Fetal hypoxia during pregnancy remains one of the most pressing problems in obstetrics and neonatology. According to some data, its frequency in the total number of births varies between 4 and 6%, according to others - it reaches 10.5%.

The pathology associated with hypoxia, that is, with a lack of oxygen, is dangerous not only in the prenatal period, but also further leads to serious consequences in children. In 63%, the pathological changes in the body associated with it develop in the prenatal period, on average, in 21% - in the intrapartum period and in 5-6% - already during the neonatal period. How to determine fetal hypoxia and can it be avoided?

Why is pathology dangerous?

This pathological condition, which often complicates pregnancy and childbirth, is the most common cause of fetal mortality and morbidity in infancy.

Lack of oxygen in different periods of pregnancy and childbirth is characterized by the development of different pathologies and various consequences. So, for example, during the period of organ laying, it is possible to slow down the development of the embryo and the formation of developmental anomalies, during the period of tissue differentiation of organs - to a delay in further development, to developmental pathology or damage to the central nervous system (in 60-80%), to a violation of the adaptive mechanisms of the fetus and newborns, an increase in the incidence of the latter.

Severe intrauterine fetal hypoxia can also be the cause of stillbirth or death of newborns in the early postpartum period (in 23%), impairments or delays in newborns' intellectual and / and psychomotor development. In addition, they have lesions of the heart and blood vessels (78%), central nervous (98% and more) and urinary (70%) systems, severe eye diseases.

What is fetal hypoxia?

The term "fetal hypoxia" is used to denote a complex of changes in its body resulting from insufficient oxygen supply to its organs and tissues or inadequate assimilation (utilization) of oxygen by them.

This is not an independent disease or a primary nosological form, but a condition that is the result of pathological processes of a different nature in the mother-placenta-fetus system and complicates the intrauterine development of the latter.

Even in the case of an uncomplicated, physiologically proceeding pregnancy, the supply of oxygen to the fetus is significantly lower than in adults. But compensatory-adaptive mechanisms (an increase in heart rate, a large minute volume of blood, a significant oxygen capacity of the blood, etc.) at any stage of development ensure its resistance to this deficiency, leading the supply of oxygen to full compliance with the needs for it.

A disorder of compensatory mechanisms leads to a hypoxic state, which, depending on the duration, is subdivided into:

1. Chronic, developing as a result of oxygen deficiency for a long time with a complicated course of pregnancy. Chronic intrauterine fetal hypoxia is mainly associated with morphological and functional changes in the placenta, which usually occur as a result of a violation of its blood supply due to inflammatory, degenerative and other types of damage.
2. Subacute, which is characterized by a decrease in the degree of adaptive capacity of the fetus and develops 1-2 days before the onset of labor.
3. Acute, arising already during childbirth. Acute fetal hypoxia very rarely develops during pregnancy. An unfavorable factor in terms of prognosis is its often observed development against the background of already existing chronic hypoxia.

Causes and forms of hypoxia

The understanding of the numerous causes and mechanisms of development makes it possible to understand how to avoid fetal hypoxia during pregnancy. All causal factors are conventionally grouped into three groups:

• diseases and disorders in the body of a pregnant woman, leading to oxygen deficiency - pathology in the cardiovascular and pulmonary systems, compression syndrome of the inferior vena cava, poisoning or intoxication of the body, anemia, blood loss or shock of various causes, complications of the course of pregnancy or childbirth, accompanied by an excess in a woman's body, carbon dioxide or oxygen deficiency;
• disorders in the fetal-placental system, developing with, post-term pregnancy, abnormal placental location or thrombosis of the placental vessels, false cord node or thrombosis of the latter, fetal hypoxia during childbirth as a result of premature detachment of a normal placenta, abnormalities of labor, entanglement or protrusion, tension last;
• pathology in the fetus - infection, the presence of congenital malformations, hemolytic disease, anemia, prolonged compression of the head during childbirth.

Forms of hypoxia in accordance with the mechanisms of its development

Arterial hypoxemic

Which includes:

• hypoxic, resulting from a violation of oxygen supply to the uteroplacental blood flow;
• transplacental - the result of circulatory disorders in the placenta or in the fetal-placental system and disorders of the gas exchange function of the placenta.

Hemic

Associated with anemia due to blood loss or hemolytic syndrome, as well as with a decrease in the degree of oxygen affinity of fetal hemoglobin.

Ischemic

Developing due to:

• low cardiac output with cardiac and vascular abnormalities, insufficient contractility of the heart muscle or severe heart rhythm disturbances;
• increased resistance in blood vessels (mechanical compression, thrombosis of the uterine arteries, etc.), including due to a violation of the properties of blood.

Mixed

It is a combination of two or more mechanisms of oxygen deficiency.

In practice, arterial-hypoxemic and mixed forms are most often encountered.

Oxygen deficiency is the main factor in the development mechanism of metabolic disorders, organ functioning and, as a result, the development of the terminal state. A decrease in the degree of oxygen saturation of the blood leads to a violation of its respiratory function and the development of an acidic environment. Changed conditions are the reason for the violation and many parameters of the constancy and self-regulation of the internal environment of the body.

Initially, the universal compensatory response is aimed at protecting vital systems and organs and preserving their function. This occurs by stimulating the hormonal function of the adrenal glands and increasing their release of catecholamines, as a result of which the fetal heart rate during hypoxia initially increases. In addition, the centralization of blood circulation (redistribution of blood) develops due to vasospasm in certain organs that are not vital (lungs, intestines, spleen, kidneys, skin).

All this contributes to the improvement of blood circulation in the vital organs (heart, brain, adrenal glands, placenta) and, accordingly, to an increase in oxygen delivery to them by reducing its delivery to "less important" organs and tissues, which leads to the development of metabolic acidosis (acidic Wednesday) in the latter.

Significant and prolonged hypoxia causes depletion of compensatory mechanisms, inhibition of the function of the adrenal cortex, a decrease in the content of catecholamines and cortisol in the blood. This causes a deterioration in endocrine regulation by the function of vital centers, a decrease in the frequency of heart contractions and a decrease in blood pressure, a slowdown in blood flow velocity, stagnation of blood in the veins and its accumulation in the portal vein system.

Such violations are accompanied by a change in the viscosity of blood and its flowing properties, a disorder of microcirculation, a violation of gas exchange in them, a decrease in pH, an increase in the permeability of the wall of small vessels, tissue edema, etc.

Pronounced changes in macrodynamics and microdynamics, accompanied by metabolic disorders, cause tissue ischemia and even necrosis, primarily in the brain, as well as small, sometimes massive hemorrhages in it and in other organs, dysfunctions of the respiratory and cardiovascular centers of the brain and etc.

The consequences of hypoxia in a child after birth

The severity and duration of the preservation of these effects depend on the degree and duration of hypoxia. Depending on its intensity, there are:

• mild degree, or functional hypoxia - there are only hemodynamic disorders;
• deep, which is accompanied by a reversible violation of all types of metabolism;
• severe, or destructive, in which irreversible damage develops at the cellular level.

Clinical presentation and diagnosis

Clinical signs and subjective symptoms of fetal hypoxia during pregnancy are very scarce and difficult to recognize. For this, it is necessary to listen to the heartbeat by a gynecologist with a stethoscope.

As a result of auscultation of heartbeats, the assumption of the presence of a pathological condition may arise when there is a deviation from the norm (an increase or, conversely, a decrease) in the number of heart contractions. In these cases, additional (instrumental and diagnostic) studies are required.

Can a pregnant woman independently determine fetal hypoxia?

A general understanding of the mechanisms of this condition helps a woman to understand that a lack of supply or utilization of oxygen by the fetus necessarily leads to a change in the nature of his motor activity. You can recognize this with a correct assessment of your sensations during fetal movements.

How does the fetus behave during hypoxia?

At the initial stages of the pathological state, a pregnant woman notes an increase in the frequency and an increase in the intensity of movements. In the case of a long-term lack of oxygen or its progression, the degree of motor activity decreases until the complete cessation of movements.

A decrease in the number of movements to 3 or less within one hour is a clear sign of hypoxic suffering and is a direct indication for immediate additional research to decide on the choice of further tactics of pregnancy management.

Instrumental and diagnostic signs of fetal hypoxia at a later date, sometimes at an earlier date, are detected by means of such indirect techniques as echography, cardiotocography, blood flow in the vessels of the uteroplacental-fetal system, determination of the fetal biophysical profile, oxygen and carbon dioxide pressure, acid-base state and lactic acid content in a woman's blood, biochemical study of amniotic fluid, the level of certain hormones, etc.

The most accurate and informative methods in late pregnancy (in the third trimester) are cardiotocography, ultrasound scanning and Doppler.

