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052
052
Song weiwei
songww@sj-hospital.org
Cell phone:13591441088
What is fetal distress?
• Fetal factors
– cardiovescular dysfunction
– deformity
• umbilical cord and placental factors
– abnormal cord:entanglement,
nuchal umbilical cord
prolapse of cord
– abnormal placenta
Causes of Hypoxia*
risk factors
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
Intrapartum causes of fetal
hypoxia**
• Abnormal presentation of the fetus (i.e.
breech)
• Premature onset of labor
• Rupture of membrane more than 24 hours
prior to delivery
• Prolonged labor
• Administration of narcotics and anesthetics
• 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**).
Pathophysiology
• Hypoxia!
– Acidosis----sympathetic nerve excited----
• hypertension,
• tachycardia (initial signs)
– profound acidosis-----vagus nerve----
• hypotension,
• bradycardia,
• hyperperistalsis----meconium discharge
– chronic condition:
• nutritional deficiency----FGR
Clinical manifestation
• Term infants
• Growth-retarded infants
• Post-term infants
• Breech presentation delivery
• The degree of meconium aspiration and the length of
exposure to meconium determines the severity of the
hypoxia suffered by the fetus. Staining of the umbilical
cord, skin, or nails of the infant indicates exposure to
meconium 3 to 6 hours in utero prior to delivery.
Assessment
**
Antepartum Testing:
Tests for antepartum fetal evaluation include:
• Fetal movement count
• Non stress test
• Contraction stress test
• Biophysical profile
Fetal movement
• fetal movement
• amniotic fluid volume
• respiratory movement
• movement of extremity
• NST
Intrapartum Testing