Intrauterine hypoxia

Intrauterine hypoxia
placental infarct (left of image), a cause of intrauterine hypoxia. H&E stain.
Specialty	Pediatrics

Intrauterine hypoxia (also known as fetal hypoxia) occurs when the fetus is

Complications arising from intrauterine hypoxia are some of most common causes of preeclampsia.[8] Preeclampsia is a hypertensive disorder that occurs during the second trimester (after the 20th week of pregnancy) resulting from a poorly perfused placenta.^[9] The World Health Organization estimates that preeclampsia and eclampsia are responsible for about 14% of maternal deaths globally (around 50,000 to 75,000 deaths annually).^[10]

During pregnancy, women with preeclampsia faces serious risk of damage to vital organs such as the kidneys, liver, brain, and the blood system. This hypertensive disorder may also cause damage to the placenta leading to issues such as

Intrauterine hypoxia can be attributed to maternal, placental, or fetal conditions.^[12] Kingdom and Kaufmann classifies three categories for the origin of fetal hypoxia: 1) pre-placental (both mother and fetus are hypoxic), 2) utero-placental (mother is normal but placenta and fetus is hypoxic), 3) post-placental (only fetus is hypoxic).^[13]

Pre-placental hypoxia is most commonly caused by external hypoxic environments (such as high altitude). It can also be caused by maternal respiratory conditions (such as asthma), cardiovascular conditions (such as heart failure, pulmonary hypertension, and cyanotic heart disease), and hematological conditions (such as anemia).^[14] Conditions such as obesity, nutritional deficiencies, infections, chronic inflammations, and stress can also affect the maternal oxygen supply and fetal uptake.^[12]

The most preventable cause is maternal smoking.

Utero-placental hypoxia is associated with abnormal placental implantation, impaired vascular remodeling and vascular diseases.^[14] It is also associated with pregnancies complicated by gestational hypertension, intrauterine growth restriction, and pre-eclampsia.^[25][26]

Post-placental hypoxia is associated with mechanical obstructions of the umbilical cords, reduced uterine artery flow, progressive fetal cardiac failure, and genetic anomalies.^[12][14]

The perinatal brain injury occurring as a result of birth asphyxia, manifesting within 48 hours of birth, is a form of hypoxic ischemic encephalopathy.^[27]

Diagnosis

This section is empty. You can help by adding to it. (October 2021)

Treatment

Treatment of infants with birth asphyxia by lowering the core body temperature is now known to be an effective therapy to reduce mortality and improve neurological outcome in survivors, and hypothermia therapy for neonatal encephalopathy begun within 6 hours of birth significantly increases the chance of normal survival in affected infants.^[28]

There has long been a debate over whether newborn infants with birth asphyxia should be resuscitated with 100% oxygen or normal air.

Underlying etiology of intrauterine hypoxia serves as a potential therapeutic target. If maternal preeclampsia[34] is the underlying cause of fetal growth restriction (FGR) antihypertensive therapy and magnesium sulfate are potential therapies.^[12] Antihypertensive treatment is used to reduce blood pressure and prevent pulmonary edema and cerebral hemorrhages. An effective course of antihypertensive treatments should reduce blood pressure to below 160/110 mmHg. Magnesium sulfate acts as a vasodilator, reducing vascular resistance and protect the blood-brain barrier (BBB). The goal of these treatments is to prolong pregnancy and increase fetal survival. Each day gained by treatment in utero increases fetal survival and intact survival by 1%–2% up to 28 weeks gestation.^[35]

Prevention

Medical testing and care can be performed in order to prevent intrauterine hypoxia, though can be difficult. These tests don't directly detect hypoxia, but instead detects the general well-being of the baby and ensures that the baby is healthy since hypoxia causes a wide range of responses. These tests can include prenatal testing, such as fetal movement and amniotic fluid levels, Doppler examination, or fetal heart rate.^[36] Another risk factor is premature birth in which medical intervention, such as premature birth prevention or C-section delivery, can be used as prevention for intrauterine hypoxia.^[37]

Studies have shown a connection between tetrahydrobiopterin (BH₄) deficiency and hypoxia-ischemia brain injury, though further studies need to be done.^[38] Measuring fetal BH₄ levels can be another way to look out for intrauterine hypoxia.^{[citation needed]}

During birth, birth asphyxia can occur in which cardiotocograph can be used to monitor the baby's health during labor.^[39]

Epidemiology

In the United States, intrauterine hypoxia and birth asphyxia were listed together as the tenth leading cause of neonatal death.^[40]

Society

IH/BA is also a causative factor in cardiac and circulatory birth defects the sixth most expensive condition, as well as premature birth and low birth weight the second most expensive and it is one of the contributing factors to infant respiratory distress syndrome (RDS) also known as hyaline membrane disease, the most expensive medical condition to treat and the number one cause of infant mortality.^[41][42][43]

Medicolegal

In the United States the National Practitioner Data Bank 2006 Annual Report obstetrics-related cases accounted for 8.7 percent of all 2006 physician Malpractice Payment Reports and had the highest median payment amounts ($333,334).^[44]

References