1) Intrauterine growth restriction and fetal distress can occur due to issues with the placenta such as hypoplasia (weight less than 500g), defects in development, or blood circulation problems from hemorrhage, edema, thrombosis or infarction. 2) Diagnosis involves monitoring the fetal heart rate through auscultation during pregnancy and labor as well as additional tests like biophysical profile, Doppler ultrasound of the umbilical artery, and cardiotocography during labor. 3) Treatment involves addressing any maternal health issues, close fetal monitoring, and emergency cesarean delivery if worsening blood flow or certain abnormal heart rate patterns on monitoring are observed.

1. Intrauterine growth restriction
Fetal distress
Medvediev M.V., MD, PhD
Department of Obstetrics and Gynecology

2. Feto-placental system
• Placenta – is the
constantly developing
and gradually maturing
fetal organ which has
limited lifetime – 40
weeks

3. STAGES OF THE FORMATION
OF THE FETO-PLACENTAL
SYSTEM
IMPLANTATION
• The trophoblast of the
implanted embryo produces
histolytic ferments, which
dissolve the epithelium and
connective tissue of the
endometrium
• In 24 hours the blastocoele
penetrates in endometrium
more than half, and for 48 hours
- by pillar.

4. • Photograph
of the
implantation
process
obtained by
hysterosсopy
STAGES OF FETO-PLACENTAL SYSTEM
FORMATION
IMPLANTATION
blastocyst
endometrium

5. Intervillous space
endometrium
primary villus
chorionic
membrane
maternal blood
vessels
Trophoblast actively destroys walls of small blood vessels
in the endometrium, as a result maternal blood occupies
free space (lacuna) between the primary villi which are the
predecessors of the intervillous space

6. • Vascularization of villous begins on the 3d week of
development and secondary villi are converted into
tertiary
• Active circulation of the maternal blood between villi
begins later after spiral arteries will be revealed –
approximately on the 40th day of pregnancy
endometrium
tertiary villous
chorionic
membrane

7. FETO-PLACENTAL BLOOD
CIRCULATION
• complete
placental
circulation
occurs by the
end of the 2nd
month of
intrauterine
development

8. • intervillous space
STRUCTURE OF PLACENTA
Maternal blood

9. FUNCTIONS OF
PLACENTA
The synthesis of hormones:
• gonadotropin
• estrogens
• progesterone
• corticoids
• ACTH
• Melanotropin
• thyrotropic hormone
• somatomammotropin
(prolactin)
• androgens
• Vasopressin
• histamine, acetylcholine

10. In normal pregnancy:
• placenta takes form of disk 12-20 cm
in diameter, 2-4 cm of thickness
• weight of placenta comprises in
average 500-600 g
• ratio of the placenta weight to the
weight of fetus is more than 0,2

11. HYPOPLASIA OF PLACENTA
(weight less than 500 g)
DEFECTS OF PLACENTAL
DEVELOPMENT
– intrauterine fetal death from asphyxia
– Intrauterine fetal grows retardation
insufficient area of placenta functioning

12. Reasons of blood circulation
disturbances in placenta
 hemorrhage
 edema
 thrombosis
and embolia
 infarction

13. Premature separation of normally
implanted placenta (0,06-0,5% of all
lobour)
•Concealed bleeding
•Visible bleeding
The hemorrhage

14. Diagnostics of fetal distress
during pregnancy
• Auscultation of heart activity
• Physiological standard – 110-170
b/min
• Heart beat rate above 170 b/min. and
below 110 b/min. testifies about fetal
distress

15. Biophysical profile of fetus (BPF) (from 30 weeks
of pregnancy) - sum of the following parameters:
• Fetal tone
• Fetal movements
• Non stress test
• Fetal breathing
• Amniotic fluid volume

16. Dopplerometry of
blood flow in
umbilical artery
Diagnosis of fetal distress
during pregnancy

17. Diagnostic criteria:
• normal blood flow - high diastolic
component on dopplerogramms, the ratio
of systole to diastole in no more than 3.

18. Diagnostic criteria:
Pathologic blood flow:
• Retarding blood flow - reduction in the
diastolic component, the ratio of systole to
diastole is more than 3.
S/D >3

19. Diagnostic criteria:
Pathologic blood flow:
• The terminal blood flow (high probability of antenatal
death)
absent
diastolic
component

20. Diagnostic criteria:
Pathologic blood flow:
• Terminal blood flow (high probability of antenatal death)
reverse
diastolic blood
flow

21. Diagnostics:
• Auscultation of heart activity with each
visit to doctor
• If the frequency of heart beats is above
170 beats/min. or below 110 beats /min.
biophysical profile of the fetus should be
done

22. Treatment of fetal
distress syndrome
• Treatment of associated diseases of pregnant
female, which lead to the appearance of fetal
distress syndrome
• Dynamic observation of fetal state
• Detection of worsening in the indices of fetal blood
flow (appearance of zero or reverse blood flow in the
umbilical arteries) is indication for emergency
cesarean section

23. Treatment
• There is no effective drug
or non pharmacologic
method of fetal distress
syndrome treatment

24. Diagnostics of fetal distress during
labor
• Auscultation – determination of the
frequency of heart rate

25. Procedure of auscultation in labor
• Calculation of the heart beats during 1
minute every 15 minutes in latent phase
and every 5 minutes in active phase
• Auscultation before and after uterine
contraction is required
• In the presence of disturbances
cardiotocography must be done

26. • КТГ
Synchronous electronic registration:
Fetal heart rate
Uterine contraction

27. Indications for Cesarean section
according to CTG findings
• Tachycardia > 180
• Bradycardia < 100
• Monotonic variability
(beats./min.) – less
than 2

28. Indications for Cesarean section
according to CTG findings
• Early
decelerations
with amplitude
more than 50
beats/min

29. Indications for Cesarean section
according to CTG findings
• late
decelerations
with amplitude
more than 30
beats/min

30. Indications for Cesarean section
according to CTG findings
• variable
decelerations
with amplitude
more than 30
beats/min

31. Treatment
• There is no effective drug or
non medical method of
treatment for fetal distress
syndrome

32. Tactics of labor
management
1) Avoiding of the position on the
back (lithotomy);
2) Stopping of the oxytocin;
3) Treatment of mother’s pathologic
state

33. Tactics of labor
management
4) If the fetal distress was diagnosed
urgent delivery must be done:
– in the first stage of labor - cesarean
section;
– In the second stage:
• cephalic presentation – obstetric
forceps or vacuum extraction;
• breech presentation – extraction of
the fetus.

34. Thank you!