Intrauterine fetal hypoxia

Pregnancy is both a joy and a constant worry about the condition and development of the future baby. One of the reasons for concern is often the diagnosis of "intrauterine hypoxia": many pregnant women hear about this condition from their doctor, but not all of them have any idea what it means. We will try to open this topic by answering the most frequent questions of expectant mothers.

Epidemiology

Intrauterine hypoxia can be detected at any stage of the gestation process. The earlier the oxygen deficiency appears, the more seriously it affects the mental and physical condition of the baby.

According to medical statistics, intrauterine hypoxia of one degree or another is diagnosed in 10-15% of pregnant women.

Causes of the intrauterine fetal hypoxia

"Intrauterine hypoxia" this term literally means that the future baby does not have enough oxygen. This condition can be chronic (observed during pregnancy) and acute (during labor).

Medics distinguish several reasons for such a malfunction:

• Diseases in the expectant mother.

If there is a lack of oxygen in the blood of a woman, the fetus will also experience a deficit of oxygen. The fact is that some systemic pathologies increase the risk of hypoxia. For example, the most common cause of intrauterine fetal hypoxia is considered iron deficiency anemia, which reduces the amount of hemoglobin - a protein substance that helps oxygen to spread throughout the body. Other diseases that contribute to the development of fetal hypoxia are cardiovascular pathologies, which are accompanied by vascular spasms, improper blood flow. Spasms provoke deterioration of blood flow in the future baby. Similar negative changes are observed in pyelonephritis, chronic diseases of the respiratory and urinary system, diabetes mellitus.

• Intoxication, bad habits in the expectant mother.

In the lumen of the respiratory bronchioles there are specific structures in the form of bubbles, which are called alveoli: in the lungs they can be counted more than one thousand. Each alveolus has an extensive capillary network, thanks to which oxygen enters the blood from the air. Inside the alveolar surface there is a specific "lubricant". Consumption of alcoholic beverages is accompanied by the release of alcohol vapors with exhalation: these vapors change the density of the lubricant, which negatively affects the transfer of oxygen into the blood. As a result, hypoxia is formed first in the woman and then in the fetus. Cigarette smoke also aggravates hypoxia: tarry substances clog the alveoli, disrupting the production of lubrication. If the expectant mother smokes, her blood always contains less oxygen than is necessary for the normal intrauterine development of the baby.

• Prenatal abnormalities.

Problems such as underdevelopment of the placenta, abnormal development of the umbilical cord, premature detachment, uterine hypertonicity, overpregnancy, etc., are also common causes of fetal hypoxia. Sometimes the cause should be sought in the fetus itself. For example, it may have developmental defects, or there is a Rh incompatibility between the mother and the future baby. [1]

Risk factors

Several factors are known to cause fetal hypoxia. These factors include:

• diseases in a woman that developed before pregnancy (heart and vascular diseases, kidney diseases, chronic bronchitis, bronchial asthma, diabetes mellitus, hypertension);
• pregnancy disorders (toxicosis, eclampsia, overpregnancy, polyuria, gestosis, placental insufficiency);
• impaired fetal development (hemolytic disease);
• multiple births;
• umbilical cord entanglement.

In addition, some external factors can also lead to intrauterine hypoxia. We are talking about unfavorable environmental conditions, regular use of certain medications, various kinds of intoxication (poisoning). Women who smoke and abuse alcohol are also at risk. [2]

Pathogenesis

The basic point in the pathogenesis of intrauterine hypoxia is the lack of oxygen, which, in turn, becomes a trigger in the development of acidosis. Most of the indicators of homeostasis are disturbed.

At the very beginning of the development of pathology there are compensatory processes on the part of the child's body, the main systems are activated. However, if the situation does not improve, then soon these mechanisms are depressed, the phase of destructive disorders begins.

Early protective and compensatory response of the body consists in stimulation of adrenal functions, increased production of catecholamines and other vasoactive components, the effect of which causes increased heart rate, increased peripheral vascular tone, redistribution of blood flow. These processes allow to increase the minute volume, increase cerebral blood flow, activate the functional state of the heart, adrenal glands, placenta. At the same time, blood circulation slows down in the lung and kidney tissues, in the digestive system and dermis: this causes the development of ischemia, which increases the likelihood of weakening of the sphincter of the anus, which is accompanied by the release of meconium into the amniotic fluid.

