{{Short description|Medical condition when the fetus is deprived of sufficient oxygen}} {{Infobox medical condition (new) | name = Intrauterine hypoxia | image = Placental infarct - intermed mag.jpg | caption = [[Micrograph]] of a [[placental infarct]] (left of image), a cause of intrauterine hypoxia. [[H&E stain]]. | pronounce = | field = | synonyms = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Intrauterine hypoxia''' (also known as '''fetal hypoxia''') occurs when the fetus is [[relative deprivation|deprived]] of an adequate supply of [[oxygen]]. It may be due to a variety of reasons such as [[prolapse]] or [[Vascular occlusion|occlusion]] of the [[umbilical cord]], [[placental infarction]], maternal diabetes (prepregnancy or [[gestational diabetes]])<ref>{{Cite journal|last=Tarvonen M, Hovi P, Sainio S, Vuorela P, Andersson S, Teramo K|date=2021|title=Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus|journal=Acta Diabetologica|volume=58 |issue=11 |pages=1563–1573 |doi=10.1007/s00592-021-01756-0 |pmid=34151398 |pmc=8505288 }}</ref> and [[Smoking and pregnancy|maternal smoking]]. [[Intrauterine growth restriction]] may cause or be the result of hypoxia. Intrauterine hypoxia can cause cellular damage that occurs within the [[central nervous system]] (the brain and spinal cord). This results in an increased mortality rate, including an increased risk of [[sudden infant death syndrome]] (SIDS). Oxygen deprivation in the fetus and neonate have been implicated as either a primary or as a contributing risk factor in numerous neurological and neuropsychiatric disorders such as [[epilepsy]], [[attention deficit hyperactivity disorder]], [[eating disorders]] and [[cerebral palsy]].<ref>{{cite journal | vauthors = Maslova MV, Maklakova AS, Sokolova NA, Ashmarin IP, Goncharenko EN, Krushinskaya YV | s2cid = 1170955 | title = The effects of ante- and postnatal hypoxia on the central nervous system and their correction with peptide hormones | journal = Neuroscience and Behavioral Physiology | volume = 33 | issue = 6 | pages = 607–11 | date = July 2003 | pmid = 14552554 | doi = 10.1023/A:1023938905744 }}</ref><ref>{{cite journal | vauthors = Habek D, Habek JC, Jugović D, Salihagić A | title = [Intrauterine hypoxia and sudden infant death syndrome] | journal = Acta Medica Croatica | volume = 56 | issue = 3 | pages = 109–18 | year = 2002 | pmid = 12630342 }}</ref><ref>{{cite journal | vauthors = Bulterys MG, Greenland S, Kraus JF | title = Chronic fetal hypoxia and sudden infant death syndrome: interaction between maternal smoking and low hematocrit during pregnancy | journal = Pediatrics | volume = 86 | issue = 4 | pages = 535–40 | date = October 1990 | doi = 10.1542/peds.86.4.535 | pmid = 2216618 | s2cid = 245156371 }}</ref><ref>{{cite journal | vauthors = Peleg D, Kennedy CM, Hunter SK | title = Intrauterine growth restriction: identification and management | journal = American Family Physician | volume = 58 | issue = 2 | pages = 453–60, 466–7 | date = August 1998 | pmid = 9713399 }}</ref><ref>{{cite journal | vauthors = Rosenberg A | title = The IUGR newborn | journal = Seminars in Perinatology | volume = 32 | issue = 3 | pages = 219–24 | date = June 2008 | pmid = 18482625 | doi = 10.1053/j.semperi.2007.11.003 }}</ref><ref>{{cite journal | vauthors = Gonzalez FF, Miller SP | title = Does perinatal asphyxia impair cognitive function without cerebral palsy? | journal = Archives of Disease in Childhood. Fetal and Neonatal Edition | volume = 91 | issue = 6 | pages = F454-9 | date = November 2006 | pmid = 17056843 | pmc = 2672766 | doi = 10.1136/adc.2005.092445 }}</ref>
