Asphyxia of the fetus and newborn

Asphyxia may occur at various diseases of a mother and complications of childbirth (internationa asphyxia)involving violation of placental circulation and gas exchange of the fetus. There are menacing and developing asphyxia fruit. While threatening symptoms of asphyxia asphyxia yet, but there are signs that indicate a change of reactivity of the fetus (increased or decreased physical activity, lack of response cardiac activity when conducting functional tests: breath mother at the height of inhalation and exhalation, irritation cold skin of the abdomen). More distinct and often observed symptoms of the developing fetal asphyxia fruit are: the increase of heart fruit-more than 150 beats per 1 min.
(OK 120-140 beats per 1 min); ischemia heart rate less than 120 beats per 1 min, not aligned in pauses between contractions (trouble) for 30 seconds. after their completion; violation of heart rate; deafness heart sounds, noises; discharge meconium (in childbirth in the pelvic presentation meconium can be squeezed out mechanically and discharge it in the period of exile is no evidence of asphyxia fruit). The clearest indicator of asphyxia is a heart disorder of the fetus, therefore, systematic listening to the fetal heart sounds great importance for the detection beginning of asphyxia and steps taken towards its elimination. With the advent of primary, even nerezko expressed signs of asphyxia is necessary to start fighting with her. At diseases of a mother and complications of childbirth, leading to disruption of gas exchange fruit, carry out preventive measures even before occurrence of a change of heart activity of the fetus and other symptoms of asphyxia.
For the prevention and treatment of asphyxia fruit are the most rational methods of Khmelevsky, Nikolaev, Persianinova.
Method Khmelevsky: at the beginning of asphyxia fruit intravenous mother 40-50 ml of 40% solution of glucose with 2% solution of ascorbic acid and 5-10 ml 10% solution of chloride calcium. In addition, assign inside to 100 g of glucose, 2 g of calcium chloride, 0.5 g ascorbic acid, 30 mg, thiamine-bromide (vitamin B1) and 8 drops diluted hydrochloric acid on a half-glass of water.
Method Nikolaeva: with the appearance of signs of asphyxia fruit pregnant or give birth mother to breathe oxygen through every 5 minutes for 10 min. to the steady improvement of cardiac sounds of the fetus. Simultaneously injected 50 ml of 40% glucose solution and 300 mg of ascorbic acid. Glucose can be given orally (50 grams of glucose dissolved in 1 Cup of hot water). Intramuscularly administered 1 ml of 10% solution of koratala (cardiazol). If necessary, all this can be repeated after 15 minutes or later. Method Persianinova: intravenous mother 150-200 ml of 5% solution of bicarbonate (bicarbonate) sodium and 100-200 ml 10-20% glucose solution (solution injected separately). Re-introduction of the solution sodium bicarbonate you through 11/2-2 hours, since by this time the action of alkaline solutions stops. Effective for the treatment of intrauterine asphyxia and intravenous administration of 2 ml of 2% solution of sigutina. If the measures of combating asphyxia fruit do not give proper effect, it is necessary to resort to the acceleration of delivery. Method of delivery depends on the conditions existing in each particular case.
Newborn asphyxia is characterized by the fact that the child born alive (heart sounds are heard), breathing does not appear at all or only some of the irregular surface of the respiratory movements. There are two forms of newborn asphyxia: a light, or blue, and heavy, or white. When the blue asphyxia the skin and mucous membranes of the child of cyanotic, reflexes decreased heart rate slowed, tone muscles satisfactory. We were born in a white asphyxia pale skin, mucous membranes of cyanotic, cardiac activity weakened sharply, reflexes sharply lowered or absent, the muscles are relaxed.
For the revival of the children born in asphyxia, first of all you must release the respiratory tract of mucus rubber cylinder or suction unit (foot, water, electric suction and so on). Childbirth in the head previa remove mucus is better to start from the moment of birth of the head. For the revival of the newborn apply methods of Legenchenko, Persianinova, Negovskaya.
Method Legenchenko: the umbilical cord is not bandaged, and newborn continues to receive oxygen from the mother through the placenta. To the child did not cool down, his warmth with the reflector or bath with warm water (the optimum temperature of the environment for the newborn - 35-37 degrees). To accelerate the elimination of phenomena asphyxia method Legenchenko can be combined with other measures, designed to reflex stimulation of the respiratory centre (spray cold water, inhalation of vapours of liquid ammonia and other). Method Persianinova - introduction to the artery of umbilical cord hypertonic solutions of calcium chloride (10% 3 ml) and glucose (40% 5-7 ml) can be applied and when neperevyazannymi the umbilical cord after the separation of the child from the mother. Method Negovskaya is to use hardware artificial respiration (see).
Methods of Legenchenko and Persianinova effective asphyxia, easy, and in some newborns with asphyxiation moderate severity. In severe asphyxia the midwife should start a revival with artificial breath of his mouth in a mouth. If you have the proper equipment use respirators. At the same time introducing artery of umbilical cord solution of calcium chloride.
When the child is born in a state of asphyxia along with measures of its recovery in the umbilical vein, you must enter 10-25 ml of 5% sodium bicarbonate solution and 10 ml of 10% glucose solution. The number of input child alkaline solution is determined by its weight and the severity of asphyxia. In light of asphyxia and low weight (up to 3000 g) to introduce 10 ml of 5% sodium bicarbonate solution, with an average weight (3000 - 4000 g) - 15 ml and large (over 4000 g) - 20 ml If the child is born in severe asphyxia, depending on weight enter respectively 15 - 20-25 ml of 5% sodium bicarbonate solution.

