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Asphyxia


Cessation of fetal respiration with continued cardiac activity. The causes of asphyxia are many types of obstetric pathology: impaired placental circulation, which can be associated with pressing the umbilical cord between the bones of the pelvis and the fetus (if the umbilical cord prolapses), with a tight entanglement of the umbilical cord around the neck or the body of the fetus, with a significant portion of the placenta separated from its bed and prostrate . It can occur in difficult, long births associated with a narrow pelvis, stiffness of the soft birth canal, facial presentation and other complications of the labor act, as well as diseases of other organs and systems.
Symptoms and course:
Oxygen starvation can begin even during pregnancy with toxicosis, prolongation, chronic infection and last for several days, weeks or even months. The deterioration of the fetus is manifested by its intense and frequent movements or, on the contrary, by passive behavior, instability of cardiac activity: acceleration of heartbeat (160 or more beats per minute), followed by a slowdown (100 or less beats per minute), deaf tones and arrhythmia.
Recognition:
In the diagnosis of intrauterine hypoxia of the fetus help instrumental and laboratory methods of clinical examination: electro-and phonocardiography, amnioscopy, the study of the acid-base composition of the blood of the fetus, obtained from the presenting part. The condition of a child born asphyxiated is most accurately determined by the Angar scale in the first minute after birth. The system is based on taking into account the condition of the newborn according to five major clinical signs: cardiac rhythm, respiratory activity, muscle tone, reflex excitability and skin color.
Treatment:
The most common treatment for fetal asphyxia is the Nikolaev triad. It consists in intravenous administration of a 40% glucose solution with 100 mg of ascorbic acid, ml of 10% cordiamine solution with active oxygen therapy (oxygen inhalation) to the mother. In parallel, use drugs that improve uteroplacental circulation and oxygenation of fetal blood. For the normalization of the acid-base composition of the blood of the fetus used infusion therapy. If natural delivery is not possible, resort to cesarean section. To revitalize the newborn, the airways are freed from mucus and amniotic fluid, the child is placed in a warm bath without separating him from the mother, and 3 ml of 10% calcium chloride solution, 10-20 ml of 5% sodium bicarbonate solution is injected into the umbilical artery. Carry out artificial ventilation of the lungs using a breathing apparatus.
Prevention: timely and effective treatment of diseases and complications of pregnancy, its postponing, rational management of childbirth, taking into account the interests of the fetus.