distres

disttres fetal

1. Fetal
distress
LIN QI DE
2005.9.5

2. 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

3. 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

4. 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

5. 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

6. Chronic
Fetal
distress
Pathogenesis
IUGR
(intrauterine growth
retardation)

7. 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

8. FHR:120~160 bpm / FHR variability

9. Early
deceleration，ED

10. Late deceleration，LD

11. Variable
deceleration，VD）

12. 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
pO
2
<10mmHg (15~30mmHg)
CO
2
>60mmHg (35~55mmHg)

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

14. Management
Remove the induced factors actively
Correct the acidosis: 5%NaHCO
3
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

15. 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