Intrauterine fetal hypoxia

Pregnancy is both joy and constant anxiety for the condition and development of the unborn baby. One of the reasons for concern is often the diagnosis of "intrauterine hypoxia": many pregnant women hear about this condition from a doctor, but not all of them know what it is about. We will try to reveal 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 oxygen deficiency appears, the more seriously it affects the mental and physical condition of the baby.

According to medical statistics, intrauterine hypoxia of varying degrees is diagnosed in 10-15% of pregnant women.

Causes of the intrauterine fetal hypoxia

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

Doctors identify several reasons for this problem:

• Diseases in the expectant mother.

If a woman has a lack of oxygen in her blood, then the fetus will also experience its deficiency. The fact is that with some systemic pathologies, the risk of developing hypoxia increases. For example, iron deficiency anemia is considered the most common cause of intrauterine fetal hypoxia, in which the amount of hemoglobin, a protein substance that helps oxygen to be carried throughout the body, decreases. Other diseases that contribute to the development of fetal hypoxia are cardiovascular pathologies, which are accompanied by vasospasm, improper blood circulation. Spasms provoke a deterioration in blood flow in the unborn baby. Similar negative changes are observed in pyelonephritis, chronic diseases of the respiratory and urinary systems, and diabetes mellitus.

• Intoxication, bad habits in the expectant mother.

In the lumen of the respiratory bronchioles there are specific structures in the form of vesicles called alveoli: in the lungs, you can count 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 "lubrication". The use of alcoholic beverages is accompanied by the release of alcohol vapor 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 exacerbates hypoxia: tarry substances clog the alveoli, disrupting the production of lubrication. If the expectant mother smokes, then her blood always contains less oxygen than is necessary for the normal intrauterine development of the child.

• Gestation pathologies.

Problems such as underdevelopment of the placenta, impaired development of the umbilical cord, premature detachment, uterine hypertonicity, overmaturity, etc., also often cause fetal hypoxia. Sometimes the cause should be sought in the fetus itself. For example, he may have developmental defects, or there is a Rh incompatibility between the mother and the unborn baby. [1]

Risk factors

There are several factors that can lead to intrauterine fetal hypoxia. These factors include:

• diseases in a woman that developed even before pregnancy (diseases of the heart and blood vessels, kidneys, chronic bronchitis, bronchial asthma, diabetes mellitus, hypertension);
• disorders during pregnancy (toxicosis, eclampsia, overmaturity, polyhydramnios, preeclampsia, placental insufficiency);
• impaired fetal development (hemolytic disease);
• multiple pregnancy;
• umbilical cord.

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

Pathogenesis

The basic moment of the pathogenesis of intrauterine hypoxia is the lack of oxygen, which, in turn, becomes a trigger in the development of acidosis. Violated most of the indicators of homeostasis.

At the very beginning of the development of pathology, compensatory processes take place 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 inhibited, and the phase of destructive disorders begins.

An early protective and compensatory reaction of the body consists in stimulating the functions of the adrenal glands, increased production of catecholamines and other vasoactive components, the action of which causes an increase in heart rate, an increase in the tone of peripheral vessels, and a redistribution of blood flow. These processes make it possible to increase the parameters of minute volume, increase cerebral circulation, and activate the functional state of the heart, adrenal glands, and placenta. At the same time, blood circulation in the tissues of the lungs and kidneys, in the digestive system and dermis slows down: this causes the development of ischemia, during which the likelihood of weakening of the anus sphincter increases, which is accompanied by the release of meconium into the amniotic fluid.

With prolonged and severe intrauterine hypoxia, adrenal function is sharply inhibited, the level of cortisol and catecholamines in the bloodstream decreases. Against the background of inhibition of hormonal secretion, vital organs suffer, the heart rate decreases, blood pressure indicators fall, venous congestion forms, 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 does not have enough oxygen are bradycardia, a slowdown in the child's heart rate. Of course, the expectant 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 the pregnancy.

But changes in the intensity of movements and pushes of the baby can be felt at home. All pregnant women listen to their feelings: sometimes the movements happen more often, sometimes less. Doctors warn: if the baby has sharply reduced the intensity of pushing movements - less than three episodes per day - then you need to visit an obstetrician-gynecologist as soon as possible, as this indicates a possible chronic intrauterine hypoxia.

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

It is quite difficult to notice intrauterine hypoxia in the first trimester of gestation, because the baby cannot yet “help” in the diagnosis. The only way out is to regularly undergo preventive examinations with your gynecologist (it is optimal to do this weekly).

Stages

The stages of intrauterine hypoxia are determined depending on the degree of circulatory disorders:

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

Forms

In 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 does not last long, therefore it does not pose a particular danger to the fetus;
• moderate 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 with a complicated course of the gestation process against the background of severe toxicosis, infectious diseases, as well as with Rh incompatibility between the woman and the fetus.

Intrauterine hypoxia can form in the first trimester of pregnancy, in the second half, as well as during childbirth. Prolonged oxygen deficiency stimulates anaerobic glycolysis. Under 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 indicators fall, heartbeat slows down, collapse develops.