With prolonged and severe intrauterine hypoxia, adrenal function is sharply depressed, the level of cortisol and catecholamines in the bloodstream decreases. Against the background of depressed hormonal secretion, vital organs suffer, heart rate decreases, blood pressure drops, venous stasis is formed, and blood accumulates in the portal vein system. [3]

Symptoms of the intrauterine fetal hypoxia

It is not always possible to detect intrauterine hypoxia at an early stage of formation, since the pathology is prone to sudden development.

The first signs that the baby lacks oxygen are bradycardia, a slowing of the baby's heart rate. Of course, the future mother will not be able to fix this symptom on her own, so it is important to visit the doctor regularly to assess the course of pregnancy.

But you can also feel changes in the intensity of the baby's movements and tremors at home. All pregnant women listen to their sensations: sometimes they move more often, sometimes less often. Medical professionals warn: if the baby has sharply reduced the intensity of pushing movements - less than three episodes per day - it is necessary to visit an obstetrician-gynecologist as soon as possible, as this indicates possible chronic intrauterine hypoxia.

In an acute state of hypoxia, the baby, on the contrary, becomes overly active, his thrusts become stronger, and the episodes become more frequent and longer.

It is quite difficult to notice intrauterine hypoxia in the first trimester of pregnancy, because the baby can not yet "help" in the diagnosis. The only way out is to have regular preventive checkups with your gynecologist (weekly is optimal).

Stages

The stages of intrauterine hypoxia are defined according to the degree of circulatory disorder:

• Compensation stage I (does not cause the development of complications and symptoms are not regularly detected).
• Stage II subcompensation (requires treatment because the body is no longer able to correct the malfunction on its own).
• Stage III decompensation (oxygen deficiency increases, posing a threat to the future child).

Forms

According to its course, intrauterine hypoxia is divided into several types, and each of them has its own characteristic differences:

• Short-term intrauterine hypoxia appears suddenly and lasts for a short time, so it is not particularly dangerous for the fetus;
• Moderate-to-severe intrauterine hypoxia is usually detected during labor;
• acute intrauterine hypoxia is characterized by an increase in pathological symptoms a few days before the onset of labor;
• chronic intrauterine hypoxia occurs in the complicated course of the process of pregnancy against the background of severe toxemia, infectious diseases, as well as in Rh incompatibility between the woman and the fetus.

Intrauterine hypoxia can occur in the first trimester of pregnancy, in the second half of pregnancy, and during labor. Prolonged oxygen deficiency stimulates anaerobic glycolysis. In such conditions, the body is forced to slow down the supply of oxygen to the intestines, skin, liver and kidneys. Centralization of blood flow causes an increase in tissue metabolic acidosis. Severe intrauterine fetal hypoxia quickly leads to a failure of the compensatory mechanism. This is manifested in the depletion of the sympatho-adrenal apparatus and the adrenal cortex. Blood pressure drops, heart rate slows down, collapse develops.

Intrauterine hypoxia in labor develops due to a disorder of uteroplacental circulation, which can be observed in the following conditions:

• premature placental abruption;
• umbilical cord prolapse;
• malposition of the placenta and fetus;
• increased uterine tone and uterine ruptures;
• acute hypoxic state in a woman in labor;
• circulatory disturbance due to compression of the fetal head during labor.

Complications and consequences

Intrauterine hypoxia makes its own adjustments in the work of organs and systems of the body, and oxygen consumption is reduced to the minimum possible. First of all, the available oxygen is distributed for the main vital processes, but the digestive system, lungs, kidneys and some other tissues can be severely affected: it is usually in these organs that the consequences are found.

If hypoxia in the fetus took place in the first trimester of pregnancy, then complications can turn out to be incorrect formation of the cardiovascular system, nervous system, brain structures, kidneys.

Fetal hypoxia in the second half of gestation can cause growth retardation of the child: often in this situation children are born underweight, with various mental and nervous disorders.

Severe intrauterine hypoxia can even lead to fetal death, or can be fatal in the first 24 hours of the infant's life.

