4) Fetal Distress - Diagnostic; Placental Insufficiency, Asphyxia; Apgar Score; Prolonged Pregnancy

Question 1

What is the definition for Fetal Distress?

Answer 1

• Also known as Fetal Hypoxia

Question 2

What Factors contribute to Fetal Distress?

Answer 2

Antenatal

• Environmental
• Other Diseases during Pregnancy - DM, HTN, or Infection
• Conditions complicating pregnancy - preeclampsia, emesis

During Delivery = Either Maternal, Fetal, or Placental

Question 3

What are the Obstetric Reasons for Fetal Distress?

Answer 3

• Umbilical Cord Prolapse / Compression
• Placental Previa
• Uterine Rupture
• Prolonged Labor
• Oligohydraminos - Low amniotic fluid
• Breech Presentation
• Multiple Pregnancy

Question 4

What are the Gynaecological Reasons for Fetal Distress?

Answer 4

• chorioamnionitis - (infection of the amniotic sac)
• Preeclampsia / Eclampsia
• Gestational Diabetes
• Uterine Abnormalities - Fibroids
• Substance Use - Corticosteroids, Tetracyclines, Opioids (Delivery)

Question 5

What’s found upon anamnesis for Fetal Distress?

Answer 5

• 2 or more spontaneous abortions
• Previous Fetal Death
• Previous Operative Deliveries - C-Section, Forceps, Vacuum-Extraction
• Preeclampsia / Eclampsia

Question 6

What are the Diagnostic Methods for Fetal Distress?

Answer 6

1) NST (Non-Stress Test) / Cardiotocography = done during 3rd Trimester + Labor to detect signs; Tachycardia if MORE THAN 160bpm, or Bradycardia if LESS THAN 120bpm

2) Ultrasound

3) Blood Gas Test (Fetal Scalp Blood) = Assess 02, C02, pH, Bicarbonates

4) Amnioscopy = detects meconium staining / color change of amniotic fluid

5) Amniocentesis (INVASIVE!)

Question 7

What is Ultrasound used for?

Answer 7

• Biparietal Diameter (BPD) = Measure the distance of 2 sides of Fetal Head
• Head Circumference (HC)
• Femur Length (FL)
• Abdominal Circumference (AC)

DOPPLER US = For Uterine, Umbilical Arteries and for Ductus Venosus

Amniotic Fluid Index (AFI)

Question 8

Describe Fetal Asphyxia

Answer 8

• When Uterine OR Umbilical BF is impaired –> Decreased uterine / placental perfusion
• C02 accumulation in Fetal Circulation –> decreasing pH (acidemia)
• Prolonged periods of decreased perfusion can cause —> metabolic acidosis

Question 9

How is Fetal Asphyxia Managed?

Answer 9

• Change position from supine –> lateral recumbent so that uterus is away from great vessels, thereby improving fetal oxygenation
• Oxygenation for Mother
• Administer IV or Ephedrine = improves uterine blood flow; since epidural causes decreased utero-placental perfusion
• Make sure the uterine contractions are NOT hyperstimulated
• Correct Cord Compression = Corrected via changing maternal position OR, insert intrauterine catheter into uterine cavity

Question 10

Describe the APGAR Score

Answer 10

A = Appearance
P = Pulse
G = Grimace (Reflex irritability)
A = Activity (Tone)
R = Respiration

Question 11

What is Prolonged Pregnancy?

Answer 11

• Pregnancy persists for MORE THAN 42 Weeks

DUE TO - Nulliparity (NEW), Obesity, Previous Prolonged Pregnancy

COMPLICATIONS - Stillbirth, Shoulder Dystocia, Macrosomia, C-Section, Oligohydraminos

Tx = Induction of Labor