BIRTH ASPHYXIA

BY ANNE E. ODARO
MCM/2017/69852
CLINICAL CASE
Nekesa is a 43 year old female from Makongeni. She has a
BMI of 32 and is hypertensive. She is para 6+2 G 9. She
was brought to the maternity ward at GBD 32 weeks 2 days
with 2 episodes of convulsions. She was managed for
eclampsia and as soon as she was stable the baby was born
via caesarean section.
Baby Nekesa did not cry immediately after birth, her APGAR
at 5 minutes was 5 and she has a weak cry at this time. her
birth weight is 1.75kgs.

a)What is the most likely condition baby Nekesa has?

b)What are the risk factors that led to her current condition?
c)What is the next step in her management?
Definition of terms
• Anoxia: – Complete lack of oxygen.

• Hypoxia: – Decreased availability of oxygen

• Hypoxemia: – Decreased arterial concentration

of oxygen.

• Ischemia: – Insufficient blood flow to cells or

organ resulting in interrupted metabolism and
death of the cell or organ affected.
Definition
• Birth asphyxia is defined as a reduction of
oxygen delivery and an accumulation of carbon
dioxide owing to cessation of blood supply to the
fetus around the time of birth.
• It is the medical condition resulting from 
deprivation of oxygen to a newborn infant that
lasts long enough during the birth process to
cause physical harm, usually to the brain.
Cont…
• Birth asphyxia is a pathologic condition seen in a
neonate who has no spontaneous breathing or
represented irregular breathing movements after
birth. It is an emergency condition and needs
quick treatment.  
• Hypoxic damage can occur to most of the
infant's organs (heart, lungs, liver, gut, kidneys),
but brain damage is of most concern and
perhaps the least likely to quickly or completely
heal.
ETIOLOGY
Pathologically, any factors which interfere with
the circulation between maternal and fetal blood
exchange could result in the happens of
perinatal asphyxia. These factors can be:
maternal
delivery or
fetal
Cont…
• Maternal factors:
hypoxia, anemia, diabetes, hypertension,
smoking, nephritis, heart disease, too old or too
young,etc
• Delivery conditions:
Abruption of placenta, placenta previa, prolapsed
cord, premature rupture of membranes,etc
• Fetal factors:
Multiple birth, congenital or malformed fetus,etc
Pathophysiology
• When fetal asphyxia happens, the body will
attempt to redistribute blood flow to different
organs via “inter-organ shunts” in order to
prevent some important organs including brain,
heart and kidneys from hypoxic damage.
Cont…
Cont…
1. Hypoxic cellular changes
a) Reversible damage(early stage): Hypoxia may decrease the
production of ATP  the  of cellular functions. (Reversible)
b) Irreversible damage: Prolonged hypoxia irreversible cellular
damage complications

2. Development of asphyxia
a) Primary apnea: breathing stops but normal muscular tone or

hypertonia, tachycardia (quick heart rate), and hypertension .

Happens early and shortly, self-defended
mechanism ， organ damage may be spared if corrected quickly
Cont…
b) Secondary apnea: Features of severe asphyxia
or unsuccessful resuscitation, usually result in
damage of organ function.

Other damages:
a. Persistent pulmonary hypertension (PPHN)
b. Hyper/hypoglycemia
c. Hyperbilirubinemia
Causes
• Inadequate oxygenation of maternal blood due to 
hypoventilation during anesthesia, heart diseases, 
pneumonia, respiratory failure
• Low maternal blood pressure due to hypotension
 e.g. compression of vena cava and aorta, excess
anaesthesia
• Inadequate relaxation of uterus due to excess 
oxytocin
• Premature separation of placenta
• Placental insufficiency
• Knotting of umbilical cord around the neck of
infant
Causes of birth asphyxia
Clinical Presentation
• Fetal asphyxia

fetal heart rate: tachycardia bradycardia

fetal movement: increase decrease

amniotic fluid: meconium-stained

Cont…
Cont…

Degree of asphyxia:

Apgar score 8~10: no asphyxia

Apgar score 4~8: mild/cyanosis asphyxia

Apgar score 0~3: severe/pale asphyxia

Cont…
Complications:
CNS: HIE, ICH
RS: MAS, RDS, pulmonary hemorrhage
CVS: heart failure, cardiac shock
GIS: NEC, stress gastric ulcer
Others: hypoglycemia, hypocalcemia, hyponatremia
Diagnosis
Clinical:
Evidence of fetal distress
 Fetal metabolic acidosis
Abnormal neurological state(AVPU <A)
Multiorgan involvement
Management
AIRWAY

1/ Open by placing the head in the neutral position

2/ Clean up completely amniotic fluid from the

airway by suction with syringe as soon as possible

3/ If meconium-stained, suction catheter should be

placed to ensure meconium is be removed
Cont…
BREATHING
1/ Ensure face mask covers nose & mouth connect
to oxygen bag
2/ Establish respiration of 30-40/min with chest
wall movement
3/ If no response, intubation & mechanic
ventilation is necessary
Cont…
CIRCULATION
1/ if heart rate <60/bpm, start external cardiac
compression with fingers

2/ ratio 3:1 ( 90 compressions to 30

bpm)
Cont…
DRUGS
1/ if profound bradycardia, give adrenaline
(1:10000, 0.1-0.3ml/kg) by endotracheal tube or
umbilical vein

2/ if no response, intravenous fluid (saline,

albumin, plasma, blood) with 10ml/kg

3/ if acidosis, give 5% sodium bicarbonate (SB)

with 3-5ml/kg

4/ if bradypnea, consider using naloxone

(0.1mg/kg)
Cont…
• EVALUATION

Evaluate the result of resuscitation to

determine if more rescue necessary:
▫ If not good, repeat the resuscitation (up to 30
minutes)
▫ If good, transmit baby to NICU
Cont…
TREATMENT SUMMARY
• A= Establish open airway: Suctioning, if necessary 
endotracheal intubation
• B= Breathing: Through tactile stimulation, PPV,
bag and mask, or through endotracheal tube
• C= Circulation: Through chest compressions and
medications if needed
• D= Drugs: Adrenaline .01 of .1 solution
• Hypothermia treatment to reduce the extent of
brain injury
• Epinephrine 1:1000 (0.1-0.3ml/kg) IV
• Saline solution for hypovolemia
REFERENCES
• "Brain damage from perinatal asphyxia:
correlation of MR findings with gestational age --
Barkovich and Truwit 11 (6): 1087 -- American
Journal of Neuroradiology". www.ajnr.org.
Retrieved 2008-03-27.
• Kenya, Basic Pediatric Protocols, 2016 Edition.
• Kaye, D. (2003-03-01). "Antenatal and
intrapartum risk factors for birth asphyxia among
emergency obstetric referrals in Mulago Hospital,
Kampala, Uganda". East African Medical Journal.
80 (3): 140–143. doi:10.4314/eamj.v80i3.8683.
ISSN 0012-835X. PMID 12762429.
THANK YOU
QUESTIONS?