Foetal Distress.pptx basic information and knowledge

foetal distress ppt, basic knowledge and information

1. Foetal Distress Dr s mohan Mbbs Mahathma ghandi memorial hospital

2. What is fetal distress? Fetal distress describes a condition when the fetus shows signs of distress during late pregnancy or labor. Most healthcare providers have replaced the term fetal distress with non-reassuring fetal status (NRFS). There are many reasons why the fetus could show signs of distress, such as labor, reactions to medications or issues with the umbilical cord or placenta. Fetal distress can be dangerous and cause complications for both mother and the fetus. the obstetrician looks for signs of distress as part of pregnancy care.

3. What are the signs of fetal distress? The most common signs of fetal distress are: Changes in the fetal heart rate (lower or higher rate than normal ). Abnormal fetal heart ( fetal heart < 120/min or > 160 beat / min ) The fetus moves less for an extended period of time. Low amniotic fluid.

4. Abnormal cardiotocography ( Non reassuring fetal status ) -Fetal tachycardia or bradycardia especially during & after contraction -Decreased beat-beat variability in base line fetal heart - Late deceleration

5. Biochemical sign- Fetal scalp blood PH < 7.2 or showing elevated lactate level Metabolic acidosis is more reliable predictor of Fetal Distress but is not always available

6. What causes fetal distress? The most common cause of fetal distress is the fetus not getting enough oxygen. The fetus gets oxygen from the mother. she takes in oxygen into her lungs, then the blood carries it to the placenta. It’s handed off to the placenta and transferred to the fetus's blood. Anything that interrupts this process may lead to fetal distress.

7. Other conditions that may lead to non-reassuring fetal status are: Too frequent contractions ( tachysystole ). Fetal anemia. Oligohydramnios (low amniotic fluid). Pregnancy-induced hypertension. Preeclampsia. Abnormally low blood pressure .

8. Late-term pregnancies (41 weeks or more). Fetal growth restriction (very small baby). Placental abruption. Placental previa . Umbilical cord compression. a chronic condition like diabetes, kidney disease or heart disease. expecting identical twins.

9. How is fetal distress diagnosed? The health care provider diagnoses fetal distress by reading the fetal heart rate. A low heart rate, or unusual patterns in the heart rate, could signal fetal distress. Checking the fetal heart rate is a good way to find out if it's tolerating pregnancy and labor well. During pregnancy the obstetrician may recommend other tests to monitor the fetal heart rate:

10. Nonstress test. An electronic fetal monitor measures the fetal heart rate while sitting or laying down. A belt with an electronic sensor is placed around the belly . During that time, the fetal heart rate is measured and recorded. The test can also measure the uterine contractions. The results are either reactive or not reactive based on how active the fetus is. Biophysical profile . An ultrasound that measures fetal movement, muscle tone, breathing movement and amniotic fluid volume. It’s sometimes combined with a nonstress test.

11. When is a NST Performed NST are generally performed after 28 weeks of gestational age. Before 28 weeks, the fetus is not developed enough to respond to the test protocol. Before 28 weeks of gestational age 50% of NST are non-reactive in neurologically healthy fetus. At 28-32 weeks gestation NST is nonreactive in 15% cases of healthy fetus

12. What are the long-term effects of fetal distress? Fetal distress can have lasting effects on the baby . Prolonged lack of oxygen during delivery can lead to brain injury, cerebral palsy or even stillbirth. If baby is in distress, health care providers will make every attempt to deliver the baby safely and before severe complications arise.

13. Interpretation Normal / Reassuring - Suspicious -one non reassuring category and reminder are reassuring. Pathological / Non reassuring -2 or more non-reassuring categories or one or more abnormal categories . Terminal- variability <2

14. At 32weeks or below acceleration of at least 10 beats lasting for 10 seconds should be taken normal instead of 15 beats or more lasting for 15 seconds after 32 weeks of gestational age

15. During labor

16. Late decelerations

17. Etiology of fetal distress 1)Respiratory depression - Cardiac failure - Chest infection - Eclampsia 2)Hypotension - Haemorrhage & shock - Spinal Anaesthesia - Supine hypotensive syndrome

18. Hypertension Severe Anemia Maternal acidosis

19. Placental – Abruptio placentae - Placental Insufficiency due to any cause 3)Cord - Cord Prolapse - Cord entanglement tightly around neck 4) Uterus - Uterine hyper stimulation - Uterine rupture or Scar dehiscence 5) Fetal - Excessive moulding - Fetal congenital heart lesions

20. How is fetal distress treated? If in labor, some of the things we may do to help during fetal distress include: Changing the position. This may increase the blood return to your heart and oxygen supply to the fetus. Giving oxygen through a mask. Giving fluids through IV line. Giving medicine to slow or stop contractions. Amnioinfusion .

21. Administration of oxygen to mother (6-8 L/min) Decrease uterine activity (stop oxytocin drip if used) Tocolytic to be given when uterus is hyper tonus Amnioinfusion – It is a process to increase intra-uterine fluid volume by introducing 500ml of normal saline in the uterus in case of thick meconium and oligohydrmnios It dilutes or washout meconium & prevents meconium aspiration and cord compression

22. If baby is in trouble The provider may need to deliver it right away. They may use forceps or a vacuum extractor if fully dilated and the baby is low enough in uterus . Otherwise , perform an emergency c-section . provider will council pt through what is happening and why they are concerned. They will ask for consent before any procedure.

23. Removal of the fetus from its unfavorable environment If the fetal heart rate pattern remains non reassuring If facilities are available, it is ideal is to perform fetal scalp blood sample PH → acidosis → immediate delivery . The method of delivery will depend on cervical dilation , the position and presentation of the fetus If fetal distress in 2nd stage of labor and prerequisites of forceps or vacuum are fulfill then vaginal delivery otherwise C.S

24. References World Health Organization. Guidelines on basic newborn resuscitation. 2012. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347–70. World Health Organization. The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM. 2016. Google Scholar World Health Organization. Guidelines on basic newborn resuscitation. Geneva: World Health Organization; 2012. https://apps.who.int/iris/bitstream/handle/10665/75157/9789241503693_eng.pdf;jsessionid=AE98884DC6B54A390246FA7DA013D07D?sequence=1.