Fetal Distress

Август 3, 2022

Содержание

2. What is fetal distress? Fetal distress is the term commonly used to describe fetal hypoxia. It
3. Etiology Fetal oxygen supplied from: maternal circulation-----placenta------umbilical cord------fetus maternal factors cardiovescular diseases acute bleeding uterus
4. Etiology Fetal factors Cardio vascular dysfunction deformity umbilical cord and placental factors abnormal cord: entanglement, nuchal
5. Causes of Hypoxia Maternal risk factors Diabetes Pregnancy-induced or chronic hypertension Maternal infection Sickle cell anemia
6. Intrapartum: Abnormal presentation of the fetus (breech) Premature onset of labor Rupture of membrane more than
7. Maternal hypoventilation Maternal hypoxia Hypotension can be caused by either epidural anaesthesia or the supine position,
8. Pathophysiology Hypoxia! Acidosis----sympathetic nerve excited---- hypertension, tachycardia (initial signs) profound acidosis-----vagus nerve---- hypotension, bradycardia, hyperperistalsis----meconium discharge
9. Clinical manifestation Chronic fetal distress FGR dysfunction of maternal-placental-fetal unit fetal heart monitoring fetal movement calculation
10. Clinical manifestation Acute fetal distress fetal heart rate characteristics of fluid fetal movement acidosis
11. How to define the newborn asphyxia Usually with fetal distress. Apgar score: 8-10 normal 4-7 mild
12. APGAR
13. Effects of Asphyxia Fetal hypoxia is associated with severe complications in all systems. The infant may
14. MANAGEMENT There have been no recent trials of operative versus conservative management of suspected fetal distress
15. Class 1: immediate threat to the life of the woman or fetus. Perform this as soon
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Слайд 2

What is fetal distress?
Fetal distress is the term commonly used

to describe fetal hypoxia. It is a clinical diagnosis made by indirect methods and should be defined as:
Hypoxia that may result in fetal damage or death if not reversed or the fetus delivered immediately.
More commonly a fetal scalp pH of less than 7.2 is used to indicate distress

Слайд 3

Etiology
Fetal oxygen supplied from:
maternal circulation-----placenta------umbilical cord------fetus
maternal factors
cardiovescular diseases
acute bleeding
uterus

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Etiology
Fetal factors
Cardio vascular dysfunction
deformity
umbilical cord and placental factors
abnormal cord:
entanglement,

nuchal umbilical cord,
prolapse of cord.
abnormal placenta

Слайд 5

Causes of Hypoxia
Maternal risk factors
Diabetes
Pregnancy-induced or chronic hypertension

Maternal infection
Sickle cell anemia
Chronic substance abuse
Asthma
Seizure disorders
Post-term or multiple-gestation pregnancy

Слайд 6

Intrapartum:
Abnormal presentation of the fetus (breech)
Premature onset of labor

Rupture of membrane more than 24 hours prior to delivery
Prolonged labor
Administration of narcotics and anesthetics

Causes of Hypoxia

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Maternal hypoventilation
Maternal hypoxia
Hypotension can be caused by either epidural

anaesthesia or the supine position, which reduces inferior vena cava return of blood to the heart. The decreased blood flow in hypotension can be a cause of fetal distress (supine hypotension syndrome**).

Causes of Hypoxia

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Pathophysiology
Hypoxia!
Acidosis----sympathetic nerve excited----
hypertension,
tachycardia (initial signs)
profound acidosis-----vagus nerve----
hypotension,
bradycardia,
hyperperistalsis----meconium discharge
chronic condition:
nutritional

deficiency----Fetal Growth Retardation (FGR)

Слайд 9

Clinical manifestation
Chronic fetal distress
FGR
dysfunction of maternal-placental-fetal unit
fetal heart monitoring
fetal movement calculation
amnioscopy

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Clinical manifestation
Acute fetal distress
fetal heart rate
characteristics of fluid
fetal movement
acidosis

Слайд 11

How to define the newborn asphyxia
Usually with fetal distress.
Apgar score: 8-10

normal
4-7 mild asphyxia
0-3 severe asphyxia

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APGAR

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Effects of Asphyxia
Fetal hypoxia is associated with severe complications in all

systems. The infant may suffer:
Hypoxic ischemic encephalopathy
Meconium aspiration syndrome
Acidosis with decompensation
Cerebral palsy
Neonatal seizures

Слайд 14

MANAGEMENT
There have been no recent trials of operative versus conservative management

of suspected fetal distress
Signs of antenatal fetal distress require monitoring with a view to induction of labour or planned caesarean section.
Immediate delivery of a preterm fetus with suspected fetal distress may reduce the risk of intrauterine hypoxia but increases the risks associated with prematurity. Benefit may be gained by deferring delivery, especially if there is uncertainty; however, evidence is lacking to guide this decision
Continuing fetal distress during labour may indicate the need for delivery to be expedited. Speed of delivery should take into account the severity of fetal heart rate and blood sampling abnormalities and relevant maternal factors.The urgency of caesarean section should be documented using the following standardised scheme in order to aid clear communication between healthcare professionals about the urgency of a caesarean section

Слайд 15

Class 1: immediate threat to the life of the woman or

fetus. Perform this as soon as possible after decision. 30 minutes is an appropriate audit standard.
Class 2: maternal or fetal compromise which is not immediately life-threatening. In most situations, within 75 minutes of making the decision.. However, this is not achieved in a substantial proportion of cases, although it is uncertain how significant this is clinically
There is some evidence that very short 'decision-to-incision' time (<20 minutes) may be inversely proportional to neonatal outcomes, ie lower umbilical pH and Apgar scores
Amnioinfusion has been shown to be beneficial in suspected umbilical cord compression (particularly when there is oligohydramnios), with a reduced risk of caesarean section:
In this process, sodium chloride or Ringer's lactate is infused transcervically or, if the membranes are still intact, via a needle inserted under ultrasound guidance through the uterine wall.
The potential adverse effects include umbilical cord prolapse, uterine scar rupture and amniotic fluid embolism.
The current evidence on the safety and efficacy of this procedure means it is not recommended in the UK for intrauterine fetal resuscitation; it is only undertaken under special arrangements that include audit and research

Fetal Distress

Содержание

What is fetal distress? Fetal distress is the term commonly used

EtiologyFetal oxygen supplied from:maternal circulation-----placenta------umbilical cord------fetusmaternal factorscardiovescular diseasesacute bleedinguterus

EtiologyFetal factorsCardio vascular dysfunctiondeformityumbilical cord and placental factorsabnormal cord: entanglement,

Causes of Hypoxia Maternal risk factors Diabetes Pregnancy-induced or chronic hypertension

Intrapartum: Abnormal presentation of the fetus (breech) Premature onset of labor

Maternal hypoventilation Maternal hypoxia Hypotension can be caused by either epidural

PathophysiologyHypoxia!Acidosis----sympathetic nerve excited----hypertension,tachycardia (initial signs)profound acidosis-----vagus nerve----hypotension, bradycardia,hyperperistalsis----meconium dischargechronic condition: nutritional

Clinical manifestationChronic fetal distressFGRdysfunction of maternal-placental-fetal unitfetal heart monitoringfetal movement calculationamnioscopy

Clinical manifestationAcute fetal distressfetal heart ratecharacteristics of fluidfetal movementacidosis

How to define the newborn asphyxiaUsually with fetal distress.Apgar score: 8-10