in the pituitary gland - because of it, labor begins, a child is born, thanks to it, the uterus contracts and the afterbirth is separated, and then - again due to it - the uterus "closes" and the bleeding stops. The uterus is a powerful muscular organ that, after the placenta has passed, "squeezes the throat" of the vessels, prevents blood loss, and contributes to a good contraction of the uterus.)

6. Dissimilar intravenous blood coagulation

- DIC syndrome. An unpredictable complication, extremely dangerous. To save the life of a postpartum woman, emergency assistance from a hematologist is required. More common than commonly believed.

(IM: Maybe this really occurs "more often than it is commonly believed", but I did not have the opportunity to encounter this. Usually a woman who is observed by an obstetrician is simultaneously examined in an antenatal clinic. The necessary tests are taken from her, and any deviations in blood coagulation are determined in advance.If there are any problems, if it is assumed that a woman is at risk of developing DIC, then home birth should be abandoned.

Probably, there really are situations when DIC develops suddenly, without any deviations in the analyzes during pregnancy. Here I would like to say that in my first place is still the spiritual basis of preparation for childbirth. To avoid such a formidable pathology, a woman must prepare herself spiritually, take communion, take a blessing for a home birth. My practice confirms that everything is given to us according to our spiritual sins. The blessing is the key to a successful outcome.)

7. Multiple ruptures of the cervix.

(IM: This can happen if a woman gives birth alone, without the supervision of an obstetrician. If she was preparing for a home birth with an obstetrician, then the cervix should be ready for childbirth. other.

True, such preparation may not work - there is the concept of a "rigid neck" (this means that the tissues are not elastic at all), and in such cases it is also necessary to use hormonal drugs. But the obstetrician is able to determine this in advance and in time to start preparing even such a cervix for childbirth, so that everything goes well.

There were cases when I just did a finger massage of the cervix after 36 weeks of pregnancy (this is the verge of mature pregnancy - only after it can I prepare the cervix). When such a woman enters childbirth, and the period of full opening is already approaching (when there is already a feeling of pushing, but the cervix is ​​not yet fully open, and it is still impossible to push), then it is also necessary to do finger massage and remove the cervix, not allowing the woman to push. In this case, antispasmodics should be administered intravenously, weaker or stronger (intravenously - for a better effect).

An obstetrician must correctly guide a woman in childbirth, taking into account the condition of the cervix - this is an individual matter, for each cervix you need to look for its own approach. But even if cervical ruptures occur, a professional obstetrician with the help of special mirrors-holders is obliged to sew up both the cervix and the vagina, and other parts of the birth canal.)

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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 confirmation of this. It is especially dangerous if labor was accompanied by pathologies. In this case, the consequences for women's health can remind 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 (obesity of the expectant mother, a large fetus or its abnormal presentation in the womb, overwork of the woman in labor during labor, previous inflammatory processes);
  • ruptures of soft tissues (strong 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 empty 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, and intense production of oxytocin 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 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, causing urgent hospitalization of a recent woman in labor. Do not ignore the prevailing problem if a woman has such changes in her 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. The appearance and increase in the size of hemorrhoids, which must be shown to the proctologist on an individual basis, is not excluded.
  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 overall health, it's 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 types 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 can be the following states:

  • 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, desperately needs 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 natural delivery. Here are some valuable tips 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 has 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

