Indian Journal of Obstetrics and Gynecology Research 2020;7(4):461–466 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Obstetrics and Gynecology Research Journal homepage: www.ijogr.org Review Article A drowning fetus sends a distress signal, which is an indication for a Caesarean section Aleksandr Urakov1,2,*, Natalia Urakova3 1Dept. of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk, Russia 2Dept. of Modeling and Synthesis of Technological Structures, Udmurt Federal Research Center of Ural Branch of RAS, Izhevsk, Russia 3Dep. of Obstetrics and Gynecology, Izhevsk State Medical Academy, Izhevsk, Russia ARTICLEINFO ABSTRACT Article history: The review is devoted to the prevention of neonatal asphyxia by assessing the reserves of adaptation of the Received 10-07-2020 fetus to intrauterine hypoxia in the second half of pregnancy and then choosing a safe type of delivery. The Accepted 24-07-2020 history of development of a new functional test that provides a non-invasive assessment of fetal adaptation Available online 07-12-2020 reserves to intrauterine hypoxia using sonography is shown. It is proposed to use ultrasound to determine the duration from the beginning of apnea in a pregnant woman to the appearance of a distress signal, the fetus inside the uterus when its reserves of adaptation to hypoxia are exhausted. If a distress signal appears Keywords: earlier than 10 seconds from the start of breath retention of pregnant woman is recommended to refuse of Apgar score physiology birth and is offered delivery by Cesarean section. Neonatal asphyxia Intrauterine hypoxia © This is an open access article distributed under the terms of the Creative Commons Attribution Apnea License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and Adaptation reproduction in any medium, provided the original author and source are credited. Resistance Sonography Diagnostics Encephalopathy 1. Introduction modern standards of obstetric care do not exclude the harmful effect of intrauterine hypoxia on the fetus. It is very According to the World Health Organization, perinatal tragic that hypoxia is the first to damage brain cells. 3–5 asphyxia is one of the three common causes of under-five child mortality (11%) following preterm birth (17%) and Virginia Apgar developed in 1953 the Apgar scoring pneumonia (15%). 1 However, it is sad that the diagnosis which has shown relevance in assessing the general well- of perinatal asphyxia is made only after the completion of being of the newborn at delivery and also determining labor. The diagnosis of perinatal asphyxia is made when the the response and effectiveness of resuscitation. 6–8 The umbilical cord arterial pH is <7, the APGAR (Appearance, Apgar scoring still remains an important tool in newborn Pulse, Grimace, Activity, and Respiration) score is 0-3 assessment and monitoring the progress of resuscitation in at the fifth minute, and there are central nervous system a resource-poor setting. 6 manifestations like seizures, lethargy, coma, hypotonia, or Unfortunately, in gynecology and obstetrics, there is still 2 hypertonia and multisystem organ dysfunction. no officially recognized scale for evaluating the adaptive Therefore, even after the completion of labor, the ability of the fetus to the tests that it will face during newborn remains for some time without assessing the state physiological childbirth. Long-term labor, the presence of their health and the degree of hypoxia. That is why of meconium-stained amniotic fluid, and preeclampsia * Corresponding author. are considered irrefutable evidence of possible perinatal E-mail address: [email protected] (A. Urakov). asphyxia. 9 https://doi.org/10.18231/j.ijogr.2020.100 2394-2746/© 2020 Innovative Publication, All rights reserved. 461 462 Urakov and Urakova / Indian Journal of Obstetrics and Gynecology Research 2020;7(4):461–466 Therefore, we can conclude that the prediction of 3. Objective neonatal asphyxia has not improved dramatically over the past few hundred years. This review is intended to show the significance of sonographic research of fetal motor activity dynamics In particular, to reduce neonatal mortality, it was during a pregnant woman holds her breath in order proposed to improve prenatal care, monitor mothers to determine the fetal resistance to hypoxia during the during childbirth with a partograph, improve emergency upcoming physiological delivery, on the one hand, and the obstetric care, and improve skills of doctors in neonatal diagnostic value of fetal resistance to apnea indicators in 10 resuscitation and management of sick newborns. But the order to choose a safe type of birth for the fetus, namely, by implementation of these recommendations is also not able physiological delivery or by Cesarean section. to predict and exclude neonatal asphyxia. At the same time, it has long been known that a 4. Results Caesarean section can reliably protect the child’s brain from the tragic tests that it may be subjected to during Almost 100 years ago, the great physiologist Sir Joseph physiological childbirth. This operation was the first carried Barcroft stated that during pregnancy and physiological out, at least, in the year 715 BC. 11 In 2012, about 23 million childbirth, occurring in different conditions, fetuses are Caesarean sections were performed worldwide, and it is subjected to intrauterine hypoxia of varying degrees of 13 claimed that more widespread use of Caesarean sections severity. But, Sir Joseph Barcroft believed that natural may lead to better outcomes. 