==Presentation== ===Maternal Consequences=== Complications arising from intrauterine hypoxia are some of most common causes of preeclampsia.<ref>{{cite journal | vauthors = Thompson LP, Crimmins S, Telugu BP, Turan S | title = Intrauterine hypoxia: clinical consequences and therapeutic perspectives | journal = Research and Reports in Neonatology | date = September 2015 | volume = 5 | pages = 79–89 | doi = 10.2147/RRN.S57990 | doi-access = free }}</ref> Preeclampsia is a hypertensive disorder that occurs during the second trimester (after the 20th week of pregnancy) resulting from a poorly perfused placenta.<ref>{{Cite web|last=Publishing|first=Harvard Health|title=Preeclampsia And Eclampsia|url=https://www.health.harvard.edu/a_to_z/preeclampsia-and-eclampsia-a-to-z|access-date=2020-07-28|website=Harvard Health|date=26 October 2018 }}</ref> The World Health Organization estimates that preeclampsia and eclampsia are responsible for about 14% of maternal deaths globally (around 50,000 to 75,000 deaths annually).<ref>{{cite journal | vauthors = Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Alkema L | date = June 2014 | title = Global causes of maternal death: a WHO analysis | journal = The Lancet Global Health | volume = 2 | issue = 6 | pages = e323–33 |doi=10.1016/S2214-109X(14)70227-X | pmid = 25103301 | doi-access = free | hdl = 1854/LU-5796925 | hdl-access = free }}</ref>
During pregnancy, women with preeclampsia faces serious risk of damage to vital organs such as the kidneys, liver, brain, and the blood system. This hypertensive disorder may also cause damage to the placenta leading to issues such as [[premature birth]]s, miscarriages, placental abruption, or even stillbirths. In some cases, preeclampsia can eventually lead to stroke and organ failure. Untreated, preeclampsia can progress and turn into eclampsia which is much more severe with the addition of seizures. Eclampsia seizures could lead to uncontrollable twitching and a loss of consciousness, which could potentially lead to the death of the mother and or the baby.<ref>{{cite journal | vauthors = Peres GM, Mariana M, Cairrão E | title = Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal | journal = Journal of Cardiovascular Development and Disease | volume = 5 | issue = 1 | date = January 2018 | page = 3 | pmid = 29367581 | pmc = 5872351 | doi = 10.3390/jcdd5010003 | doi-access = free }}</ref>
==Cause== [[File:Placenta.svg|right|210px]] Intrauterine hypoxia can be attributed to maternal, placental, or fetal conditions.<ref name=":0">{{cite journal | vauthors = Fajersztajn L, Veras MM | title = Hypoxia: From Placental Development to Fetal Programming | journal = Birth Defects Research | volume = 109 | issue = 17 | pages = 1377–1385 | date = October 2017 | pmid = 29105382 | doi = 10.1002/bdr2.1142 | s2cid = 28778818 }}</ref> Kingdom and Kaufmann classifies three categories for the origin of fetal hypoxia: 1) pre-placental (both mother and fetus are hypoxic), 2) utero-placental (mother is normal but placenta and fetus is hypoxic), 3) post-placental (only fetus is hypoxic).<ref>{{cite journal | vauthors = Kingdom JC, Kaufmann P | title = Oxygen and placental villous development: origins of fetal hypoxia | journal = Placenta | volume = 18 | issue = 8 | pages = 613–21; discussion 623–6 | date = November 1997 | pmid = 9364596 | doi = 10.1016/s0143-4004(97)90000-x }}</ref>
Pre-placental hypoxia is most commonly caused by external hypoxic environments (such as high altitude). It can also be caused by maternal respiratory conditions (such as asthma), cardiovascular conditions (such as [[heart failure]], [[pulmonary hypertension]], and [[Cyanotic heart defect|cyanotic heart disease]]), and hematological conditions (such as [[anemia]]).<ref name=":1">{{cite journal | vauthors = Hutter D, Kingdom J, Jaeggi E | title = Causes and mechanisms of intrauterine hypoxia and its impact on the fetal cardiovascular system: a review | journal = International Journal of Pediatrics | volume = 2010 | article-number = 401323 | date = 2010 | pmid = 20981293 | pmc = 2963133 | doi = 10.1155/2010/401323 | doi-access = free }}</ref> Conditions such as obesity, nutritional deficiencies, infections, chronic inflammations, and stress can also affect the maternal oxygen supply and fetal uptake.<ref name=":0" />