The essence first period lies in the fact that the cervix is ​​fully opened and preparations are underway for the passage of the child through the birth canal. This period can last for different times. It depends on the muscle activity of the uterus and on whether the woman has given birth before or not. On average, during the first childbirth in women, the cervical dilatation takes from 12 to 18 hours. For repeat births, this will take 6 to 9 hours. With each subsequent birth, this period will last a shorter amount of time and pass with the least pain for the woman. Also, the first stage of labor can be called the latent (latent) phase of labor. It continues until the opening of the cervix by 3-4 cm. Next, the active phase of labor begins, which will end with the birth of a child. The full opening of the cervix is ​​considered to be an increase in its lumen in diameter of about 10-12 cm. With the appearance of strong contractions, it can be judged that the cervix has opened. Initially, contractions (muscle contractions of the uterus) are observed at intervals of 10-15 minutes, and then their frequency and soreness increase, and the interval between them is reduced to several minutes. Throughout pregnancy, the cervix is ​​closed, which leads to the preservation of the fetus. In its center is the cervical (cervical) canal, which begins with the external and ends with the internal uterine pharynx. Just before childbirth, the cervical canal begins to open. After the first signs of labor appear, one or two fingers can be inserted through a manual vaginal examination. With the appearance of regular contractions, the cervix is ​​shortened due to the tension of its muscles. This, in turn, leads to the opening of the cervical canal. At the first birth, the opening of the internal uterine pharynx occurs first, and then the external one. With repeated childbirth, the external and internal pharynx open simultaneously. With each subsequent contraction, the cervix gradually opens. On average, within an hour, its lumen can increase by several centimeters. Also, the fetal bladder affects the opening of the uterus. During contractions, its pressure on the cervix increases due to the accumulation of amniotic fluid in the lower part of the uterus and the presenting part of the fetus. The dilatation of the cervix can be monitored with a digital examination. When a certain number of fingers are inserted into the external pharynx, you can set the appropriate width of its lumen. Each inserted finger takes about 2 cm. This method determines the rate of dilatation of the cervix during childbirth. Once the contractions have begun, you can insert one, in rare cases, two fingers. After a few hours, with a normal delivery, the obstetrician can safely insert four fingers, which will indicate the expansion of the cervical canal by 8 cm.In the case when the boundaries of the external uterine pharynx cannot be established with the introduction of all fingers of the hand, then they say that the cervix has completely opened ... In the first stage of labor, the presenting part of the fetus passes to the entrance to the small pelvis, and then to the birth canal. In this case, the child descends into the lower part of the uterus, where its contracting muscles press it against the bones of the small pelvis. The area of ​​the uterus in which the presenting part of the fetus is fixed during childbirth is called the abutment belt. It is here that the amniotic fluid is divided into the anterior, which are below the adjacent part of the fetus, and the posterior, located above. When the cervix is ​​dilated by 8 cm or its full dilatation by 10-12 cm, the fetal bladder should normally rupture. In this case, there is a timely outpouring of amniotic fluid. In the case of a rupture of the fetal bladder with a width of the external uterine pharynx of 6-7 cm, one speaks of premature (early) discharge of amniotic fluid. True, there are times when the fetal bladder does not rupture and the child is born in a shell. Normally, rupture of the fetal bladder occurs when the child is located in the lower part of the uterus. In this case, the place of rupture is located above the area of ​​the internal os of the uterus. In the event of a rupture of the bladder above the birth canal, the following complication may occur: when the presenting part of the fetus passes, the opening of the uterine pharynx can be closed by the amniotic membranes, which, in turn, will lead to prolonged labor, possible trauma and oxygen starvation of the fetus. By the end of pregnancy, the amount of amniotic fluid reaches about 1.5 liters. However, at the end of the first stage of labor, only the anterior amniotic fluid is discharged, the posterior water is poured out after the birth of the child. As a rule, after the bladder has burst and the amniotic fluid has left, the active phase of labor begins. Premature discharge of amniotic fluid earlier in pregnancy in many cases leads to premature birth and the birth of a premature baby. Early rupture of amniotic fluid at a time closer to the time of delivery can lead to infection of the fetus. In most cases, premature discharge of amniotic fluid occurs when the fetus is not properly positioned before childbirth and a woman has a narrow pelvis.

Predisposing factors for premature discharge of amniotic fluid include the following conditions:

  1. Unbalanced nutrition, in which the body of a pregnant woman does not receive the necessary amount of nutrients necessary for the normal development of the child and the formation of a full-fledged child's place (placenta, fetal bladder).
  2. Disregard for personal hygiene rules. A pregnant woman needs to more carefully observe the hygiene of the genitals to prevent infection from entering the uterine cavity.
  3. Unskilled or insufficient supervision of pregnant women. Late detection of pregnancy complications (high blood pressure, edema, genital tract infections) by medical personnel. And also failure to comply with doctor's prescriptions.
  4. A large number of artificially terminated pregnancies (abortions) in a woman's medical history. After several abortions, cervical insufficiency may occur, in which the cervix will not close tightly, as a result of which the woman will not be able to bear the fetus within the prescribed period. In most cases, pregnancy in a woman with cervical insufficiency ends with either a spontaneous miscarriage or, at best, premature birth.
  5. Multiple pregnancy. In the presence of two or more fetuses in the uterus, excessive overstretching of its walls occurs at a later date, which leads to premature rupture of amniotic fluid.
  6. Fragile membranes of the fetal bladder. It can occur if there are two or more fetuses in the uterus: excessive overstretching of its walls occurs at a later date, which leads to premature rupture of amniotic fluid.
  7. The impact of both external factors (harmful chemicals, infections) and internal anomalies in the development of the female body caused by heredity.
  8. Fetal infection during pregnancy. In most cases, the infection is carried through the blood from the mother to the child, less often when the genitals and cervix are injured.
  9. The presence of a large amount of amniotic fluid in the uterine cavity (polyhydramnios).