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

• premature detachment of the placenta;
• umbilical cord prolapse;
• abnormal presentation of the placenta and fetus;
• increased tone and rupture of the uterus;
• acute hypoxic condition in a woman giving birth;
• circulatory disorders as a result of squeezing the fetal head during childbirth.

Complications and consequences

Intrauterine hypoxia makes its own adjustments to the functioning of the 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 suffer greatly: usually the consequences are found in these organs.

If hypoxia in the fetus occurred in the first trimester of pregnancy, then complications can result in improper formation of the cardiovascular system, nervous system, brain structures, and kidneys.

Hypoxia in the fetus in the second half of gestation can cause inhibition of the growth of the child: often in such a situation, underweight children are born, with various mental and nervous disorders.

A severe degree of intrauterine hypoxia can even lead to the death of the fetus, or cause death in the first 24 hours of a baby's life.

To prevent all this, it is important to diagnose and try to fix the problem as early as possible. [4]

Intrauterine hypoxia and asphyxia of the newborn

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

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

Intrauterine hypoxia underlies the hemodynamic disturbance in the fetus: the function of the brain stem sections is impaired, which leads to premature respiratory activity and aspiration of amniotic fluid. With the aggravation of acidosis, the respiratory center is inhibited, and with prolonged pathology, rapid hypoxic damage to the structures of the nervous system occurs.

With the development of asphyxia of the newborn, emergency resuscitation measures are carried out. [5]

Diagnostics of the intrauterine fetal hypoxia

Diagnostic procedures for determining intrauterine hypoxia are divided into the following stages:

• Listening (auscultatory method) helps to identify obvious violations of the fetal heart rate (slow, rapid, abnormal heart rhythm).

Instrumental diagnostics in the form of electrocardiography demonstrates an altered or elongated P wave, a prolonged PQ interval, a ventricular complex, a split R wave, a negative or flat ST segment, etc. Phonocardiography indicates an altered amplitude and increasing duration of heart sounds, with their splitting and the appearance of noise. Cardiotocography allows you to detect initial symptoms, which manifests itself in the form of tachycardia or moderate bradycardia, a low-modulating type of curve, a weak response to functional tests, the appearance of late decelerations that occur as a reaction to uterine contractions. [6]

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

• examine the acid-base balance in the blood (tests are taken from the presenting part of the child's body);
• monitor the motor activity of the baby;
• assess the quality of respiratory movements using ultrasound;
• determine the quality and biochemistry of amniotic fluid.

Differential diagnosis

Differential diagnosis of intrauterine hypoxia and asphyxia is carried out with pathologies that are accompanied by cardiorespiratory depression, acute blood loss, intracranial hemorrhage, brain developmental defects, diaphragmatic hernia, dysfunction of the heart or pulmonary system. [7]

Treatment of the intrauterine fetal hypoxia

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

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

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

Medications

Therapeutic measures for intrauterine hypoxia may include the appointment 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 the vessels of the placenta, improve trophism.
• Vasodilators and antispasmodics (Eufillin, Curantil, Partusisten, Izadrin, etc.):
  • contribute to the elimination of hypertonicity, dilate the vessels of the uterus;
  • stimulate placental metabolism and hormonal activity.
• Drugs that improve the rheological properties of blood and prevent thrombosis, anticoagulants (Kurantil, Trental, Heparin).
• Means that optimize metabolic and energy processes in the placenta (group B vitamins, ascorbic acid, vitamin E, methionine, glucose, Inosine, potassium orotate).

Proginova	The drug is prescribed only with confirmed estrogen deficiency, in an individually selected dosage and under constant monitoring of hormonal levels. Reception of estrogen-containing drugs may be accompanied by headache, nausea, rash on the body, changes in body weight.
Curantyl	Assign 75 mg per day, in divided doses. The duration of treatment is determined by the doctor. Possible adverse reactions: headache, dizziness, dyspepsia, general weakness.
Trental	Trental, or Pentoxifylline, is administered by injection, in individually selected dosages. Possible side effects include arrhythmia, changes in blood pressure, dizziness, headache, nausea, sleep disturbances, and peripheral edema.
Inosine	Assign 0.6-0.8 g per day, with a possible gradual increase in dosage. The course of admission is 1-3 months. Treatment may be accompanied by itching and redness of the skin, elevated levels of uric acid.
Glucose solution 5%	It is used intravenously drip, in a 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 per day. The doctor determines the course of therapy individually. The most common side effects include itchy skin, feeling tired, and headaches.