12 adaptation to hypoxia does not completely protect people from the harmful effects of lack of oxygen. In particular, However, there is no officially recognized rating scale he stated that high-altitude hypoxia reduces the mental and for fetal adaptation to the upcoming intrauterine hypoxia in physical abilities of people. 14 childbirth, which would be the basis for the indication for a It was shown that evolution has given the lungs, blood, Cesarean section that can exclude neonatal asphyxia. and placenta of a pregnant woman and the brain of a fetal an It is believed that the indication for a Caesarean section is adaptation to hypoxia. 13–17 However, there is no mention a difficult birth, a double pregnancy, high blood pressure in of a functional test for fetal resistance to acute intrauterine the mother, childbirth in the buttock area, or problems with hypoxia. 14,16,17 Official obstetrics and gynecology do not the placenta or umbilical cord. 11,12 Among these indications have a standard functional test to assess the reserves there is no conclusion about the low resistance of the of adaptation of the fetus to intrauterine hypoxia before fetus to intrauterine hypoxia during pregnancy and before delivery. childbirth. However, such recommendations have already At the same time, adult reserves of adaptation to been given to obstetricians and gynecologists acute hypoxia for more than 100 years are estimated by the maximum possible duration of voluntary apnea. This In this regard, to improve the quality of obstetric care method was proposed by the Russian researcher V.A. and preserve the health of the fetus and newborn at the Shtange and is called "Shtange test". 18 In 1914, V.A. risk of hypoxic damage to brain cells during physiological Stange, of Petrograde, found that average healthy persons childbirth, it makes sense to pay attention to innovations that could hold the breath for from 45 to 50 seconds, while have not been noticed by the international community of patients with weak heart muscles could do so but for from obstetricians and gynecologists. 10 to 20 seconds. While V.A. Stange seemed to have had no suspicion that the breath-holding test was based on an apnea 2. Materials and Methods due to decreased alkaline reserve, nevertheless he reported observation on number of chronic diseases, in which he There was a thorough study of inventions and scientific found the duration of the apneic pause shortened in about articles published between 2010 and 2020 in the databases the degree in which so-called acidosis is known to occur E-Library, EAPATIS, PATENTCSOPE, Google Patent, from the results of the observes. Google Scholar, Scopus, PubMed, Science Direct and About 10 years ago in Russia, the principle of the Yandex. The results were analyzed, prioritized, and Shtange test was used as the basis for a functional summarized. Keywords of the search strategy: childbirth, test to assess the adaptation of the fetus to intrauterine fetus, fetal brain, cerebral cortex, neonatal asphyxia, hypoxia. 19,20 Just before that it was invented «N.A. intrauterine hypoxia, oxygen, pregnancy, apnea, resistance, Urakova’s intrauterine scuba and ventilation method of sonography, diagnostics, adaptation to hypoxia, The fetal lungs with respiratory gases» (RU Application N information was limited to the possibility of using it at the 2010134466. 17.08.2010) and «The way of saving the fetus end of pregnancy, before or during delivery to assess the in case of sudden intrauterine hypoxia» (RU Application N resistance of the fetus to intrauterine hypoxia. 12 inventions 2011109952. 16.03.2011). In these inventions it is proposed were evaluated for review. to use sonographic monitoring of fetal motor activity inside Urakov and Urakova / Indian Journal of Obstetrics and Gynecology Research 2020;7(4):461–466 463 the uterus. To protect the fetus from death in intrauterine motor activity was performed sonographically. The results hypoxia, it was proposed to immediately hyperventilate the showed that voluntary apnea causes fetal hypoxia, which is lungs of the pregnant woman and the fetus with respiratory manifested by characteristic changes in its motor activity. It gas. At the same time, for ventilation of the lungs of the turned out that the dynamics of fetal motor activity during fetus inside the uterus, it was proposed to use a special apnea almost exactly repeats the dynamics of motor activity intrauterine scuba tank, which was proposed to be put on of fish in their acute hypoxia in the water.