The initial signs of oxygen starvation during cardiotocography are:

• increase in heart rate up to 170 beats per minute or decrease it to 100 beats;
• a decrease in the degree of variability of the heart rate (rhythm variability), which normally amounts to 5-25 beats per minute (indicates the normal regulation of heart function by the sympathetic and parasympathetic systems);
• short-term monotonous nature of the heart rate, making up no more than 50% of the recording made;
• reduced response to functional tests;
• cardiotocogram assessment, ranging from 5 to 7 points.

With a pronounced oxygen deficiency, the following are observed:

• significant (more than 170 beats per minute) tachycardia or bradycardia, less than 100 beats per minute;
• marked decrease in rhythm variability;
• monotony of the heart rate, making up more than 50% of the recording;
• a paradoxical response to functional tests and a late (after 10-30 seconds) response in the form of a decrease in the heart rate of the fetus in response to its movement (during a non-stress test);
• the assessment of the cardiotocogram is from 4 points and below.

In diagnostics, Doppler study of blood circulation in the vessels of the brain and the fetal aorta is of great importance. This technique at an earlier stage, in comparison with cardiotocography, reveals intrauterine hypoxia in pregnant women and allows them to recommend constant careful observation and treatment.

Hypoxia during childbirth is also manifested by disorders of the heart. The most accessible diagnostic methods during this period are auscultation and cardiotocography.

Diagnostic symptoms in the 1st stage of labor include:

1. The initial signs (regardless of presentation) are bradycardia, which is about 100 beats per minute, periodically arising monotonous heart rhythm, a response to contractions, which is expressed in a late decrease in the heart rate to 70 beats.
2. Pronounced signs are bradycardia, reaching 80 beats per minute with cephalic presentation or tachycardia (up to 200 beats) with breech presentation, persistent arrhythmia and monotony of heart rhythm, independent of presentation. In addition, responses to contractions, expressed in long-term late decreases in the frequency of the rhythm in the form of W-shaped complexes in the case of a cephalic presentation and a combination of its increase with a decrease (up to 80 beats per minute) - with a breech presentation.

In the II stage of labor:

1. Initial signs - bradycardia up to 90 beats or an increase in the frequency of contractions (tachycardia) up to 200 beats per minute, a periodically arising monotonous heart rate, after pushing - a later decrease in the heart rate to 60 beats per minute.
2. Pronounced signs - bradycardia up to 80 or tachycardia over 190 beats per minute, persistent monotonous rhythm, rhythm disturbance, late and prolonged slowdown of the rhythm (up to 50 beats) with cephalic or pelvic presentation, with cephalic presentation - W-shaped complexes.

In addition, the presence of meconium in the amniotic fluid also speaks in favor of the threatening situation (but only with cephalic presentation). It can appear as separate suspended fragments (with initial signs) or a dirty emulsion (in severe cases). However, its presence may be the result of not only acute hypoxia, but also long-term or short-term oxygen deficiency, which took place before the onset of labor. Birth is possible without asphyxiation if hypoxic episodes have not recurred.

An unfavorable sign during the first and second stages of labor, in contrast to the prenatal period, is the occurrence of pronounced regular motor and / or respiratory activity of the fetus, which leads to severe aspiration syndrome.

Treatment and prevention of fetal hypoxia

The treatment program consists of correcting the therapy of concomitant pathology (if any), normalizing blood circulation in the placenta, improving the delivery of oxygen and energy components to the fetus, measures to increase its adaptive capabilities and the course of metabolic processes, as well as increasing resistance to oxygen deficiency.

Direct treatment of fetal hypoxia is carried out using methods and drugs that contribute to:

1. Relaxation of the myometrium.
2. Expansion of the uteroplacental vessels.
3. Improving the rheological characteristics of blood.
4. Stimulation of metabolism in the myometrium and placenta.

For these purposes, bed rest is prescribed, a woman breathes with a mixture of oxygen and air for 1 hour to twice a day, taking a protein-oxygen cocktail, hyperbaric oxygenation - if a pregnant woman has cardiovascular insufficiency.

Among the drugs used are Sigetin, Efillin, Curantil, Trental, anticoagulants (Heparin), Methionine, folic acid, high doses of vitamin B 12, Cocarboxylase, Lipostabil, Halosorbin, antioxidants (vitamins E and C, glutamic acid) ...

In acute hypoxia, chronic hypoxia at 28-32 weeks in the absence of the desired result from the treatment, deterioration of the biophysical profile and cardiotocogram, the presence of oligohydramnios, the appearance of meconium in the amniotic fluid, emergency delivery is indicated regardless of the gestational age.

During the birth period, as preparation for the surgical () or obstetric (perineo- or episiotomy, the imposition of obstetric forceps, vacuum extraction, extraction by the pelvic end), breathing with humidified oxygen, intravenous administration of glucose, Euphyllin, Cocarboxylase and ascorbic acid, Sigetin are used to resolve labor.

Prevention consists in early prenatal diagnosis, treatment of concomitant diseases (cardiovascular and pulmonary pathology, diabetes mellitus, etc.), identification, thorough examination, as well as timely hospitalization and treatment of women at risk.

What is fetal hypoxia

While the baby is in the womb, his lungs are not working yet. They are filled with liquid, and although they sometimes breathe, oxygen does not flow through them.

The only source of oxygen for the baby is the placenta, and she, in turn, receives it from the mother's blood. If at any of the stages its intake is impaired, oxygen starvation of the fetus, or hypoxia, develops.

Fetal hypoxia during pregnancy

The time of the onset of hypoxia, as well as its duration, play a very important role in the baby's future. The sooner and longer, the worse. In the early stages, hypoxia can cause abnormalities in the development of organs, including the infant's brain, and lead to neurological problems in the future.

Hypoxia is also unsafe in late pregnancy. It does not allow the baby to develop correctly and in time, causes intrauterine growth retardation. Severe hypoxia in later stages can lead to the need for an early cesarean section.

Hypoxia during labor

In addition to the time of pregnancy, dangerous hypoxia can begin during childbirth, then it is called acute. Normally, all babies at birth experience a moderate lack of oxygen and are quite well adapted to temporary hypoxia.

However, in some cases, generic hypoxia can be dangerous: in premature babies, with prolonged labor, with bleeding or infection.

Severe hypoxia with almost complete cessation of oxygen supply is called fetal asphyxia. Asphyxia is almost asphyxiation. It can develop only as a result of complications: premature detachment of the placenta, repeated entanglement with the umbilical cord, infringement of the umbilical cord and some others.

Possible causes of hypoxia

From the mother's side:

• Low - less than 120g / l - blood hemoglobin (anemia);
• Bronchitis, asthma and other lung diseases;
• Smoking during pregnancy;
• Kidney disease;
• Diabetes mellitus and others.

From the side of the fetus:

• Congenital malformations;
• Intrauterine infections;
• Placental insufficiency;

During childbirth:

• Abnormal presentation of the fetus (pelvic, oblique);
• Multiple births (twins, triplets);
• Prolapse of the umbilical cord;
• other.

Signs of fetal hypoxia, how to determine fetal hypoxia?

In the early stages, it is almost impossible to reliably detect hypoxia, it can only be assumed if the mother is diagnosed with anemia or another disease.

After 18–20 weeks, when the baby begins to move with might and main in the uterus, the mother may suspect hypoxia due to a decrease in its activity. If fetal movements have become sluggish and less frequent, see a doctor for examination.

Signs of hypoxia during examination:

• On - a delay in fetal development, that is, its size and weight are less than the norm for a given period;
• On: deterioration of blood flow in the placenta, in the uterine arteries, a decrease in the fetal heart rate (bradycardia);
• On CTG (after 30 weeks): the total score is 8 or less, the fetal health indicator (FSP) is more than 1, the decrease in the basal heart rate is less than 110 at rest and less than 130 during movements, etc. CTG tends to give many false-positive results, that is, to identify hypoxia where there is none. In case of poor analysis, most often you just need to redo it the next day.

In difficult cases, other diagnostic methods are also used, such as amnioscopy and taking blood from the skin of the fetal head (only in childbirth).

During childbirth, the presence of hypoxia can be judged by the color of the amniotic fluid. If the waters are cloudy, greenish in color, and even worse - with an admixture of meconium, then the baby is already experiencing a lack of oxygen. Transparent amniotic fluid is a sign of good blood supply and the condition of the baby.

How to deal with hypoxia

Throughout pregnancy, it is very important for all expectant mothers to walk in the fresh air as much as possible. This simple rule will help you prevent many complications of pregnancy, including fetal hypoxia.

A sufficient supply of oxygen with inhaled air ensures a good metabolism in the placenta and reduces the likelihood of hypoxia. But in addition to prophylaxis, walking can and should be used to treat mild hypoxia. No oxygen cocktails can replace 3-4 hours spent in the fresh air.

