Fetal hypoxia: consequences for the child

The normal course of pregnancy can greatly complicate the diagnosis, which sounds threatening for the expectant mother - “fetal hypoxia”. According to statistics, every third pregnant woman faces such a problem to one degree or another. Why a child begins to suffer from a lack of oxygen and how it is dangerous for his health, we will tell in this article.

What it is?

Fetal hypoxia is a state of oxygen deprivation, in which the child suffers quite a lot. Most expectant mothers have chronic hypoxia, in which the lack of oxygen in the baby lasts for a long time. Sometimes the condition is acute, and this is very dangerous for the fetus, since it can lead to the death of the child in utero from asphyxiation.

With an insufficient level of oxygen, which the baby receives through the bloodstream for all 9 months, serious changes occur in his body - the metabolism changes, pathological changes are observed in the nervous system of the baby.

If hypoxia is insignificant, the baby is quite capable of coping with this condition with practically no consequences for himself, since the compensatory mechanisms even in an unborn baby are incredibly large. So, the baby “stores” oxygen in advance, since the number of O2 molecules in his blood is much higher than in the blood of an adult, therefore, when starvation begins, he will be able to consume his own reserves for some time. In addition, in the baby, the adrenal glands respond promptly to the lack of oxygen in all, which immediately produce hormones in response, allowing for a while to increase blood pressure, normalize the heart rate.

Despite all this, these mechanisms, unfortunately, are not able to compensate for prolonged hypoxia or acute fetal hypoxia. When the gynecologist who is observing the expectant mother speaks about the presence of fetal hypoxia, he must specify the degree of the problem in question. Grade 1 is insignificant, the second and third may be the basis for hospitalization of a pregnant woman or premature delivery if the baby's condition is threatening.

Lack of oxygen during pregnancy is usually chronic.

Acute hypoxia most often develops during childbirth and is provoked by incorrect actions of medical personnel - stimulation of contractions with strong medications, aggressive acceleration of the labor process.

Doctors can predict the possible consequences for the child already in the delivery room, since the state of the baby immediately after birth speaks volumes. Depending on him, he is given the first grades in life - points on the Apgar scale, this assessment system necessarily includes an assessment of the post-hypoxic state. The lower the score, the more serious future problems can be. A child born with acute hypoxia is characterized by low scores in the first 10 minutes after birth, but after an hour the child can safely put 7-8 Apgar points. In this case, the forecasts are positive. If the baby's condition does not improve or begins to deteriorate, the forecasts are not so rosy.

Causes

Chronic hypoxia can appear for a number of reasons:

diabetes mellitus in the mother;
viral infection in the first trimester of pregnancy;
pregnancy with twins or triplets;
long-term state of threat of termination of pregnancy, threatening miscarriage;
partial placental abruption, spotting;
post-term pregnancy (more than 40 weeks);
anemia of a pregnant woman;
violation of uteroplacental blood flow;
bad habits - smoking during pregnancy, alcohol, drugs.

Acute hypoxia occurs in cases of complications during childbirth with:

entwining the baby with the umbilical cord with clamping the umbilical cord ring;
polyhydramnios;
pregnancy with twins and triplets;
premature placental abruption, which is often the case with rapid, rapid labor or labor, which is stimulated by piercing the fetal bladder or medication;
primary or secondary weakness of the birth forces.

Diagnostics

Diagnosis of fetal hypoxia is not an easy task, because babies behave differently in the womb. One is lazy due to temperament and rarely moves, the other is active, and his frequent movements are often taken by women and doctors as a manifestation of hypoxia. Some symptoms should alert you:

a change in the nature of the fetal motor activity, in which at first the baby moves chaotically and often with strong painful shocks, and then, as oxygen starvation develops, the movements become more and more rare;
the height of the bottom of the uterus is much lower than normal;
the child develops with a noticeable lag (fetometric indicators are below the lower limit of the norm);
the pregnant woman has a lack of water.

In late pregnancy, doctors advise to follow the baby's movements especially carefully, the number of movements should be recorded in a diary.

Normally, a waking baby should perform up to 10 movements per hour. It can be coups, easily perceptible and discernible, and barely noticeable movements. It is recommended to register movements from 20-22 weeks of pregnancy until its end.

If the doctor suspects hypoxia on the basis of the deviations from the norms described above, he will definitely prescribe a CTG to the pregnant woman. In the course of cardiotocography, sensors attached to the abdomen will record all the baby's movements, changes in his heart rate, and even hiccups will be reflected. Additional research methods include dopplerometry, and fetal ECG, and ultrasound (this differs from the standard ultrasound procedure in that the doctor will look not at the parts of the child's body, but at the blood flow rate in the uterine arteries, in the umbilical cord). An extended blood test from the mother's vein, in addition to the listed methods, allows you to establish whether there is enough hemoglobin in the blood and to clarify other biochemical factors.

