WELL BEING
Assessment of fetal wellbeing is
either:
TYPES
Acute: Suddenly occurring associated with
otherwise normal fetus. (E.g. Placental separation).
Chronic: Associated usually with
intrauterine growth restriction (IUGR - small
for date fetus).
:AETIOLOGY
Impairment of the placental circulation
due to thrombosis of the vessels or
placental infarcts.
Hypertensive states of pregnancy (PE,
eclampsia, and chronic hypertension).
Accidental hemorrhage or placenta
praevia.
Postmaturity syndrome.
Diabetic pregnancy when associated with
vasculopathy.
Placental infarctions.
Idiopathic.
PATHOLOGY
Fetal response to placental insufficiency:
Redistribution of blood flow preferentially
perfusion.
Decreased fetal movement to conserve
energy.
Disturbance of fetal heart rate due to
Reactive:
Normally a rise in FHR of at
least 15 bpm, for at least 15
sec. will occur at least twice
within a period of 15-20 min.
testing.
Non reactive:
No FHR changes or changes
less than normal
Management according to
:NST
Reactive NST: repeat every week.
Non reactive NST: Further fetal
evaluation:
Ultrasound Biophysical Profile Score
(BPPS)
Colour Doppler velocimetry studies
(fetal umbilical and cerebral arteries)
Oxytocin Challenge Test (OCT).
Ultrasound Biophysical
:(Profile Score (BPPS
The BPP is one of the most popular and
informative tests for antepartum fetal
surveillance (AFS). It is a simple test
based on clear ultrasound parameters that
can pick up those fetuses at risk of
hypoxia. Each tested parameter is given a
score (either 0 or 2).
Pathophysiology of hypoxia:
Decreased Oxygen supply to the fetus
during labour is associated with decreased
elimination of CO2, with resultant fetal
respiratory acidosis and decreased fetal
blood PH.
CAUSES OF INTRAUTERINE
FETAL HYPOXIA (FETAL
(DISTRESS
1. Acute fetal hypoxia:
Cord accidents (cord prolapse, cord compression, true
knots, coils around fetal neck, and rupture vasa praevia).
Placental separation (accidental Haemorrhage, placenta
praevia).
Placental compression (prolonged ROM, uterine
hypertonicity, obstructed labour).
Some congenital and or chromosomal fetal anomalies.
forceps procedure.
Breech extraction in cases of