If there is no threat of miscarriage or increased uterine tone, it is useful to do aqua gymnastics and swimming.

In more serious cases, according to the decision of the doctor, hospitalization in the hospital and treatment with drugs is necessary. To do this, apply:

• Curantil
• Actovegin
• Trental
• Oxygen cocktail

and other means, depending on concomitant diseases. For example, with an increased tone of the uterus, magnesia is prescribed, no-shpu, ginipral, etc.

Severe hypoxia at the end of pregnancy can sometimes require a caesarean section. Children born with acute hypoxia or asphyxia often require resuscitation and longer care.

Intrauterine fetal hypoxia is a deficiency of oxygen required by the embryo for the proper formation and development of organs and tissues. This pathology can lead to serious consequences for the health and life of both the baby and the mother, and therefore it is important to diagnose and begin treatment in a timely manner.

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Types of intrauterine hypoxia

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

First group:

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

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

1. Threatening - symptoms of oxygen deficiency are not observed, but conditions develop that are provoking factors (prolonged pregnancy, aging of the placenta ahead of time, etc.). Prevention of hypoxia is necessary.
2. Beginning - the clinical picture of oxygen starvation is clearly expressed, which requires an immediate start of treatment.

Chronic hypoxia

Intrauterine hypoxia in the embryo most often develops in the second and third trimester, when the fetal oxygen demand sharply increases. Under the influence of a damaging factor, adaptive mechanisms are triggered for a certain time. They protect the organs and tissues of the fetus without stopping the normal development process. With prolonged hypoxia, the protective ability decreases and the disease begins to progress.

There are the following degrees of chronic lack of oxygen in the fetus:

1. Compensated. Develops at the beginning of oxygen deficiency. During this period, the work of the adrenal cortex increases, affecting the amount of hormones. Thus, the heart rate, vascular tone, blood volume, as well as erythrocytes and hemoglobin increase. All these changes contribute to faster movement and oxygenation of cells. At this stage, more intense fetal movements are the main symptom. In the first stage, the uterus and placenta are able to cope with the negative effects of oxygen deficiency and ensure the normal development of the embryo. With the timely restoration of the mother's condition, pregnancy proceeds as usual.
2. Partially compensated. The protective functions of the fetus rebuild the body's work to provide oxygen to vital organs (heart, brain and spinal cord). As a result, the remaining tissues are exposed to insufficient blood supply, ischemia occurs. For example, such a process in the intestine leads to the opening of the anus and the release of meconium into the amniotic fluid. At this stage, the protective capabilities of the uterus and placenta are practically exhausted. Urgent treatment is needed, since the risk of disruption in the formation of many organs of the embryo is significantly high.
3. Decompensated. There is a breakdown in the body. The adrenal cortex can no longer produce cortisol, even in minimal amounts. The heart rate decreases, the fetus becomes inactive, the movements practically disappear. Continued oxygen starvation leads to minor hemorrhages in the brain and other organs, blood clots may form. Due to the accumulation of carbon dioxide in the blood, the baby tries to breathe through the glottis, which leads to the ingress of mucus, water and meconium into the lungs. This is a direct path to asphyxiation during childbirth when attempting the first breath.

Fetal hypoxia scheme

The reasons

The mechanisms of development and the factors that lead to oxygen deficiency can be quite diverse and are grouped into several categories.

Diseases and conditions of the mother

The first group of factors relates to the diseases and lifestyle of a pregnant woman:

• decreased hemoglobin;
• systemic diseases (for example, diabetes mellitus);
• severe blood loss;
• diseases of the heart, kidneys, lungs and bronchi, infectious lesions;
• smoking, staying in rooms with polluted air;
• toxic damage to the body;
• low birth weight, narrow pelvis;
• sedentary lifestyle.

Violation of uteroplacental blood flow

• post-term pregnancy;
• high risk of quick birth;
• various complications and pathologies during pregnancy (gestosis and others);
• structural and functional disorders of the placenta and umbilical cord;
• placenta previa or improper attachment in the uterus;
• kinking or prolapse of the umbilical cord;
• complications during childbirth.

Features of the course and complications of this pregnancy

Intrauterine fetal hypoxia can cause the following problems during pregnancy:

1. The threat of interruption. It arises both as a result of stress and severe overwork of a woman, and in connection with various diseases of the mother and disorders in the development of blood flow between the uterus and the placenta.
2. Increased tone of the uterus. Prolonged and frequent muscle contractions occur long before the baby is born. As a result, the flow of arterial blood to the embryo is disrupted.
3. Multiple pregnancy. It is more difficult for the uterus and placenta to provide oxygen to multiple embryos.

Diseases and conditions of the fetus

Reasons for hypoxia:

• infections;
• malformations of organs and systems;
• intracranial hematoma;
• incompatibility of the blood of the embryo and the mother;
• breech presentation.

Signs of hypoxia

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

At a later date, the mother needs to carefully monitor the baby's movements. Some doctors believe that hiccups and increased movements may also indicate hypoxia. But the cause of such symptoms may be the wrong position of the fetus in the uterus or stress on the mother. If these signs quickly pass, then there is no reason to worry.

A decrease in the number of waves of movements during the day is the main alarming indicator, when it appears, you should immediately consult a doctor for a more thorough diagnosis.

Diagnostics

It is possible to detect the onset of hypoxia during a routine examination of a pregnant woman - poor tests (low hemoglobin is the first symptom of oxygen deficiency in the mother's blood) or a woman's complaints about a decrease in fetal activity. After that, a more thorough examination takes place in order to recognize the presence of oxygen starvation in the embryo.

The first step is to interview the expectant mother:

• woman's age;
• medical history;
• current condition, presence of non-standard symptoms;
• previous pregnancies - course and outcome;
• bad habits, lifestyle;
• working conditions.

Cardiotocography

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

The principle of operation of the CTG apparatus

Research results for a healthy fetus:

• heart contractions from 120 to 160 beats per minute;
• the heartbeat increases with the activity of the embryo or the sudden movement of the pregnant woman;
• there is no slowing down of heart contractions.

With fetal hypoxia, the results of cardiotocography will have the following features:

• strongly slowed down or, conversely, accelerated heartbeat;
• decreased motor activity of the embryo;
• there is a frequent decrease in the heart rate.

Doppler

One of the types of ultrasound diagnostics, in which the vessels and the state of blood flow in the uterus, placenta and umbilical cord are assessed. The result of the study is a Doppler study based on the analysis of the frequency difference between the sent and reflected signals from the moving red blood cells. Diagnostics by this method is most informative at the period of 21-22 weeks of pregnancy.

Doppler

Amnioscopy

This method is used exclusively from the 37th week of pregnancy, as there is a high risk of premature birth. The woman sits in a gynecological chair, the external and internal genitals are treated with an antiseptic. An amnioscope is inserted through the cervix into the uterus, with its help the doctor examines the state of the amniotic fluid, the presence of impurities in them.

Counting fetal movements

It is rather a method of primary diagnostics, on the basis of which a pregnant woman applies for a more thorough examination of the body. It is used from 25 weeks. The woman lies down on one side and counts the baby's movements. Normally, there should be at least 10 movements within an hour.

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

Ultrasound examination (ultrasound)

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

Ultrasound during pregnancy

Treatment methods

The causes and consequences of hypoxia are quite diverse. In this regard, the treatment is selected purely individually, depending on the degree of pathology, concomitant conditions, gestational age and other factors.

Treatment of fetal hypoxia without medication

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

1. Reducing physical exertion, emotional stress, dosed bed rest. These measures lead to a decrease in vascular tone, which stabilizes blood flow to the fetus.
2. Good nutrition.
3. Oxygen therapy. Inhalation of 50% air mixture a couple of times a day. Sometimes oxygen cocktails of 200 ml can be used 10 minutes before meals or 2 hours after.
4. Hyperbaric oxygenation. The pregnant woman is placed in a special pressure chamber, in which she breathes a gas mixture under a pressure above atmospheric. Thus, the level of oxygen access to tissues and organs is improved.

Pressure chamber for pregnant women

Drug treatment

Medicines for hypoxia are divided into several groups depending on the condition of the pregnant woman and the characteristics of the pathology:

1. Treatment of the underlying disease of the mother or fetus (diabetes mellitus and others).
2. Normalization of blood circulation between mother and embryo (Actovegin, vitamins E and C, amino acids).
3. Preparations for relaxing the muscles of the uterus - Ginipral, Magnesium B6, No-shpa, Papaverine.
4. To improve blood clotting - Trental, Curantil.