The most preventable cause is maternal smoking. [[Cigarette smoking]] by expectant mothers has been shown to have a wide variety of deleterious effects on the developing fetus.<ref>{{cite journal | vauthors = Mund M, Louwen F, Klingelhoefer D, Gerber A | title = Smoking and pregnancy--a review on the first major environmental risk factor of the unborn | journal = International Journal of Environmental Research and Public Health | volume = 10 | issue = 12 | pages = 6485–99 | date = November 2013 | pmid = 24351784 | pmc = 3881126 | doi = 10.3390/ijerph10126485 | doi-access = free }}</ref> Among the negative effects are [[carbon monoxide]] induced tissue hypoxia and [[placental insufficiency]] which causes a reduction in blood flow from the [[uterus]] to the [[placenta]] thereby reducing the availability of oxygenated blood to the fetus. Placental insufficiency as a result of smoking has been shown to have a [[causal]] effect in the development of [[pre-eclampsia]]. While some previous studies have suggested that carbon monoxide from cigarette smoke may have a protective effect against preeclampsia, a recent study conducted by the Genetics of Pre-Eclampsia Consortium in the United Kingdom found that smokers were five times more likely to develop pre-eclampsia.<ref name="pmid18259022">{{cite journal | vauthors = Pipkin FB | title = Smoking in moderate/severe preeclampsia worsens pregnancy outcome, but smoking cessation limits the damage | journal = Hypertension | volume = 51 | issue = 4 | pages = 1042–6 | date = April 2008 | pmid = 18259022 | doi = 10.1161/HYPERTENSIONAHA.107.106559 | doi-access = free }}</ref> [[Nicotine]] alone has been shown to be a [[teratology|teratogen]] which affects the [[autonomic nervous system]], leading to increased susceptibility to hypoxia-induced brain damage.<ref name="pmid18259022" /><ref>{{cite journal | vauthors = Slotkin TA | title = Fetal nicotine or cocaine exposure: which one is worse? | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 285 | issue = 3 | pages = 931–45 | date = June 1998 | pmid = 9618392 }}</ref><ref>{{cite journal | vauthors = Bouhours-Nouet N, May-Panloup P, Coutant R, de Casson FB, Descamps P, Douay O, Reynier P, Ritz P, Malthièry Y, Simard G | s2cid = 16661101 | display-authors = 6 | title = Maternal smoking is associated with mitochondrial DNA depletion and respiratory chain complex III deficiency in placenta | journal = American Journal of Physiology. Endocrinology and Metabolism | volume = 288 | issue = 1 | pages = E171-7 | date = January 2005 | pmid = 15585597 | doi = 10.1152/ajpendo.00260.2003 }}</ref><ref>{{cite journal | vauthors = Gogiia TE | title = [Risk of iugr syndrome development during preeclampsia of the pregnant] | journal = Georgian Medical News | issue = 128 | pages = 15–7 | date = November 2005 | pmid = 16369054 }}</ref><ref>{{cite journal | vauthors = Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM | title = Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features | journal = American Journal of Obstetrics and Gynecology | volume = 173 | issue = 4 | pages = 1049–57 | date = October 1995 | pmid = 7485292 | doi = 10.1016/0002-9378(95)91325-4 }}</ref><ref>{{cite journal | vauthors = Kingdom JC, Kaufmann P | title = Oxygen and placental villous development: origins of fetal hypoxia | journal = Placenta | volume = 18 | issue = 8 | pages = 613–21; discussion 623–6 | date = November 1997 | pmid = 9364596 | doi = 10.1016/S0143-4004(97)90000-X }}</ref> Maternal anemia in which smoking has also been implicated is another factor associated with IH/BA.{{clarify|What is IH/BA?|date=February 2019}} Smoking by expectant mothers causes a decrease in maternal nucleated red blood cells, thereby reducing the amount of red blood cells available for oxygen [[transport]].<ref>{{cite journal | vauthors = Chełchowska M, Laskowska-Klita T | title = Effect of maternal smoking on some markers of iron status in umbilical cord blood | journal = Roczniki Akademii Medycznej W Bialymstoku | volume = 47 | pages = 235–40 | year = 2002 | pmid = 12533965 }}</ref><ref>{{cite journal | vauthors = Habek D, Habek JC, Ivanisević M, Djelmis J | s2cid = 46837857 | title = Fetal tobacco syndrome and perinatal outcome | journal = Fetal Diagnosis and Therapy | volume = 17 | issue = 6 | pages = 367–71 | year = 2002 | pmid = 12393968 | doi = 10.1159/000065387 }}</ref><ref>{{cite book | title = Pathology of the human placenta | first1 = Kurt | last1 = Benirschke | first2 = Peter | last2 = Kaufmann | name-list-style = vanc | page = 453 | publisher = Springer | edition = 4th | date = March 2000 | isbn = 978-0-387-98894-8 }}</ref>