To prevent all of this from happening, it's important to diagnose and try to correct the problem as early as possible. [4]

Intrauterine hypoxia and asphyxia of the newborn baby

Speaking of asphyxia of the newborn, they mean a malfunction associated with impaired gas exchange: lack of oxygen is complemented by an overabundance of carbon dioxide and the development of metabolic acidosis due to the accumulation of underoxidized metabolic products.

Asphyxia refers to terminal conditions that are detected in the adaptation period against the background of the baby's exit from the maternal womb.

Intrauterine hypoxia is the basis of hemodynamic disturbance in the fetus: the function of the brain stem sections is impaired, leading to premature respiratory activity and aspiration of amniotic fluid. As acidosis worsens, the respiratory center is depressed, and in prolonged pathology there is rapid hypoxic damage to the structures of the nervous system.

If the newborn develops asphyxia, emergency resuscitation measures are carried out. [5]

Diagnostics of the intrauterine fetal hypoxia

Diagnostic procedures to determine intrauterine hypoxia are categorized into these steps:

• Listening (auscultation) helps to detect obvious abnormalities in the fetal heart rate (slowing, rapid, irregular heart rhythm).

Instrumental diagnosis in the form of electrocardiography demonstrates altered or prolonged P, prolonged PQ interval, ventricular complex, split R, negative or flat ST segment, etc. Phonocardiography indicates altered amplitude and increased duration of heart tones, with their splitting and the appearance of murmurs. Cardiotocography allows to detect the initial symptomatology, which is manifested as tachycardia or moderate bradycardia, low-modulating curve type, poor response to functional tests, the appearance of late decelerations that occur as a reaction to uterine contractions. [6]

During labor, the cardiotocogram is scored by a scoring system, taking into account all of the baby's heart rate indicators:

• Examine the acid-base balance in the blood (tests are taken from the anterior part of the baby's body);
• observe the infant's motor activity;
• assess the quality of respiratory movements with ultrasound;
• determine the quality and biochemistry of the amniotic fluid.

Differential diagnosis

Differential diagnosis of intrauterine hypoxia and asphyxia is performed with pathologies that are accompanied by cardiorespiratory depression, acute blood loss, intracranial hemorrhage, brain development defects, diaphragmatic hernia, cardiac or pulmonary dysfunction. [7]

Treatment of the intrauterine fetal hypoxia

In order for the treatment of intrauterine hypoxia to be extremely effective, it is necessary to directly affect the probable cause of the pathological condition - for example, to treat the initial disease of the pregnant woman, to promote adequate oxygen supply to the fetus, to ensure the normal course of metabolic reactions in the body. To accomplish these tasks, it is necessary to correct the transportation of oxygen through the placenta. [8] This can be done in these ways:

• improve the patency of placental uterine and fetoplacental blood vessels;
• to relieve uterine muscle tone;
• stabilize the function of the blood coagulation system;
• stimulate metabolic processes in the myometrium and placenta.

If there is a suspicion of intrauterine hypoxia, as well as in case of already diagnosed problem, it is important to provide a woman with bed rest, which will serve as a prevention of hypertonus and improve blood circulation in the pelvis.

Medications

Therapeutic measures for intrauterine hypoxia may include the administration of the following groups of medications:

• Estrogen-containing drugs:
  • regulate placental-uterine circulation;
  • contribute to the expansion of the smallest vessels of the uterus and the adjacent side of the placenta;
  • activate placental-uterine metabolic processes;
  • increase the permeability of placental vessels, improve trophicity.
• Vasodilators and antispasmodics (Euphyllin, Kurantil, Partusisten, Izadrin, etc.):
  • contribute to the elimination of hypertonus, dilate the uterine vessels;
  • stimulate placental metabolism and hormonal activity.
• Drugs that improve blood rheological properties and prevent thrombosis, anticoagulants (Kurantil, Trental, Heparin).
• Agents that optimize metabolic and energy processes in the placenta (B vitamins, ascorbic acid, vitamin E, methionine, glucose, Inosine, potassium orotate).

