Intrauterine fetal hypoxia

Pregnancy is both joy and constant anxiety about the health 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 the doctor, but not all of them know what it is about. We will try to cover this topic by answering the most frequently asked 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 varying degrees is diagnosed in 10-15% of pregnant women.

Causes 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).

Doctors identify several reasons for this problem:

• Diseases of the expectant mother.

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

• Intoxication, bad habits of the expectant mother.

In the lumen of the respiratory bronchioles there are specific structures in the form of bubbles, which are called alveoli: there are thousands of them in the lungs. 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". Drinking 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 develops first in the woman and then in the fetus. Cigarette smoke also aggravates hypoxia: tarry substances clog the alveoli, disrupting the production of lubricant. If the expectant mother smokes, her blood always contains less oxygen than is necessary for the normal intrauterine development of the child.

• Pathologies of pregnancy.

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

Risk factors

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

• diseases in women that developed before pregnancy (heart and vascular diseases, kidney diseases, chronic bronchitis, bronchial asthma, diabetes mellitus, hypertension);
• disorders during pregnancy (toxicosis, eclampsia, post-term pregnancy, polyhydramnios, gestosis, placental insufficiency);
• impaired fetal development (hemolytic disease);
• multiple pregnancy;
• 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 types of intoxication (poisoning). Women who smoke and abuse alcohol are also at risk. [ 2 ]

Pathogenesis

The basic moment of pathogenesis of intrauterine hypoxia is the lack of oxygen, which, in turn, becomes the trigger for the development of acidosis. Most homeostasis indicators are disrupted.

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 suppressed, and the phase of destructive disorders begins.

The early protective and compensatory reaction of the body consists of 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 allow increasing the indicators of minute volume, increasing cerebral circulation, activating 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 anal sphincter increases, which is accompanied by the release of meconium into the amniotic fluid.

With prolonged and severe intrauterine hypoxia, adrenal function is sharply suppressed, the level of cortisol and catecholamines in the bloodstream decreases. Against the background of suppression 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 intrauterine fetal hypoxia

It is not always possible to detect intrauterine hypoxia at an early stage of development, since the pathology tends to develop suddenly.

The first signs that the baby is not getting enough oxygen are bradycardia, a slowdown in the baby's heart rate. Of course, the expectant mother will not be able to record this symptom on her own, so it is important to regularly visit a doctor to assess the progress of the pregnancy.

But changes in the intensity of the baby's movements and kicks can be felt at home. All pregnant women listen to their feelings: sometimes the movements happen more often, sometimes less often. 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, since this indicates possible chronic intrauterine hypoxia.

In acute hypoxia, the baby, on the contrary, becomes overly active, his kicks gain strength, 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 cannot yet “help” in the diagnosis. The only way out is to regularly undergo preventive examinations with your gynecologist (optimally, do this weekly).

Stages

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

• Stage I compensation (does not cause the development of complications, and symptoms are not detected regularly).
• Stage II subcompensation (requires treatment, since the body is no longer able to correct the problem on its own).
• Stage III of decompensation (oxygen deficiency increases, posing a threat to the unborn 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 does not last long, so 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 several days before the onset of labor;
• Chronic intrauterine hypoxia occurs when the pregnancy process is complicated by severe toxicosis, infectious diseases, and also when there is Rh incompatibility between the woman and the fetus.

Intrauterine hypoxia can develop in the first trimester of pregnancy, in its second half, and also during labor. A prolonged oxygen-deficient state stimulates anaerobic glycolysis. In such conditions, the body is forced to slow down the oxygen supply to the intestines, skin, liver and kidneys. Centralization of blood flow causes an increase in tissue metabolic acidosis. Severe intrauterine hypoxia of the fetus quickly leads to a failure of the compensatory mechanism. This is manifested in the exhaustion of the sympathoadrenal apparatus and the adrenal cortex. Blood pressure drops, the heartbeat slows down, and collapse develops.

Intrauterine hypoxia during childbirth develops as a result of 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 ruptures of the uterus;
• acute hypoxic condition in a woman giving birth;
• circulatory disorder resulting from compression of the fetal head during labor.

