fetal distress and dfm

7/25/2019 Fetal Distress and DFM

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Fetal DistressSong weiwei

[email protected]

Cell phone:13591441088
mailto:[email protected]:[email protected]


2/17

What is fetal distress?

Fetal distress is the term ommonl! "sed todesri#e $etal h!po%ia. &t is a linial diagnosis

made #! indiret methods and sho"ld #e de$inedas:-

'!po%ia that ma! res"lt in $etal damage ordeath i$ not re(ersed or the $et"s deli(ered

immediatel!. )ore ommonl! a $etal salp p' o$ less than *.+ is"sed to indiate distress


3/17

)aternal h!potensionCord prolapse and ompression

,terine h!perontratilit!,teroplaental ins"$$iien!)aternal dr"gs#normal presentation o$ the $et"s i.e. #reeh/remat"re onset o$ la#or

"pt"re o$ mem#rane more than +4 ho"rs prior to deli(er!rolonged la#ordministration o$ narotis and anesthetis

Causes of fetal distress


4/17

Maternal risk factors for fetal

distress.

)aternal ris2 $ators ia#etes regnan!-ind"ed or hroni h!pertension

)aternal in$etion Si2le ell anemia Chroni s"#stane a#"se sthma Sei"re disorders ost-term or m"ltiple-gestation pregnan!


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Pathophysiology

'!po%ia idosis----s!mpatheti ner(e e%ited----

h!pertension6

tah!ardia initial signs/

pro$o"nd aidosis-----(ag"s ner(e----

h!potension6

#rad!ardia6

h!perperistalsis----meoni"m disharge

hroni ondition:

n"tritional de$iien!----F7


6/17

Whats the typical signs of fetal

distress?**

!pial signs o$ $etal distress inl"de :

ate heart rate deelerations

aria#le deelerations rolonged #rad!ardia

)eoni"m staining.


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)eas"rement o$ the $etal heart rate: a#normaldeelerations and dereased (aria#ilit! d"ringontrations are s"ggesti(e o$ $etal distress.

&ntermittent a"s"ltation o$ the $etal heart rate is arelia#le indiator o$ $etal well #eing and an #e"sed in low ris2 deli(eries. o"tine eletroni$etal monitoring is not reommended $or low-ris2

women in la#or when ade;"ate linial monitoringinl"ding intermittent a"s"ltation #! trained sta$$is a(aila#le .


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Contin"o"s intrapart"m $etal monitoring is

the mainsta! in most modern o#stetri "nits.

he heart rate o$ the $et"s is monitored todetet inreases or dereases d"ring

ontrations. he (aria#ilit! and trends are

interpreted to determine $etal distress or

well #eing.


9/17

Salp p' meas"rement helps to determinethe presene o$ aidosis and $etal h!po%iaand ma! in$l"ene the deision o$

whether to ontin"e o#ser(ation or toper$orm a esarean deli(er!.


10/17

Treatment

)other=s ondition m"st #e treated to pre(ent

h!po%ia to the $et"s inl"ding:

>lood press"re sta#iliation

)aternal positioning on the le$t side

)onitoring maternal o%!genation el(i e%am to identi$! ord presentation


11/17

Treatment

?%!gen administration to the mother ma! pro(ideadditional a(aila#ilit! o$ o%!gen to the $et"s.

rained neonatal res"sitation sta$$ sho"ld #e

a(aila#le at all times and sho"ld #e present in the

deli(er! s"ite $or those patients with 2nown ris2$or $etal distress or h!po%ia.

Cesarean setions are per$ormed i$ all else $ails6

and are the last alternati(e when $aed with the

possi#ilit! o$ $etal distress.


12/17

Decreased fetal movment

ereption o$ $etal mo(ement t!piall! #egins in

the seond trimester6 and o"rs earlier in paro"s

women than n"lliparo"s women6 he mothers $irst

pereption o$ $etal mo(ement6 termedA;"i2eningB )aternal pereption o$ $etal

mo(ement is reass"ring to pregnant women6

whereas dereased $etal mo(ement F)/ is a

ommon reason $or onern.


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14/17

ereption o$ at least 10 F)s d"ring 1+ ho"rs o$ normal maternal

ati(it!

ereption o$ least 10 F)s o(er two ho"rs when the mother is at

rest and $o"sed on o"ntingereption o$ at least 4 F)s in one ho"r when the mother is at

rest and $o"sed on o"nting

ereption o$ at least 10 F)s within +5 min"tes in pregnanies ++

to 3 wee2s and 35 min"tes in pregnanies 3* or more wee2s o$

gestation

Normal fetal movments


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&n$re;"ent $etal mo(ement does not neessaril! mean the $et"s isompromised or e(en inati(e. oor pereption o$ $etal ati(it!

ma! #e d"e to earl! gestational age6dereasedDinreased amnioti

$l"id (ol"me6 maternal position sitting or standing (ers"s l!ing/6

$etal position anterior position o$ the $etal spine/6 anterior

plaenta6 and maternal ph!sial ati(it! or j"st #eing mentall!

distrated/6 ransient dereases in $etal ati(it! an #e d"e to $etal

sleep states6 maternal dr"g "se eg6 sedati(es/6 or maternal

smo2ing.


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Evaluation

Nonstress test/cardiotocography:ro(ides immediatereass"rane o$ $etal (ia#ilit! and well-#eing

Ultrasound:al"a#le assessment tool6 o$ pregnanies

ompliated #! persistent F) despite a reati(e et2e stain or $low !tometr!/ to detet

$etomaternal hemorrhage sho"ld #e per$ormed in the e(al"ation

o$ the pregnant patient who presents with F) and a

sin"soidal $etal heart rate pattern6 "ne%plained $etal

tah!ardia6 or $etal h!drops on "ltraso"nd assoiated with

ele(ated middle ere#ral arter! oppler (eloit!.


17/17

Thank you

fetal distress and dfm

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