Proginova	The drug is prescribed only when estrogen deficiency is confirmed, in an individually adjusted dosage and under constant monitoring of hormonal levels. Taking estrogen-containing drugs may be accompanied by headache, nausea, body rash, weight change.
Curantil	It is prescribed 75 mg per day, in several doses. The duration of treatment is determined by a doctor. Possible adverse reactions: headache, dizziness, dyspepsia, general weakness.
Trental	Trental, or Pentoxifylline, is administered by injection in individually adjusted doses. Possible side effects include arrhythmias, changes in blood pressure, dizziness, headache, nausea, sleep disturbances, and peripheral edema.
Inosine	Appointed at 0.6-0.8 g per day, with a possible gradual increase in dosage. The course of administration - 1-3 months. Treatment may be accompanied by itching and redness of the skin, increased uric acid level.
Glucose solution 5%	It is administered intravenously by drip, in the volume of up to 1500 ml per day. The optimal rate of administration is 100 drops per minute. Possible side effects: allergic reactions, dyspepsia.
Vitamin E	Tocopherol is taken orally in the form of capsules, from 50 to 300 g daily. The doctor determines the course of therapy individually. Among the most common side effects are itchy skin, fatigue, headache.

Vitamins

In case of mild to moderate intrauterine hypoxia, the doctor may advise a woman to change her diet, including vitamin-rich foods in the diet. Special attention should be paid to such vitamins:

• Folic acid is a very important vitamin, especially in the first trimester of pregnancy. It takes part in the formation of the placenta, and its deficiency negatively affects the development of the neural tube of the fetus, can even lead to spontaneous abortion.
• B-group vitamins are also responsible for the normal intrauterine development of the child, ensure adequate metabolic processes, absorption of nutrients from food, contribute to the formation of the nervous, endocrine, cardiovascular and immune system of the baby. With a lack of vitamin _B6 in women often develops toxicosis.
• Vitamin E is an antioxidant and participates in tissue respiration processes. Deficiency of tocopherol can provoke spontaneous abortion and intrauterine hypoxia.
• Vitamin _D3 is produced under the influence of ultraviolet light and improves the bioavailability of phosphorus and calcium.
• Beta-carotene takes part in the general development and trophic of the fetus, and its deficiency can lead to the development of anemia - one of the factors in the formation of intrauterine hypoxia.

Physiotherapy treatment

Intrauterine hypoxia may be an indication for the prescription of oxygen therapy - special oxygen procedures to maintain the functional state of the respiratory and cardiovascular systems.

The most effective way to deliver oxygen into the bloodstream is considered to be oxygen inhalation. The essence of the procedures is as follows: the patient breathes using a special mask or nasal cannula, inhaling pure oxygen or a gas mixture enriched with oxygen. The composition of the inhaled mixture, duration and frequency of treatment is determined by the attending physician.

Oxygen therapy helps the body of the woman and the fetus to replenish the lack of oxygen, reducing the risk of developing a pathological condition. Among other things, the treatment helps to eliminate the effects of stress, improves sleep, reduces the manifestations of toxicosis.

In addition, doctors may prescribe galvanization with magnesium preparations, electrophoresis, acupuncture and electrorelaxation.

Folk treatment

Folk recipes are appropriate as an auxiliary method to eliminate mild to moderate intrauterine hypoxia. As available remedies can be used:

• Birch juice (preferably fresh, but can be canned without sugar), 1 liter per day;
• Hawthorn fruit tea (100 ml before each meal);
• lingonberry compote (one cup daily after meals).

Use folk treatment should be used carefully, having previously consulted with a doctor, taking into account the intolerance of various products and assessing the likelihood of allergic reactions. In case of any unfavorable signs during treatment, you should immediately consult a doctor.

Herbal treatment

The use of herbs in pregnancy is quite a risky step, because most medicinal plants have a complex action and can harm the fetus. Doctors warn that you should never drink herbal infusions and decoctions without first consulting your gynecologist.

Among herbal remedies for intrauterine hypoxia have long been used preparations of mokrika and warty birch. There are many variants of potion preparation. For example: pour into a thermos dry raw material of mochrytsa (1 tbsp. L.), pour a glass of boiling water, kept overnight. Take before meals 50 ml, up to four times a day.

