1、,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Fetal distress,Fetal 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,Definition,Chronic fetal distress,occurs usually in antepartum,Acute fetal distress,occurs usually in intrapartum.,Maternal,blood oxygen shortage,Maternal-fetal,oxygen transport and exchange obstacle,Abnormal,fetal,own fac
2、tors,Etiology,Maternal factors,Hypertensive disorder,Low 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 infection,Etiology,Maternal-fetal oxygen transport and exchange obstacle,1）Poor function of the placenta(hypertensive disorder；chronic hypertension,chronic nephritis,postterm pregnancy,diabetes),2）Abnormal umbilical cord(prolapse,edema,long,short,t
3、orsion,knot,wrap the neck),Etiology,Fetal factors,1)Abnormality in growth(heart,liver,lung),2)Intrauterine infection,3)Incompatibility of mother and,fetus blood group,4)Intracranial hemorrhage,Etiology,Hypoxia、accumulation of carbon dioxide,Respiratory Acidosis,FHR,FHR,Intestinal peristalsis（蠕动）,Relaxation of the anal sphincter,Meconium staining,Fetal or neonatal pneumonia,Pathogenesis,Acute fetal distress,Chronic,fetal,distress,Pathogenesis,FGR,(Fetal growth restriction),Pathophysiology,Fetal d
4、istress,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 death,Clinical manifestation,Acute 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)Varia
5、ble deceleration,Umbilical factors,Clinical manifestation,Acute fetal distress,if the FHR 100 beats/min,according with FHR variability less than 5bpm and frequent late deceleration,it indicates the fetal has severe distress,maybe die in the uterus.,FHR and FHR variability,Early deceleration(ED),Late deceleration(LD),Variable deceleration(VD),Clinical manifestation,Acute fetal distress,(2)Meconium staining of the amniotic fluid,divided into 3 grades:I、Light green.,II、Yellow-green.III、Brown,(3)Fet
6、al movement,Frequent,Reduce Disappear,(4)Acidosis FBS(fetal blood sample),(rarely used),pH7.20,(7.25-7.35),pO,2,60mmHg(3555mmHg),Clinical manifestation,Chronic fetal distress,1)Fetal movement:,Normal：30/12h,Abnormal：,Frequent,Reduce Disappear,if,180 or 120 bpm,meconium staining(IIIII),(2),Meconium staining grade III,amniotic fluid volume2cm,(3),FHR100 bpm continually,accompany,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 p
7、ossible.use some tools,Treatment(Chronic,fetal,distress),Regular antenatal care,treat complications,improve placental blood supply,Extended gestation near term,suitable cesarean section,Note,Although careful neonatal neurologic testing may be able to detect those infants who have suffered in utero fetal distress with resulting impaired neurologic outcome,it cannot differentiate antepartum from intrapartum asphyxia.,Prevention,Closely follow up the high risk pregnancy,active management of complications of pregnancy and also medical and surgical complications in pregnancy,According to the results of monitor,select the best time and method to end high risk pregnancy,Intensify monitoring during labor,
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