Not for nothing that the entire period of pregnancy, doctors carefully monitor the condition of their patients. The slightest health problems of mothers can lead to serious abnormalities in the development of the fetus. Some of them are incompatible with life and lead to fetal death during pregnancy. It is denoted by the term "antenatal death". If it occurs at the time of birth, then this is the intranatal death of the fetus (according to ICD-10, the code has O36.4.). A deeper discussion of this issue may be of interest not only to doctors, but also to future parents.
Etiology
Studying the causes of intranatal 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 incompatibility between the mother and the fetus. As you can see, in order to foresee everything, a woman needs to be kept in a hospital and a full, comprehensive examination is required. Add here what is rather difficult to predict, placenta previa, prenatal discharge of water and other pathological processes.
To separate the antenatal and intranatal deaths, upon admission to the hospital, a woman is connected to the CTG apparatus and the heartbeat is heard. If the condition of the fetus does not cause concern, then the card indicates that at the time of the onset of labor, a living fetus is in the uterus. Now the joint task of the mother and the doctors is to preserve it until it is born.
The concept of "stillbirth"
At first glance, it is simple, but it is quite capacious. If the fetus has not taken its first breath, it will be considered stillborn. Moreover, if there is a heartbeat or other signs of life, then resuscitation measures are carried out. 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, it will be a miscarriage. However, signs of life will not matter.
Observation history
In order to correctly establish the chain of events and to track whether it was really the intrapartum death of the fetus, obstetricians keep detailed records of observations of the pregnant woman. If the heartbeat is heard until entering the birth ward, but a child appears without signs of life, then something happened at the very last moment. And here it is already necessary to figure out whether a medical error was made or whether the peculiarities of development and presentation led to the intrapartum death of the fetus.
Stillbirth can be antenatal if cardiac arrest occurs for a period of 28 weeks and up to the day of birth. It may be due to abnormalities of the fetus and placenta. Not a single doctor can predict all possible scenarios, despite the most thorough examination.
Prevention
Unfortunately, intrapartum fetal death cannot be predicted and prevented. All the staff of the maternity hospital works in order to prevent this event, to help the baby to be born alive and healthy. But preventive measures begin long before the delivery of a woman in labor with labor in the hospital. To a large extent, they consist in protecting the health of women for all 9 months, as well as in the careful and professional management of childbirth. This applies to those that proceed normally, and pathological.
The difficulty of the issue
Intranatal fetal death is still being studied. Each such case is a tragedy for the mother and an unpleasant event for all the doctors accompanying the pregnancy. But at the same time, it provides new research material that can be used to prevent this from happening in the future.
Pathological processes that can occur in the mother and fetus lead to tragedy. It is very important for a woman to monitor her health, undergo screening 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, asphyxia plays a major role. It is usually secondary, as it follows from many diseases and their complications. Infections (influenza, typhoid, pneumonia), chronic diseases (malaria and syphilis) are of great importance. Intoxication of various etiologies, acute poisoning, toxicosis, and the effects of various kinds of drugs also affect. Violation of the cerebral circulation of the fetus and intracranial injuries leave little chance of survival. Therefore, the combination of asphyxia and birth injury is considered the most dangerous.
Birth complications
They do not always run smoothly. Sometimes pregnancy goes well, the baby and mother are healthy, but upon admission to the hospital, bleeding suddenly opens, the umbilical cord falls out or a number of unplanned complications arise that require immediate medical attention.
Among the causes of intranatal fetal death can be called 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 may occur in violation of obstetric care. At home birth accompanied by an incompetent assistant, this probability increases many times over.
Pathology 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 - pathology of the umbilical cord.
With intranatal fetal death, fetal maceration and placental ischemia are usually absent. Hydrostatic tests are negative, but in some cases can be positive. The most common causes of fetal death during the birth process are the following:
- Asphyxia.
- Skull injury.
- Subdural hemorrhages.
- With abnormalities of the position of the fetus.
- Departure of water before the onset of labor. Normally, they are designed to facilitate the exit of the fetus and its passage through the birth canal.
- A large fetus with a narrow basin of a woman.
- Rapid birth. This is also a pathology of the birth process, when the neck instantly opens, and in a few minutes a baby is born. 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 pose and figure out how to bandage the umbilical cord.
