Fetal distress
LIN QI DE
2005.9.5
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,
Definition
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
Placenta,umbilical factors
1) Obstructed of umbilical blood flow
2) Dysfunction of placenta
3) Fetal factors
4) Malformations of cardiovascular system
5) Intrauterine infection
Etiology
Hypoxia,accumulation of carbon dioxide
?
Respiratory Acidosis
?
FHR? → FHR ?→ FHR ?
?
Intestinal peristalsis
?
Relaxation of the anal sphincter
?
Meconium aspiration
?
Fetal or neonatal pneumonia
Pathogenesis
Acute
fetal
distress
Chronic
Fetal
distress
Pathogenesis
IUGR
(intrauterine growth
retardation)
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
FHR:120~160 bpm / FHR variability
Early deceleration,ED
Late deceleration,LD
Variable deceleration,VD）
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
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