Acute birth hypoxia does not need extended diagnostics, since a fetal monitor operating in real time immediately registers the pathological state of oxygen deprivation in a child as soon as it occurs.

The most reliable sign is bradycardia - a decrease in the heart rate in a crumbs that have not yet had time to be born. If the normal fetal heart rate is from 120 to 170 beats per minute, then in a baby who suffers oxygen starvation, the heart rate will be at the level of 80-90 beats per minute. Tachycardia also speaks of a lack of oxygen if the child's heart rate is above 180-190 beats per minute.

The amniotic fluid in which a child with chronic hypoxia was located is sometimes dark or dark green in color, with an unpleasant odor of meconium (the original feces of a newborn). After birth, the baby himself will be weaker than other babies, he will have a decreased or increased muscle tone, neurological disorders of varying severity.

Possible consequences

The most formidable, but, alas, quite real consequence of oxygen starvation is cerebral hypoxia. It is the brain that suffers from hypoxia more often and stronger than other organs. Even the most experienced doctor will not undertake to predict what disorders will be caused by dysfunction of one or another part of the brain in the perinatal period. However, it is quite possible to assess the traumatic impact after childbirth. And if some disorders, such as problems with speech development, become apparent later, then gross hypoxic-ischemic lesions of the central nervous system in most cases can be diagnosed even in the maternity hospital, in extreme cases - in the very first months of the baby's life.

The consequences for the nervous system due to brain cells dying during oxygen deficiency can be different. - from moderate hyperactivity of the child in the future to severe lesions, which include cerebral palsy, paresis of various dislocations. With complicated childbirth in a state of acute hypoxia, cerebral hemorrhage, ischemia, and cerebral edema often occur. The lesions that occur with such violations can be total and irreversible.

Both acute and chronic oxygen deficiency can lead to a wide variety of diseases, mainly neurological in nature. So, problems with vision or hearing are a fairly common post-hypoxic consequence. If hypoxia has been prolonged, then the child may have underdevelopment or abnormal development of some internal organs, heart defects, kidneys, and so on. Minor neurological disorders in most cases, the child manages to "outgrow" the age of 6-7, naturally, with constant supervision by a neurologist and following all his recommendations.

In general, the prognosis for possible consequences directly depends on how early hypoxia was detected and how quickly the treatment was provided. That is why women are not advised to miss their next appointment at a consultation, and women with chronic diseases have to visit an obstetrician two to three times more often.

Pregnancy treatment

The established fact of hypoxia during pregnancy should in no case be ignored; fast and effective therapy is needed to minimize the possible consequences for the baby. Doctors urge expectant mothers, first of all, to calm down, since excessive nervous experiences only aggravate the already rather difficult state of the child.

In the later stages, severe hypoxia may become an indication for urgent delivery by caesarean section. In the earlier stages, when the baby is still very early to be born, doctors will try to do everything possible to make the baby better. Treatment can take place at home, but provided that the severity of hypoxia does not exceed 1 degree. The rest of the cases are subject to urgent hospitalization and constant monitoring of the pregnant woman and the baby in the hospital.

Doctors prescribe mothers to bed rest, it is with it that the blood supply to the placenta increases and minor hypoxia can be cured in the shortest possible time. The main approach to drug therapy is to use drugs that improve uteroplacental blood flow, such as "Curantil", "Actovegin". In severe hypoxia, these drugs are administered intravenously by drip. In other situations, it is allowed to take pills. A woman is prescribed vitamins, iron and magnesium preparations. Treatment courses are repeated.

If a woman has an underlying disease, which, presumably, caused the onset of oxygen deficiency, then treatment should include therapy for this disease.

Two specialists take part in this - an obstetrician-gynecologist who knows what can and cannot be done to his patient in an "interesting" position, and a specialist doctor who is in charge of the disease. They must prescribe medications and manipulations together, the treatment, as it was before pregnancy, usually changes.

A child who has experienced acute birth hypoxia, in the very first hours after birth, will be provided with powerful vascular therapy, and he will also be injected with sedatives, vitamins, especially group B. The neurologist will observe the baby from the first hours of his independent life.

Treatment after birth

Without exception, all children who have experienced hypoxia during their intrauterine existence are shown special observation by a pediatric neurologist. Almost always, such babies, regardless of the consequences, are put on dispensary registration. They, in the overwhelming majority of cases, are recommended therapeutic massage from the very first days, taking vitamins, water procedures with the use of sedative decoctions of medicinal herbs. Many babies, after 3-4 years old, require classes with a speech therapist in order to overcome possible problems with speech development and pronunciation.

The rest of the treatment depends only on what post-hypoxic diagnosis was established, because with cerebral palsy, one approach and the choice of medications are required, and with pathological loss of hearing or vision, it is completely different. Infantile cerebral palsy is considered to be the most difficult in treatment, and increased muscle tone without other neurological symptoms can be corrected most easily. Parents should prepare for a rather long treatment, since the post-hypoxic consequences that need to be corrected have to be eliminated for years.