Our bodies work to maintain a stable balance of chemicals, including water, oxygen, electrolytes, and acid levels. On a day-to-day basis, we don’t think much about our body’s equilibrium until we get a signal that things may be “off”, such as thirst to drink more water or hunger for glucose for the brain to operate.
When the balance is out of sync, it can cause injury or damage to the body’s cells, organs, or the brain. The balance can be more important during development in the womb where small imbalances can cause damage to the developing brain and organs of the baby. Increased acidity in the blood and other tissues can cause neurodevelopmental delay, brain injury, or death.
What is Fetal Acidosis?
Acidosis is a condition where the body fluids are too acidic. Acid levels are measured in pH where the blood has a pH of about 7.4. A pH level of 7.35 or lower is considered acidosis. A pH level of 7.45 or higher is alkalosis. Acidosis is generally categorized as respiratory acidosis or metabolic acidosis.
Acidosis in the fetus can cause birth complications, brain injury, or death. There are a number of possible causes of fetal acidosis, including maternal, placental, and fetal sources of high acid levels. When the acid levels in the blood are too high, treatment generally involves lowering the pH through administering base chemicals, like bicarbonate. Treatment may also require addressing the underlying cause of high acid levels.
Fetal Metabolic Acidosis
Metabolic acidemia is generally caused by increased production of acids in the body (such as lactic acid), or problems in riding the body of acid because of kidney problems. Metabolic acidosis can be caused by problems in oxygen diffusion through low oxygen levels or hypovolemia.
Fetal metabolic acidosis is tested by sampling the blood in the umbilical cord. However, the normal range in the fetus depends on which blood vessel is sampled because the umbilical artery generally has a lower pH than the umbilical vein. Fetal metabolic acidemia is defined as an umbilical vessel pH of less than 7.20.
Fetal Respiratory Acidosis
Respiratory acidosis is generally caused by a buildup of carbon dioxide in the blood. Carbon dioxide is usually expelled through the blood to the lungs. Respiratory acidosis may be caused by a low breathing rate or conditions affecting the lungs, like asthma or emphysema.
Fetal respiratory acidosis is tested by sampling the blood in the umbilical cord. However, the normal range in the fetus depends on which blood vessel is sampled because the umbilical artery generally has a lower pH than the umbilical vein. Fetal respiratory acidemia is defined as umbilical vessel pH of less than 7.20 and partial carbon dioxide pressure of 66 or higher (or 50 or higher in the umbilical vein).
Causes of Acidosis in Babies
There are a number of possible causes of fetal acidosis, including maternal conditions, problems in the placenta, or fetal problems. The causes of acidosis may also differ if it involves respiratory acidosis or metabolic acidosis. Risk factors for acidosis in the mother may include:
- Kidney disease
- Obesity
- Diabetes
- Asthma
- Opioid users
- Some diets
Causes of Respiratory Acidosis
Causes of respiratory acidosis from too much carbon dioxide in the blood may include:
- Airway obstruction
- Asthma
- Chronic respiratory diseases
- Chronic obstructive pulmonary disease (COPD)
- Emphysema
- Pneumonia
- Chronic bronchitis
- Cystic fibrosis
- Lung cancer
- Traumatic chest injury
- Obesity
- Sedative drugs
- Alcohol impairment
- Nerve problems
In a fetus, the lungs are not used for breathing. Instead, oxygen and carbon dioxide are exchanged through the placenta. If there is a build-up of carbon dioxide in the blood in the fetus, it may be caused by respiratory conditions in the mother. Respiratory acidosis in the mother may be caused by chronic breathing problems, traumatic injury, drug or alcohol impairment, hemorrhage, or epidural anesthesia. Uterine contractions can also interrupt blood flow to the baby, which can cause hypoxia and acidosis.
Placental problems can cause acute acidosis if the placenta tears away from the blood supply to the mother, resulting in hypoxia and acidosis. During delivery or labor, compression or damage to the umbilical cord may also lead to hypoxia and acidosis.
Causes of Metabolic Acidosis
Causes of metabolic acidosis generally involve problems with the kidneys where the kidneys cannot properly eliminate acid and it builds up in the blood and tissue. Metabolic acidosis may be caused by a chemical imbalance in the body, kidney problems, severe dehydration, or diabetes. Poisoning by some chemicals, including aspirin, methanol, or ethylene glycol may also lead to acidosis.
Lactic acid is another cause of metabolic acidosis. When the body breaks down carbohydrates to use for energy, it produces lactic acid. The body may produce too much lactic acid because of some activities, drugs, or medical conditions, including:
- Cancer
- Carbon monoxide poisoning
- Chronic alcoholism
- Liver failure
- Low blood sugar
- Seizures
- Eclampsia
- Hypoxia
Signs and Symptoms of Fetal Acidosis
Signs and symptoms of fetal acidosis are generally noticed by signs and symptoms of the mother. Symptoms may involve those related to some underlying disease or problem, like breathing problems that lead to acidosis, including breathing problems and symptoms related to a lack of oxygen. Signs include:
- Feeling tired
- Confusion
- Shortness of breath
- Rapid breathing
- Headache
- Increased heart rate
Acidosis is generally diagnosed through testing the blood. Arterial blood gas tests can show the levels of oxygen and carbon dioxide in the blood and blood pH. Other diagnostic tests can check kidney function, pH levels, proteins, blood sugars, electrolytes, and other chemical levels which can diagnose the type of acidosis.
Complications of Acidosis and Injuries
Fetal acidosis is classified as acute or chronic. Acute fetal acidosis may occur for a short period and chronic acidosis may occur for days. The severity of the acidosis can affect the complications and outcome of the condition. In acute fetal acidosis, oxygen supply is the primary concern because it is often the lack of oxygen that is causing the build-up of acid. Hypoxia, or not enough oxygen, can lead to organ damage, brain damage, and death.
Even if the mother is healthy and there are no problems with placental function, conditions with the fetus can cause chronic acidosis. Some diseases, infections, fetal tumors, cardiac abnormalities, arrhythmias, or hemorrhage can cause a drop in pH levels and dangerous acidosis.
Acidosis and Birth Injury Malpractice
There are many possible causes of acidosis and acidosis in the mother, acidosis through placental malfunction, or acidosis within the fetus can cause serious injury to the baby. Monitoring the health of the mother, fetus, and baby throughout the pregnancy is important to gauge the health and safety of the mother and baby.
Medical malpractice involves failing to provide the standard of care which causes an injury or harm. Malpractice in acidosis injuries may be caused by failure to properly monitor the health of the mother and baby, failure to order certain tests, failure to properly interpret diagnostic tests, delayed delivery, anesthesia errors, or medication errors.
Acidosis Birth Injury Attorneys
If your child suffered a birth injury because of fetal acidosis or lack of oxygen, talk to an experienced Philadelphia medical malpractice attorney about holding the doctors and healthcare systems accountable. Do not hesitate to contact Gilman & Bedigian today for a free consultation.