Perinatal Asphyxia

Asheber Gaym M.D.

January 2009
 Outline

• Define Perinatal Asphyxia

• Discuss diagnosis of perinatal asphyxia
• List complications of perinatal asphyxia
• Outline management of perinatal asphyxia

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 Definitions

• Asphyxia refers to the occurrence of tissue hypoxia and

acidosis. It signifies that the risk of tissue damage is very high
due to the combined insult.
• The fetal brain is the most sensitive fetal organ to asphyxial
insult and incurs mild to severe damage depending on the
degree and duration of asphyxia.
• In severe perinatal asphyxia, multisystem organ damage can
occur leading to the hypoxic ischemic encephalopathy
syndrome.
• Hypoxic insult can be a long standing uteroplacental
insufficiency ( chronic asphyxia) exacerbated by acute
intrapartal asphyxia or a sudden intrapartal asphyxial insult in
a previously health fetus.

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 Diagnosis of Perinatal Asphyxia

• Diagnosis of perinatal asphyxia is based on the apgar

scoring system at birth and whenever available blood
gas and acid-base studies on the umbilical cord blood
sample immediately following birth.
• An apgar score of less than 7 at the first minute after
delivery is one criteria used to define perinatal
asphyxia.
• Clinical findings in a neonate indicating hypoxic
ischemic encephalopathy are also used to identify
cases of neonatal asphyxia.
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 Predisposing Factors to Perinatal Asphyxia

Maternal Fetal Labor and delivery

•Preeclampsia/eclampsia •Post term pregnancy •Mechonium stained liquor

•Antepartum hemmorhage •Preterm labor
•Chronic hypertension •Multifetal gestations
•Chronic renal disease •Congenitally malformed
•Chronic respiratory fetus
disease •Fetal growth restriction
•Heart disease •Cord prolapse
•Anemia •Oligohydramnios
•RH Isoimmunization •Polyhydramnios
•PROM •Abnormal fetal well being
•Diabetes mellitus test results
•Thyroid disorders •Malpresentations
•Malpositions
•External Cephalic Version
•Prolonged labor
•Abnormal fetal heart rate
patterns in labor
•Instrumental deliveries
•Caesarean deliveries
•Vaginal breech delivery
•Internal podalic versions
•Induction/augmentation
of labor

When any of these risk factors are present, careful intrapartum monitoring and
preparations for neonatal resuscitation should be made.

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 The Apgar Score
Parameter 0 1 2
Respiratory effort Apnea Depressed Vigorous cry at
respiratory effort birth
Heart rate Asystole <100 >100
Color Cyanosis Acrocyanosis – Pink
Central pink and
peripheral cyanosis

Reflex Irritability No reaction Weak reflex effort Grimace with

stimulation
Tone Flaccid Weak activity and Active
tone present
Apgar score – scored in the first (to give time for neonatal adaptation) and fifth ( to
assess the success of resuscitative measures) minutes. In cases where the fifth minute
apgar score is depressed, the score is repeated at 10th , 15th …etc until a normal score
is noted.

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 Complications of Perinatal Asphyxia

Immediate Neonatal Complications Long term sequel

•Hypoxic Ischemic Encephalopathy – •Cerebral palsy

cardio pulmonary failure; renal failure; •Minimal brain lesions- dyslexia; etc
shock; adrenal hemorrhage; intracranial •Low school performance in later life
hemorrhages •Psychiatric disorders
•Prolonged neonatal hospitalizations
•Neonatal mortality
•Increased risk of infection

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 Outline of Management of Perinatal Asphyxia

• At delivery of the head, clean the face of

secretions
• Keep under a radiant warmer, dry and assess the
first minute apgar score
• If first minute apgar score is normal (>7); assess
fifth minute apgar score and if still normal
perform a quick check for anomalies and return
to mother
• If first minute apgar score is <7, initiate neonatal
resuscitation.
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