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) Low oxygen carried by RBC(severe
anemia)
2) obstructed of Utero-placental blood flow
3) fetal factors
 Etiology
Fetal acute hypoxia
placenta previa
placental abruption
oxytocin is misused
narcotic and sedative use too much
umbilical abnormal es. prolapse of cord
true knot of cord
turning around
 Etiology
Fetal chronic hypoxia
low oxygen carried by RBC
lesion of uterine placental blood vessels
as pregnancy induced hypertension
GDM
post-term pregnancy
Fetal factors: malformation of cardiovascular
system and anemia
 Pathogenesis
 Blood gas analysis
respiratory and metabolic acidosis

 Cardiovascular system
fetal heart rate ￪ → FHR ￬→ FHR ￪

 urinary system
 Pathogenesis
 digestive system
meconium aspiration

 respiratory system
pneumonia → apnea → no breath

 central nervous system

encephaledema and encephalorrhagia
 Clinical manifestation
Main manifestation
abnormal of fetal heart rate
fetal heart rate monitoring
fetal movement
 Clinical manifestation
Acute fetal distress
reason: prolapse of cord
placenta previa
placental abruption
shock
prolonged labor
 Clinical manifestation
Acute fetal distress
(1)FHR early stage >160 bpm
late stage <110 bpm
Late deceleration
Variable deceleration
FHR:120~160 bpm / FHR variability
Early deceleration，ED
Late deceleration，LD
Variable deceleration，VD）

No regular
 Clinical manifestation
Acute fetal distress
(2) Meconium staining of the amniotic fluid
grade I light green
II yellow green
III brown
(3) Fetal movement
Frequently→decrease and weaken
 Clinical manifestation
Acute fetal distress
(4) Acidosis
FBS (fetal blood sample)
pH<7.10 metabolic acidosis
pO2<10mmHg (15~30mmHg)
CO2>60mmHg (35~55mmHg)
 Clinical manifestation
Chronic fetal distress
reason: hypertensive disorders
chronic nephritis , DM,
severe anemia,
intrahepatic cholestasis
 Clinical manifestation
Chronic fetal distress
(1) Fetal movement
decreased <10 /12h
(2) biophysical score of fetus
10-8' no hypoxia
8-6' acute or chronic hypoxia maybe
6-4' acute or chronic hypoxia
<4' acute and chronic hypoxia
 Clinical manifestation
Chronic fetal distress
(3) Fetal growth restriction

(4) abnormal of fetal heart rate monitoring

 Management
 Acute fetal distress
(1) for reason left lateral position
stop use oxytocin
(2) oxygen
(3) teminate the pregnancy
delivery in short time--delivery
forceps delivery
or cesarean section
 Management
 Chronic fetal distress
(1) general processing- stay in bed,left
lateral position,oxygen
(2) terminate the pregnancy
full-term pregnancy
abnormal fetal heart rate monitoring
biophysical score of fetus <4'
(3) expectant treatment