Magne B6 (515 rubles) Actovegin (1048 rubles) Ginipral (245 rubles) Curantil (509 rubles) No-shpa (50 rubles) Vitamin E (123 rubles)

Fetal hypoxia: hospital treatment

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

Hospital treatment occurs in the following cases:

1. If there is a need to administer drugs intramuscularly.
2. Intoxication of a pregnant woman as a result of infections, poisoning. It is important to constantly monitor the condition of the woman and the fetus, as well as replenish the loss of fluid in the body by introducing intravenous solutions (glucose, sodium bicarbonate, and others).
3. Placental abruption. In a hospital, the condition of the mother, placenta and fetus is monitored. If the treatment does not help, then in case of detachment in a significant area and severe bleeding, a cesarean or cleaning is performed, depending on the duration of pregnancy.
4. Infectious diseases of viral or bacterial origin. In this case, antibiotics (Cefazolin, Acyclovir) may be prescribed.

Acyclovir (343 rubles) Cefazolin (24 rubles)

Possible consequences

Intrauterine fetal hypoxia, even to a mild degree, can further lead to unpleasant consequences for the child and mother. First of all, the fetus suffers, since oxygen deficiency negatively affects the development of its organs and systems. Severe degrees of oxygen starvation lead to premature birth and fetal death. In this case, the woman in labor often has bleeding, and in the later stages - difficult childbirth. In the most difficult situations, a woman may have further problems with re-conception.

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

Chronic

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

• small stature and underweight;
• low hemoglobin;
• weak immunity (predisposition to viral infections);
• hyperactivity at an older age;
• poor thermoregulation after childbirth.

Sharp

With this form of hypoxia, the following consequences can be observed:

• intestinal necrosis;
• high risk of sudden infant death syndrome;
• pneumonia;
• serious damage to the central nervous system;
• development of cerebral palsy.

How to avoid fetal hypoxia?

It is easier to learn how to prevent the risk of developing oxygen starvation of the fetus than to deal with the consequences in the future. There are various preventive measures both before the onset of pregnancy (during the planning and preparation period) and during its course. With a responsible attitude of a woman to this issue, the risk of hypoxia is significantly reduced.

Prevention before pregnancy

The main aspects of preparing a woman for pregnancy is giving up bad habits (smoking, drugs, alcohol) and examining the body for diseases. Treating existing ailments before fertilization will help minimize their impact on fetal development.

During pregnancy

To avoid hypoxia, the expectant mother must adhere to the following rules:

• register for up to 12 weeks and strictly follow the schedule of required studies;
• visit a doctor in the absence of pathologies once a month and a half in the first trimester and once every 4 weeks in the second and third;
• observe the daily routine (sleep at least 8 hours);
• good nutrition;
• taking vitamin complexes for pregnant women, folic acid is especially important (favorably affects the absorption of iron) and magnesium (is responsible for the formation of blood vessels);
• walks in the open air;
• healthy lifestyle.

Hypoxia- This is a pathological condition in which an oxygen deficiency is formed in the body due to its reduced supply from outside and / or due to dysfunction of utilization in cells.

Hypoxia

"Hypoxia" - hypo and oxigenium (lack of oxygen), translated from the ancient Greek language. Most people understand hypoxia as oxygen starvation (lack of oxygen)since in this case, tissues and organs are dysfunctional from oxygen deficiency.

General characteristics of hypoxia

Determination of hypoxia

Hypoxia- a typical and dangerous pathological process that occurs in the body with a wide range of diseases and acute conditions, and provokes them. For example, hypoxia can be caused by various factors, as well as accompany a wide range of diseases, and can even be the main link in the appearance of pathological changes or diseases.

Based on this, hypoxia- a typical general pathological process, does not apply to either the diagnosis or the syndrome.

The effect of hypoxia at the cellular level is divided into two types - adaptive reactions and decompensation.

During the onset of hypoxia, the body triggers adaptive defense reactions that support, for a short time, almost normal vital functions of organs and tissues. With prolonged exposure to hypoxia, the body's reserves run out and adaptive protective reactions are turned off - decompensation occurs.

Decompensation is characterized by the occurrence of irreversible disorders in organs and tissues - from organ failure to death.

Development of hypoxia

Compensatory reactions during hypoxia are expressed by oxygen deficiency at the cellular level, and their task is to restore the amount of oxygen in the tissues. To eliminate the effect of hypoxia, the organs of the cardiovascular and respiratory systems are included in the complex of compensatory reactions, and a change in biochemical processes in tissues and organ structures, most severely suffering from oxygen deficiency, is triggered. Until the supply of compensatory reactions is completely exhausted, organs and tissues will not suffer from a lack of oxygen. However, if oxygen supply is not normalized during the depletion of compensatory mechanisms, then irreversible decompensation will begin in the tissues with damage to both cells and dysfunction of the entire organ.

In acute and chronic hypoxia, the nature of compensatory reactions is different. So, in acute hypoxia, compensatory reactions consist in increased breathing and blood circulation, that is, blood pressure rises, tachycardia occurs (heart rate is more than 70 beats per minute), breathing becomes deep and frequent, the heart pumps more blood volume per minute than normal ... In addition, in response to acute hypoxia from the bone marrow and spleen, all the "reserves" of erythrocytes, which are necessary to transport oxygen to the cells, enter the systemic circulation.

hypoxia

All these reactions are aimed at normalizing the amount of oxygen delivered to cells by increasing the volume of blood passing through the vessels per unit of time and increasing the amount of oxygen carried. With very severe acute hypoxia, in addition to the development of these reactions, there is also a centralization of blood circulation, which consists in redirecting all available blood to vital organs (heart and brain) and a sharp decrease in the blood supply to the muscles and organs of the abdominal cavity. The body directs all oxygen to the brain and heart - organs that are critical for survival, and, as it were, “deprives” of those structures that are currently not needed for survival (liver, stomach, muscles, etc.).

If acute hypoxia is eliminated without depleting the body's reserves, then the person will survive, and all his organs and systems after a while will work completely normally. If hypoxia continues longer than the period of effectiveness of compensatory reactions, then irreversible changes will occur in organs and tissues.

Compensatory reactions in chronic hypoxia develop against the background of severe, long-term diseases or conditions. First, to compensate for the oxygen deficiency, the number of erythrocytes in the blood increases, which makes it possible to increase the volume of oxygen carried by the same volume of blood per unit of time. Also, in erythrocytes, the activity of the enzyme increases, which facilitates the transfer of oxygen from hemoglobin directly to the cells of organs and tissues. New alveoli are formed in the lungs, breathing deepens, the volume of the chest increases, additional vessels are formed in the lung tissue, which improves the flow of oxygen into the blood from the surrounding atmosphere. The heart, which has to pump a greater volume of blood per minute, hypertrophies and grows in size. Changes also occur in tissues - the number of mitochondria (organelles that use oxygen to provide cellular respiration) increases in cells, and many new capillaries are formed in tissues. It is because of the activation of microcirculation and a large number of capillaries during hypoxia that a person develops a pinkish color of the skin, which is mistaken for a "healthy" blush.

Adaptive reactions in acute hypoxia are reflexive, and therefore, when oxygen starvation is eliminated, they cease to act, and the organs completely return to the mode of functioning in which they existed before the development of an episode of hypoxia. In chronic hypoxia, the adaptive reactions are not reflex, they develop due to the restructuring of the mode of functioning of organs and systems, and therefore their action cannot be quickly stopped after the elimination of oxygen starvation.

In chronic hypoxia, the body can change its mode of functioning in such a way that it will fully adapt to the conditions of oxygen deficiency and will not suffer from it at all. For example, this is how the organism of the inhabitants of megalopolises adapts.

In acute hypoxia, complete adaptation to oxygen deficiency cannot occur, since the body simply does not have time to restructure the modes of functioning, and all its compensatory reactions are designed only to temporarily maintain the functioning of organs until adequate oxygen delivery is restored.

That is why a person can have a state of chronic hypoxia for many years without interfering with his normal life and work, and acute hypoxia in a short period of time can lead to death or irreversible damage to the brain or heart.

Compensatory reactions during hypoxia always lead to a change in the mode of functioning of the most important organs and systems. These manifestations of compensatory reactions can be conditionally considered symptoms of hypoxia.

Types of hypoxia

Hypoxia, depending on the development mechanism, is divided into:

• Exogenous hypoxia (hypoxic hypoxia) - caused by environmental factors.
• Endogenous hypoxia - caused by various diseases or disorders that a person has:
• Respiratory (respiratory, pulmonary) hypoxia.
• Circulatory (cardiovascular) hypoxia: Ischemic; Stagnant.
• Hemic (blood) hypoxia: Anemic; Caused by inactivation of hemoglobin.
• Tissue (histotoxic) hypoxia. Substrate hypoxia.
• Overload hypoxia. Mixed hypoxia.

Depending on the rate of development and course:

• Lightning fast (instant) - develops within a few seconds (no longer than 2 - 3 minutes);
• Acute - develops within a few tens of minutes or hours (no longer than 2 hours);
• Subacute - develops within a few hours (no longer than 3-5 hours);
• Chronic - develops and lasts for weeks, months or years.

