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2.1
Fetal Hypoxia
In Utero Hypoxia

Presentation

We report for the first time an unusual presentation of blueberry muffin lesions in a neonate born from a mother affected by severe anemia during pregnancy. [ncbi.nlm.nih.gov]

Entire Body System

  • Cerebral Palsy

    This is mainly because of consequences of fetal hypoxia that may lead to cerebral palsy. A fetus suffering from hypoxia initially compensates by producing energy through anaerobic metabolism. [ncbi.nlm.nih.gov]

    […] and cerebral palsy,” available here. [kennerlyloutey.com]

  • Anemia

    We report for the first time an unusual presentation of blueberry muffin lesions in a neonate born from a mother affected by severe anemia during pregnancy. [ncbi.nlm.nih.gov]

    Anemia or circulatory deficiencies can lead to inadequate transport and delivery of oxygen to the tissues. [medical-dictionary.thefreedictionary.com]

    Fetus Hypoxic fetus  Hypoxic Hypoxia  PIH  Post maturity  Severe Maternal Anemia  Sickle cell anemia  Anemic Hypoxia  Immune Hydrops  Non Immune Hydrops  Ischemic Hypoxia (Acute)  Cord Compression  Accidental Hemorrhage Fetus of Diabetic [slideshare.net]

  • Falling

    Vasoconstriction of the cutaneous vessels induced by increased NE secretion during hypoxia may obviously produce a fall in tcpO2.(ABSTRACT TRUNCATED AT 400 WORDS). [ncbi.nlm.nih.gov]

    During hypoxia, anaerobic metabolism produces lactic acid; there is fall in pH and a decrease in ATP. [easymbbs.org]

    Acidemia is said to occur when arterial pH falls below 7.35 (except in the fetus – see below), while its counterpart ( alkalemia ) occurs at a pH over 7.45. Arterial blood gas analysis and other tests are required to separate the main causes. [en.wikipedia.org]

    Late decelerations occur when a fall in the level of oxygen in the fetal blood triggers chemoreceptors in the fetus to cause reflex constriction of blood vessels in nonvital peripheral areas in order to divert more blood flow to vital organs such as the [perinatology.com]

    The NICE guideline below demonstrates how to decide which category a CTG falls into. 3 Reassuring Baseline heart rate 110 to 160 bpm Baseline variability 5 to 25 bpm Decelerations None or early Variable decelerations with no concerning characteristics [geekymedics.com]

  • Crying

    At birth, visible signs of fetal asphyxia and hypoxia include: blue or pale skin color; low heart rate; weak muscle tone; poor reflexes; weak cry; no cry; and difficulty breathing. [bottarleone.com]

    Cough or sneezing Activity and tone Limp Some flexion of limbs Active movements Respiration Nil Slow, irregular Good, crying 2. [easymbbs.org]

    For example, in hypoxic-ischemic encephalopathy a mild condition may exhibit as poor muscle tone, transient feeding, crying and sleep abnormalities, and neurological findings only become close to normal after three to four days after birth. [wisegeek.com]

    Signs at birth include blue skin or pale skin, lower heart rate, weakened muscle tone, a weaker cry, poor reflexes, and breathing difficulties. [defranciscolaw.com]

  • Pain

    Damages that you may be able to recover on behalf of your baby include medical treatment, medical equipment, medications, the cost of lifelong and rehabilitative care, therapy, pain and suffering, and lost enjoyment of life. [defranciscolaw.com]

    Contraction Pattern s During latent phase labor (prior to 4 cm), contractions may occur every 3-5 minutes and may or may not be painful. [brooksidepress.org]

    Other symptoms include oliguria (secondary to acute renal failure), uterine contractions or vaginal bleedings (secondary to placental abruption), and vomiting and epigastric pain (secondary to HELLP syndrome). [dovepress.com]

Respiratoric

  • Pneumonia

    If myocardial depression is severe enough, late decelerations may be absent all together Etiologies of Late Decelerations Excessive uterine contractions Maternal hypotension Maternal hypoxemia (asthma, pneumonia) Reduced placental exchange as in: Hypertensive [perinatology.com]

    Fetal Hypoxia Inadequate oxygenation of maternal blood as a result of hypoventilation during anesthesia, cyanotic heart disease, pneumonia, respiratory failure. [easymbbs.org]

