Intrapartum fetal death: causes, methods of prevention

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

It is not for nothing that doctors carefully monitor the condition of their patients throughout the entire period of pregnancy. The slightest he alth problems of the mother can lead to serious deviations in the development of the fetus. Some of them are incompatible with life and lead to fetal death during pregnancy. It is referred to as "antenatal death". If it occurs at the time of childbirth, then this is intranatal fetal death (according to ICD-10, the code is O36.4.). A deeper consideration of this issue may be of interest not only to doctors, but also to future parents.

Etiology

Studying the causes of intrapartum fetal death allows doctors to develop new, effective methods of prevention. In the antenatal phase, the fetus can die from dozens of different problems. This includes toxicosis of the second half of pregnancy, immunological incompatibilitybetween the mother and fetus. As you can see, in order to provide for everything, a woman needs to be kept in a hospital and a complete, comprehensive examination should be carried out. Add here what is quite difficult to predict, placenta previa, prenatal discharge of water and other pathological processes.

To separate antenatal death from intrapartum, upon admission to the maternity hospital, a woman is connected to a CTG machine, and her heartbeat is heard. If the condition of the fetus does not cause concern, then the card notes that at the time of the onset of labor, there is a live fetus in the uterus. Now the joint task of the mother and doctors is to save him until the birth.

The concept of "stillbirth"

At first glance, it is simple, but it turns out to be quite capacious. If the fetus has not taken its first breath, it will be considered stillborn. At the same time, if a heartbeat or other signs of life are observed, then resuscitation measures are taken. And here it is important to separate the concepts of intranatal fetal death or antenatal.

All this we are talking about a fetus that was born at a period of at least 28 weeks and weighing at least 1 kg. With delivery at an earlier date, this will be a miscarriage. In this case, signs of life will not matter.

Surveillance history

In order to properly establish the chain of events and see if it really was an intrapartum fetal death, obstetricians keep detailed records of observations of the pregnant woman. If the heartbeat is heard until admission tothe delivery room, but a child is born without signs of life, which means that something happened at the very last moment. And here it is already necessary to understand whether a medical error was made or the features of development and presentation led to intrapartum death of the fetus.

Stillbirth can be antenatal if cardiac arrest occurs between 28 weeks and up to the day of delivery. It may be due to abnormalities of the fetus and placenta. No doctor can predict all possible scenarios, despite the most thorough examination.

Prevention

Unfortunately, intrapartum fetal death cannot be predicted or prevented. The entire staff of the maternity hospital is working to prevent this event, to help the baby be born alive and he althy. But preventive measures begin long before the arrival of a woman in labor with contractions in the hospital. To a large extent, they consist in protecting the he alth of a woman throughout all 9 months, as well as in the careful and professional conduct of childbirth. This applies to both those that proceed normally and pathological.

Difficulty of the question

Intranatal fetal death is still being studied. Each such case is a tragedy for the mother and an unpleasant event for all physicians who accompany pregnancy. But at the same time, it provides new material for research that can be used to prevent this from happening in the future.

Pathological processes that can occur inbody of mother and fetus. It is very important for a woman to take care of her he alth, to undergo an examination before conception and cure all chronic diseases.

Main reasons

Intranatal fetal death is a consequence of a violation of the birth process. And most often the main role is played by asphyxia. It is usually secondary, as it follows from a variety of diseases and their complications. Infections (flu, typhoid, pneumonia), chronic diseases (malaria and syphilis) are of great importance. Intoxication of various etiologies, acute poisoning, toxicosis, and exposure to various kinds of drugs also affect. Violation of cerebral circulation of the fetus and intracranial injuries leave little or no chance of survival. Therefore, the combination of asphyxia and birth trauma is considered the most dangerous.

Complications during childbirth

They don't always go smoothly. Sometimes the pregnancy goes well, the baby and mother are he althy, but upon admission to the hospital, bleeding suddenly opens, the umbilical cord falls out, or a number of unplanned complications arise that require an immediate response from doctors.

Among the causes of intranatal fetal death are complications of childbirth with a narrow pelvis, incorrect position (transverse or oblique). The birth process itself may not go as nature intended. Here you can highlight the incorrect insertion of the head and various complications of childbirth. Intranatal fetal death can occur in violation of the technique of obstetrics. In a home birth accompanied by an incompetent assistant, suchthe probability multiplies.

Pathologies of the birth process

As you can see, the topic is deep and very capacious. Intranatal fetal death (ICD-10 - O36.4.) is most often associated with intrauterine asphyxia, that is, oxygen starvation. This is usually caused by pathology of the placenta, such as its premature detachment. In second place in frequency - umbilical cord pathology.

With intrapartum fetal death, fetal maceration and placental ischemia are usually absent. Hydrostatic tests are negative, but may be positive in some cases. The most common causes of fetal death during childbirth include the following:

1. Asphyxia.
2. Skull injury.
3. Subdural hemorrhages.
4. For fetal position anomalies.
5. Water breaks before labor starts. Normally, they are designed to facilitate the exit of the fetus and its passage through the birth canal.
6. A large fetus with a narrow pelvis of a woman.
7. Rapid delivery. This is also a pathology of the birth process, when the cervix instantly opens, and a child is born in a few minutes. Because of this, childbirth occurs in a public toilet, in a store. Mom does not have time to do anything, it remains only to take the most comfortable position and figure out how to tie the umbilical cord.
8. Birth injury of the spine is less common.

