Docstoc

Fetal distress (PowerPoint)

Document Sample
Fetal distress (PowerPoint) Powered By Docstoc
					Fetal distress
         Dr Feroz
           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(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
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                          ↓
fetal              FHR↑ → FHR ↓→ FHR ↑
distress                       ↓
                    Intestinal peristalsis
                               ↓
               Relaxation of the anal sphincter
                               ↓
                    Meconium aspiration
                               ↓
                Fetal or neonatal pneumonia
      Pathogenesis


Chronic       IUGR
Fetal       (intrauterine growth
distress      retardation)
 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
FHR:120~160 bpm / FHR variability
Early deceleration,ED
Late deceleration,LD
Variable deceleration,VD)
  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
     pO2<10mmHg (15~30mmHg)
     CO2>60mmHg (35~55mmHg)
 Clinical manifestation
Chronic fetal distress
  (1) Placental function
            (24h E3<10mg or E/C<10)
  (2) FHR
  (3) BPS
  (4) Fetal movement
  (5) Amnioscopy
             Management
   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
             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

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:598
posted:4/29/2010
language:English
pages:16