And a few more recipes that improve the blood supply of oxygen to the fetus:

• 1 tsp. Dry flowers of meadow clover poured 200 ml of boiling water, insist for 20 minutes, filtered. Take 1 tbsp. L. Up to five times a day.
• 1 tbsp. Dry rose hips brewed in a cup of boiling water, drink three times a day after meals.
• 1 tsp. Dandelion pour 200 ml of boiling water, insist under a lid for half an hour. Drink 1 tbsp. Three times a day before meals.
• Add red rowanberry fruit to tea and compote, at least 2-3 times a day.

Homeopathy

Homeopathic treatment can be combined with traditional therapy: you should not refuse from the medications prescribed by the attending physician, as intrauterine hypoxia is a serious pathological condition, and without medical assistance, life-threatening and health-threatening complications may develop.

There are some recommendations for taking homeopathic remedies, and it is especially important for pregnant women to heed them carefully:

• homeopathic and conventional medicines should not be taken at the same moment - it is better if 1-1.5 hours pass between their intake;
• if a hormonal drug is to be taken, homeopathy is better to be taken in the other half of the day;
• do not drink the homeopathic remedy with tea, coffee, herbal infusions (optimally - plain water).

Granules, drops, pills and other homeopathic remedies are selected by a homeopathic specialist, depending on the individual characteristics of the woman and the detected painful signs. As a rule, a properly selected drug helps not only to improve the supply of oxygen to the fetus, but also relieves the condition of the future mother: for example, eliminates toxicosis.

In the medicine cabinet of a pregnant woman should have such homeopathic remedies that can eliminate intrauterine hypoxia:

• Colchicum 6;
• Antimonium crudum 6;
• Ipecacuana 6;
• Cuprum metallicum 6.

Dosages are prescribed individually. The doctor may recommend taking Nux Vomica 6 or Vomikum-Heel from complex preparations.

Surgical treatment

In case of intrauterine hypoxia that cannot be treated, in case of acute hypoxic condition, the doctor may decide to perform a cesarean section operation. The intervention is a surgical cavity operation in which the baby leaves the uterus through a specially made incision.

Caesarean section can be primary or secondary. A primary caesarean section is said to be performed when the operation is performed routinely before labor begins, in order to prevent possible risks in labor. Secondary cesarean section is performed during labor, in case of acute intrauterine hypoxia of the fetus.

Surgical treatment is performed only when prescribed by a doctor, if indicated. During surgery, general (endotracheal) or regional (epidural or spinal) anesthesia may be used.

Prevention

To prevent the appearance of intrauterine hypoxia in pregnancy, a woman should prepare in advance for the process of pregnancy, treat all diseases, eat right and lead a healthy lifestyle. Doctors give the following recommendations in this regard:

• in preparation for pregnancy, you should take a course of multivitamin preparations approved by your doctor;
• it's important to put all bad habits behind you;
• moderate physical activity and outdoor exercise are encouraged.

If pregnancy has already occurred, you can use these tips as prevention:

• timely visit a doctor for registration in the LCD (up to the twelfth week of pregnancy);
• Do not miss visits to the gynecologist, have regular checkups;
• take frequent and quality vacations;
• avoid conflict, avoid stress;
• a full and varied diet;
• take multivitamin medications approved by your doctor;
• Follow all recommendations and appointments of the gynecologist;
• avoid hypodynamia, take long walks;
• prevent the onset of colds and infectious diseases.

If a woman suffers from chronic pathologies, it is necessary to constantly monitor their course, undergo examinations and take tests. In addition, the doctor may recommend practicing breathing exercises, yoga, swimming.

Forecast

Moderate intrauterine hypoxia detected in a timely manner responds well to treatment and does not cause the development of adverse effects. In severe hypoxic conditions, such complications may develop:

• neuroses, instability of the child's mental state;
• physical and mental underdevelopment, frequent headaches, neurocirculatory dystonia;
• high intracranial pressure;
• hydrocephalus, epileptic syndrome;
• cerebral cysts;

Cranial nerve disorders.

Severe hypoxia has the most negative prognosis: the child may become disabled or die. Moderate and moderately severe intrauterine hypoxia has a more favorable prognosis, but only if timely and adequate treatment is provided.