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Asphyxia of the fetus


Cessation of fetal breathing with continued cardiac activity. The causes of asphyxia are many types of obstetric pathology: placental circulation disorders, which may be associated with pressing the umbilical cord between the bones of the pelvis and the fetus (when the umbilical cord falls out), tightly entwining the umbilical cord around the neck or trunk of the fetus, with the separation of a significant part of the placenta from its bed and presentation . It can occur in difficult, prolonged births associated with a narrow pelvis, stiffness of the soft birth canal, facial presentation and other complications of the birth 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 can last for several days, weeks, and even months. Deterioration of the fetus is manifested by its intense and frequent movements, or, conversely, by passive behavior, instability of cardiac activity: acceleration of the heartbeat (160 or more beats per minute), followed by deceleration (100 or less beats per minute), the appearance of dull tones and arrhythmia.
Recognition:
Instrumental and laboratory methods of clinical examination help in the diagnosis of intrauterine hypoxia of the fetus: electro- and phonocardiography, amnioscopy, the study of the acid-base composition of the fetal blood obtained from the precursor. The condition of a child born in a state of asphyxia is most accurately determined by the Hangar scale in the first minute after his birth. The system is based on taking into account the condition of the newborn according to five most important clinical signs: heart rate, respiratory activity, muscle tone, reflex excitability and skin color.
Treatment:
The most common treatment for fetal asphyxiation is the triad of Nikolaev. It consists in the intravenous administration of a mother of 40% glucose solution with 100 mg of ascorbic acid, ml of 10% cordiamine solution with active oxygen therapy (inhalation of oxygen). In parallel, drugs are used that improve utero-placental circulation and fetal blood oxygenation. To normalize the acid-base composition of the blood of the fetus, infusion therapy is used. If natural delivery is not possible, resort to a cesarean section. To revitalize the newborn, the airways are freed from mucus and amniotic fluid, put the child in a warm bath, without separating him from the mother, 3 ml of 10% calcium chloride solution, 10-20 ml of 5% sodium bicarbonate solution are introduced into the umbilical artery. Perform artificial ventilation of the lungs using a breathing apparatus.
Prevention: timely and effective treatment of diseases and complications of pregnancy, its prolongation, rational management of the birth certificate taking into account the interests of the fetus.