Fetal distress - مسيره Flashcards
what the fetal distress refer to ?
is the term commonly used to describe fetal hypoxia
as we mention that the fetal distress refer to the hypoxia so what the causes of the hypoxia in fetus ?
Hypoxia may result in fetal damage or death if the hypoxia won’t reversed or the fetus delivered immediately because it may leading to cerebral palsy
does all the fetus liable to fetal stress ?
no , only pt with risk factor
what’re the risk factor of fetal stress ?
-MATERNAL DISEASE 1-Diabetes 2-Hypertensive disorders in pregnancy 3-Maternal infection 4-haemoglobinopathy 5-Chronic substance abuse 6-Maternal pyrexia
-PREGNECY PROPLEM
1-Prolonged labor
2-Post-term
3-precipitate labor
(refers to childbirth after an unusually rapid labor (combined 1st stage and second stage duration is under two hours) and culminates in the rapid, spontaneous expulsion of the infant. Delivery often occurs without the benefit of asepsis.Physically, precipitous labor can cause: Increased risk of vaginal and/or cervical tearing or laceration. Increased risk of hemorrhage. Risk of infection in baby or mother if birth takes place in an unsterilized environment.)
4-Uterine hyperstimulation_____ by giving oxytocin
-PLACENTAL CAUSE 1-Cord prolapse 2-Placental abruption 3-Chorioamnionitis 4-Antenatal & intrapartum haemorrhge
-Meconium ___ as result of profound acidosis lead to o parasympathtic over activity lead to increase the peristalsis movement lead to release it before it time
- multiple pregnancy
- IUGR____ because the fetus is weak and small for the uterine contraction
why does hypoxia lead to fetal distress ?
Hypoxia 1st will Results in anaerobic metabolism—lactic acid—metabolic acidosis—-sympathetic nerve stimulation—- tachycardia
then when there is profound acidosis—–vagus nerve—-bradycardia, hyperperistalsis—-meconium discharge which lead to bacterial irratation pneomnitis
then in sever condition of acidosis lead to neurological damage & even death (cerebral palsy )
what’s the effect of the hypoxia in the fetus (asphyxia)?
it’s associated with severe complications in all systems. The infant may suffer:
1-Hypoxic ischemic encephalopathy
2-Cerebral palsy
3-Neonatal seizures
4-Meconium aspiration syndrome
How to test the fetus well being antepartum
(during labor )?
-For the low risk group
we do Intermittent auscultation of the fetal heart rate by
pinard or hand-hold doppler.
( auscultation immediately after a contraction for at least 1 minute every 15 min in the first stage ) then
(every 5 min in the second stage)
- For high risk group we perform Continuous intrapartum fetal monitoring CTG
- Scalp pH measurement
what’re the indication of the Continuous intrapartum fetal monitoring (CTG) ?
it’s only used in high risk groups and when
- we use the oxytocin in the induction of labor
- if there is meconium,
- Vaginal bleeding
- maternal pyrexia
- abnormal FHR in intermittent monitoring
Do we use Routine electronic fetal monitoring in low risk ?
Routine electronic fetal monitoring is not recommended for low-risk women in labor.
what’re the normal parameters in the CTG ?
1-heart rate 110-160 BPM
2-Absence of deceleration
3-Presence of acceleration
4-Baseline variability 5-25BPM
If one of the parameters are abnormal is it pathological ?
no, it’s suspicious CTG but we need reasurance
but If two or more parameters are non-reassuring—pathological CTG
as we said the normal fetal heart rate is (110-160) and the heart beat should accelerate not deaccelerate
but if we found there is no acceleration do we have to worry ?
Absence of acceleration during labour is of uncertain significance
if the fetal is simple variable or early acceleration do we have to worry ?
no normally the fetal heart beat is variable between 5_25
and also early acceleration is normal .
So Simple variable deceleration or early deceleration later on in labor are not usually signs of fetal compromise
when we should worry if we see the CTG ?
- when there is late deaccelation that means when the uterine contraction the deaccelation of the fetal heart will begin after end of this contracation this is because of decrease the placental perfusion
- and the variable deaccelartion it happen before ,with or after this because of cord prolapse
- but the most dangerous is the reverse flow
seen in doplar
+but normally the heart deccleate but not bellow the the basal line and this deaccelration begin and end with the uterine contraction this called early deaccelation which is normal happen due to the engagment of the heat in the late labor
what’s the normal fetal PH when we perform the Fetal blood sampling ?
if more than 7.25(normal)
but we should do it along with the CTG if normal CTG we repeat the blood sample every 60 min
but if the CTG abnormal we do it every 30 min
