Fetal Distress

Song weiwei
songww@sj-hospital.org
Cell phone:13591441088

What is fetal distress?

Fetal distress is the term commonly used to
describe fetal hypoxia. It is a clinical diagnosis
made by indirect methods and should be defined
as:Hypoxia that may result in fetal damage or
death if not reversed or the fetus delivered
immediately.
More commonly a fetal scalp pH of less than 7.2 is
used to indicate distress

Causes of fetal distress

Maternal hypotension
Cord prolapse and compression
Uterine hypercontractility
Uteroplacental insufficiency
Maternal drugs
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 risk factors for fetal

distress.
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

Pathophysiology
Hypoxia!
Acidosis----sympathetic nerve excited--- hypertension,
tachycardia (initial signs)

profound acidosis-----vagus nerve--- hypotension,

bradycardia,
hyperperistalsis----meconium discharge

chronic condition:
nutritional deficiency----FGR

Whats the typical signs of fetal

distress?**
Typical signs of fetal distress include :
Late heart rate decelerations
Variable decelerations
Prolonged bradycardia
Meconium staining.

 Measurement of the fetal heart rate: abnormal

decelerations and decreased variability during
contractions are suggestive of fetal distress.
Intermittent auscultation of the fetal heart rate is a
reliable indicator of fetal well being and can be
used in low risk deliveries. Routine electronic
fetal monitoring is not recommended for low-risk
women in labor when adequate clinical monitoring
including intermittent auscultation by trained staff
is available .

 Continuous intrapartum fetal monitoring is

the mainstay in most modern obstetric units.
The heart rate of the fetus is monitored to
detect increases or decreases during
contractions. The variability and trends are
interpreted to determine fetal distress or
well being.

 Scalp pH measurement helps to determine

the presence of acidosis and fetal hypoxia
and may influence the decision of
whether to continue observation or to
perform a cesarean delivery. Neurologic
deficits usually occur when there is a
severe acidosis, due to hypoxia, present at
birth. Severe hypoxia will often cause
hypoxic-ischemic encephalopathy in the
infant.

Treatment
Mothers condition must be treated to prevent
hypoxia to the fetus including:
Blood pressure stabilization
Maternal positioning on the left side
Monitoring maternal oxygenation
Pelvic exam to identify cord presentation

Treatment
Oxygen administration to the mother may provide
additional availability of oxygen to the fetus.
Trained neonatal resuscitation staff should be
available at all times and should be present in the
delivery suite for those patients with known risk
for fetal distress or hypoxia.
Cesarean sections are performed if all else fails,
and are the last alternative when faced with the
possibility of fetal distress.

Decreased fetal movment

Perception of fetal movement typically begins in
the second trimester, and occurs earlier in parous
women than nulliparous women, The mother's first
perception of fetal movement, termed
"quickening Maternal perception of fetal
movement is reassuring to pregnant women,
whereas decreased fetal movement (DFM) is a
common reason for concern.

Decreased fetal movment

Perception of fetal movement typically begins in
the second trimester, and occurs earlier in parous
women than nulliparous women, The mother's first
perception of fetal movement, termed
"quickening Maternal perception of fetal
movement is reassuring to pregnant women,
whereas decreased fetal movement (DFM) is a
common reason for concern.

Normal fetal movments

Perception of at least 10 FMs during 12 hours of normal maternal
activity
Perception of least 10 FMs over two hours when the mother is at
rest and focused on counting
Perception of at least 4 FMs in one hour when the mother is at
rest and focused on counting
Perception of at least 10 FMs within 25 minutes in pregnancies 22
to 36 weeks and 35 minutes in pregnancies 37 or more weeks of
gestation

Infrequent fetal movement does not necessarily mean the fetus is

compromised or even inactive. Poor perception of fetal activity
may be due to early gestational age,decreased/increased amniotic
fluid volume, maternal position (sitting or standing versus lying),
fetal position (anterior position of the fetal spine), anterior
placenta, and maternal physical activity (or just being mentally
distracted), Transient decreases in fetal activity can be due to fetal
sleep states, maternal drug use (eg, sedatives), or maternal
smoking.

Evaluation
Nonstress test/cardiotocography: Provides immediate
reassurance of fetal viability and well-being
Ultrasound: Valuable assessment tool, of pregnancies
complicated by persistent DFM despite a reactive NST.
Doppler velocimetry: Useful if fetal growth restriction has
been identified on ultrasound examination
Testing for fetomaternal transfusion A maternal assay
(Kleihauer-Betke stain or flow cytometry) to detect
fetomaternal hemorrhage should be performed in the evaluation
of the pregnant patient who presents with DFM and a
sinusoidal fetal heart rate pattern, unexplained fetal
tachycardia, or fetal hydrops on ultrasound associated with
elevated middle cerebral artery Doppler velocity.

Thank you