Risk factors delivery of the newborns with distress

Abstract

The final purpose of pregnancy and delivery is healthy newborn. 65% of fetus development takes place in the conditions of placenta hypoperfusion has an enhanceable risk of perinatal damages. Placenta dysfunction is the widest pregnancy pathology which varies from 24% to 46%.

The aim of the work: to investigate risk factors of the  distress onset in newborns to prevent this complication.

Materials and methods: 142 case reports of delivery mothers and case reports of their newborns underwent retrospective analysis. All women were examined according to the protocols. State of newborns was assessed by Apgar scale. All infants with distress and their mothers were divided into 3 groups according randomized evaluation with Apgar scale. First group included 75 newborns with Apgar score on the first minute of 6-7 points, group II contained 46 neonates with an estimate of 4-5 points, group III consisted of 21 infants with points 3 or less. The control group included 20 infants without distress. There anamnestic, clinical-laboratory, histological and statistical methods were used in scientific work. The women’s age was from 16 to 42, the average age without reliable distinctions in all groups. The high percentage of extragenital pathology were noticed in all groups, which amounted to 36%, 45.65%, 71.45% in the comparison group - 85%. Traced deepening severity distress of increasing frequency of complications in labor: the group I childbirth complication rates were 40,00% in group II - 52,17%, in group III complication rates during labor were significantly higher - 71 and 43%, the control group it had only 15%.

The average scores of Apgar on the first minute amounted to 6,76±0,13 p., 4,70±0,21 p., 2,86±0,17 p. Children with severe distress recovered significantly more active. Apgar scores increased by 1.76 p. in the III group after five minutes (p<0.005) and was 4,57±0,23 p., II - at least 1,42 (6,12±0,18 p.), in the I group was only 0.38 p. (7,14±0,35 p.). Premature infants restored faster than full-term newborns. Apgar scores differed hardly in the control group on the first and fifth minute: 8,80±0,24 p. and 9,50 ± 0,26 p. The average weight of the babies in the I group was 3384,68±236,43 g, which was significantly higher (p<0.001) than in the II and III groups (2510,42±187,23 g, 2234,29 69,56 g, respectively) and significantly lower (p<0.05) rate control  group (3852,50±196,38 g). Morphological changes in the placenta are most pronounced in severe distress - 85.71% purulent diffuse chorioamnionitis and detsiduitis with bleeding, premature the placenta aging.

Conclusions:

1. Risk factors for the development of fetal distress during labor are: extragenital pathology (42.96%), first childbirth (53.52%), complications of pregnancy (51.40%) (especially in the first and second trimesters, late gestosis), premature delivery (38.03%), complications during delivery (50.02%).

2. The severity of the fetus at birth corresponds to more pronounced changes in the placenta in the form of local and diffuse purulent chorioamnionitis and detsiduitis, indicating a chronic infectious process, dysfunction of the placenta can cause fetal weight at birth, violation of adaptive opportunities of a fetus during labor.

3. It is necessary to inspect more carefully women with infections, adequate treat revealed infections, supervise infected women in risk group of development of placentary insufficiency.