Premature discharge of amniotic fluid can occur gradually, in this case, a woman notes the appearance of a small amount of discharge with a slight admixture of blood, or abruptly, when the fluid comes out immediately in large quantities. The rapid discharge of amniotic fluid allows you to accurately determine the onset of labor. By the nature of the lost fluid and the condition of the pregnant woman, you can determine further actions during and after childbirth. The color of the waters in a yellow-greenish color indicates oxygen starvation of the fetus, in this case, you may need the help of a pediatric resuscitator during childbirth. The appearance of an unpleasant odor indicates intrauterine infection of the fetus. In this case, it is necessary to pay more attention to the condition of the child and the mother after childbirth, the definition of the disease and postpartum care. Depending on the duration of pregnancy and the possibility of infection of the fetus after premature discharge of amniotic fluid, various measures are taken. With a premature pregnancy at a period of 35-37 weeks, if after the poured water during the day there is no labor activity (no contractions), measures are taken to induce childbirth with medication. If the administration of drugs does not give a positive effect and labor does not occur, the pregnant woman is prepared for surgery. With a gestational age of 28-34 weeks, immediate hospitalization is carried out in a special department of the maternity hospital, where the condition of the woman and the fetus will be constantly monitored. In case of infection of the fetus, immediate delivery is recommended, and in the future - antibacterial treatment, both for the mother and the newborn child.
Once the amniotic fluid has passed, labor must be completed within the first 12 hours to maintain fetal health. Monitoring a woman in the first stage of labor consists of measuring blood pressure, listening to the fetal heartbeat, and monitoring the strength and frequency of contractions. Modern equipment allows all these activities to be carried out simultaneously. The first stage of labor is accompanied by significant painful sensations that arise due to the pressure of the presenting part of the fetus on the pelvic bones and their further divergence, pressing of the nerve endings, stretching of the uterine ligaments. The intensity of pain largely depends on the individual threshold of pain sensitivity, the emotional state of the pregnant woman and the attitude towards future motherhood. At the beginning of the first period, contractions last a few seconds and alternate with fairly long periods of relaxation. As the contractions become more frequent, their pain accompaniment will increase. At this time, it is necessary to remain calm, monitor urination and breathing. It is strictly forbidden to take pain relievers, eat or drink plenty of fluids. This can lead to difficulties with surgery, if required during childbirth. Self-pain relief techniques can be used during intense contractions. These include stroking the lower third of the abdomen from the middle to the sides and pressing the sacrum with your fingers, as well as rubbing it. Contractions will be easier to tolerate if you breathe correctly (inhale deeply through your nose and exhale through your mouth). During contractions, it is undesirable to lie down, since in this case the uterus will exert pressure on the vena cava, which carries blood and nutrients to the fetus, as a result, oxygen starvation of the fetus may occur. It is best to walk, while pain is reduced, and you can also take a knee-elbow position or a squatting position. At the peak of pain, you need to try to relax the muscles as much as possible, which will contribute to a faster course of labor. Anesthesia is performed depending on the nature of the pain, the physical and emotional state of the woman and the fetus, the degree of cervical dilatation and the course of labor. Any medical intervention (medicinal or instrumental) must have good reasons. One of the most frequent surgical interventions in the first stage of labor is amniotomy - an instrumental opening of the fetal bladder. Self-rupture of the fetal bladder occurs towards the end of the first period and is accompanied by the leakage of amniotic fluid. However, in 7% of cases this does not happen. The need for this intervention must be clearly justified. Before an amniotomy is performed, the obstetrician carefully examines the woman. Amniotomy can be performed both before and during childbirth. Performing an amniotomy before childbirth is necessary for labor to appear. In most cases, it is used for prolonged pregnancy (prolonged pregnancy), when the gestation period reaches 41 weeks or more, and there are no signs of labor. With prolonged pregnancy, there is a decrease in the functional abilities of the placenta, in which the fetus suffers. The child ceases to receive a sufficient amount of oxygen and nutrients, metabolic products are not excreted from the amniotic fluid, which can cause fetal poisoning. For longer periods, after the 41st week of pregnancy, the weight and size of the fetus increase intensively, which can significantly complicate the course of natural childbirth, since the child simply cannot pass through the birth canal. It is also dangerous to carry out independent childbirth due to the high risk of birth trauma to the fetus and women in labor. The reason for opening the fetal bladder is also such a serious and dangerous complication of pregnancy as gestosis, in which the functions of the kidneys and the cardiovascular system are impaired. In this regard, extensive edema appears, blood circulation is disturbed, blood pressure rises, and harmful metabolic products accumulate in the blood. In this condition, the fetus suffers. In severe cases of gestosis, the central nervous system is damaged. Also, the reason for performing an amniotomy is the Rh-conflict between mother and child. This condition occurs with a negative Rh factor in a woman and a positive one in a child. In the case of carrying a pregnancy before the period at which the child becomes viable, after carrying out control studies using ultrasound and analysis of amniotic fluid, an artificial call to labor is performed with medications and amniotomy in order to save the child's life and reduce the harmful effects of antibodies on his vital organs. The most common reason for an amniotomy is an abnormal prenatal period. This condition is characterized by prolonged pain in the lower abdomen, sometimes for several days, accompanied by rare contractions.