Utero-placental hypoxia is associated with abnormal placental implantation, impaired vascular remodeling and vascular diseases.<ref name=":1" /> It is also associated with pregnancies complicated by [[gestational hypertension]], [[intrauterine growth restriction]], and [[pre-eclampsia]].<ref>{{Cite journal|last1=Hutter|first1=Damian|last2=Kingdom|first2=John|last3=Jaeggi|first3=Edgar|date=2010|title=Causes and Mechanisms of Intrauterine Hypoxia and Its Impact on the Fetal Cardiovascular System: A Review|journal=International Journal of Pediatrics|volume=2010|article-number=401323|doi=10.1155/2010/401323|issn=1687-9740|pmc=2963133|pmid=20981293|doi-access=free }}</ref><ref>{{Cite journal|last1=Keyes|first1=Linda E.|last2=Armaza|first2=J. Fernando|last3=Niermeyer|first3=Susan|last4=Vargas|first4=Enrique|last5=Young|first5=David A.|last6=Moore|first6=Lorna G.|date=July 2003|title=Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia|journal=Pediatric Research|volume=54|issue=1|pages=20–25|doi=10.1203/01.PDR.0000069846.64389.DC|issn=0031-3998|pmid=12700368|s2cid=25586771|doi-access=free}}</ref>
Post-placental hypoxia is associated with mechanical obstructions of the umbilical cords, reduced uterine artery flow, progressive fetal cardiac failure, and genetic anomalies.<ref name=":0" /><ref name=":1" />
The perinatal brain injury occurring as a result of birth asphyxia, manifesting within 48 hours of birth, is a form of [[Cerebral hypoxia|hypoxic ischemic encephalopathy]].<ref>{{Cite journal|date=2019-11-13|title=Hypoxic-Ischemic Encephalopathy: Practice Essentials, Background, Pathophysiology|url=https://emedicine.medscape.com/article/973501-overview}}</ref>
==Diagnosis== {{Empty section|date=October 2021}}
==Treatment==
Treatment of infants with birth asphyxia by lowering the core body temperature is now known to be an effective therapy to reduce mortality and improve neurological outcome in survivors, and [[hypothermia therapy for neonatal encephalopathy]] begun within 6 hours of birth significantly increases the chance of normal survival in affected infants.<ref>{{Cite journal|last=Shankaran|first=Seetha|date=December 2012|title=Therapeutic Hypothermia for Neonatal Encephalopathy|journal=Current Treatment Options in Neurology|volume=14|issue=6|pages=608–619|doi=10.1007/s11940-012-0200-y|issn=1092-8480|pmc=3519960|pmid=23007949}}</ref> [[File:Ola Didrik Saugstad by Christian Ursilva.jpg|thumb|Ola Didrik Saugstad in 2025]] There has long been a debate over whether newborn infants with birth asphyxia should be resuscitated with 100% oxygen or normal air.<ref>{{cite journal | vauthors = Davis PG, Tan A, O'Donnell CP, Schulze A | s2cid = 24825982 | title = Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis | journal = Lancet | volume = 364 | issue = 9442 | pages = 1329–33 | year = 2004 | pmid = 15474135 | doi = 10.1016/S0140-6736(04)17189-4 }}</ref> It has been demonstrated that high concentrations of oxygen lead to generation of oxygen [[free radicals]], which have a role in [[reperfusion injury]] after asphyxia.<ref>{{cite journal | vauthors = Kutzsche S, Ilves P, Kirkeby OJ, Saugstad OD | title = Hydrogen peroxide production in leukocytes during cerebral hypoxia and reoxygenation with 100% or 21% oxygen in newborn piglets | journal = Pediatric Research | volume = 49 | issue = 6 | pages = 834–42 | date = June 2001 | pmid = 11385146 | doi = 10.1203/00006450-200106000-00020 | doi-access = free | author-link4 = Ola Didrik Saugstad }}</ref> Research by [[Ola Didrik Saugstad]] and others led to new international guidelines on newborn resuscitation in 2010, recommending the use of normal air instead of 100% oxygen.<ref>ILCOR Neonatal Resuscitation Guidelines 2010</ref><ref>{{cite web | url = http://www.norway.gr/News_and_events/Events/Older-articles/Norwegian-paediatrician-honoured-by-University-of-Athens-/ | title = Norwegian paediatrician honoured by University of Athens | work = Norway.gr }}</ref> Increasing the oxygen concentration to the mother has shown little effect on the fetus as hyperoxygenated blood does not perfuse the placental exchange site well.<ref name="pmid4606933">{{cite journal | vauthors = Seeds AE, Escarcena L | title = Prevention and correction of fetal acidosis and hypoxia | journal = Clinical Obstetrics and Gynecology | volume = 17 | issue = 3 | pages = 115–34 | date = September 1974 | pmid = 4606933 | doi = 10.1097/00003081-197409000-00008 }}</ref>