Depending on the prevalence of oxygen deprivation, hypoxia is subdivided into general and local.

Exogenous hypoxia

Exogenous hypoxia (hypoxic) is caused by a decrease in the amount of oxygen in the inhaled air. Accordingly, blood leaves the lungs, insufficiently saturated with oxygen and a small amount of gas is brought to the cells of various organs / tissues. Exogenous hypoxia is manifested by cyanosis (cyanosis of the skin and mucous membranes), dizziness and fainting.

exogenous hypoxia normobaric

Depending on the atmospheric pressure, exogenous hypoxia is subdivided into hypobaric and normobaric.

Hypobaric hypoxiadue to the low oxygen content in rarefied air with low atmospheric pressure. Such hypoxia develops in mountainous areas and at high altitudes.

Normobaric hypoxiadevelops at a low oxygen content in air with normal atmospheric pressure. Normobaric exogenous hypoxia can develop when you are in mines, wells, on submarines, in diving suits, in tight spaces with a lot of crowded people, with general air pollution or smog in cities, as well as during an operation with a malfunctioning anesthetic and respiratory equipment.

Respiratory (respiratory, pulmonary) hypoxia

respiratory hypoxia

Respiratory (respiratory, pulmonary) hypoxia develops in diseases of the respiratory system (bronchitis, pulmonary hypertension, any pathology of the lungs, etc.), when the penetration of oxygen from the air into the blood is difficult. Against the background of respiratory hypoxia, complications such as respiratory failure, cerebral edema and gas acidosis can develop.

Circulatory (cardiovascular) hypoxia

Circulatory (cardiovascular) hypoxia develops against the background of various circulatory disorders (for example, a decrease in vascular tone, a decrease in total blood volume after blood loss or dehydration, an increase in blood viscosity, increased coagulation, centralization of blood circulation, venous stasis, etc.). If a circulatory disorder affects the entire network of blood vessels, then hypoxia systemic... If blood circulation is disturbed only in the area of \u200b\u200ban organ or tissue, then hypoxia is local.

With circulatory hypoxia, a normal amount of oxygen enters the blood through the lungs, but due to circulatory disorders, it is delivered to organs and tissues with a delay, as a result of which oxygen starvation occurs in the latter.

According to the mechanism of development, circulatory hypoxia is ischemic and stagnant. Ischemic formhypoxia develops with a decrease in the volume of blood passing through organs or tissues per unit of time. This form of hypoxia can occur with left ventricular heart failure, heart attack, cardiosclerosis, shock, collapse, vasoconstriction of some organs and other situations.

Stagnant formhypoxia develops with a decrease in the speed of blood flow through the veins - with thrombophlebitis of the legs, right ventricular heart failure, increased intrathoracic pressure and other situations when blood stagnation occurs in the venous bed. With a stagnant form of hypoxia, venous blood does not return to the lungs in time to remove carbon dioxide and oxygenate. As a result, there is a delay in the delivery of the next portion of oxygen to organs and tissues.

Hemic (blood) hypoxia

Hemic (blood) hypoxia develops with a violation of quality characteristics or a decrease in the amount of hemoglobin in the blood. Hemic hypoxia is divided into two forms - anemicand due to changes in the quality of hemoglobin.

Anemic hemic hypoxia due to a decrease in the amount of hemoglobin in the blood, that is, anemia of any origin or hydremia (dilution of blood due to fluid retention in the body). With anemic hypoxiaoxygen is normally bound and carried by blood to organs and tissues. But due to the fact that there is too little hemoglobin, an insufficient amount of oxygen is brought to the tissues and hypoxia occurs in them.

Hypoxia, caused by a change in the quality of hemoglobin, is associated with poisoning with various toxic substances that lead to the formation of forms of hemoglobin that are unable to carry oxygen (methemoglobin or carboxyhemoglobin). When the qualities of hemoglobin changeits amount remains normal, but it loses its ability to carry oxygen. As a result, when passing through the lungs, hemoglobin is not saturated with oxygen and the blood flow does not deliver it to the cells of all organs and tissues. A change in the qualities of hemoglobin occurs when a number of chemicals are poisoned, such as carbon monoxide (carbon monoxide), sulfur, nitrites, nitrates, etc.

Tissue (histotoxic) hypoxia

Tissue (histotoxic) hypoxia develops against the background of a violation of the ability of organ cells to absorb oxygen. The cause of tissue hypoxia is a reduced activity or deficiency of enzymes of the mitochondrial respiratory chain, which convert oxygen into the forms in which it is used by cells for all vital processes.

Disruption of the work of enzymes of the respiratory chain can occur in the following cases:

• Suppression of the activity of enzymes of the respiratory chain in case of poisoning with cyanides, ether, urethane, barbiturates and alcohol;
• Lack of the amount of enzymes of the respiratory chain against the background of a deficiency of vitamins B1, B2, PP and B5;
• Disruption of the work of enzymes of the respiratory chain in case of poisoning with nitrates, microbial toxins, exposure to a large amount of thyroid hormones, etc.;
• Damage to the structure of enzymes under the action of radioactive radiation, with uremia, cachexia, severe infectious diseases, etc.

Tissue hypoxia can exist for a long period of time.

Substrate hypoxia

substrate hypoxia

Substrate hypoxia develops with normal oxygen delivery to tissues, but in conditions of a lack of basic nutrients, which are subjected to oxygen oxidation. Substrate hypoxia can develop during starvation, diabetes mellitus and other conditions when there is not enough glucose and fatty acids in the cells.

Overload hypoxia

overload hypoxia

Overload hypoxia can develop during hard physical work, when cells intensively consume oxygen. In such cases, the cells simply do not have enough oxygen delivered. Such physiological hypoxia is not dangerous and passes after the completion of the stage of high physical activity.

Mixed hypoxia

Mixed hypoxia is a combination of several types of endogenous hypoxia and occurs in severe, life-threatening lesions of various organs and systems, such as, for example, shock, poisoning, coma, etc.

Acute hypoxia

Acute hypoxia develops quickly, within several tens of minutes and lasts a limited period of time, ending either with the elimination of oxygen starvation, or with irreversible changes in organs that will lead to serious illness or even death. Acute hypoxia usually accompanies acute conditions in which the blood flow, the amount and quality of hemoglobin change sharply, such as, for example, blood loss, cyanide poisoning, heart attack, etc.

acute hypoxia

Any option acute hypoxia it is necessary to eliminate it as soon as possible, since the body will be able to maintain the normal functioning of organs and tissues for a limited period of time until the compensatory-adaptive reactions are exhausted. And when the compensatory-adaptive reactions are completely exhausted, under the influence of hypoxia, the most important organs and tissues (primarily the brain and heart) will begin to die off.

In principle, acute hypoxia is more dangerous than chronic hypoxia, since it can quickly lead to disability, organ failure, or death. And chronic hypoxia can exist for years, giving the body the opportunity to adapt, to live and function quite normally.

Chronic hypoxia

chronic hypoxia

Chronic hypoxia develops over several days, weeks, months or even years, and occurs with long-term current diseases. The body adapts to chronic hypoxia by changing the structure of cells under new conditions, which allows the organs to function quite normally. In principle, chronic hypoxia is safer than acute, because develops slowly and the body is able to adapt to new conditions with the help of compensation mechanisms.

Myocardial hypoxia

myocardial hypoxia

Myocardial hypoxia is one of the most dangerous diseases and is characterized by insufficient oxygen supply to the heart muscle.

This condition occurs when there is a sudden decrease in oxygen supply to the heart muscle. The cells do not have time to adapt to the changed conditions. Metabolism continues in them, but it becomes incomplete, and under-oxidized metabolites accumulate. When hypoxia persists, the tissues of the heart muscle die.

Clinically, this condition is manifested by attacks of chest pain, an increase in their duration and intensity. In the future, myocardial infarction develops - necrosis of the heart muscle with the loss of its contractile function.

Myocardial hypoxia can be caused by the following reasons:

• low oxygen content in atmospheric air;
• lung diseases with impaired gas exchange in them;
• a decrease in the amount of blood flowing through the myocardium, due to the pathology of the coronary arteries;
• deterioration of the blood's ability to carry oxygen, for example, with carbon monoxide poisoning;
• violation of oxygen utilization by the cells themselves, for example, in case of poisoning with cyanides, heavy metals.

Fetal hypoxia

Fetal hypoxia - a dangerous pathological process characterized by a reduced supply of oxygen to the fetus.

Hypoxia occurs due to atypical processes in the female body. The time of formation, course and intensity of manifestation of symptoms directly affect the development and general health of the child. Treatment of hypoxia must be carried out as early as possible so that the disease does not cause irreparable consequences.