Fetal presentation

During pregnancy, a woman visits ultrasound three times, where the presentation of the fetus is necessarily fixed. Until 28 weeks it doesn't matter.because the fetus is still moving freely in the uterus. Already after 30 weeks, a third of women out of 100 have a fetus in breech presentation. And closer to childbirth, only 1-3 of them retain their position. The rest are turned head to the cervix. It is this position that ensures the physiological passage through the birth canal.

Intranatal fetal death in breech presentation was common a few decades ago. At the same time, in some cases, the child was born without complications, but in others, the extension of the arms and the tilting of the head occurred, and the fetus could not pass through the cervix. Today, in addition to cesarean section, a fairly large number of childbirth techniques are practiced, which are designed to facilitate the passage of the fetus to minimize the risk of asphyxia.

Patological anatomical diagnostics

After the birth of a dead fetus, the doctor must examine the body and make a conclusion about when death occurred. A lot can already be said even from outward appearances. And here it is clearly possible to trace the boundaries of antenatal and intranatal fetal death. With intrauterine death before the onset of the birth period, a pronounced maceration of the skin is observed. That is, the fetus began to decompose even in the uterine cavity. In case of death during labor, this cannot be (in extreme cases, it may be present on small areas of the skin).

That is, pronounced maceration can be considered a sign of stillbirth. The placenta due to the termination of the fetal and the preservation of the maternalblood circulation becomes anemic as a result of compression of its vessels. It is also an important research material. It allows you to understand what happened, at what stage the fetus stopped its vital activity. And also to study in detail what it is - intrapartum fetal death.

Some statistics

The problem of infant mortality is acute for modern medicine. The figures are gradually declining, today many fewer children die in childbirth than 50 years ago. But still, its level remains quite high. Intranatal losses, along with antenatal losses, cause significant damage to society, reducing the participation of each generation in the process of social production by about 2%.

Analysis of risk factors suggests that this is most often the case in cases of late pregnancy. Intrapartum fetal death is most common in the 32 to 36 age group. There were more housewives in the group of women who lost children during childbirth than working ones. The advantage in the sample remained with women with a secondary education or a working speci alty. The presence of bad habits was recorded in 29% of women. Approximately 20% of heredity was aggravated by cancer, endocrine pathology, mental illness and alcoholism.

For 80% of women, intrapartum death is a great tragedy, as the child was long-awaited and very desired. Only a fifth of the patients were not registered at the dispensary for pregnancy. The majority, namely 97%, regularly visited a doctor and followed all the recommendations. At the same time, the majority (55%) had a high risk of perinatal risk in the card.

Diagnosed diseases

More than half of the patients had serious cardiovascular disease. In 68% of cases, the gestational period was complicated by anemia. Approximately 14% of cases are due to endocrine pathologies, underweight or obesity. In 43%, the pregnancy proceeded against the background of SARS. 24% had a history of pyelonephritis. Of course, this does not mean that in the presence of such diseases during childbirth there will be a similar outcome. But it is necessary to warn about chronic ailments. Sometimes ignoring such a simple rule leads to tragedy. Fortieth week, difficult labor, dead baby, but do a caesarean at 38 weeks and a life would be saved.

Conclusions

They are not final at all. The study of the causes, diagnosis and prevention of intrapartum fetal death is a whole direction in the work of dozens of specialists in the field of obstetrics, obstetrics and gynecology, neonatology. Even though infant mortality during childbirth has declined, it still requires close attention.

The most significant risk factors are: early onset of sexual activity, aggravated obstetric and gynecological history (induced abortions), cardiovascular pathologies and anemia, infectious diseases during pregnancy, polyhydramnios, threatened miscarriage, genital infections. Premature birth is also considered a potential threat, because for some reason the body decided to get rid offrom the fetus ahead of time.

We should not forget that today few people give birth at home. This usually happens in a specialized department where doctors take delivery. On the one hand, this is good and right. On the other hand, the human factor cannot be written off in this case. During a shift, a dozen women pass by one doctor, each of which is painful and scary. And he has his own problems, he wants to quickly leave home. Of great importance are the damage inflicted on the fetus under conditions of "obstetric aggression". There have been studies that have shown that fetal loss occurs most frequently in the second stage of labor, the period of active obstetric care.

That is why a new concept is being developed today, according to which doctors are required to maintain maximum distance and intervene in the course of childbirth only when necessary. In this regard, they also conduct courses for expectant mothers, so that when they enter the maternity ward, they know what they will face and do not panic.

Instead of a conclusion

Today, a serious problem facing modern medical institutions was considered. The death of a fetus during childbirth is a heavy blow for every woman, because most often this is a desired and already beloved child. In this regard, the topic should be studied further, and the conclusions drawn should be reported to doctors. Gradually, the percentage of intrapartum losses should decrease.