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

Chronic
IUGR
Fetal
distress
(intrauterine growth
retardation)
Risk Factor

• Pregnancy woman >35 years old

• IUFD
• Fetal Growth Restriction
• Oligohidramnion or polihidramnion
• Gemelli
• Rhesus sensitivity
• Hipertension
• DM
• Serotinus
Sign and symptom

• Thick and green meconium in amnion fluid

• Tachycardia/ bradycardia/ irregularity of FHR
• Fetal acidosis
Clinical examination

• Cardiotocography (CTG)
• Non Stress Test (NST)
• Contraction Stress Test (CST) or Oxytocin
Challenge Test (OCT)
• Fetal Bloos Sample (FBS)
• Biophysical profile
 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
Management

• Repositioning the patient to the left side

• Stop oxytocin
• Identification of maternal causes
• Vaginal examination if there’s no problem in
mother and FHR is abnormal in minimal 3
contraction
 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