Asphyxia of the fetus and newborn occurs when the termination or sudden flow of oxygen from the mother's blood in the body of the fetus or not breathing newborn, which is not separated from the mother. Hypoxia of a fetus accompanied by the development in utero, often intrapartum, asphyxia. When the newborn asphyxia breath is missing or is expressed in a separate irregular or surface respiratory movements in the presence of cardiac activity.
Causes asphyxia: 1) the lack of oxygen and excess carbon dioxide or oxygen deficiency in the mother (acute blood loss, shock, cardiovascular diseases, intoxication, diseases of respiratory organs and blood system); 2) difficulties blood circulation in the vessels of the umbilical cord and violations of uteroplacental circulation pathology of the umbilical cord and placenta, toxemia of pregnancy, postmaturity, the anomaly of labor activity and others); 3) diseases of the fetus and violations of its functions the Central nervous system (malformations and birth trauma with lesions of the brain and spinal cord, severe form of congenital heart disease, hemolytic disease, listeriosis and other infectious diseases); 4) the full or partial obstruction of the Airways at birth.
Diagnostics. It is advisable to distinguish threatening asphyxia fruit - the state when the symptoms of asphyxia no, but there are such diseases pregnant, which can lead to intrauterine asphyxia, and signs that indicate a change of reactivity of the fetus. When started asphyxia, changes, pointing to hypoxia of the fetus: palpitations (in the intervals between contractions over 160 beats per 1 min), strengthening the sonorous tones of the heart, which remains clear and rhythmic, the strengthening of the movements of the fetus. More severe asphyxia accompanied wrong rhythm and change ucashenie heart rate slowing down to 100 beats per 1 min. and below, the change of power and sonorous tones, which are determined by the strong, weak, deaf and fuzzy. The behavior of the fetus becomes restless, movement frequent and severe. In the amniotic fluid appears meconium. Finally, asphyxia goes into the past, terminal, when the fetus is threatened with danger of death. However, there is a strong deceleration of the fetal heart, heart sounds become deaf, the admixture of meconium to amniotic waters increases, fetal movement slowed and then stopped.
Prevention and treatment of asphyxia of the fetus and newborn consist in eliminating the complication of pregnancy and childbirth, correct and careful management of labour, regulation of labor activity on the evidence, the timely use of therapeutic activities and obstetric operations with account of the interests of mothers and children. While threatening and began A. use the triad Nikolaev (oxygen, cardiazol, glucose, ascorbic acid); intravenous 2 ml of 2% solution of sigutina. Accelerating at the same time delivery, it should stand A., not amenable to therapeutic influences, to raise the issue of urgent and careful delivery (weekends and abdominal tongs, removing the fetus for pelvic end, when adverse obstetric situation caesarean section).
Asphyxia newborns observed in 4-6% of births. By severity there are 3 degrees: I degree ("blue" asphyxia) is characterized by severe skin cyanosis of the newborn, slow heart beats, rare and superficial breath. With II degree A. the skin of the baby sharply cyanotic (libidna A.), palpitations or significantly slowed sharply, heart sounds when listening with a stethoscope deaf irregular at sonority, breathing is absent. At the III degree ("white", or "pale", asphyxia) newborn baby is not breathing, his pale skin, mucous membranes of cyanotic, palpitations very slow, often ritmichno, the colours are deaf, muscle tone and reflexes are absent, limbs hanging as a whip. A. newborns often combined with intracranial hemorrhage.
When deriving a newborn A. compulsory and immediate event is the release of the respiratory tract of the child from the amniotic fluid and mucus. The extraction of fluids perform better using a catheter with a Central hole (Fig. 1)connected with any aspirator (water, electric or foot suction). Instead of previously used the manual method of artificial respiration, traumatic for the newborn and useless in USSR at the present time for the revival of the babies born in A., applied methods of Legenchenko, Persianova hardware and artificial respiration by the method Negovskaya.

Fig. 1. The release of tracheal mucus from using elastic catheter.