Underlying etiology of intrauterine hypoxia serves as a potential therapeutic target. If maternal preeclampsia<ref>{{cite web | url = https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 | title = Maternal preeclampsia | work = Mayo Clinic }}</ref> is the underlying cause of fetal growth restriction (FGR) antihypertensive therapy and magnesium sulfate are potential therapies.<ref name=":0" /> Antihypertensive treatment is used to reduce blood pressure and prevent pulmonary edema and cerebral hemorrhages. An effective course of antihypertensive treatments should reduce blood pressure to below 160/110 mmHg. Magnesium sulfate acts as a vasodilator, reducing vascular resistance and protect the blood-brain barrier (BBB). The goal of these treatments is to prolong pregnancy and increase fetal survival. Each day gained by treatment in utero increases fetal survival and intact survival by 1%–2% up to 28 weeks gestation.<ref>{{cite journal | vauthors = Baschat AA, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, Germer U, Moyano D, Turan S, Hartung J, Bhide A, Müller T, Bower S, Nicolaides KH, Thilaganathan B, Gembruch U, Ferrazzi E, Hecher K, Galan HL, Harman CR | s2cid = 25449681 | display-authors = 6 | title = Predictors of neonatal outcome in early-onset placental dysfunction | journal = Obstetrics and Gynecology | volume = 109 | issue = 2 Pt 1 | pages = 253–61 | date = February 2007 | pmid = 17267821 | doi = 10.1097/01.AOG.0000253215.79121.75 | doi-access = | hdl = 11577/1773054 | hdl-access = free }}</ref> {{clear}}
== Prevention == Medical testing and care can be performed in order to prevent intrauterine hypoxia, though can be difficult. These tests don't directly detect hypoxia, but instead detects the general well-being of the baby and ensures that the baby is healthy since hypoxia causes a wide range of responses. These tests can include prenatal testing, such as fetal movement and amniotic fluid levels, [[Doppler ultrasonography|Doppler examination]], or fetal heart rate.<ref>{{cite journal | vauthors = Salihagić-Kadić A, Medić M, Jugović D, Kos M, Latin V, Kusan Jukić M, Arbeille P | s2cid = 8301182 | title = Fetal cerebrovascular response to chronic hypoxia--implications for the prevention of brain damage | journal = The Journal of Maternal-Fetal & Neonatal Medicine | volume = 19 | issue = 7 | pages = 387–96 | date = July 2006 | pmid = 16923693 | doi = 10.1080/14767050600637861 | url = http://medlib.mef.hr/655/1/salihagic-kadic_a_et_al_rep_655.pdf }}</ref> Another risk factor is premature birth in which medical intervention, such as premature birth prevention or C-section delivery, can be used as prevention for intrauterine hypoxia.<ref>{{Cite web|title=Preventing Hypoxic-Ischemic Encephalopathy (HIE)|url=https://hiehelpcenter.org/medical/prevention/|access-date=2020-07-28|website=HIE Help Center|language=en-US}}</ref>
Studies have shown a connection between [[Tetrahydrobiopterin deficiency|tetrahydrobiopterin (BH<sub>4</sub>) deficiency]] and hypoxia-ischemia brain injury, though further studies need to be done.<ref>{{cite journal | vauthors = Vásquez-Vivar J, Whitsett J, Derrick M, Ji X, Yu L, Tan S | title = Tetrahydrobiopterin in the prevention of hypertonia in hypoxic fetal brain | journal = Annals of Neurology | volume = 66 | issue = 3 | pages = 323–31 | date = September 2009 | pmid = 19798726 | pmc = 2785106 | doi = 10.1002/ana.21738 }}</ref> Measuring fetal BH<sub>4</sub> levels can be another way to look out for intrauterine hypoxia.{{citation needed|date=December 2020}}
