课件10级大5上妇产科学093fetal distress.pptxVIP

Fetal distressDefinitionFetal distress is defined as depletion of oxygen and accumulation of carbon dioxide,leading to a state of “hypoxia and acidosis ” during intra-uterine life. fetal distress divided into acute and chronic fetal distress Chronic fetal distress occurs usually in antepartum Acute fetal distress occurs usually in intrapartum.EtiologyMaternal blood oxygen shortageMaternal-fetal oxygen transport and exchange obstacleAbnormal fetal own factorsEtiologyMaternal factorsHypertensive disorderLow oxygen carried by RBC(severe anemia, Minor arterial insufficiency : heart disease with heart failure; pregnancy with lung disease )Acute bleeding(placenta previa, placental abruption) Shock and acute infectionEtiologyMaternal-fetal oxygen transport and exchange obstacle1） Poor function of the placenta (hypertensive disorder；chronic hypertension, chronic nephritis, postterm pregnancy, diabetes)2） Abnormal umbilical cord (prolapse, edema, long ,short, torsion, knot, wrap the neck)EtiologyFetal factors 1) Abnormality in growth (heart, liver, lung) 2) Intrauterine infection 3) Incompatibility of mother and fetus blood group 4) Intracranial hemorrhagePathogenesisHypoxia、accumulation of carbon dioxide ?Respiratory Acidosis?FHR? → FHR ? ?Intestinal peristalsis（蠕动）?Relaxation of the anal sphincter?Meconium staining?Fetal or neonatal pneumoniaAcute fetal distressPathogenesis FGR(Fetal growth restriction)ChronicfetaldistressPathophysiologyFetal distress is physiologic and pathophysiologic responses to an asphyxiated state in uterus, progressive fetal asphyxia will result in: 1) decompensation of the pathophysiologic responses 2) permanent central nervous system damage 3) other organs damage or deathClinical manifestationAcute fetal distress (1) Abnormal fetal heart rate (FHR)： Important criteria to diagnose fetal distress (FHR)160 beats/min (tachycardia) 110 beats/min (bradycardia) (LD) Repeated Late deceleration Placenta dysfunction (VD) Variable decelerati