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Fetal distress occurs due to a disturbance in the exchange of oxygen between the baby and its mother through the placenta. Doctors speak of fetal distress when they see, through the monitor, that the fetal heart rate is altered during follow-up of delivery. When a doctor suspects the existence of the loss of fetal well-being, measures are taken such as, that the mother change her position or give her oxygen, but if there are no results, then the baby is extracted as soon as possible.
Once born, the Apgar test can reveal the extent of damage that fetal distress has done to the baby. To avoid the serious consequences of the decrease in oxygen.
The causes that can produce an alteration in the oxygen exchange between the fetus and its mother can be maternal, fetal, placental, funicular (umbilical cord) and uterine:
1. Maternal causes. Some maternal conditions involve a decrease in the transplacental supply of oxygen. These conditions can be:
- Arterial hypotension. It involves a decrease in maternal arterial blood flow to the placenta and may be caused by acute bleeding during pregnancy, by the ingestion of hypotensive drugs or by supine decubitus syndrome, which is produced by compression of the inferior vena cava by the pregnant uterus.
- Maternal hypoxia. Certain heart diseases, severe anemia, or respiratory failure can decrease the placental flow of oxygen to the fetus during pregnancy.
- Maternal acidosis. It occurs in pregnant women with insulin-dependent diabetes, which are decompensated.
- Arterial hypertension. Both chronic arterial hypertension (HT) and pregnancy-induced hypertension can lead to delayed intrauterine growth and fetal distress.
2. Placental causes. Certain alterations of the placenta (from heart attacks to placenta previa), placental senescence (proper aging of the placenta in prolonged pregnancy) and placental abruption (the most serious) can lead to fetal distress.
3. Funicular causes. They refer to the umbilical cord. The free circulation of blood in the umbilical cord is necessary for the maintenance of an adequate metabolic exchange between the fetus and the mother. This circulation can be altered when a true knot occurs, a cord wrap around the baby's neck or one of its limbs, or when there is a short cord, which makes it difficult for the baby to exit through the birth canal.
4. Fetal causes. Fetal distress occurs because the quantity or quality of fetal blood reaching the placenta is not adequate. It may be due to fetal hemolytic anemia due to Rh incompatibility or the direct action of a toxin (infections, toxins or radiation).
5. Uterine causes. A tumor or a uterine malformation can also cause fetal distress. Supine decubitus syndrome is common, which occurs in some pregnant women, when they adopt the supine position; the uterus compresses the vena cava against the abdomen (posterior part) and hinders venous return (especially in the case of a voluminous uterus), resulting in a rapid decrease in cardiac output and hypotension, leading to fetal distress. It is common in the third trimester of pregnancy.
When the fetus cannot maintain its homeostasis, injury and cell death occurs. Depending on the number of cells affected, the lesion will be greater or lesser. Three stages can be distinguished in the process of decreased oxygen exchange between the mother and her baby:
- Reversible injury. It is the most frequent. Cell function is affected, but normal function can be restored and does not leave sequelae.
- Irreversible injury. It occurs when there is cell death of parenchyma, which does not regenerate. There are sequelae such as brain injuries.
- Fetal or neonatal death. When the oxygen interruption is intense and lasting, it produces a lesion of parenchyma essential for life, which results in death in utero or hours after birth.
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