Fruit hypoxia – the pre-natal syndrome which is characterized by a complex of the changes from a fruit caused by insufficient intake of oxygen to its fabrics and bodies. The hypoxia of a fruit is characterized by violations from vitals, first of all, of TsNS. Diagnosis of a hypoxia of a fruit includes carrying out a kardiotokografiya, dopplerometriya of uterine and placentary blood circulation, obstetric ultrasonography, an amnioskopiya. Treatment of a hypoxia of a fruit is directed to normalization of a uterine and placentary blood-groove, improvement of a rheology of blood; sometimes this state demands an early rodorazresheniye of the woman.
The hypoxia of a fruit is registered in 10,5% of cases of total number of pregnancy and childbirth. The hypoxia of a fruit can develop in various terms of pre-natal development, be characterized by various degree of oxygen insufficiency and consequences for the child's organism. The fruit hypoxia which developed in early terms of a gestation causes defects and delay of development of an embryo. On late terms of pregnancy the hypoxia is followed by a fruit growth inhibition, defeat of TsNS, decrease in adaptation opportunities of the newborn.
Fruit hypoxia reasons
The hypoxia of a fruit can be a consequence of a wide range of the adverse processes happening in an organism of the child, mother or in a placenta. The probability of development of a hypoxia in a fruit increases at diseases of a maternal organism – anemia, cardiovascular pathology (heart diseases, a hypertension), diseases of kidneys, respiratory system (chronic bronchitis, bronchial asthma, etc.), diabetes, toxicoses of pregnancy, polycarpous pregnancy, STD. Negatively alcoholism, nicotinic, narcotic and other types of dependence of mother affects supply of a fruit with oxygen.
Danger of a hypoxia of a fruit increases at the violations of fruit and placentary blood circulation caused by threat of an abortion, a pregnancy perenashivaniye, umbilical cord pathology, fetoplatsentarny insufficiency, anomalies of patrimonial activity and other complications of pregnancy and patrimonial process. In development of an intranatalny hypoxia carry a hemolytic disease of a fruit, congenital anomalies of development, pre-natal infection to risk factors (a herpetic infection, toxoplasmosis, clamidiosis, mycoplasmosis, etc.), repeated and hard obvity umbilical cords around the child's neck, a head compression, long on time, in the course of childbirth.
In response to a hypoxia at a fruit, first of all, the nervous system as nervous tissue the most sensitive to deficiency of oxygen suffers. Since 6-11 weeks of development of an embryo, the lack of oxygen causes a delay of maturing of a brain, violation in a structure and functioning of vessels, delay of maturing of a hematoencephalic barrier. Also the hypoxia is tested by tissues of kidneys, hearts, fruit intestines.
The insignificant hypoxia of a fruit can not cause clinically significant damages of TsNS. At a heavy hypoxia of a fruit ischemia and necroses in various bodies develop. After the birth at the child developing in the conditions of a hypoxia the wide range of violations – from neurologic frustration to a delay of mental development and heavy somatic deviations can be observed.
Classification of a hypoxia of a fruit
On time of a current and speed of emergence allocate the sharp and chronically developing fruit hypoxia.
Developing of a sharp hypoxia of a fruit is usually connected with anomalies and complications of the patrimonial act – rapid or long childbirth, pressing or loss of an umbilical cord, a long sdavleniye of a head in patrimonial ways. The sharp hypoxia of a fruit can sometimes develop during pregnancy: for example, in case of a rupture of a uterus or a premature otsloyka of a placenta. At a sharp hypoxia violations of functions of vitals of a fruit promptly accrue. The sharp hypoxia is characterized by increase of heartbeat of a fruit (more than 160 . in min.) or its urezheniye (less than 120 . in min.), arrhythmia, dullness of tones; strengthening or easing of physical activity etc. Quite often against the background of a sharp hypoxia fruit asphyxia develops.
Leads long moderate deficiency of oxygen in the conditions of which the fruit develops to a chronic hypoxia. At chronic deficiency of oxygen there is a pre-natal hypotrophy; in case of exhaustion of compensatory opportunities of a fruit the same violations develop, as at sharp option of a current. The hypoxia of a fruit can develop during pregnancy or childbirth; separately the hypoxia which arose at the child after the birth owing to a disease of hyaline membranes, pre-natal pneumonia etc. is considered.
Taking into account compensatory and adaptation opportunities of a fruit the hypoxia can get the compensated, subcompensated and dekompensirovanny forms. As under adverse conditions the fruit tests not only a hypoxia, but also the whole complex of difficult violations of exchange, in world practice this state is defined as "distress syndrome" which is subdivided on dorodovy, developed in labor and respiratory.
Displays of a hypoxia of a fruit
Expressiveness of the changes developing at a fruit under the influence of a hypoxia is defined by intensity and duration of the tested oxygen insufficiency. Initial displays of a hypoxia cause in a fruit heartbeat increase, then - its delay and a priglushennost of tones of heart. In amniotic waters meconium can appear. At a hypoxia of easy degree physical activity of a fruit increases, at heavy – the movements urezhatsya and slowed down.
