Intrauterine hypoxia: clinical consequences and therapeutic perspectives

Figures & data

Table 1 Diagnostic criteria for preeclampsia

Clinical signs	Measured outcomes
Blood pressure	140 mmHg systolic or 90 mmHg diastolic on two occasions greater than 4 hours apart
And Proteinuria	• Greater than 300 mg on 24 hour urine Or • Protein/creatinine ratio >0.3 • Dipstick reading of greater than 1+
Or, in the absence of proteinuria, new-onset hypertension with the new onset of any of the following:
Thrombocytopenia Renal insufficiency	Platelet count < 100,000/μL • Serum creatinine greater than 1.1 mg/dL or doubling of creatinine in absence of renal disease • Oliguria – less than 500 mL of urine output in 24 hours
Impaired liver function	Elevated transaminases to twice upper limit of normal
Pulmonary edema	Shortness of breath and decreased oxygen saturation
Cerebral or visual symptoms	Headaches, tinnitus, visual disorders, brisk tendon reflexes

Table 2 The management algorithm for pregnancies complicated by FGR

Finding	Interpretation	Action
Abnormal UmbA and/or CPR; normal MCA and veins	Asphyxia extremely rare	Biweekly Doppler US
BPS ≥8/10, AFI normal	Increased risk of intrapartum distress	Weekly BPS
Blood flow redistribution, low MCA, normal veins	Hypoxemia possible, asphyxia rare	Weekly Doppler US
UmbA absent EDV normal vein BPS ≥6/10, oligohydramnios	Hypoxemia common, acidemia/asphyxia possible, onset of fetal compromise	34 weeks: deliver <32 weeks: antenatal steroids, daily testing
Fetal compromise	Hypoxemia common, acidemia/asphyxia likely	>32 weeks: deliver
UAREDV Increased DV pulsatility BPS ≥6/10, oligohydramnios		<32 weeks: admit, steroids, individualize testing daily
Fetal decompensation Compromise by above criteria, absent or reversed DV A-wave, pulsatile UmbV, BPS <6/10, oligohydramnios	Cardiovascular instability, metabolic compromise, stillbirth imminent, high perinatal mortality irrespective of intervention	Delivery at tertiary care center with highest level of NICU care

Abbreviations: AFI, amniotic fluid index; BPS, biophysical profile score; CPR, cerebroplacental ratio; DV, ductus venosus; EDV, end-diastolic volume; FGR, fetal growth restriction; MCA, middle cerebral artery; NICU, neonatal intensive care unit; UAREDV, umbilical artery end-diastolic velocity; UmbA, umbilical artery; UmbV, umbilical vein.