Complications and consequences

Intrauterine hypoxia makes its own adjustments to the functioning of the body's organs and systems, and oxygen consumption is reduced to the minimum possible. First of all, the available oxygen is distributed to 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, complications may result in the abnormal formation of the cardiovascular system, nervous system, brain structures, and kidneys.

Hypoxia in the fetus in the second half of pregnancy can cause growth retardation in the child: often in such a situation, children are born with insufficient weight, with various mental and nervous disorders.

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

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

Intrauterine hypoxia and asphyxia of the newborn

When speaking about neonatal asphyxia, we mean a problem associated with impaired gas exchange: a lack of oxygen is supplemented by an excess of carbon dioxide and the development of metabolic acidosis caused by the accumulation of under-oxidized metabolic products.

Asphyxia is a terminal condition that is detected during the adaptation period following the baby’s exit from the mother’s womb.

Intrauterine hypoxia underlies hemodynamic disturbances in the fetus: the function of the brain stem regions is disrupted, which leads to premature respiratory activity and aspiration of amniotic fluid. With worsening acidosis, the respiratory center is suppressed, and with prolonged pathology, rapid hypoxic damage to the structures of the nervous system occurs.

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

Diagnostics intrauterine fetal hypoxia

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

• Listening (auscultatory method) helps to determine obvious disturbances in the fetal heart rate (slowing, acceleration, irregular heart rhythm).

Instrumental diagnostics in the form of electrocardiography demonstrates a changed or extended P wave, an extended PQ interval, a ventricular complex, a split R wave, a negative or flat ST segment, etc. Phonocardiography indicates a changed amplitude and increasing durations of heart sounds, with their splitting and the appearance of noise. Cardiotocography allows us to detect initial symptoms, which manifest themselves in the form of tachycardia or moderate bradycardia, a low-modulating type of curve, a weak reaction to functional tests, the appearance of late decelerations, occurring as a reaction to uterine contractions. [ 6 ]

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

• the acid-base balance in the blood is examined (tests are taken from the presenting part of the child's body);
• observe the infant's motor activity;
• evaluate the quality of respiratory movements using ultrasound examination;
• determine the quality and biochemistry of amniotic fluid.

Differential diagnosis

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

Treatment intrauterine fetal hypoxia

In order for the treatment of intrauterine hypoxia to be as effective as possible, it is necessary to directly influence the probable cause of the pathological condition - for example, to treat the underlying 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 adjust the transport of oxygen through the placenta. [ 8 ] This can be done in the following ways:

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

If intrauterine hypoxia is suspected, as well as if the problem has already been diagnosed, it is important to provide the woman with bed rest, which will serve as a preventative measure against hypertonicity and improve blood circulation in the pelvis.

Medicines

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

• Estrogen-containing drugs:
  • regulate placental-uterine blood circulation;
  • promote 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 and improve trophism.
• Vasodilators and antispasmodics (Euphyllin, Curantil, Partusisten, Isadrin, etc.):
  • help eliminate hypertonicity, dilate the blood vessels of the uterus;
  • stimulate placental metabolism and hormonal activity.
• Drugs that improve the rheological properties of blood and prevent thrombus formation, anticoagulants (Curantil, 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 in case of confirmed estrogen deficiency, in an individually selected dosage and under constant monitoring of hormonal levels. Taking estrogen-containing drugs may be accompanied by headache, nausea, rash on the body, and changes in body weight.
Curantil	Prescribed at 75 mg per day, in several doses. The duration of treatment is determined by the doctor. Possible side effects: 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 disorders, and peripheral edema.
Inosine	Prescribed at 0.6-0.8 g per day, with a possible gradual increase in dosage. The course of treatment is 1-3 months. Treatment may be accompanied by itching and redness of the skin, increased levels of uric acid.
Glucose solution 5%	It is used intravenously by 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 capsules, from 50 to 300 g per day. The course of therapy is determined by the doctor individually. Among the most common side effects are itchy skin, a feeling of fatigue, and headache.

