Fetal distress.ppt

Fetal distress LIN QI DE 2005.9.5 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. Maternal factors Microvascular ischaemia(PIH) Low oxygen carried by RBC(severe anemia) Acute bleeding(placenta previa, placental abruption) Shock and acute infection obstructed of Utero-placental blood flow Placenta、umbilical factors Obstructed of umbilical blood flow Dysfunction of placenta Fetal factors Malformations of cardiovascular system Intrauterine infection Hypoxia、accumulation of carbon dioxide ? Respiratory Acidosis ? FHR? → FHR ?→ FHR ? ? Intestinal peristalsis ? Relaxation of the anal sphincter ? Meconium aspiration ? Fetal or neonatal pneumonia Chronic Fetal distress Clinical manifestation Acute fetal distress (1)FHR FHR180 beats/min (tachycardia) 100 beats/min (bradycardia) (LD) Repeated Late deceleration Placenta dysfunction (VD) Variable deceleration Umbilical factors FHR:120~160 bpm / FHR variability 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) pH7.20 pO210mmHg (15~30mmHg) CO260mmHg (35~55mmHg) Clinical manifestation Chronic fetal distress (1) Placental function (24h E310mg or E/C10) (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) FHR160 or 120 bpm meconium staining (II~III) (2) Meconium staining grade III amniotic fluid volume2cm (3) FHR100 bpm continually Management Termina