Intrauterine hypoxia

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Intrauterine hypoxia
Classification and external resources
ICD-10 P20, P21 (birth asphyxia)
ICD-9 768
DiseasesDB 1416
MeSH D001238

Intrauterine hypoxia (IH, and birth asphyxia) occur when the fetus is deprived of an adequate supply of oxygen. IH is used to describe inadequate oxygen availability during the gestation period, birth asphyxia (also referred to as perinatal asphyxia or Asphyxia neonatorum ) can result from inadequate supply of oxygen immediately prior to, during or just after delivery. There is considerable controversy over the diagnosis of birth asphyxia due to medicolegal reasons.[1][2] Because of its lack of precision, the term is eschewed in modern obstetrics.[3]

IH may be due to a variety of reasons such as cord prolapse, cord occlusion, placental infarction and maternal smoking. Intrauterine growth restriction (IUGR) may cause or be the result of hypoxia. Birth asphyxia may result due to prolonged labor, breech delivery in full-term infants; placental abruption, and maternal sedation in premature infants. Oxygen deprivation is the most common cause of perinatal brain injury.[4]

Intrauterine hypoxia and birth asphyxia can cause hypoxic ischemic encephalopathy which is cellular damage that occurs within the central nervous system (the brain and spinal cord) from inadequate oxygen. This results in an increased mortality rate, including an increased risk of Sudden infant death syndrome (SIDS). Oxygen deprivation in the fetus and neonate have been implicated as either a primary or as a contributing risk factor in numerous neurological and neuropsychiatric disorders such as epilepsy, ADHD, eating disorders and cerebral palsy. " The problem of perinatal brain injury, in terms of the costs to society and to the affected individuals and their families, is extraordinary." (Yafeng Dong, PhD)[5][6][7][8][9][10]

Contents

[edit] Cause

Placenta.svg

There are various causes for intrauterine hypoxia (IH). The most preventable cause is maternal smoking. Cigarette smoking by expectant mothers has been shown to have a wide variety of deleterious effects on the developing fetus. Among the negative effects are carbon monoxide induced tissue hypoxia and placental insufficiency which causes a reduction in blood flow from the uterus to the placenta thereby reducing the availability of oxygenated blood to the fetus. Placental insufficiency as a result of smoking has been shown to have a causal effect in the development of pre-eclampsia. While some previous studies have suggested that carbon monoxide from cigarette smoke may have a protective effect against preeclampsia, a recent study conducted by the Genetics of Pre-Eclampsia Consortium (GOPEC) in the United Kingdom found that smokers were five times more likely to develop pre-eclampsia.[11]

Nicotine alone has been shown to be a teratogen which affects the autonomic nervous system, leading to increased susceptibility to hypoxia-induced brain damage.

Maternal smoking, a preventable cause of intrauterine hypoxia.

[12][13][14][15][16][17]

Maternal anemia in which smoking has also been implicated is another factor associated with IH/BA. Smoking by expectant mothers causes a decrease in maternal nucleated red blood cells (NRBC), thereby reducing the amount of red blood cells available for oxygen transport.[18][19][20]

The perinatal brain injury occurring as a result of birth asphyxia, manifesting with-in 48 hours of birth, is a form of hypoxic ischemic encephalopathy. Treatment of infants suffering 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.

[edit] Epidemiology

Disability-adjusted life year for birth asphyxia and birth trauma per 100,000 inhabitants in 2002

In the United States intrauterine hypoxia and birth asphyxia was listed as the tenth leading cause of neonatal death. Sudden infant death syndrome in which fetal hypoxia has been shown to be a key factor is the third leading cause of death. The World Health Organization (WHO) estimates that globally, between four and nine million newborns suffer birth asphyxia each year. Leading to an estimated 1.2 million deaths and about the same number of infants who develop severe disability. WHO estimates for global neonatal deaths caused by birth asphyxia are 29%.[21][22]

[edit] Financial Costs

Intrauterine hypoxia or birth asphyxia IH/BA was the ninth most expensive medical condition treated in U.S. hospitals by average hospital cost and resultant hospital charge.[23] IH/BA is also a causitive 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.[24][25][26]

Most expensive medical condition treated in U.S. hospitals. 4 out of 10 linked to intrauterine hypoxia/birth asphxia Cost Hospital Charge
1. Infant respiratory distress syndrome $45,542 $138,224
2. Premature birth and low birth weight $44,490 $119,389
6. Cardiac and circulatory birth defects $35,960 $101,412
9. Intrauterine hypoxia or birth asphyxia $27,962 $74,942

[edit] 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).[27]