    Pneumothorax, emphysema, chronic bronchitis, asthma, severe pneumonia, and aspiration are among the most frequent causes. It can also occur as a compensatory response to chronic metabolic alkalosis. [en.wikipedia.org]

Cardiovascular

  • Tachycardia

    A significant rise in NE was only found with additional tachycardia which is often associated with a loss of oscillation amplitude. [ncbi.nlm.nih.gov]

    FETAL TACHYCARDIA Fetal tachycardia is defined as a baseline heart rate greater than 160 bpm and is considered a nonreassuring pattern ( Figure 3 ). [aafp.org]

    Signs of early fetal hypoxia include tachycardia and increased variability of the fetal heart rate; profound fetal hypoxia is characterized by bradycardia and a sinusoidal fetal heart rate pattern. hypoxia a broad term meaning diminished availability [medical-dictionary.thefreedictionary.com]

    Fetal hypoxia and fetal acidosis can cause bradycardia or tachycardia. Bradycardia is more likely a worse sign. [learningaboutelectronics.com]

    Below this is bradycardia, and above this is tachycardia. Baseline The baseline should be counted for at least 30 seconds, and preferably 60 seconds, between contractions. This provides a reference. [sharinginhealth.ca]

  • Heart Disease

    Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol. ‎ Pagina 475 - Seitchik J. The management of functional dystocia in the first stage of labor. Clin Obstet Gynecol, 1987:30:42-49. ‎ [books.google.ro]

    Fetal Hypoxia Inadequate oxygenation of maternal blood as a result of hypoventilation during anesthesia, cyanotic heart disease, pneumonia, respiratory failure. [easymbbs.org]

    Fetal oxygenation is affected by many factors: Maternal respiratory disease smoking seizure anemia hypotension regional anaesthesia position autoimmune conditions heart disease Uteroplacental hyperstimulation (normal, prostaglandins, oxytocin) abruption [sharinginhealth.ca]

    With fetal maturation, there is a decreased baseline heart rate and increased heart rate variability with episodic accelerations that are coupled to fetal movement. [dovepress.com]

Fetus

  • Fetal Disorder

    Four fetal behaviors were classified by the actocardiograms. Five numeric actocardiographic parameters were evaluated. Fetal outcomes were studied with actocardiograms of central nervous system lesion and common fetal disorders. [omicsonline.org]

Urogenital

  • Cesarean Section

    In many cases, a finding of fetal hypoxia will require the prompt delivery of the baby by cesarean section. [medicalneg.com]

    A 3,281 g male neonate was delivered by emergency cesarean section, with Apgar scores of 1 and 3 at 1 and 5 min, respectively. [ncbi.nlm.nih.gov]

Neurologic

  • Neonatal Seizures

    When compared with intermittent auscultation of FHR, continuous electronic FHR monitoring is associated with a reduction in the risk of neonatal seizures at the expense of an increased risk of cesarean delivery9, Irrespective of the method used to analyze [ispub.com]

    However, this current strategy fails to recognize as many as 85% of growth restricted fetuses and although intrapartum monitoring has reduced the incidence of neonatal seizures, the rates of cerebral palsy and neonatal death have not decreased since its [journals.plos.org]

  • Lethargy

    […] tissue may be irreparably damaged. anemic hypoxia due to inadequate supply of hemoglobin in the blood. cerebral hypoxia may be acute or chronic causing either a tremor-convulsion syndrome or one of longer term weakness, ataxia, apparent blindness and lethargy [medical-dictionary.thefreedictionary.com]

Workup

Usually the diagnostic workup is initiated based on the risk factors of the pregnant mother and the presenting signs and symptoms. [xpertdox.com]

Ultrasound

  • Small For Gestational Age Fetus

    Small-for-gestational-age (SGA) infants born at term: growth and development during the first year of life. [aafp.org]

Treatment

Animal studies have suggested the possibility of prophylactic treatment to prevent neuronal loss after the hypoxic event. Intrapartum diagnostic tools should aim for detecting fetal hypoxemia/hypoxia when the fetus is still compensated. [ncbi.nlm.nih.gov]

Mild to severe instances of hypoxic-ischemia encephalopathy can know a 60 percent survival rate with lifelong treatments and monitoring necessary. [wisegeek.com]

