Fetal distress

Question 1

Fetal distress definition

Answer 1

Hypoxia that mught result in fetal damage or death if no reversed or the fetus delivered urgently

Question 2

Risk factors

Answer 2

Long labour
Meconium
Epidurals and oxytocin
Pre-eclampsia
IUGR

Question 3

Diagnosis

Answer 3

Scalp pH <7.2 or ominous fetal heart rate abnormalities
Things to look out for:
Meconium stained amniotic fluid
CTG: Dr C Bravado

Question 4

Dr C Bravado - DR

Answer 4

Define Risk (meconium, fever, IUGR)

Question 5

Dr C Bravado - C

Answer 5

Contractions per 10 mins - hyperstimulation? (>5)

Question 6

Dr C Bravado - BR

Answer 6

Baseline rate (should be 110-160bpm). Tachycardias associated with fever, fetal infection and hypoxia. Steep sustained deterioration in rate suggests acute fetal distress

Question 7

Dr C Bravado - V

Answer 7

Variablity: should be >5bpm except when asleep, should not sleep >45mins

Question 8

Dr C Bravado - A

Answer 8

Accelerations: with movement or contractions reassuring

Question 9

Dr C Bravado - D

Answer 9

Decelerations
Early - synchronous with contractions as normal response to head compression
Variable - vary in timing, usually reflect cord compression which can lead to hypoxia
Late - persist after contraction completed and suggestive of fetal hypoxia

Question 10

Dr C Bravado - O

Answer 10

Overall assessment

Question 11

Management

Answer 11

Left lateral position
Oxygen and IV fluid
Stop oxytocin
Vaginal examination to exclude cord prolapse or very rapid progress
If simple measures fail, fetal blood sampling is performed
7.2 but abnormal pattern continues: second sample after 30 mins
Scalp sampling impossible or sustained bradycardia: delivery