Hypoxia can be diagnosed at any stage of pregnancy. The sooner intrauterine fetal hypoxia occurs, the more seriously it will affect the development of the child (both mental and physical). It can also damage the central nervous system, but this is in the case of untimely or incorrect treatment. Medical statistics show that oxygen deficiency is observed in 10-15% of all pregnancies. Treatment in this case is primarily aimed at normalizing the flow of blood to the uterus and placenta, but in case of acute fetal hypoxia, it is recommended to induce labor artificially, and not to use any methods of treatment.

Intrauterine fetal hypoxia

The causes of intrauterine fetal hypoxia are various pathologies occurring in the maternal body, as well as unfavorable environmental factors. Hypoxia can occur due to diseases:

• hypertension
• diabetes
• heart disease
• preeclampsia and eclampsia
• chronic bronchitis or bronchial asthma
• various kidney diseases

Intrauterine causes of hypoxia:

• damage to the integrity of the uterus
• prolonged squeezing of the head, neck of the child during childbirth
• complication of the baby's passage through the birth canal, most often due to large volumes or improper posture of the baby
• an increase in the volume of amniotic fluid
• pregnancy with two, three or more fetuses
• intrauterine infection of a child
• blockage by the placenta of the birth canal from the uterus
• wrapping the umbilical cord around the baby's neck
• impaired blood flow in the placenta

In addition, significant causes of intrauterine fetal hypoxia can be external factors:

• poor ecology and high air pollution in the place where the expectant mother lives
• taking a large number of medications
• chemical poisoning
• abuse by a woman during pregnancy of alcoholic beverages, nicotine or drugs

Fetal hypoxia

By flow rate hypoxia is divided into:

• short-term, i.e. occurs quickly and unexpectedly
• moderate - expressed directly during childbirth
• acute - signs of the disease are observed several days before the upcoming birth
• chronic fetal hypoxia - it appears with severe toxicosis, incompatibility of blood groups or Rh factors of the mother and child, intrauterine infections of the fetus.

By the time of occurrence hypoxia is divided:

• formed in the first months of pregnancy
• in the second half of the allotted time
• during childbirth
• after childbirth occurs very rarely.

Symptoms of fetal hypoxia

It is quite difficult to determine hypoxia, since it can appear suddenly. But it is very important to diagnose hypoxia in the early stages, because this will allow you to quickly start treatment and avoid the consequences.

The main symptom of fetal hypoxia is slow heartbeat, but this cannot be noticed at home. The first sign for consulting a doctor is change in the intensity of fetal tremors... Every woman feels a stirring, but if the child makes itself felt less than three times a day, you should immediately contact a specialist, because this indicates chronic intrauterine fetal hypoxia.

The acute form, which occurs suddenly, is characterized by completely opposite signs - the child is too active, pushes hard.

Signs of fetal hypoxia in the first three months of pregnancy are very difficult to determine, so it will be better for a woman and a fetus to have a doctor's examinations on a weekly basis.

Consequences of fetal hypoxia

If symptoms are ignored or if you see a doctor late, hypoxia seriously threatens the health and development of the fetus.

Complications chronic fetal hypoxia can be:

• disorders of development and formation of internal organs, bones and brain of the fetus
• intracellular edema
• internal hemorrhage
• delayed fetal development

For a newborn baby effects no less serious:

• changes in the structure and structure of some internal organs; hemorrhage
• inability to independently perform functions characteristic of the first days after birth
• neurological diseases
• mental retardation
• psychical deviations
• Cerebral palsy and autism

Acute and chronic fetal hypoxia can lead to the death of the fetus in the womb or the death of the child during the first week of life.

How to determine fetal hypoxia

Determining fetal hypoxia starting from the fifth month of pregnancy will not be difficult. It is much more difficult to do this in the first 3 months, but the earlier the diagnosis is made, the higher the likelihood of avoiding the consequences of the disease.

Diagnosis of fetal hypoxia consists of:

• using special gynecological diagnostic techniques, the transparency, color and amount of amniotic fluid are assessed
• dopplerometry, which allows you to track the speed of blood flow in the umbilical cord and placenta
• listening through a stethoscope of heart rate
• monitoring the intensity of fetal movements

Treatment of fetal hypoxia

At the first manifestations of symptoms of fetal hypoxia, a pregnant woman is immediately hospitalized. The first thing that the treatment is aimed at is stabilization of the oxygen supply to the fetus and a decrease in the tone of the uterus. For this, the patient is prescribed strict bed rest and taking medications that will improve oxygen permeability and metabolism. Often also prescribed and (), which allows you to increase blood oxygenation not only in the mother's body, but also in the fetus.

When the first improvements in the condition of the fetus are observed, a woman can perform gymnastics, various breathing exercises, and attend aqua gymnastics. If no measures to normalize the supply of oxygen to the fetus have given the desired effect or the symptoms of fetal hypoxia persist for more than twenty-eight weeks of pregnancy, it is best to immediately perform a cesarean section. In case of acute hypoxia for a newborn child, the help of a resuscitator is needed.

Prevention of fetal hypoxia

Prevention of fetal hypoxia should be performed by a woman who decided to become a mother, namely:

• choose the right way to give birth to a child. With a caesarean section, there is less chance of fetal hypoxia than with natural childbirth
• timely treatment of diseases that accompany pregnancy
• avoid strong physical exertion, only breathing exercises
• get enough rest
• rationalize nutrition by consuming large amounts of vitamins and calcium
• lead a healthy lifestyle, give up alcohol, nicotine and drugs
• be regularly observed in the antenatal clinic
• register with an obstetrician-gynecologist on time
• planning a pregnancy and carefully preparing for it, by examining doctors, treating chronic, infectious or gynecological diseases

There are many studies related to the treatment of fetal hypoxia. One of them - .

Consequences of hypoxia

The consequences of hypoxia can be different, and depend on during what period of time oxygen starvation was eliminated and how long it lasted. If hypoxia was eliminated during a period when the compensatory mechanisms were not depleted, then there will be no negative consequences, after a while the organs and tissues will completely return to their normal mode of operation. But if hypoxia was eliminated during the period of decompensation, when the compensatory mechanisms were depleted, then the consequences depend on the duration of oxygen starvation. The longer the period of hypoxia turned out to be against the background of decompensation of adaptive mechanisms, the stronger and deeper the damage to various organs and systems. Moreover, the longer hypoxia lasts, the more organs are damaged.

During hypoxia, the brain suffers the most, since it can withstand 3-4 minutes without oxygen, and from 5 minutes necrosis will begin to form in the tissues. The heart muscle, kidneys and liver are able to withstand a period of complete absence of oxygen for 30-40 minutes.

The consequences of hypoxia are always due to the fact that in the absence of oxygen, the process of anoxic oxidation of fats and glucose begins in cells, which leads to the formation of lactic acid and other toxic metabolic products that accumulate and ultimately damage the cell membrane, leading to its death. When hypoxia lasts long enough from poisonous products of improper metabolism, a large number of cells die in various organs, forming whole areas of dead tissue. Such areas sharply worsen the functioning of the organ, which is manifested by the corresponding symptoms, and in the future, even with the restoration of the flow of oxygen, will lead to a persistent deterioration in the work of the affected tissues.

The main consequences of hypoxia are always caused by a malfunction of the central nervous system, since it is the brain that suffers primarily from oxygen deficiency. Therefore, the consequences of hypoxia are often expressed in the development of a neuropsychiatric syndrome, which includes parkinsonism, psychosis and dementia. In 50-70% of cases, neuropsychiatric syndrome can be cured. In addition, the consequence of hypoxia is exercise intolerance, when, with minimal stress, a person has palpitations, shortness of breath, weakness, headache, dizziness and pain in the heart. Also, the consequences of hypoxia can be hemorrhages in various organs and fatty degeneration of muscle cells, myocardium and liver, which will lead to disruptions in their functioning with clinical symptoms of insufficiency of one organ or another, which cannot be eliminated in the future.

Hypoxia - causes

The causes of exogenous hypoxia can be the following factors:

• Dense atmosphere at altitude (altitude sickness, altitude sickness, pilot illness);
• Being in close quarters with a large crowd of people;
• Being in mines, wells or in any enclosed spaces (for example, submarines, etc.) with no communication with the external environment;
• Poor ventilation of premises;
• Working in diving suits or breathing through a gas mask;
• Strong air pollution or smog in the city of residence;
• Malfunctioning anesthesia and respiratory equipment.