[edit] References

  1. ^ Blumenthal, I (2001). "Cerebral palsy—medicolegal aspects". Journal of the Royal Society of Medicine 94 (12): 624–7. PMC 1282294. PMID 11733588. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1282294. 
  2. ^ Dhar, KK; Ray, SN; Dhall, GI (1995). "Significance of nuchal cord". Journal of the Indian Medical Association 93 (12): 451–3. PMID 8773129. 
  3. ^ ACOG. Committee Opinion, Number 326, December 2005: Inappropriate Use of the Terms Fetal Distress and Birth Asphyxia. http://www.acog.org/publications/committee_opinions/co326.cfm. Retrieved June 9, 2010. 
  4. ^ O'Brien, JR; Usher, RH; Maughan, GB (1966). "Causes of Birth Asphyxia and Trauma". Canadian Medical Association journal 94 (21): 1077–85. PMC 1935461. PMID 5933054. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1935461. 
  5. ^ Maslova, MV; Maklakova, AS; Sokolova, NA; Ashmarin, IP; Goncharenko, EN; Krushinskaya, YV (2003). "The effects of ante- and postnatal hypoxia on the central nervous system and their correction with peptide hormones". Neuroscience and behavioral physiology 33 (6): 607–11. doi:10.1023/A:1023938905744. PMID 14552554. 
  6. ^ Habek, D; Habek, JC; Jugović, D; Salihagić, A (2002). "Intrauterine hypoxia and sudden infant death syndrome". Acta medica Croatica : casopis Hravatske akademije medicinskih znanosti 56 (3): 109–18. PMID 12630342. 
  7. ^ Bulterys, MG; Greenland, S; Kraus, JF (1990). "Chronic fetal hypoxia and sudden infant death syndrome: interaction between maternal smoking and low hematocrit during pregnancy". Pediatrics 86 (4): 535–40. PMID 2216618. 
  8. ^ Peleg, D; Kennedy, CM; Hunter, SK (1998). "Intrauterine growth restriction: identification and management". American family physician 58 (2): 453–60, 466–7. PMID 9713399. 
  9. ^ Rosenberg, A (2008). "The IUGR newborn". Seminars in perinatology 32 (3): 219–24. doi:10.1053/j.semperi.2007.11.003. PMID 18482625. 
  10. ^ Gonzalez, FF; Miller, SP (2006). "Does perinatal asphyxia impair cognitive function without cerebral palsy?". Archives of disease in childhood. Fetal and neonatal edition 91 (6): F454–9. doi:10.1136/adc.2005.092445. PMC 2672766. PMID 17056843. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2672766. 
  11. ^ Pipkin FB; Genetics of Preeclampsia Consortium. Hypertension. Smoking in moderate/severe preeclampsia worsens pregnancy outcome, but smoking cessation limits the damage. 2008 Apr;51(4):1042-6. Epub 2008 Feb 7. PMID 18259022
  12. ^ Slotkin, TA (1998). "Fetal nicotine or cocaine exposure: which one is worse?". The Journal of pharmacology and experimental therapeutics 285 (3): 931–45. PMID 9618392. 
  13. ^ Bouhours-Nouet, N; May-Panloup, P; Coutant, R; De Casson, FB; Descamps, P; Douay, O; Reynier, P; Ritz, P et al (2005). "Maternal smoking is associated with mitochondrial DNA depletion and respiratory chain complex III deficiency in placenta". American journal of physiology. Endocrinology and metabolism 288 (1): E171–7. doi:10.1152/ajpendo.00260.2003. PMID 15585597. 
  14. ^ Gogiia, TE (2005). "Risk of iugr syndrome development during preeclampsia of the pregnant". Georgian medical news (128): 15–7. PMID 16369054. 
  15. ^ Pipkin FB. et. al.Smoking in moderate/severe preeclampsia worsens pregnancy outcome, but smoking cessation limits the damage. Genetics of Preeclampsia Consortium. PMID 18259022
  16. ^ Salafia, CM; Minior, VK; Pezzullo, JC; Popek, EJ; Rosenkrantz, TS; Vintzileos, AM (1995). "Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features". American journal of obstetrics and gynecology 173 (4): 1049–57. doi:10.1016/0002-9378(95)91325-4. PMID 7485292. 
  17. ^ Kingdom, JC; Kaufmann, P (1997). "Oxygen and placental villous development: origins of fetal hypoxia". Placenta 18 (8): 613–21; discussion 623–6. doi:10.1016/S0143-4004(97)90000-X. PMID 9364596. 
  18. ^ Chełchowska, M; Laskowska-Klita, T (2002). "Effect of maternal smoking on some markers of iron status in umbilical cord blood". Roczniki Akademii Medycznej w Bialymstoku (1995) 47: 235–40. PMID 12533965. 
  19. ^ Habek, D; Habek, JC; Ivanisević, M; Djelmis, J (2002). "Fetal tobacco syndrome and perinatal outcome". Fetal diagnosis and therapy 17 (6): 367–71. doi:10.1159/000065387. PMID 12393968. 
  20. ^ Pathology of the human placenta By Kurt Benirschke, Peter Kaufmann. page 453. Publisher: Springer; 4th edition (March 23, 2000) Language: English ISBN 0387988947 ISBN 978-0387988948
  21. ^ National Center for Health Statistics
  22. ^ Bang, AT; Bang, RA; Baitule, SB; Reddy, HM; Deshmukh, MD (2005). "Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitating with mouth-to-mouth, tube-mask or bag-mask". Journal of perinatology : official journal of the California Perinatal Association 25 Suppl 1: S82–91. doi:10.1038/sj.jp.7211275. PMID 15791282. 
  23. ^ Hospital Review
  24. ^ Rueda-Clausen, CF; Morton, JS; Davidge, ST (2009). "Effects of hypoxia-induced intrauterine growth restriction on cardiopulmonary structure and function during adulthood". Cardiovascular research 81 (4): 713–22. doi:10.1093/cvr/cvn341. PMID 19088083. 
  25. ^ Sly, PD; Drew, JH (1981). "Massive pulmonary haemorrhage: a cause of sudden unexpected deaths in severely growth retarded infants". Australian paediatric journal 17 (1): 32–4. PMID 7247876. 
  26. ^ Hyaline Membrane Disease eMedicine
  27. ^ National Practitioner Data Bank 2006 Annual Report

[edit] External links

Certain conditions originating in the perinatal period / fetal disease (P, 760–779)
Maternal factors and
complications of pregnancy,
labour and delivery
Length of gestation
and fetal growth
Birth trauma
By system
Infectious
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