Vitamins

With mild to moderate intrauterine hypoxia, the doctor may advise the woman to change her diet, including foods rich in vitamins in her diet. Particular attention should be paid to such vitamins:

• Folic acid is a very important vitamin, especially in the first trimester of gestation. It takes part in the formation of the placenta, and its deficiency negatively affects the development of the neural tube of the fetus, and can even lead to spontaneous abortion.
• B-group vitamins are also responsible for the normal intrauterine development of the child, ensure the adequate flow of metabolic processes, the absorption of nutrients from food, and contribute to the formation of the nervous, endocrine, cardiovascular and immune systems of the baby. With a lack of vitamin B ₆  , toxicosis often develops in women.
• Vitamin E is an antioxidant and takes part in the processes of tissue respiration. Tocopherol deficiency can provoke spontaneous abortion and intrauterine hypoxia.
• Vitamin D ₃  is produced under the influence of ultraviolet rays, improves the bioavailability of phosphorus and calcium.
• Beta-carotene is involved in the overall development and trophism 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 appointment of oxygen therapy - special oxygen procedures to maintain the functional state of the respiratory and cardiovascular systems.

The most effective way to deliver oxygen to 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, the duration and frequency of treatment is determined by the attending physician.

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

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

Alternative Treatment

Alternative prescriptions are appropriate as an auxiliary method for the elimination of mild to moderate intrauterine hypoxia. The available resources are:

• birch sap (preferably fresh, but canned without sugar), 1 liter per day;
• hawthorn fruit tea (100 ml before each meal);
• compote or cranberries (a cup daily after meals).

It is necessary to use alternative treatment carefully, after consulting with the doctor, taking into account intolerance to various products and assessing the likelihood of developing allergic reactions. In case of any adverse symptoms during treatment, you should immediately consult a doctor.

Herbal treatment

The use of herbs during pregnancy is a rather risky step, because most medicinal plants have a complex effect and can harm the fetus. Doctors warn that in no case should you drink herbal infusions and decoctions without first consulting with your gynecologist.

Among herbal remedies for intrauterine hypoxia, preparations of woodlice and warty birch have long been used. There are many options for preparing the drug. For example: dry raw woodlice (1 tablespoon) are poured into a thermos, poured with a glass of boiling water, kept overnight. Take 50 ml before meals, up to four times a day.

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

• 1 tsp dry flowers of meadow clover pour 200 ml of boiling water, infuse for 20 minutes, filter. Take 1 tbsp. L. Up to five times a day.
• 1 st. L. Dry rose hips are brewed in a cup of boiling water, drunk three times a day after meals.
• 1 tsp dandelion pour 200 ml of boiling water, insist under the lid for half an hour. Drink 1 tbsp. Three times a day before meals.
• The fruits of red mountain ash are added to tea and compote, at least 2-3 times a day.

Homeopathy

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

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

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

Granules, drops, tablets and other homeopathic remedies are selected by a homeopathic specialist, depending on the individual characteristics of the woman and on 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 alleviates the condition of the expectant mother: for example, it eliminates toxicosis.

In the first aid kit, a pregnant woman should have such homeopathic remedies that can eliminate intrauterine hypoxia:

• Colchicum 6;
• Antimonium krudum 6;
• Ipecac 6;
• Cuprum metallicum 6.

Dosages are prescribed individually. Of the complex preparations, the doctor may advise taking Nux vomica 6 or Vomikum-heel.

Surgery

With intrauterine hypoxia that is not treatable, with an acute hypoxic condition, the doctor may decide to perform a caesarean section. The intervention is a surgical abdominal operation in which the child leaves the uterus through a specially made incision.

Cesarean section can become primary or secondary. They say about the primary if the operation is carried out as planned before the onset of labor, in order to prevent possible risks in childbirth. Secondary caesarean section is performed during childbirth, with acute intrauterine fetal hypoxia.

Surgical treatment is carried out only as prescribed by the doctor, if indicated. During the operation, it is possible to use a general (endotracheal) or regional (epidural or spinal) method of anesthesia.

Prevention

To prevent the occurrence of intrauterine hypoxia during pregnancy, a woman must prepare in advance for the gestation process, treat all diseases, eat right and lead a healthy lifestyle. Doctors give the following recommendations about this:

• in preparation for pregnancy, you should drink a course of multivitamin preparations approved by your doctor;
• it is important to leave all bad habits in the past;
• moderate physical activity, walks in the fresh air are welcome.

If pregnancy has already occurred, then the following tips can be used as a preventive measure:

• visit a doctor in a timely manner for registration with the LCD (up to the twelfth week of gestation);
• do not miss visits to the gynecologist, regularly examined;
• rest often and qualitatively;
• avoid conflicts, stress;
• eat a full and varied diet;
• drink multivitamin preparations approved by the doctor;
• follow all the recommendations and appointments of the gynecologist;
• avoid hypodynamia, walk a lot;
• prevent the occurrence of colds and infectious diseases.

If a woman suffers from chronic pathologies, then it is necessary to constantly monitor their course, undergo examinations and take tests. Additionally, the doctor may advise the practice of breathing exercises, yoga, swimming.

Forecast

Intrauterine hypoxia of moderate degree, detected in a timely manner, responds well to treatment and does not cause the development of adverse effects. In severe hypoxia, the following complications may develop:

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

Cranial nerve disorders.

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