內容09級-婦產科學3fetal distress

1、Fetal distressFetal 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 DefinitionRecent reviewFetal distress is physiologic and pathophysio

2、logic病理生理 responses to an asphyxiated缺氧 state in uterus.if not correct progressive fetal asphyxia, it will result in pensation代償失調 of the physiologic responses and cause permanent central nervous system damage and other organs damage or deathChronic fetal distress occurs usually in antepartum Acute

3、fetal distress occurs usually in intrapartum.Maternal 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 fail

4、ure; pregnancy with lung disease )Acute bleeding(placenta previa, placental abruption) Shock and acute infectionEtiologyMaternal-fetal oxygen transport and exchange obstacle1） Poor functioning of the placenta (hypertensive disorder；Chronic hypertension, Chronic nephritis, postterm pregnancy, Diabete

5、s)2） abnormal umbilical cord (prolapse, edema, long ,short, torsion, knot, wrap the neck)EtiologyFactors of fetal 1) Abnormality in growth (heart, liver, lung) 2) Intrauterine infection 3) patibility of mother and fetus blood group 4) Intracranial（顱內） hemorrhageEtiologyHypoxia、accumulation of carbon

6、 dioxide Respiratory AcidosisFHR FHR Intestinal peristalsis（蠕動）Relaxation of the anal sphincterMeconium（胎糞） stainingFetal or neonatal pneumoniaPathogenesisAcute fetal distressChronicFetaldistressPathogenesis FGR(Fetal growth restriction)Clinical manifestationAcute fetal distress (1) Abnormal fetal h

7、eart rate (FHR)： Important criteria to diagnose fetal distress (FHR)160 beats/min (tachycardia) 120 beats/min (bradycardia) (LD) Repeated Late deceleration Placenta dysfunction (VD) Variable deceleration Umbilical factorsClinical manifestationAcute fetal distress if the FHR 100 beats/min , according

8、 with FHR variability less than 5bpm and frequent late deceleration, it indicates the fetal has severe distress, maybe die in the uterus. FHR:120160 bpm / FHR variabilityEarly deceleration，EDLate deceleration，LDVariable deceleration，VD）Clinical manifestationAcute fetal distress (2) Meconium staining

9、 of the amniotic fluid, divided into 3 grades : I、 Light green. II、 Yellow-green. III 、Brown (3) Fetal movement Frequent Reduce Disappear (4) Acidosis FBS (fetal blood sample) pH7.20 (7.25-7.35) pO260mmHg (3555mmHg) Clinical manifestationChronic fetal distress 1) Fetal movement:normal： 30/12hAbnorma

10、l： Frequent Reduce Disappear , if 10/12h, the fetal may be has the distress.Clinical manifestationChronic fetal distress 2) FHR: NST,OCT or CST tests to determine the intrauterine condition of fetus. NST: Non-stress test OCT: Oxytocin challenge test CST: Contraction stress test FHR variability FHR-b

11、ase-line-variability: oscillation amplitude oscillation frequencyClinical manifestationChronic fetal distress3) Fetal biophysical monitoring (BPS) NST Fetal respiratory movement Fetal activity Muscle tension Volume of amniotic fluid Every topic has 2 score, if the whole score less than 8 , may be th

12、ere has fetal distress.Clinical manifestationChronic fetal distress4) Placental function examination: Biochemical monitoring :Late pregnancy 24h UrineE3 ( estriol ) 10mg E/C (estriol /carnine) 10 SP1 100mg/L human placenta lactogen (HPL) 180 or 120 bpm meconium staining (IIIII) (2) Meconium staining

13、 grade III amniotic fluid volume2cm (3) FHR100 bpm continually, pany with LD or severe VD (4) blood PH 7.2 Through vagina if the cervix expand to 10cm, help the patient delivery as soon as possible. use some toolsTreatment (Chronic fetal distress)Regular antenatal care, treatment complications, impr

14、ove placental blood supplyExtended gestation near term, suitable cesarean sectionNote Although careful neonatal neurologic testing may be able to detect those infants who have suffered in utero fetal distress with resulting impaired neurologic e, it cannot differentiate antepartum from intrapartum asphyxia.PreventionClosely follow up the high risk pregnancy, active management