Fetal distress

Definition

Fetal distress is defined as depletion

of oxygen and accumulation of carbon
dioxide,leading to a state of “hypoxia
and acidosis ” during intra-uterine life.
 Etiology
Maternal factors
1. Microvascular ischaemia(PIH)
2. Low oxygen carried by RBC(severe anemia)
3. Acute bleeding(placenta previa, placental
abruption)
4. Shock and acute infection
5. obstructed of Utero-placental blood flow
 Etiology
Placental umbilical
factors
1) Obstructed of umbilical
blood flow
2) Dysfunction of
placenta
3) Fetal factors
4) Malformations of
cardiovascular system
5) Intrauterine infection
 Pathogenesis
Hypoxia 、 accumulation of carbon dioxide
￬
Respiratory Acidosis
Acute fetal ￬
distress
FHR ￪ → FHR ￬→ FHR ￪
￬
Intestinal peristalsis
￬
Relaxation of the anal sphincter
￬
Meconium aspiration
￬
Fetal or neonatal pneumonia
 Pathogenesis

Chronic IUGR
Fetal (intrauterine growth
distress restriction)
 Clinical manifestation
Acute fetal distress
(1)FHR
FHR>180 beats/min (tachycardia)
<100 beats/min (bradycardia)
(LD) Repeated Late deceleration
Placenta dysfunction
(VD) Variable deceleration
Umbilical factors
 Clinical manifestation
Acute fetal distress
(2) Meconium staining of the amniotic fluid
grade I 、 II 、 III
(3) Fetal movement
Frequently→decrease and weaken
(4) Acidosis
FBS (fetal blood sample)
pH<7.20
pO2<10mmHg (15~30mmHg)
CO2>60mmHg (35~55mmHg)
 Clinical manifestation
Chronic fetal distress
(1) Placental function
(24h E3<10mg or E/C<10)
(2) FHR
(3) BPS
(4) Fetal movement
(5) Amnioscopy
 Assessment
Antepartum Testing:
Tests for antepartum fetal
evaluation include:
• Fetal movement count
• Non stress test
• Contraction stress test
• Biophysical profile
 Biophysical profile

• fetal movement
• amniotic fluid volume
• respiratory movement
• movement of extremity
• NST
 Intrapartum Testing
Tests utilized to assess
fetal well being during
labor include:
• Intermittent
auscultation of the fetal
heart rate
• Continuous electronic
fetal monitoring
• Scalp pH
measurement
 What’s the typical signs of fetal
distress?

Typical signs of fetal distress include :

• late heart rate decelerations
• variable decelerations
• prolonged bradycardia
• indications of meconium staining.
 Awareness
• Intrapartum hypoxia is thought to be the
leading cause of cerebral palsy and now
accounts for 3 to 15% of cerebral palsy
cases.
• Chronic fetal hypoxia, caused by maternal
smoking or anemia, may also contribute to
a predisposition for Sudden Infant Death
Syndrome (SIDS).
 Treatment of Hypoxia
Mother’s condition must be treated to
prevent hypoxia to the fetus including:

• Blood pressure stabilization

• Maternal positioning on the left side
• Monitoring maternal oxygenation
• Pelvic exam to identify cord presentation
• Termination of pregnancy
 INTRA-UTERINE RESUSCITATION GUIDELINE

• Syntocinon off
• Position
full left lateral; continue for transfer &
on operating table (if FHR remains low
try right lateral / knee elbow for
possible cord compression)
• Tocolysis
terbutaline 0.25 mg subcutaneous (0.5
ml from a 1ml ampoule).
• Oxygen
maximum flow (15 litre/min) via tight
fitting Hudson mask with reservoir bag
• Fluid
Hartmann’s 1 litre rapid infusion (unless
fluid intake restricted e.g.
preeclampsia)
• Ephedrine
consider if low maternal blood pressure
 Management
 Remove the induced factors actively
 Correct the acidosis: 5%NaHCO3 250ML

 Terminate the pregnancy

(1) FHR>160 or <120 bpm
meconium staining (II~III)
(2) Meconium staining grade III
amniotic fluid volume<2cm
(3) FHR<100 bpm continually
 Management
 Terminate the pregnancy
(4) Repeated LD and severe VD
(5) Baseline variability disappear with LD
(6) FBS pH<7.20

Forceps delivery
Caesarean section
Thank You !