At the expressed hypoxia at a fruit blood circulation violations develop: the tachycardia and rise HELL which are replaced by bradycardia and recession HELL is noted short-term. Rheological violations are shown by a condensation of blood and an exit of plasma from the vascular course that is followed by intracellular and fabric hypostasis. As a result of the increased fragility and permeability of vascular walls there are hemorrhages. Decrease in a tone of vessels and delay leads blood circulation to an ishemization of bodies. At a hypoxia in an organism of a fruit acidosis develops, the balance of electrolytes changes, tissue respiration is broken. Changes in vitals of a fruit can cause his pre-natal death, asphyxia, intra cranial patrimonial injuries.
Diagnosis of a hypoxia of a fruit
Suspicion on the fact that the fruit tests a hypoxia can arise at change of its physical activity – uneasy behavior, strengthening and increase of stirs. The long or progressing hypoxia leads to weakening of stirs of a fruit. If the woman notices such changes, she should address the gynecologist who is carrying out conducting pregnancy immediately. When listening heartbeat of a fruit an obstetric stethoscope the doctor estimates the frequency, sonority and a rhythm of warm tones, existence of noise. For detection of a hypoxia of a fruit the modern gynecology uses carrying out a kardiotokografiya, phonocardiography of a fruit, dopplerometriya, ultrasonography, an amnioskopiya and amniocentesis, laboratory researches.
During a kardiotokografiya it is possible to trace ChSS of a fruit and its physical activity. On change of heartbeat depending on rest and activity of a fruit judge its state. Kardiotokografiya, along with a phonocardiography, is widely applied in labor. At doppler sonography of uterine and placentary the speed and character of a blood-groove in vessels of an umbilical cord and placenta which violation leads to a fruit hypoxia krovotokaizuchatsya. Kordotsentez under control of ultrasonography is carried out for an intake of umbilical blood and a research of acid-base balance. The revealed delay of its growth can be the Ekhoskopichesky sign of a hypoxia of a fruit. Besides, in the course of obstetric ultrasonography the structure, volume and color of amniotic waters is estimated. The expressed abundance of water or lack of water can signal about trouble.
Carrying out an amnioskopiya and amniocentesis via the channel of a neck of a uterus allows to estimate visually transparency, color, amount of amniotic liquid, existence of inclusions in it (flakes, meconium), to carry out biochemical tests (measurement , a research of content of hormones, enzymes, concentration of CO2). Amnioskopiya is contraindicated during the prelying of a placenta, a colpitis, a tservitsita, threat of termination of pregnancy. Direct assessment of amniotic liquid is carried out after its izlitiya in the I period of childbirth. In favor of a hypoxia of a fruit impurity in amniotic waters of meconium and their greenish color testifies.
Treatment of a hypoxia of a fruit
In case of detection of a hypoxia of a fruit the pregnant woman is hospitalized in an obstetric and gynecologic hospital. Existence of a hypoxia of a fruit demands correction of the available obstetric and ekstragenitalny pathology of mother and normalization of fetoplatsentarny blood circulation. Strict rest, oxygenotherapy is shown to the pregnant woman. The therapy directed to decrease in a tone of a uterus (a papaverine, , , , ), reduction of intra vascular coagulability is carried out (, a dextran, a haemo derivative of blood of calfs, ).
The chronic hypoxia of a fruit demands introduction of the medicines improving cellular permeability for oxygen and metabolism (essentsialny phospholipids, vitamins E, C, B6, glutamic acid, glucose), antigipoksant, neuroprotectors. At improvement of a condition of the pregnant woman and reduction of the phenomena of a hypoxia of a fruit of the pregnant woman the respiratory gymnastics, an akvagimnastika, Ural federal district, an induktotermiya can be recommended. At inefficiency of complex measures and preservation of symptoms of a hypoxia of a fruit on term over 28 weeks the rodorazresheniye in the emergency order (the emergency Cesarean section) is shown.
Childbirth at a chronic hypoxia of a fruit is conducted with use of the kardiomnitoring allowing to apply in due time additional measures. At the sharp hypoxia which developed in labor, the child needs the resuscitation help. Timely correction of a hypoxia of a fruit, rational conducting pregnancy and childbirth allow to avoid development of gross violations in the child. Further all children developing in the conditions of a hypoxia are observed at the neurologist; quite often they need the help of the psychologist and logopedist.
Fruit hypoxia complications
Heavy degree of a hypoxia of a fruit is followed by the hardest polyorgan dysfunctions at the newborn. At hypoxemic defeat of TsNS perinatal encephalopathy, brain hypostasis, an arefleksiya, spasms can develop. From respiratory system the post-hypoxemic pnevmopatiya, pulmonary hypertensia are noted; cardiovascular violations include heart diseases and vessels, an ischemic necrosis of an endokard, etc.
Influence of a hypoxia of a fruit on kidneys can be shown by a renal failure, an oliguriya; on a GIT – vomiting, vomiting, enterokolity. Quite often owing to a heavy perinatal hypoxia at the newborn the DVS-syndrome, a secondary immunodeficiency develop. Asphyxia of newborns develops in 75-80% of cases against the background of the previous fruit hypoxia.
Prevention of a hypoxia of a fruit
The prevention of development of a hypoxia of a fruit demands from the woman of responsible preparation for pregnancy: treatments of ekstragenitalny pathology and diseases of bodies of reproductive system, refusal of unhealthy habits, balanced diet. Conducting pregnancy has to be carried out taking into account risk factors and timely control of a condition of a fruit and the woman. Prevention of development of a sharp hypoxia of a fruit consists in a right choice of a way of a rodorazresheniye, prevention of patrimonial injuries.