This condition leads to overwork of the woman and difficulties in the process of birth. During childbirth, amniotomy is performed only if the fetus is surrounded by a very dense membrane and its independent rupture does not occur. Also, piercing of the fetal bladder is carried out with weak labor, when there is a noticeable decrease in the frequency of contractions, the cervical dilatation stops or slows down, which leads to prolonged labor. This manipulation is also recommended when a flat fetal bladder is detected. This condition occurs with a small amount of amniotic fluid. Normally, the amniotic fluid, representing the anterior waters (from 100 to 200 ml), together with the presenting part of the fetus, puts pressure on the cervix, causing it to open. With low water, the anterior waters are presented in a volume of 10-15 ml, during contractions, the adjacent part of the fetus turns out to be a tightly wrapped bladder shell, which leads to a weakening of labor. One of the rarest reasons for opening the fetal bladder is the location of the placenta in the lower part of the uterus. In this case, during childbirth, premature placental abruption may occur, which may be complicated by intrauterine bleeding. Carrying out an amniotomy avoids this complication, since after discharge of amniotic fluid, the presenting part of the fetus will press the edge of the placenta, which will prevent its early discharge from the walls of the uterus. After the start of the first contractions, most often after 4-6 hours, the cervix opens and then anesthesia can be performed. Depending on the painful sensations of the woman, the introduction of painkillers can be made at the beginning of the first period for relaxation and a short rest before further childbirth, when maximum effort is required to give birth to a child. For this purpose, analgesics are most often used, which are administered intramuscularly or intravenously. They will act for several hours and will give the woman in labor mentally and physically prepare for childbirth and even get some sleep. In most cases, you can determine how intense the pain during childbirth can be. They will be most painful in primiparous women with a large fetus, premature birth, painful menstruation before pregnancy, and inadequate psychological preparation of a woman for childbirth. During childbirth, pain increases after the discharge of amniotic fluid during prolonged labor, with the use of labor stimulants (oxytocin). Labor pain can change its character over time. Initially, it arises from the contractions of the muscles of the uterus and the opening of its cervix and is characterized by dull, pulling sensations that do not have a clear location. Pain occurs in the uterus or may be felt in the lumbar region. Then it appears when the child moves along the birth canal, due to the stretching of the muscles of the vagina. At this moment, the painful sensations are acute and have a clear location, they are determined in the vagina, rectum and perineum, depending on where the presenting part of the fetus is located. The psychological preparation of a woman for childbirth plays an important role in reducing pain. For this, polyclinics and specialized centers for pregnant women conduct special courses on preparation for childbirth. The main task of such classes is to teach women the correct behavior and breathing during the birth of a child. Doctors explain in detail to pregnant women how the stages of childbirth will go, what to look for and how to relieve their feelings and help the baby to be born faster. With this preparation, it is easier for a woman in labor to focus, for example, on correct breathing during labor, than to think about how the birth will go and what sensations she will have. During childbirth, depending on the condition of the woman and the fetus, the period and course of labor, several types of pain relief can be performed. For the first period, intravenous or intramuscular administration of a narcotic analgesic (promedol) in small doses is most often used, which does not adversely affect the vital functions of the fetus. Also, during intense contractions, inhalation anesthesia (inhalation of anesthetic through the upper respiratory tract) with a mixture of nitrous oxide and humidified oxygen can be performed. This exercise significantly reduces pain sensitivity and helps to relax muscles, which will speed up the process of giving birth. With repeated or rapid labor, it is possible to carry out percutaneous electrical neurostimulation using special electrodes fixed in the lumbar region, on the sides, along the spine. The use of this method does not cause side effects and accelerates the dilatation of the cervix. However, in the further course of childbirth, this method does not have the proper analgesic effect when the child moves along the birth canal and can be used only in the first stage of labor. At the end of the first period, spinal anesthesia is performed under the supervision of an anesthesiologist. Spinal anesthesia is performed at the end of the first period, since earlier administration of drugs in this way can slow down or completely stop labor. With this type of anesthesia, a woman in labor can feel contractions, a manual vaginal examination performed by an obstetrician, but they will not be accompanied by pain, in other cases, the woman only feels numbness and heaviness in the legs. The positive thing about spinal anesthesia is that the woman in labor is conscious and can participate in a pain-free labor. However, there are a number of possible complications with this type of pain relief. These include a sharp decrease in blood pressure, cessation of labor and, therefore, an increase in the risk of surgery for normal delivery and severe headache. The most rare consequences of spinal anesthesia are impaired sensitivity and movement in the lower extremities, trauma to nerve endings and the introduction of infection into the woman's body. However, it should be remembered that all these consequences are reversible and every woman has every right to agree or refuse to carry out this type of pain relief. Nowadays, 90% of births take place under spinal anesthesia, and only a few percent of cases have any consequences of this intervention. There are a number of reasons why this pain relief should not be performed. These include diseases in which blood clotting is impaired, uterine bleeding, neurological diseases, inflammatory processes on the skin at the injection site, long-term use by a woman of drugs that slow down the blood coagulation process. If it is impossible to carry out childbirth under spinal anesthesia, contractions are anesthetized with promedol. It is usually administered once because of the risk of negatively affecting the fetus at the peak of pain. Local anesthesia of the perineum is also used when the child leaves the birth canal. In emergency situations with bleeding, a critical condition of the fetus (disturbances in the work of the heart) and during surgery, general anesthesia is used. Medicines are administered intravenously under the supervision of an anesthesiologist. Such an intervention is usually safe for the woman in labor and the baby. In this case, the woman's consciousness is turned off, there is a complete relaxation of the muscles and a lack of sensitivity.