Vitamins

In case of mild to moderate intrauterine hypoxia, the doctor may advise the woman to change her diet and include vitamin-rich foods in her diet. Particular attention should be paid to the following vitamins:

• Folic acid is a very important vitamin, especially in the first trimester of pregnancy. It is involved 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 vitamins are also responsible for the normal intrauterine development of the child, ensure adequate metabolic processes, absorption of nutritional components from food, and contribute to the development of the baby's nervous, endocrine, cardiovascular and immune systems. With a lack of vitamin B ₆, women often develop toxicosis.
• Vitamin E is an antioxidant and is involved in tissue respiration processes. Tocopherol deficiency can provoke spontaneous abortion and intrauterine hypoxia.
• Vitamin D3 _is produced under the influence of ultraviolet rays and improves the bioavailability of phosphorus and calcium.
• Beta-carotene is involved in the overall development and nutrition 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 to the bloodstream is considered to be oxygen inhalation. The essence of the procedure 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 are determined by the attending physician.

Oxygen therapy helps the body of the woman and the fetus to compensate for the lack of oxygen, reducing the risk of developing a pathological condition. Among other things, the treatment helps 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.

Folk remedies

Folk recipes are appropriate as an auxiliary method for eliminating mild and moderate intrauterine hypoxia. The following can be used as available means:

• birch sap (preferably fresh, but canned without sugar is also possible), 1 liter per day;
• hawthorn berry tea (100 ml before each meal);
• lingonberry compote (one cup daily after meals).

It is necessary to use folk remedies with caution, after consulting with a doctor, taking into account the intolerance of various products and assessing the likelihood of developing allergic reactions. If any unfavorable signs occur during treatment, you should immediately contact a doctor.

Herbal treatment

Using herbs during pregnancy is quite a risky step, because most medicinal plants have a complex effect 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, preparations of woodlice and warty birch have long been used. There are many options for preparing the potion. For example: pour dry raw woodlice (1 tbsp.) into a thermos, pour a glass of boiling water, and leave overnight. Take 50 ml before meals, up to four times a day.

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

• 1 teaspoon of dried meadow clover flowers is poured with 200 ml of boiling water, infused for 20 minutes, filtered. Take 1 tablespoon up to five times a day.
• 1 tbsp. of dried rose hips is brewed in a cup of boiling water and drunk three times a day after meals.
• 1 teaspoon of dandelion is poured with 200 ml of boiling water, infused under a lid for half an hour. Drink 1 tablespoon three times a day before meals.
• Add red rowan berries to tea and compote at least 2-3 times a day.

Homeopathy

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

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

• you should not take homeopathic and conventional medications at the same time - it is better if 1-1.5 hours pass between their doses;
• if you plan to take a hormonal drug, then it is better to take homeopathy in the other half of the day;
• You should not wash down homeopathic remedies with tea, coffee, or 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 the painful symptoms detected. As a rule, a correctly 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.

A pregnant woman’s medicine cabinet should contain the following homeopathic remedies that can eliminate intrauterine hypoxia:

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

Dosages are prescribed individually. From complex preparations, the doctor may recommend taking Nux vomica 6 or Vomicum-heel.

Surgical treatment

In case of intrauterine hypoxia that is not amenable to treatment, in case of acute hypoxic condition, the doctor may decide to perform a cesarean section. The intervention is a surgical abdominal operation, in which the child leaves the uterus through a specially made incision.

A cesarean section can be primary or secondary. Primary is when the operation is performed as planned before the onset of labor, in order to prevent possible risks during labor. Secondary cesarean section is performed during labor, in case of acute intrauterine hypoxia of the fetus.

Surgical treatment is performed only as prescribed by a doctor, if there are indications. During the operation, general (endotracheal) or regional (epidural or spinal) anesthesia may be used.

Prevention

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

• when preparing for pregnancy, you should take a course of multivitamin preparations approved by your doctor;
• It is important to leave all bad habits in the past;
• Moderate physical activity and walks in the fresh air are encouraged.

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

• visit a doctor in a timely manner to register with a women's clinic (before the twelfth week of pregnancy);
• do not miss visits to the gynecologist, get examined regularly;
• rest often and well;
• avoid conflicts and stress;
• eat a balanced and varied diet;
• take doctor-approved multivitamins;
• follow all recommendations and appointments of the gynecologist;
• avoid physical inactivity, walk a lot;
• prevent the occurrence of colds and infectious diseases.

If a woman suffers from chronic pathologies, it is necessary to constantly monitor their progress, undergo examinations and take tests. Additionally, the doctor may recommend the practice of 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, the following complications may develop:

• neuroses, instability of the child's mental state;
• physical and mental retardation, 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.