|Classification and external resources|
|ICD-10||P20, P21 (birth asphyxia)|
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. Because of its lack of precision, the term is eschewed in modern obstetrics.
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.
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)
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.
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.
The perinatal brain injury occurring as a result of birth asphyxia, manifesting within 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.
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%.
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. 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.
|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|
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).
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- Hyaline Membrane Disease eMedicine
- National Practitioner Data Bank 2006 Annual Report
- Hypoxic-Ischemic Brain Injury in the Newborn
- Hypoxic-Ischemic Encephalopathy
- Smoking and Pre-eclampsia
- Clear Criteria for Defining Birth Asphyxia