Second stage of labor begins after full dilation of the cervix and ends with the full birth of the child. The duration of this period also depends on whether the woman has already given birth or not, and on the intensity of the contractions. During the first birth, it can last up to 2 hours, with repeated - from 10-15 minutes to 1 hour. The period of birth of the fetus takes place in the delivery room, on the delivery bed. After the cervix is ​​completely opened, attempts are added to the contractions - an arbitrary tension of the muscles of the abdomen, perineum and diaphragm (the septum separating the abdominal organs from the chest cavity). If contractions occur spontaneously and cannot be controlled, then the attempts can be regulated. The frequency and strength of attempts is monitored by a midwife, who helps the woman to correctly distribute her efforts during each contraction. Attempts must be done during contractions, simultaneously with a deep breath, on a smooth exhalation, the woman should relax. During one fight, 3 attempts are made. No matter how difficult it may seem to a woman in labor, it is precisely this ratio of contractions and attempts that is the most optimal and contributes to a faster and less traumatic birth of a child. The passage of the fetus through the birth canal of a woman is carried out through attempts. At the same time, meeting resistance on its way from the contracting muscles and the bone base of the birth canal, the child makes rotational movements, and also bends and unbends with the help of attempts. The birth of a child takes place in stages. First, the incision of the presenting part of the fetus (most often the head) occurs - a condition in which, at the moment of pushing, part of the fetus is shown in the genital crevice, and after relaxation it disappears. Then, the eruption of the presenting part is observed, while the child moves so far along the birth canal that part of his body is fixed in the genital gap and does not hide even after the cessation of the attempt. In the second stage of childbirth, much attention is paid to the condition of the child, his cardiac activity is assessed. During intensive contractions of the muscles of the uterus, the access of oxygen decreases, the pressure inside the uterus increases, and part of the umbilical cord may be pinched, which leads to a deterioration in the condition of the fetus. In most cases, control is carried out using a cardiotocograph. This electronic device allows simultaneous recording of fetal heart rate and contraction activity. To do this, a special sensor is attached to the abdomen of the woman in labor using rubber straps. Control determination of indications is carried out every 20-30 minutes, while 120-160 beats are considered the norm. / min. With significant deviations from the norm, the course of natural childbirth can be stopped and surgery can be started. As a rule, the head of the fetus is born first, then the shoulders and pelvic part with legs appear. After the head leaves the birth canal, the midwife cleans the child's airways from mucus and amniotic fluid. The baby starts to breathe. In this case, the woman in labor can hear the cry of the child, which will mean for her that he is viable. After the first activities with the newborn, the umbilical cord is cut and the baby is applied to the mother's breast. At this moment, a small amount of colostrum is present in the mammary gland, with which the baby receives all the necessary nutrients, and in the woman's body, when the baby sucks on the breast, a hormonal substance (oxytocin) begins to be produced, which affects the contraction of the uterine muscles and reduces bleeding after childbirth. After the baby is born, doctors take general measurements (weight, height). A tag is attached to the pens, on which the surname, name and patronymic of the mother, date of birth, gender of the child, its weight and birth history number are indicated. In the meantime, the woman enters the third stage of labor. On average, the duration of the last stage of labor is about 30 minutes, both in primiparous and multiparous women. It begins after the birth of the child and ends with the release of the placenta (placenta, fetal membrane and the remnants of the umbilical cord).