Maternal vitamin C (antioxidant) treatment can ameliorate fetal vasoconstriction in hypoxic pregnancies, and therefore has the potential to improve outcomes. [anzsnasm.com]

Prognosis

The presence of seizures indicates a poor prognosis, particularly as further brain damage will likely occur. Related wiseGEEK Articles [wisegeek.com]

In this population, the prematurity and impairment of the placental area proved to have a key role in the prognosis of survival of the newborn. [scielo.br]

Treatment options and prognosis As mentioned, the majority of brachial plexus injuries will resolve spontaneously over the course of several months to a year. [shoulderdystociainfo.com]

One-minute Apgar score usually predicts immediate neonatal outcome of the baby, while 5-minute or later Apgar score is fairly predictive of future mental prognosis of such infant. [easymbbs.org]

Interpreting umbilical cord blood gases and detecting birth asphyxia The most important measurements in a blood gas test for evaluating a baby’s current condition and prognosis are the pH and the base deficit. [abclawcenters.com]

Etiology

Abstract To investigate the hypothesis that chronic fetal hypoxia contributes to the etiology of sudden infant death syndrome (SIDS), a possible interaction between the effect of maternal cigarette smoking and low hematocrit during pregnancy on the risk [ncbi.nlm.nih.gov]

If myocardial depression is severe enough, late decelerations may be absent all together Etiologies of Late Decelerations Excessive uterine contractions Maternal hypotension Maternal hypoxemia (asthma, pneumonia) Reduced placental exchange as in: Hypertensive [perinatology.com]

Such etiologies might be the stretching of the brachial plexus that can occur by the forces of labor (uterine contractions and maternal pushing) and—less likely — intrauterine cerebrovascular accidents (strokes), overstretching of the brachial plexus [shoulderdystociainfo.com]

Epidemiology

OBJECTIVE: The authors examined in an epidemiologic sample the contributions of genetic predisposition and history of fetal hypoxia to hippocampal volume in patients with psychosis. [ncbi.nlm.nih.gov]

The epidemiology of molar pregnancy and choriocarcinoma. Clin Obstet Gynecol 1984; 27: 153. ‎ Pagina 773 - Pediatr 1989:115:105. 56. Boepple PA. Mansfield MJ. Link K. et al. [books.google.ro]

Epidemiology. 2001, 12: 291-294. 10.1097/00001648-200105000-00005. [bmcmedresmethodol.biomedcentral.com]

References: Fetal Distress: Diagnosis, Conditions & Treatment at http://americanpregnancy.org/labor-and-birth/fetal-distress/ Fetal Distress – Pathogenesis, Epidemiology, Presentation, Investigations, Management at http://patient.info/doctor/fetal-distress [medicalfoxx.com]

Epidemiology The overall risk of prompt caesarean delivery needed for fetal concern was shown to be 3.1% in an unselected population [ 1 ]. [patient.info]

Pathophysiology

“If there are more focus on pattern recognition and pathophysiology it all becomes more evident.” [neoventa.com]

Clerici G, Luzietti R, Di Renzo G. " Monitoring of Antepartum and intrapartum fetal hypoxemia: pathophysiological basis and available techniques. "Biol Neonate, 2001; 246-253. 3. Bobrow C, Soothill P. "Causes and consequences of fetal acidosis." [ispub.com]

While a sense of the degree and type of injury can be estimated by physical exam and clinical observation of the baby’s movement limitations, the true extent of brachial plexus injuries and the specific pathophysiology involved can only be definitively [shoulderdystociainfo.com]

It will discuss the clinical consequences of intrauterine hypoxia and how to identify patients that present with placental pathophysiology. [dovepress.com]

Retrieved from https://www.uptodate.com/contents/the-fetal-biophysical-profile https://www.uptodate.com/contents/placental-abruption-pathophysiology-clinical-features-diagnosis-and-consequences Cramping During Pregnancy: Causes, Treatment & Prevention [abclawcenters.com]

Prevention

Animal studies have suggested the possibility of prophylactic treatment to prevent neuronal loss after the hypoxic event. Intrapartum diagnostic tools should aim for detecting fetal hypoxemia/hypoxia when the fetus is still compensated. [ncbi.nlm.nih.gov]

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