- Less commonly observed birth trauma of the spine.
Presentation of the fetus
During pregnancy, a woman visits the ultrasound three times, where the presentation of the fetus is necessarily recorded. Until 28 weeks, this does not matter, since the fetus still moves freely in the uterus. After 30 weeks, a third of 100 women have a pelvic presentation. And closer to childbirth, only 1-3 of them retain their position. The rest are turned over by the head to the cervix. It is this situation that ensures the physiological passage through the birth canal.
Intranatal fetal death with pelvic presentation a few decades ago was common. Moreover, in some cases, the child was born without complications, but in others there was an extension of the arms and tilting of the head, and the fetus could not pass through the cervix. Today, in addition to cesarean section, a rather large number of obstetric techniques are practiced, which are designed to facilitate the passage of the fetus to minimize the risk of asphyxiation.
Pathological diagnosis
After the birth of a dead fetus, the doctor should examine the body and make a conclusion about when death occurred. Even outward signs can already say a lot. And here it is clearly possible to trace the boundaries of the antenatal and intranatal fetal death. With intrauterine death before the onset of the labor period, severe maceration of the skin is observed. That is, the fetus began to decompose in the uterine cavity. With death in the process of labor, this cannot be (in extreme cases, it can be present on small areas of the skin).
That is, a sign of stillbirth can be considered pronounced maceration. The placenta due to the termination of the fetal and preservation of the maternal circulation becomes anemic as a result of compression of its vessels. It is also an important material for research. It allows you to understand what happened, at what stage the fetus ceased its activity. And also to study in detail what it is - the intrapartum death of the fetus.
Some statistics
The problem of infant mortality is an acute problem for modern medicine. The indicators are gradually decreasing; today, fewer children die in childbirth than 50 years ago. But still, her level remains quite high. Intranatal losses, along with antenatal losses, cause significant damage to society, reducing by approximately 2% the participation of each generation in the process of social production.
An analysis of risk factors indicates that this most often happens in cases of late pregnancy. Intranatal fetal death is most common in the age group of 32 to 36 years. There were more housewives in the group of women who lost children during childbirth than there were workers. The advantage in the sample remained with women with secondary education or a working specialty. The presence of bad habits was recorded in 29% of women. In about 20%, heredity was burdened by cancer, endocrine pathology, mental illness and alcoholism.
For 80% of women, intranatal death is a big tragedy, as the child was long-awaited and very welcome. Only a fifth of the patients were not registered in the dispensary for pregnancy. Most, namely 97%, regularly visited a doctor and followed all the recommendations. At the same time, the majority (55%) had a high degree of 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 occur in endocrine pathologies, underweight, or obesity. In 43%, pregnancy proceeded against the background of acute respiratory viral infections. 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 a warning about chronic ailments is a must. Sometimes ignoring such a simple rule leads to tragedy. Forty weeks, difficult births, dead baby, and had Caesarean done at 38 weeks, and life would have been 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. Although infant mortality during childbirth has declined, it still requires close attention.
The most significant risk factors are: earlier onset of sexual activity, burdened obstetric and gynecological history (artificial abortions), cardiovascular pathologies and anemia, infectious diseases during pregnancy, polyhydramnios, threatened miscarriage, genital infections. Preterm birth is also considered a potential threat, because for some reason the body decided to get rid of 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 birth. On the one hand, it’s good and right. On the other hand, the human factor cannot be written off in this case. For a shift, one doctor has a dozen women, each of whom is hurt and scared. And he has his own problems, I want to quickly go home. Of great importance are the injuries inflicted on the fetus under conditions of "obstetric aggression." Studies were conducted that showed that fetal loss most often occurred in the second stage of labor - the period of active obstetric care.
That is why today a new concept is being developed, according to which doctors are obliged to maintain the maximum distance and intervene in the course of childbirth only when necessary. In this regard, they conduct courses for expectant mothers so that when they enter the maternity ward, they know what they are faced with and do not panic.
Instead of a conclusion
Today, a serious problem facing modern medical institutions was considered. Fetal death during childbirth is a difficult blow for every woman, because most often it is a welcome and beloved child. In this regard, the topic should be studied further, and the conclusions drawn should be communicated to doctors. Gradually, the percentage of intrapartum losses should decrease.