During birth, birth asphyxia can occur in which [[Cardiotocography|cardiotocograph]] can be used to monitor the baby's health during labor.<ref>{{cite journal | vauthors = Chandraharan E, Arulkumaran S | title = Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 21 | issue = 4 | pages = 609–24 | date = August 2007 | pmid = 17400026 | doi = 10.1016/j.bpobgyn.2007.02.008 | url = http://www.sciencedirect.com/science/article/pii/S1521693407000375 | series = Risk Management in Obstetrics and Gynaecology | url-access = subscription }}</ref>
==Epidemiology== In the United States, intrauterine hypoxia and birth asphyxia were listed together as the tenth leading cause of neonatal death.<ref>{{cite web | url = https://www.cdc.gov/nchs/data/hestat/prelimdeaths04/preliminarydeaths04.htm | title = Deaths: Preliminary Data for 2004 | work = National Center for Health Statistics | date = June 2019 }}</ref>
==Society== IH/BA is also a causative factor in cardiac and circulatory birth defects the sixth most expensive condition, as well as premature birth and low birth weight the second most expensive and it is one of the contributing factors to infant respiratory distress syndrome (RDS) also known as hyaline membrane disease, the most expensive medical condition to treat and the number one cause of infant mortality.<ref>{{cite journal | vauthors = Rueda-Clausen CF, Morton JS, Davidge ST | title = Effects of hypoxia-induced intrauterine growth restriction on cardiopulmonary structure and function during adulthood | journal = Cardiovascular Research | volume = 81 | issue = 4 | pages = 713–22 | date = March 2009 | pmid = 19088083 | doi = 10.1093/cvr/cvn341 | doi-access = }}</ref><ref>{{cite journal | vauthors = Sly PD, Drew JH | title = Massive pulmonary haemorrhage: a cause of sudden unexpected deaths in severely growth retarded infants | journal = Australian Paediatric Journal | volume = 17 | issue = 1 | pages = 32–4 | date = March 1981 | pmid = 7247876 | doi = 10.1111/j.1440-1754.1981.tb00010.x | s2cid = 27929018 }}</ref><ref>{{cite journal | url = http://emedicine.medscape.com/article/409409-overview | title = Hyaline Membrane Disease | journal = EMedicine | date = 27 April 2022 }}</ref>
{| class="wikitable" |-bgcolor="#CCCffC" | Most expensive medical condition treated in U.S. hospitals. 4 out of 10 linked to intrauterine hypoxia/birth asphxia || Cost || Hospital Charge |- |1. Infant respiratory distress syndrome || $45,542 || $138,224 |- |2. Premature birth and low birth weight ||$44,490||$119,389 |- |6. Cardiac and circulatory birth defects || $35,960 || $101,412 |- |9. Intrauterine hypoxia or birth asphyxia || $27,962|| $74,942 |- |}
===Medicolegal=== In the United States the National Practitioner Data Bank 2006 Annual Report obstetrics-related cases accounted for 8.7 percent of all 2006 physician Malpractice Payment Reports and had the highest median payment amounts ($333,334).<ref>{{cite web | url = http://www.npdb-hipdb.hrsa.gov/pubs/stats/2006_NPDB_Annual_Report.pdf | title = National Practitioner Data Bank 2006 Annual Report | access-date = 2010-01-21 | archive-date = 2010-05-27 | archive-url = https://web.archive.org/web/20100527131753/http://www.npdb-hipdb.hrsa.gov/pubs/stats/2006_NPDB_Annual_Report.pdf }}</ref>
== References == {{Reflist}}
== External links == {{refbegin}} * {{cite journal | first = Santina A | last = Zanelli | name-list-style = vanc | url = http://emedicine.medscape.com/article/1183351-overview | title = Hypoxic-Ischemic Brain Injury in the Newborn | journal = Medscape | date = 3 April 2021 | publisher = WebMD LLC }} * {{cite journal | first = Santina A | last = Zanelli | name-list-style = vanc | url = http://emedicine.medscape.com/article/973501-overview | title = Hypoxic-Ischemic Encephalopathy | journal = Medscape | date = 3 April 2021 | publisher = WebMD LLC }} * {{cite web | first = Kate | last = Johnson | name-list-style = vanc | url = http://www.medscape.com/viewarticle/452726 | title = Clear Criteria for Defining Birth Asphyxia | work = Medscape | publisher = WebMD LLC }} {{refend}} {{Medical resources | DiseasesDB = | ICD10 = {{ICD10|P|20}} | ICD9 = {{ICD9|768}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }}
{{Certain conditions originating in the perinatal period}}
[[Category:Respiratory diseases]] [[Category:Respiratory and cardiovascular disorders specific to the perinatal period]]