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Sometimes HIE can be caused by various umbilical cord issues. Cord entanglement and compression is rare, but can occur. Sometimes a mother might notice a change in movement during pregnancy. Many of our families had “kick count saves” where movement stopped and they went into Labor and Delivery and their baby was born and resuscitated. Cord compression can happen intermittently during pregnancy or labor. HIE from too much or too little amniotic fluid, can also affect the umbilical cord leading to HIE.
Whether associated with a placental abruption, or just spontaneously happening, sometimes fetal-maternal hemorrhage is a cause of HIE. This occurs when a bleed happens internally and the baby and mother both lose a significant amount of blood.
HIE from Placental Issues
The placenta is a fascinating and understudied organ. It is very difficult to detect placental issues through standard imaging. There are new research studies underway through the Human Placenta Project to help understand this vital organ in hopes of catching and preventing issues, like those that can lead to HIE.
Some placental issues include placental insufficiency, where the placenta for one reason or another prematurely, or not, ages and gives out. Placental abruption is also a very common cause, but with many sub-causes. For some, they have repeat placental abruptions, for some it’s lifestyle choice, and for some it’s during labor and delivery. The placenta may also become clotted due to undiagnosed clotting disorders.
Placental previa can also occur where a vaginal delivery would be unsafe for the baby. Placental previa is routinely caught and a c-section is recommended if it does not move during the remainder of pregnancy.
HIE from Uterine Rupture or Other Uterine Causes
Uterine rupture is another cause of HIE. This can happen spontaneously, or due to another incident such as trauma, or during an attempt at a VBAC (vaginal birth after cesarean), where a scar could potentially cause a thinning in the uterus leading to rupture. It is highly recommended to work with a trained physician, or a high-risk physician, to determine your risk factor for birth options and repeat of issues.
HIE from Labor and Delivery
Labor and delivery is a complex process. Many factors come together for a healthy and successful birth. Sometimes, things go well, and other times they do not. Sometimes these are preventable, other times they are not.
Causes such as shoulder dystocia, where a baby gets “stuck” due to a position or a large baby, may or may not be preventable. While imaging can take a best guess at the size of a baby, many times ultrasound is inaccurate and a baby may be larger than originally predicted, or a mother’s pelvic girdle is not wide enough to birth a child vaginally.
Occasionally, with the above possibilities such as cord compression, placental abruption, etc. some babies need emergency c-sections if there are distress factors that occur. Sometimes these are preventable, and sometimes they are not.
HIE from Blood Clotting Disorders
Many blood clotting disorders are not detected until something goes wrong to bring them to light, as they are not standard panels and are rare. However, many of our families have found out post-HIE that they are carriers of various blood clotting disorders such as MTHFR. More research is needed to see if there is more of connection and if certain blood tests would better screen for potential issues to the mother and child.
HIE from Post-Birth Causes
Many families have babies whose HIE was not obvious right away, or who developed HIE in post-birth situations. Some of those include:
Because the combination of a lack of oxygen and lack of blood flow to the brain can cause HIE, some children who experience cardiac arrest due to several different causes, or a near-SIDS event in childhood, can experience HIE. Sometimes these are near-drownings, sometimes accidental smothering during sleep, and others due to unexpected physical trauma.
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