Method Legenchenko is that born in newborn asphyxia not separated from their mother and he continues to receive from it the oxygen gradually leaving A. According to HP Persianinova, about 60% of newborns of the number of newborn asphyxia in the I and II degrees off after the liberation of the respiratory tract of mucus, and amniotic fluid when using the method of Legenchenko for 3-4 minutes In the absence of rapid positive effect from the use of this method you should use other methods of recovery.
Method Persianinova based on the involvement in the process of restoration of the vital functions of the organism nerverending mechanisms, the initial element of which is the irritation nerveracking apparatus of the vascular wall. The latter is called chemical elements fluid injected into the artery under high pressure. The resulting pulse reflex tone vascular system, increase the reactivity of the nerve centers and contribute to the improvement of heart activity and recovery breathing by not only the reflex excitation of the respiratory centre, but also resume and improve blood circulation in the medulla.
Techniques: neperevyazannymi the umbilical cord lightly squeezing two fingers at a distance of 8-10 cm from the umbilical ring; artery filled with blood starting to Shine through Vartanova jelly as blue twisted cords and Vienna subsided. Sharp needle, put on a syringe filled with 3 ml of 10% solution of calcium chloride, under the acute angle dotted line in the artery at the distance of 6-8 cm from the umbilical ring (Fig. 2). When the needle hits the lumen of the artery, in the syringe displayed a streak of blood; at this point Tacloban individual portions introduce a solution of calcium chloride. If this measure does not provide the desired effect, you should not lose time and to enter through the same needle with another, prepared syringe 5-7 ml of 40% glucose solution.

Fig. 2. The revival of a child born in asphyxia, introduction in the umbilical artery 3 ml of 10% solution of calcium chloride in neperevyazannymi the umbilical cord.

In the absence of visible ripple to functionate the umbilical artery through Vartanova jelly fails. In such cases, hypertonic solutions of calcium chloride and glucose is injected into the artery of umbilical cord after the separation of the child from the mother. This edge of the cross-cut the umbilical cord keep clip Piana. Blunt needle, cut in the transverse direction, light rotational movements enter in one of the arteries of 1.5-2 cm, the umbilical cord together with needle capture clip Kocher, who captures well the needle in the arteries (Fig. 3). Then the needle attached to a syringe and injected the above solutions of calcium chloride and glucose. In rare cases (when a sudden heart disorder) it is necessary to resort to the introduction into the same artery 35-40 ml 0(1) the group of canned rhesus negative blood pulsator under changing pressure (from 100 to 220 mm). The introduction of blood in the small portions with a thin needle and narrow the lumen of the artery does not overload the heart and does not require the extraction of venous blood.
According to the summarized data from 6670 babies born at asphyxia, method Persianinova was quickened by 93,6% and was discharged in satisfactory condition 91,4%.
The method of artificial respiration with the help of apparatuses of physiologically substantiated. It leads to the smoothing of the lungs, oxygen saturation and reflex (through the end of the vagus nerve on Tina reflex of Hering - Breuer) initiate breathing centre (C. A. Negovsky). For artificial respiration use: a manual machine, RD-1 and breathing apparatus DP-5 with electric motor (Fig. 4). C. A. Negovsky recommends unfolding not breathing of the lungs at the beginning of carrying out of artificial breath create the pressure to 30-40 mm RT. Art. (10-12 breaths), then down to 15-20 mm at frequency breaths 24-35 in 1 min. blown into the air into the lungs through the incubation metal tube. C. F. Matveev And M. I. Koretsky believes that to intubirovti newborn difficult and traumatic; the authors recommend the use of masks and use of incubator only in the case of particularly severe asphyxia and clinical death.

Fig. 3. Introduction in the umbilical artery solution of calcium chloride.
Fig. 4.A - manual breathing apparatus, RD-1, B - breathing apparatus DP-5 with motor: 1 - expiratory valve, 2 - pressure regulator 3 - frequency control, 4 - manometer; In - foot sucking a-1; D - masks; D - incubatory.

Great importance is the rapid elimination of newborn asphyxia. Therefore, you should begin with the application of the method of Legenchenko, spending at this time of the liberation of the respiratory tract. If after that, when A. I and II degree for 3-4 minutes does not appear breath, then, not separating the child from the mother, is injected into the artery of umbilical cord solutions of calcium chloride and glucose, and with the failure of these measures do not use hardware artificial respiration. When white A. provide hardware artificial respiration in combination with the method Persianinova immediately after the liberation of the respiratory tract.
After removal of the newborn asphyxia provide full calm, careful monitoring, supply humidified oxygen (oxygen pillow or tent, incubators, etc.,), appoint mustard pack, antibiotics. When events atelectasis or secondary A. re-use of hardware artificial respiration with the aid of the mask. With symptoms of intracranial hemorrhage resulting A. and injury appropriate intramuscular administration of chlorpromazine rate of 1 to 2 mg/kg / day (0.3 to 0.5 ml of 0.25% solution in 4-6 hours).