The following factors can be the reasons for various types of endogenous hypoxia:

• Diseases of the respiratory system (pneumonia, pneumothorax, hydrothorax, hemothorax, destruction of the alveolar surfactant, pulmonary edema, pulmonary embolism, tracheitis, bronchitis, emphysema, sarcoidosis, asbestosis, bronchospasm, etc.);
• Foreign bodies in the bronchi (for example, accidental ingestion of various objects by children, depression, etc.);
• Asphyxia of any origin (for example, when the neck is compressed, etc.);
• Congenital and acquired heart defects (non-closure of the foramen ovale or Batalov's duct of the heart, rheumatism, etc.);
• Damage to the respiratory center of the central nervous system during injuries, tumors and other brain diseases, as well as when it is suppressed by toxic substances;
• Violation of the mechanics of the act of breathing due to fractures and displacements of the bones of the chest, damage to the diaphragm or muscle spasms;
• Disorders of the heart, provoked by various diseases and pathologies of the heart (heart attack, cardiosclerosis, heart failure, electrolyte imbalance, cardiac tamponade, pericardial obliteration, blockade of electrical impulses in the heart, etc.);
• A sharp narrowing of blood vessels in various organs;
• Arteriovenous shunting (transfer of arterial blood to veins through vascular shunts before it reaches organs and tissues and gives oxygen to cells);
• Stagnation of blood in the inferior or superior vena cava system;
• Thrombosis;
• Poisoning with chemicals that cause the formation of inactive hemoglobin (for example, cyanide, carbon monoxide, lewisite, etc.);
• Anemia;
• Acute blood loss;
• Disseminated intravascular coagulation syndrome (DIC);
• Violation of the metabolism of carbohydrates and fats (for example, in diabetes, obesity, etc.);
• Shock and coma;
• Excessive physical activity;
• Malignant tumors of any localization;
• Chronic kidney and blood diseases (for example, leukemia, anemia, etc.);
• Deficiency of vitamins PP, B1, B2 and B5;
• Diseases of the thyroid gland;
• Damage to cells by radiation, tissue decay products during cachexia, severe infections or uremia;
• Drug and alcohol abuse;
• Prolonged fasting.

Symptoms (signs) of hypoxia

symptoms of hypoxia

When lightning form of hypoxiaclinical symptoms do not have time to appear, since death occurs within a very short period of time (up to 2 minutes).

Acute form of hypoxia lasts up to 2-3 hours, and during this period there is a failure of all organs and systems at once, primarily the central nervous system, respiration and heart (heart rate becomes less frequent, blood pressure drops, breathing becomes irregular, etc.). If hypoxia is not eliminated during this period, then organ failure turns into coma and agony, followed by death.

Subacute and chronic formshypoxia is manifested by the so-called hypoxic syndrome. Against the background of hypoxic syndrome, symptoms from the central nervous system appear first of all, since the brain is most sensitive to oxygen deficiency, as a result of which foci of necrosis (dead areas), hemorrhages and other variants of cell destruction quickly appear in its tissues. Due to necrosis, hemorrhages and death of brain cells against the background of oxygen deficiency at the initial stage of hypoxia, a person develops euphoria, he is in an excited state, he is tormented by motor restlessness. One's own state is not critically assessed.

With further progression hypoxiathe following signs of suppression of the cerebral cortex appear, which are similar in manifestations to alcohol intoxication:

• Drowsiness;
• Lethargy;
• Headache and dizziness;
• Noise in ears;
• Lethargy;
• Impaired consciousness;
• Involuntary discharge of urine and feces;
• Nausea and vomiting;
• Coordination disorder;
• Convulsions.

Convulsions during hypoxia appear when exposed to external stimuli. Moreover, a convulsive attack usually begins with twitching of the muscles of the face, hands and feet with the addition of irregular muscle contractions of the abdomen. Sometimes with seizures, opisthotonus, which represents a person arched in an arch with unbent muscles of the neck and back, his head thrown back and his arms bent at the elbows. The human pose in opisthotonus resembles a gymnastic figure "bridge".

In addition to symptoms of suppression of the cerebral cortex, a person also develops pain in the region of the heart, irregular breathing, shortness of breath, a sharp decrease in vascular tone, tachycardia (an increase in heart rate over 70 beats per minute), a drop in blood pressure, cyanosis (cyanosis of the skin), decrease in body temperature. But when poisoned with substances that inactivate hemoglobin (for example, cyanides, nitrites, nitrates, carbon monoxide, etc.), the human skin becomes pinkish.

With prolonged hypoxia with the slow development of CNS damage, a person may develop mental disorders in the form of delirium (“delirium tremens”), Korsakov's syndrome (loss of orientation, amnesia, replacement of fictional events with real ones, etc.) and dementia.

With further progression of hypoxia, blood pressure drops to 20-40 mm Hg. Art. and there is a coma with the extinction of brain functions. If the blood pressure drops below 20 mm Hg. Art., then death occurs. In the period before death, a person may experience agonizing breathing in the form of rare convulsive attempts to inhale.

Degrees of hypoxia

Depending on the severity of the course and the severity of oxygen deficiency, the following degrees of hypoxia are distinguished:

• Easy(usually detected only during physical exertion);
• Moderate(the phenomena of hypoxic syndrome appear at rest);
• Heavy(the phenomena of hypoxic syndrome are strongly pronounced and there is a tendency to go into a coma);
• Critical(hypoxic syndrome has resulted in coma or shock, which can be fatal in agony).

Oxygen deprivation treatment

In practice, mixed forms of hypoxia usually develop., as a result of which the treatment of oxygen deficiency in all cases should be comprehensive, aimed at simultaneously eliminating the causative factor and maintaining an adequate supply of cells of various organs and tissues with oxygen.

To maintain a normal level of oxygen supply to cells in any type of hypoxia, hyperbaric oxygenation (HBO) is used - barotherapy. In barotherapy, pressure chambers are used in which a person is under increased pressure with a high oxygen content. Due to the increased pressure, oxygen is additionally dissolved directly in the blood plasma without binding to erythrocytes, which allows its delivery to organs and tissues in the required amount, regardless of the activity and functional usefulness of hemoglobin. Thanks to hyperbaric oxygenation, it is possible not only to supply the organs with oxygen, but also to expand the vessels of the brain and heart, thanks to which the latter can work at full strength.

In addition to hyperbaric oxygenation, with circulatory hypoxia, cardiac drugs and drugs that increase blood pressure are used. If necessary, a blood transfusion is performed (if blood loss has occurred that is not compatible with life).

With hemic hypoxia, in addition to hyperbaric oxygenation, the following therapeutic measures are carried out:

• Transfusion of blood or red blood cells;
• Introduction of oxygen carriers (Perftoran, etc.);
• Hemisorption and plasmapheresis for the purpose of removing toxic metabolic products from the blood;
• Administration of substances capable of performing the functions of respiratory chain enzymes (vitamin C, methylene blue, etc.);
• The introduction of glucose as the main substance that gives the cells energy for the implementation of vital processes;
• The introduction of steroid hormones to eliminate pronounced oxygen starvation of tissues.

Prevention of hypoxia

An effective prevention of hypoxia is to prevent conditions in which the body can experience oxygen starvation. To do this, you need to lead an active lifestyle, be in the fresh air every day, exercise, eat well and treat existing chronic diseases in a timely manner. When working in an office, you need to periodically ventilate the room (at least 2-3 times during the working day) in order to saturate the air with oxygen and remove carbon dioxide from it.

prevention of hypoxia in the pressure chamber

Intrauterine fetal hypoxia is a dangerous process that, unfortunately, is very common. The consequences of hypoxia can negatively affect the development of the fetus and the activity of its internal organs. The life and health of the unborn child largely depends on timely diagnosis and treatment.

Waiting for a miracle

Pregnancy is a very exciting and joyful time for every woman. But to the joyful anticipation of the birth of a baby, anxiety for his health is added. The expectant mother bears a heavy burden of responsibility. For nine months a new life develops and grows in it. The health of an unborn baby directly depends on the well-being of his mother.

There are many guidelines on how to manage your health during pregnancy. This applies to nutrition, lifestyle, emotional stress and much more. Failure to follow these simple rules can lead to adverse consequences and damage the health of the fetus.

One of these consequences can be intrauterine hypoxia, which entails disturbances in the development of the fetus and, in some cases, the fading of pregnancy. To avoid this, the expectant mother needs to carefully study the risk factors that lie in wait for her during pregnancy, and try to prevent their occurrence.

What is hypoxia

"Hypoxia" is an ancient Greek word that literally translates as "low oxygen". This term denotes oxygen starvation, which is experienced by the body or its individual organs as a result of exposure to certain factors.

With prolonged oxygen starvation, irreversible morphological processes occur in the human body. They change the structure of tissues and organs and disrupt their functional abilities. With oxygen starvation of the fetus, the process of formation of internal organs is slowed down and disrupted, the child can be born with a lag in the development of vital systems or die. These are the consequences of intrauterine hypoxia. The heart, kidneys, liver and central nervous system are most strongly affected by hypoxia.

