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1、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. Acute fetal distress: delivery periodChronic fetal distress: late pregnancy, acute distress in labor.Incidence rate: 2.7%38.5%DefinitionThe Le
2、ading cause of perinatal deathThe major cause of retarded childHypoxia (pre-labor, in labor, after birth): 90%Severe asphyxia: 4.1% mental retardationMaternal factors1)Microvascular ischemia: PIH, GDM, prolonged pregnancy2)Low oxygen carried by RBC: cardiac insufficiency, severe anemia3)Acute bleedi
3、ng and shock: placenta previa, placental abruption 4)Misuse of anesthetic 5)obstructed of Utero-placental blood flow: discordant contraction (misuse of pitocin)EtiologyPlacental、umbilical and fetal factors1)Obstructed of umbilical blood flow: prolapse of cord, circular of cord2)Dysfunction of placen
4、ta3)Fetal factors: malformation, hemolytic anemia (ABO)4)Intrauterine infection EtiologyHypoxia、accumulation of carbon dioxide Respiratory Acidosis Metabolic acidosis (irreversible damage) FHR (sympathetic N , CO2) FHR （vagus N ,hypoxia） Intestinal peristalsis（肠蠕动）（肠蠕动） Relaxation of the anal sphinc
5、ter（肛门括约肌）（肛门括约肌） Meconium(胎粪胎粪) aspiration Fetal or neonatal pneumoniaPathogenesisAcute fetal distressChronicFetaldistressPathogenesis FGR(Fetal growth retardation)Acute fetal distress(1)FHR (baseline and variability) FHR 160 beats/min (tachycardia) 110 beats/min (bradycardia)FHR monitoring: (ED):
6、fetal head to be crushed in labor (reversible) (LD): Repeated late deceleration Placenta dysfunction (VD): Variable deceleration Umbilical factors Fetal heart rate baseline and variabilityAdverse outcome FHR 100bpm Variability5bpm Repeated LD or VD.Early deceleration，EDAcute fetal distress (2) Mecon
7、ium staining of the amniotic fluid grade I、II、III (3) Fetal movement Frequently decrease and weaken (4) Acidosis FBS (fetal blood sample) pH7.20 pO260mmHg (3555mmHg) Chronic fetal distress (1) Placental function (24h E310mg or E/C2General treatment: Lie on the left side, oxygen uptakeEtiological tre
8、atment: Remove the induced factors promptlyCorrect the acidosis: 5%NaHCO3 250MLTerminate the pregnancy1. FHR160 or 110 bpm, meconium staining (IIIII)2. Meconium staining grade III, amniotic fluid volume2cm3. FHR100 bpm continually4. Repeated LD and severe VD5. Baseline variability disappear with LD6. FBS pH7.20 Forceps delivery Caesarean section
产科学英文课件：12 Fetaldistress