Third stage of labor not accompanied by pain, although the woman feels the ongoing contractions. For the birth of the placenta, it is necessary to push several times. In the case when the spontaneous birth of the placenta is difficult, you can enter oxytocin, which will accelerate its discharge. After the placenta leaves the woman, an ice pack is placed on the lower abdomen to enhance the uterine contractions. The afterbirth is carefully examined by the obstetrician for integrity to make sure that there are no parts left in the uterine cavity, due to which uterine bleeding may occur. After childbirth, the woman's condition is also monitored: the pulse is measured, blood pressure, blood flowing from the genital opening, is collected in a special container to determine the amount of blood loss. They also examine the external and internal genital organs for tears and injuries. After giving birth, the woman remains in the maternity ward for 2 hours, and then is transferred to the postpartum ward, where a 6-hour bed rest is observed.

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

In Latin, asphyxia 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 asphyxiation;
  • 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 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;
  • abnormalities 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

It does not matter what caused the lack of oxygen in the body of a newly born child, in any case, metabolic processes, hemodynamics and microcirculation are rearranged.

The severity of the pathology depends on how long and intense the hypoxia was. Due to 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 disturbances cause edema, hemorrhages and ischemic foci, which leads to hemodynamic disturbances, disturbances in 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 a violation of breathing, 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 the diagnosis: "Asphyxia of the newborn", the obstetric history data, how the childbirth proceeded, the Apgar score of the child in 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 cardiovascular system (ECG, blood pressure control, pulse, chest x-ray);
  • assessment of 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

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 baby.

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 are also prescribed (dicinone, rutin, vicasol).

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.

Effects

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 development 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 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 blood thickening, 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 brain hypoxia 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 "doll" eyes, breathing periodically slows down and stops (bradypnea alternating with apnea), a rare pulse, a 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 disorder 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 baby who suffers from birth asphyxia need special care after discharge?

Answer: Oh 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 must be provided with 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 must be registered with a pediatrician (neonatologist) and 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.