2. PERINATAL ASPHYXIA
• Occurs when there is lack of oxygen [hypoxia]
and/or lack of blood flow [ischemia].
• It can occur before birth, during birth or after
birth.
• Comprises, in varying degrees, compounds of
both hypoxia and ischemia.
• When of sufficient magnitude, it will lead to
injury which may be transient or permanent.
• Although brain injury is usually the paramount
concern, all organs may sustain injury.
3. Etiology
– Asphyxia may be due to the following:
a. Maternal disorders
–marked anemia
–uterine tetany
–severe hypotension or shock
–hemorrhage
b. Placental and umbilical abnormalities
– hydatidiform mole
–Infarction
– hemorrhage due to placenta previa or abruptio
placenta
– cord occlusion[ compression or prolapse and
obstruction of cord]
4. Etiology
c. fetal or neonatal disorders
– Trauma
– central nervous system disorders
– congenital pulmonary or cardiovascular
anomalies
– depression of the respiratory center during labor
and delivery due to maternal analgesics or
anesthesia
– obstructed air way
5. 1.Prenatal asphyxia(fetal distress)
• Fetal Distress:- is the manifestations of intrauterine
hypoxia. It may also be caused by
intra cranial damage during labour
Signs of Fetal Distress
Changes in fetal heart rate and rhythm
Meconeum staining in a presentation other than
breech
Excessive fetal movement (last signs)
Management
• Turn patient on side
• Re check FHB in 5 minutes or after next contraction
• If still irregular give oxygen and report
6. 2. BIRTH ASPHYXIA
• Birth asphyxia means failure of the newborn
baby to breath at birth.
• During asphyxia there is interference with
exchange of oxygen and carbon dioxide and
decreased oxygen in blood.
• The anoxia produced by asphyxia result in
death, permanent physical disability or mental
retardation.
• Asphyxia plays a part in 50% of stillbirth and
33% of neonatal death.
7. STAGES OF ASPHYXIA
• The asphyxiated newborn may present in one
of the following stages,
• for immediate decision only ventilatory
efforts, and heart rate is important.
8. Mild asphyxia Moderate asphyxia Severe asphyxia
No spontaneous respiration
by 30 - 60 seconds
Cyanosis No breathing
- Cyanosis Heart rate < 100/min Skin color is white
Good muscle tone Cord pulsating well Cold and limp, muscle tone
is poor
Heart rate > 100/min. APGAR score 4 - 5 Heart rate is < 100/ min
Cord pulsating well Cord pulsates feebly and his
poor tone
APGAR-score 6 - 7 APGAR score 0- 3
STAGES OF ASPHYXIA
9. Management for Mild asphyxia
• Lie flat with head slight extended
• Clear the airway, suck the oropharynx gently
• Stimulate crying by flicking the sole of the feet
gently
• Color improves and heart rate is maintained and
spontaneous respiration is often establish.
• If no improvement proceed as in sever asphyxia.
10. Management for Moderate asphyxia
• Proceed as in primary apnea
• If no improvement institute IPPV. Using
facemask and bag
• Give oxygen
11. Management For Severe Asphyxia
• Dry his skin & wrap with spry towel
• Place newborn under radiant warmer
• Using soft rubber catheter suck the or pharynx gently
• Pass nasogastric tube and secure with tape to avoid stomach
distention during
• Using tight fitting facemask & bag give ventilation with oxygen
• After 3 minutes of ventilation if no improvement report &
pass umbilical catheter and give sodium bicarbonate
• After resuscitation, take vital signs every hour for 2 hrs. Or
until infant is stable
• Give vit K 0.5 - 1 mg in to reduce risk of hemorrhage.
• Observe complications
12. Management For Severe Asphyxia
• If no increase in heart rate consider the
following:-
1) Upper airway obstruction
– Do direct laryngoscopy and suck mucus laryngeal
cysts and subglottic stenos is (rarely)
2) Fetal hemorrhage:- suspected in LBW baby
immediate infusion, saline 30ml/kg
– followed blood transfusion 30ml/kg
![PERINATAL ASPHYXIA
• Occurs when there is lack of oxygen [hypoxia]
and/or lack of blood flow [ischemia].
• It can occur before birth, during birth or after
birth.
• Comprises, in varying degrees, compounds of
both hypoxia and ischemia.
• When of sufficient magnitude, it will lead to
injury which may be transient or permanent.
• Although brain injury is usually the paramount
concern, all organs may sustain injury.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)