Fetal distress Prof Maysoon sharief Definition Fetal distress

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Fetal distress Prof. Maysoon sharief

Fetal distress Prof. Maysoon sharief

Definition Fetal distress is defined as depletion of oxygen and accumulation of carbon dioxide,

Definition Fetal distress is defined as depletion of oxygen and accumulation of carbon dioxide, leading to a state of “hypoxia and acidosis ” during intrauterine life.

Etiology Maternal factors 1) Microvascular ischaemia(PIH) 2) Low oxygen carried by RBC(severe anemia) 3)

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 Placenta、umbilical factors 1) Obstructed of umbilical blood flow 2) Dysfunction of placenta 3)

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

Pathogenesis Acute fetal distress Hypoxia、accumulation of carbon dioxide ↓ Respiratory Acidosis ↓ FHR↑ →

Pathogenesis Acute fetal distress Hypoxia、accumulation of carbon dioxide ↓ Respiratory Acidosis ↓ FHR↑ → FHR ↓→ FHR ↑ ↓ Intestinal peristalsis ↓ Relaxation of the anal sphincter ↓ Meconium aspiration ↓ Fetal or neonatal pneumonia

Pathogenesis Chronic Fetal distress IUGR (intrauterine growth retardation)

Pathogenesis Chronic Fetal distress IUGR (intrauterine growth retardation)

Clinical manifestation Acute fetal distress (1)FHR FHR>180 beats/min (tachycardia) <100 beats/min (bradycardia) (LD) Repeated

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

FHR: 120~160 bpm / FHR variability

Early deceleration,ED

Early deceleration,ED

Late deceleration,LD

Late deceleration,LD

Variable deceleration,VD)

Variable deceleration,VD)

Clinical manifestation Acute fetal distress (2) Meconium staining of the amniotic fluid grade I、II、III

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) p. H<7. 20 p. O 2<10 mm. Hg (15~30 mm. Hg) CO 2>60 mm. Hg (35~55 mm. Hg)

Clinical manifestation Chronic fetal distress (1) Placental function (24 h E 3<10 mg (2)

Clinical manifestation Chronic fetal distress (1) Placental function (24 h E 3<10 mg (2) FHR (4) Fetal movement (5) Amnioscopy

Management Ø Remove the induced factors actively Ø Correct the acidosis: Ø Terminate the

Management Ø Remove the induced factors actively Ø Correct the acidosis: Ø Terminate the pregnancy 5%Na. HCO 3 250 ML (1) FHR>160 or <120 bpm meconium staining (II~III) (2) Meconium staining grade III amniotic fluid volume<2 cm (3) FHR<100 bpm continually

Management Ø Terminate the pregnancy (4) Repeated LD and severe VD (5) Baseline variability

Management Ø Terminate the pregnancy (4) Repeated LD and severe VD (5) Baseline variability disappear with LD (6) FBS p. H<7. 20 Forceps delivery Caesarean section