Oxygen deficiency can accompany any disease or arise as an independent process, entailing defects of internal organs. For this reason, hypoxia cannot be classified as a disease, it is a pathological process, the same as inflammation or dystrophy.

Symptoms of fetal hypoxia

It is noted that in the first three months of pregnancy, oxygen deprivation develops quite rarely. This can most often occur in the second and third trimester. This is due to the fact that with the growth of the fetus, an increase in its oxygen demand also arises, and under some unfavorable circumstances, the body of a pregnant woman cannot cope with this task.

Oxygen deficiency in a baby is difficult to identify without diagnostic tests, especially in early pregnancy. But there are some signs of intrauterine hypoxia, which should be an alarming signal for the expectant mother.

The first thing to look for is fetal activity. The norm is about ten movements per day. In the initial stages of hypoxia, the baby begins to feel discomfort, therefore, is overly active. With a longer oxygen deficiency, the amount of perturbation decreases. In addition, intrauterine hypoxia can be characterized by frequent fetal hiccups.

If the deviation in the number of movements from the norm and frequent hiccups are not associated with the physical exertion of the expectant mother or being in an uncomfortable position, it is required to contact a specialist as soon as possible, who will identify the cause of this fetal behavior and, if necessary, prescribe treatment.

Causes of occurrence

The causes of intrauterine fetal hypoxia can be different. These include diseases that a pregnant woman suffers from, pathology of the placenta, infection,

Of the maternal diseases leading to fetal hypoxia, the following can be distinguished:

• anemia;
• disturbances in the work of the cardiovascular system;
• respiratory diseases;
• diabetes.

In addition, bad habits that the expectant mother suffers from affect the baby's health. Prevention of intrauterine hypoxia includes complete cessation of smoking and alcohol. Any deviation from the generally accepted norms of pregnancy can lead to oxygen starvation of the fetus. Such deviations can be detachment and premature aging of the placenta, prolonged pregnancy, or increased uterine tone.

Another factor entailing is the incompatibility of the Rh factor of the mother and the child. Such incompatibility can lead to hemolytic disease of the fetus, which is often accompanied by hypoxia. In addition to the above factors, the influence can have a mechanical effect on the fetus - entanglement with the umbilical cord, compression of the head during childbirth, and so on.

The causes of intrauterine hypoxia can also become the causes of other, no less serious complications. To avoid an adverse effect on the development of the fetus, the expectant mother needs to be monitored by a qualified specialist throughout the entire period of pregnancy.

Types of fetal hypoxia

Depending on how long oxygen deprivation lasts, intrauterine hypoxia has two forms: acute and chronic. Acute hypoxia is characterized by a sharp decrease in supplied oxygen. The most common acute form occurs during the process of childbirth or with profuse uterine bleeding. Chronic intrauterine hypoxia forms over a long period of time, gradually disrupting the processes of fetal development.

The degree of progression of oxygen deprivation

Three degrees of development of fetal hypoxia were identified. At first, the fetus, having not received the required amount of oxygen, tries to compensate for its lack. The first degree is to compensate for the lack of oxygen. In the baby's body, changes begin to occur aimed at increasing the volume of incoming oxygen. The level of a hormone that increases the tone of blood vessels, cortisol, increases. An increased level of cortisol stimulates an increase in the volume of blood that circulates through the vessels and an increase in the heart rate. The composition of the blood changes: the level of hemoglobin and erythrocytes increases. In addition, there is an increased activity of the baby. He begins to move more intensively and make breathing movements, despite the closed glottis.

At the second stage of partial compensation, the body's protective functions are determined by priority organs that are supplied with oxygen in the first place. These organs are the heart and the brain, respectively, other organs (kidneys, lungs, gastrointestinal tract) receive oxygen-poor blood, which leads to disruptions in their development and work. Lack of oxygen also leads to the breakdown of glucose. This contributes to a decrease in the supply of energy in the cells of the body and metabolic disorders.

Chronic intrauterine fetal hypoxia also has a third stage of progression - decompensation. Outwardly, the stage manifests itself as a decrease in fetal activity and a decrease in heart rate. The work of protective mechanisms aimed at providing organs with oxygen fails. Cortisol is produced in insufficient quantities, so the blood flow slows down and decreases. The blood is saturated with carbon dioxide, blood clotting is impaired, which leads to the formation of blood clots and bleeding.

Diagnostic measures

The methods of instrumental diagnostics help to determine the presence and degree of oxygen starvation. The first such method is cardiotocography (CTG). This diagnostic method is completely safe. The cardiotocography apparatus continuously records the fetal heart rate and uterine contractions. A tachogram is displayed using an ultrasonic graph. This is a graph that reflects the number of contractions of the heart muscle over a given period of time. measures fluctuations in pressure and uterine tone, displaying a hysterogram - a graph of the muscle activity of the uterus. CTG counts the number of movements and allows you to track the dependence of the heart rate on the activity of the fetus.

Starting from the twentieth week of pregnancy, an ultrasound examination with Doppler ultrasound is possible. This method is aimed at examining blood flow from the mother to the placenta and from the placenta to the fetus and allows you to detect violations of the uteroplacental circulation. Using this diagnostic method, you can also determine the quality of amniotic fluid.

In addition to the above methods, a specialist listens to the fetal heart to assess its work using an obstetric stethoscope. However, this method is inaccurate, therefore, if a heart anomaly is suspected, the doctor directs the pregnant woman to undergo CTG and ultrasound.

Treatment

Treatment of intrauterine hypoxy requires monitoring of the pregnant woman in the hospital. The woman is provided with complete rest and a therapeutic method of treatment is prescribed, which is aimed not only at enriching the blood with oxygen, but also at identifying the true cause of hypoxia. As a rule, abnormalities in the course of pregnancy, such as intrauterine fetal hypoxia, are the consequences or symptoms of a disease.

The doctor prescribes medications for the pregnant woman that reduce blood viscosity, improve blood flow from the mother to the placenta and normalize the metabolism between the mother and the fetus. The appointment of other drugs and procedures depends on the cause of hypoxia, if it is identified, and is aimed at eliminating this cause.

With positive dynamics, the patient is discharged and given recommendations for the prevention of hypoxia. These include walking in the fresh air, reducing physical activity, giving up bad habits and following certain dietary rules. If the treatment was unsuccessful, and oxygen deficiency persists, prompt extraction of the fetus is required. If the gestation period exceeds twenty-eight weeks, the doctor prescribes an operation - a cesarean section.

Prevention

There are a number of simple guidelines that can help reduce the risk of oxygen deficiency in your baby. Before planning a pregnancy, a woman needs to treat chronic diseases, get rid of bad habits. When pregnancy occurs, it is important to register with a medical institution at an early stage. Throughout the entire period of pregnancy, it is necessary to regularly visit a doctor, take tests and do an ultrasound scan. This will ensure control over the health of the pregnant woman and the baby, and, therefore, help to avoid the development of possible pathological conditions of the fetus.

An important aspect in the prevention of intrauterine hypoxia is maintaining a healthy lifestyle. It is necessary to spend a lot of time outdoors, sleep eight hours a day, and balance the diet.

During pregnancy, you need to replenish the supply of vitamins and nutrients, the level of which decreases due to the additional load on the body. Levels of calcium, magnesium and other minerals should be maintained. It is especially important to control the iron content in the blood, since its low level leads to anemia - one of the main causes of hypoxia. Vitamin preparations should be taken as prescribed by your doctor.

Effects

The consequences of intrauterine hypoxia depend on its type. Chronic hypoxia, which began early in pregnancy, when the formation of the vital systems of the fetus is just beginning, can lead to the formation of congenital defects. Hypoxia, transferred in late pregnancy, can cause a delay in fetal development, and also leads to ischemia and necrosis of individual organs. A newborn baby often has a shortage of height and weight, as well as a difficult adaptation period (restructuring of the body in a new environment). In the future, oxygen starvation experienced in the womb can cause diseases such as epilepsy and cerebral palsy.

Acute intrauterine hypoxia of the child leads to ischemia and tissue necrosis. If acute hypoxia occurs during childbirth, several consequences are possible, depending on the cause of oxygen deprivation:

1. The baby's airways are not completely cleared of amniotic fluid. In this case, the development of pneumonia is possible, in the worst case, the death of a child from suffocation.
2. Loss of large blood volume. A newborn develops hemorrhagic shock, which disrupts the mechanisms of work of all systems. Under such circumstances, there is a threat to the life of not only the baby, but also the mother.

After the birth of a baby who has undergone hypoxia in the womb, he needs constant monitoring of qualified specialists. The consequences of oxygen starvation may appear not in the first days of life, but much later. Therefore, it is very important to monitor changes and abnormalities in the development of the baby in order to identify and prevent the development of adverse effects of hypoxia.