Fetal Distress
Fetal Distress
Fetal Distress
Definition :
Fetal suffering from: lack of oxygen, increase co2 and decrease ph(7.2) The term "fetal distress" is commonly used to describe fetal hypoxia
2.
Etiology:
Maternal causes:
1. Anemia 2. Excessive He. 3. Pulmonary disease 4. Heart failure and shock 5. Cyanide and barbiturate poisoning Placental causes: 1. Compression of the placenta as in prolonged or obstructed labor 2. Premature separation of the placenta as in case of placenta previa or abruption placenta 3. Placental insufficiency as in preeclampsia, chronic renal disease, DM and post maturity Umbilical cord causes: 1. A true knot, or tight coiling of the cord around d the fetus 2. Compression of prolapsed cord 3. Compression of the cord by the forceps 4. Rupture of the vasa previa Fetal causes: 1. Prolonged compression or excessive moulding of the fetal head during labor caused by contracted pelvis, forceps or rigid periperium
3. Path physiology:
1. 2. 3. 4. Decrease maternal blood flow Decrease maternal blood oxygen Decrease placental blood flow Decrease placental blood oxygen Due to decrease oxygen in the blood, the compensatory mechanism lead to increase oxygen supply to the brain and decrease oxygen supply to different body organs In GIT (compensatory mechanism)-
Decrease the intestinal size or surface by increase intestinal movement and relaxation of the anal sphincter With the continues decrease in placental oxygen lead to decrease fetal waste removal leads to increase intestinal movements ( reverse) from down to up lead to vomiting of meconium
In the brain ( the compensatory mechanism)- lead to decrease oxygen demand lead to formation of caput succedaneum to decrease oxygen to the skin and hair lead to increase moulding of the head bones to decrease surface demand for oxygen
B. Intrapartum period:
Tachycardia & Bradycardia especially during contractions Excessive or decrease in FHR . tachycardia >160 or bradycardia <100 Passage of Meconium in cephalic presentation Due to increase intestinal movements and relaxation of anal sphincter caused by hypoxia Fetal acidosis detected by taking blood sample from fetal scalp during labor. Ph >7.2 indicates fetal acidosis due to hypoxia Elevated fetal blood lactate levels lactic acidosis Excessive formation of caput succedenium Excessive formation of moulding
5. Diagnosis:
Non-stress Test Ultrasound Cardiotocography Fetal blood sampling scalp prick
2. 3.
serious injury or death of the baby cerebral palsy seizures and mental retardation
amnioinfusion
If conservative measures are unsuccessful, immediate delivery of the baby (often by cesarean section) is required. In certain situations, it may be appropriate to resuscitate the baby in the uterus before performing the cesarean delivery: use of medication The fetus must continue to be monitored closely for signs that the treatment is not working, which would require the immediate commencement of the cesarean delivery. The negligence of a healthcare provider to implement an appropriate treatment plan can result in permanent injury, or even death, to baby and mother.
8. Nursing role:
1. Stop oxytocin 2. Reposition the patient : put the mother in lateral Rt.side position 3. Give oxygen to the mother 4. Check FHR 5. P.V examination