1. Placental insufficiency: diagnostics and
treatment.
Methods of investigation of placenta.
Fetal hypoxia.
Asphyxia of newborn.
Lecture by Andriy Berbets
2. Placental insufficiency
This is complex of disorders of
trophic, endocrine and metabolic functions of
placenta.
It causes inability to maintain the interchange
between mother and fetus
The syndrome has multifactorial genesis
9. Forms of placental insufficiency:
• Hemodynamic, provoked by disorders of
uterine-placental blood flow;
• Membranous – placental membranes are unable
to transport metabolits;
• Cellular, linked with decreased metabolic
activity of placental cells
13. Hypoxia of fetus
• It’s one of the main complications of pregnancy with
frequency 4-6%
• It’s the most common reason of antenatal and intranatal
death of fetus
• “Hypoxia” means insufficient oxygen supply and/or
utilization by tissues
14. Hypoxia classification
4 types
• 1. Hypoxic (low concentration of O2 in the blood)
• 2. Circulatory (disorder of transporting of the oxygen when
its blood concentration is normal)
• 3. Hemic (level of hemoglobin is decreased)
• 4. Tissue (low utilization of oxygen by tissues)
15. Severity of hypoxia:
Functional – mild form: only hemodynamic changes
(tachycardia, increased blood pressure)
Metabolic – moderate form (reversible tissue
changes)
Destructive – severe form, irreversible tissue
changes
18. Diagnostics of fetal hypoxia
• Cardiotocography
• Ultrasound and biophysical profile of fetus
• Test of fetal movements
• Ultrasound placentography and measurement of
its maturity
• Hormonal examination (including colpocytology)
• Cordo- and placentocentesis etc
19. Correction of fetal hypoxia
• Improvement of the blood perfusion
• Normalization of metabolism
• Improvement of oxygen interchange
• Blood vessels dilatation
• Uterus muscle relaxation
20. Asphyxia – it’s a syndrome characterized by
absence of breathing movements but with
presence of heartbeat of fetus
Classification:
1. Central (suppression of breathing centre)
2. Peripheric
3. May be caused by trauma, immaturity of fetus
nervous system, pharmacological depression
etc.
4. May be cased by lungs, heart dysfunction or
anemia
22. 3 degrees of asphyxia
Mild, moderate, severe
Apgar score 6-7 (1st min) – mild
Apgar score 5-4 (1st and 5th min) – moderate
Apgar less 3 – severe
Three stages of reanimation of the newborn
1 ABC-reanimation
2 Intensive therapy
3 Reabilitation
АВС-steps
А- airways
В- breathing
С-circulation
23. А-step
1. To put the newborn in the correct position
2. Free the nose, mouth and trachea (if needed)
3. Intubation (if needed)
В-step
1. Tactile stimulation to cause breathing
2. Artificial breathing (if needed)
• Bag and mask ventilation
• Trachea intubation (if needed)
C-step
1. To support blood circulation
2. Indirect heart massage
3. Treatment by medication
Don’t forget about “heating chain”!
25. Assessment of efficacy of
reanimation
Breath evaluation
• If spontaneous breathing is present, we can
access the ECG
• If no spontaneous breath movements are
present, we start artificial breathing with
90-100 % of oxygen
26. Heartbeat evaluation
Heartbeat (HB) is more then 100 per min:
1. If there is spontaneous breathing, and HB is more then
100/min, we stop artificial breathing (AB) and evaluate cyanosis
of the skin
2. If there is no spontaneous breathing, we continue AB
3. If there is less then 100 HB per min, AB has to be continued:
• Heartbeat is 60-100 beats – continue AB
• Heartbeat is less then 60 min – indirect heart massage
27. Indications for intubation:
• Long-time AB
• Aspiration by meconium
• Diaphragmal hernia
• No effect from bag/mask artificial breathing
Medication for C-step
• Adrenalin
• Infusive solutions
• Solution of soda (NaHCO3) for acidosis correction
• Antagonists of narcotic drugs (naloxon 0.1 mg/kg)
i.v. or per os
