fetal distress lin qi de 2005.9.5. fetal distress is defined as depletion of oxygen and accumulation...
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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 factors1) Microvascular ischaemia(PIH)2) Low oxygen carried by RBC(severe
anemia)3) Acute bleeding(placenta previa,
placental abruption) 4) Shock and acute infection5) obstructed of Utero-placental blood
flow
Etiology
Placenta 、 umbilical factors
1) Obstructed of umbilical blood flow2) Dysfunction of placenta3) Fetal factors4) Malformations of cardiovascular
system5) 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
ChronicFetaldistress
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 manifestationAcute 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