Dr SELLY SEPTINA,

SpOG
 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) Microvascular ischaemia
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
Placenta 、 umbilical factors
1) Obstructed of umbilical blood flow
2) Dysfunction of placenta
3) Fetal factors
4) Malformations of cardiovascular system
5) Intrauterine infection
 Pathogenesis
Hypoxia 、 accumulation of carbon dioxide
￬
Respiratory Acidosis
￬
Acute
FHR ￪ → FHR ￬
fetal ￬
distress Intestinal peristalsis
￬
Relaxation of the anal sphincter
￬
Meconium aspiration
￬
Fetal or neonatal pneumonia
 Pathogenesis

Chronic
IUGR
Fetal
(intrauterine growth
distress
retardation)
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
FHR:120~160 bpm / FHR variability
Early deceleration ， ED
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
pO2<10mmHg (15~30mmHg)
CO2>60mmHg (35~55mmHg)
Chronic fetal distress
(1) Placental function
(24h E3<10mg or E/C<10)
(2) FHR
(3) BPS
(4) Fetal movement
(5) Amnioscopy
 Remove the induced factors actively
 Correct the acidosis: 5%NaHCO3 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
 Terminate the pregnancy
(4) Repeated LD and severe VD
(5) Baseline variability disappear with LD
(6) FBS pH<7.20

Forceps delivery
Caesarean section