About fetal distress in pregnancy Child cause fetal distress due to hypoxia there are maternal factors like cardiovascular hypothyroidisim acute bleeding . Fetal factors like cardiovascular dysfunction, deformity,, umbilical cord and placenta factors

1. FETAL
DISTRESS

2. What is fetal distress?
 Fetal distress is the term commonly
used to describe fetal hypoxia. It is a
clinical diagnosis made by indirect
methods and should be defined as:
 Hypoxia that may result in fetal
damage or death if not reversed or
the fetus delivered immediately.
 More commonly a fetal scalp pH of
less than 7.2 is used to indicate
distress

3. Fetal Distress
 Refers to the presence of signs in a
pregnant woman before or after birth that
suggest that the fetus might not be well.
 Usually indicates that a child is suffering
from ischemia (low blood supply) or
hypoxia (low blood oxygen)
 Can cause brain damage or death if not
properly treated
 More likely to happen during prolonged
labor

4. Etiology
 Fetal oxygen supplied from:
maternal circulation-----placenta-----
-umbilical cord------fetus
 maternal factors
cardiovescular
diseases
acute bleeding

5. Etiology
 Fetal factors
Cardio vascular dysfunction
deformity
 umbilical cord and placental factors
abnormal cord:
entanglement,
nuchal umbilical cord,
prolapse of cord.
abnormal placenta

6. Causes of Hypoxia
Maternal risk factors
 Diabetes
 Preeclampsia or chronic hypertension
 Maternal infection
 Anemia
 Chronic substance abuse
 Asthma
 Seizure disorders
 Post-term or multiple-gestation
pregnancy

7. Intrapartum:
 Abnormal presentation of the fetus
(breech)
 Premature onset of labor
 Rupture of membrane more than 24
hours prior to delivery
 Prolonged labor
 Administration of narcotics and
Causes of Hypoxia

8.  Maternal hypoventilation
 Maternal hypoxia
 Hypotension can be caused by
either epidural anaesthesia or the
supine position, which reduces
inferior vena cava return of blood to
the heart. The decreased blood
flow in hypotension can be a cause
of fetal distress (supine
hypotension syndrome**).
Causes of Hypoxia

9. Pathophysiology
 Hypoxia!
Acidosis----sympathetic nerve excited----
hypertension,
tachycardia (initial signs)
profound acidosis-----vagus nerve----
hypotension,
bradycardia,
hyperperistalsis----meconium discharge
chronic condition:
nutritional deficiency-Fetal Growth

10. Clinical manifestation
 Chronic fetal distress
FGR
dysfunction of maternal-
placental-fetal unit
fetal heart monitoring
fetal movement calculation

11. Clinical manifestation
 Acute fetal distress
fetal heart rate
characteristics of fluid
fetal movement

12. How to define the newborn
asphyxia
 Usually with fetal distress.
 Apgar score: 8-10 normal
4-7 mild asphyxia
0-3 severe asphyxia

13. APGAR

14. Signs and symptoms of distress
 Decreased fetal movement felt by mother
 Increased or decreased fetal heart rate
 Vaginal bleeding
 Abdominal and back pain experienced by the
mother
 Mothers blood pressure drastically increasing
 Meconium -first excrement passed by the baby: if
this happens before birth, the baby can breathe it in,
risking infection. -shown when the mother’s water
has a yellow-green tinge instead of being clear.

15. Pre-Eclampsia:
 Is a medical condition that reduces the flow of
blood to the placenta
 Usually occurs after the first 20 weeks of
pregnancy and is characterized by high blood
pressure, rapid swelling or weight gain, and
protein in the mother’s urine.
 If left untreated it can develop into eclampsia,
which is the life-threatening occurrence of
seizures during pregnancy.

16. Pre-Eclampsia:
 The only true cure for pre-eclampsia is delivery, but
can be treated using:
 Bed rest: used to help lower blood pressure and
increase blood flow to the placenta, giving the baby
a chance to fully develop before it is delivered.
 Medication: doctors often prescribe blood pressure
medication (to lower blood pressure and increase
blood flow to placenta to nourish the baby),
corticosteroids (temporarily improve liver and platelet
function and help the baby’s lungs develop more
quickly, so that it can be delivered), or anticonvulsive
medications (prevents seizures)

17. Abnormal Position:
 Breech: when the baby’s buttocks and or feet are
positioned to be delivered first.
Breach babies can be vaginal, but are often
delivered by caesarian section.
 Transverse Presentation: when the baby is lying
sideways with the head on one of the mother’s sides
and the buttocks are on the other. This often results
in the shoulder or arm entering the birth canal first.
Transverse babies cannot be delivered vaginally
unless they are turned while in the uterus, most often
they are delivered by caesarian section.

19. Nuchal Cord
 A nuchal cord is when the umbilical cord is wrapped
360 degrees around the baby’s neck.
 This is usually not a big deal, even if it is a “tight”
nuchal cord.
 However, this can lead to a decreased heart rate in
some instances or asphyxias.
 If this happens, the doctor may attempt to clamp the
umbilical cord partway through birth.
 However, if a nuchal cord leads to decreased heart
rate or asphyxia, there may be need for an emergency
caesarian section.

21. Umbilical Cord Prolapse
 This is where the umbilical cord passes through
the cervix before or at the same time as the baby’s
head.
 When this happens, the umbilical cord can
become compressed between the baby and the
tissue of the mother, cutting off the baby’s oxygen
and blood supply.
 In most cases, the baby will then be taken out
through a C-section.
 If a C-section cannot be performed, the doctors
will try to relieve the pressure by gently lifting the

22. Umbilical Cord Prolapse Cont.
There is a greater chance of having an
umbilical cord prolapse if:
 There is too much amniotic fluid
around the baby
 The baby is in the breech position
 The mother is having twins
 The umbilical cord is unusually long

23. Premature Births
 A premature baby is one who is born
before 37 weeks.
 Most babies born at this time have
medical issues.

24. Multiple births:
 Have 2 or more infants in one pregnancy
Concerns
• born before organs or body has matured
• Need help to breathe, eat, fight infections and staying warm
• put into the NICU
• preterm labour and birth
• rick of miscarriage
• twin to twintranfusion syndrom placenta is shared
• postpartum hemorage large placenta area over distended uterus
can put the mother at risk of bleeding after the delivery
• higher chance of a Csectionabnormal amouints of amniotic fluid.

25. Fetal hypoxia is associated with
severe complications in all systems:
 Respiratory distress syndrome (RDS)- This is a
breathing problem most common in babies born
before 34 weeks of pregnancy. Babies with RDS
don’t have a protein called surfactant that keeps
small air sacs in the lungs from collapsing.
 Intraventricular hemorrhage (IVH)- This is bleeding
in the brain. It usually happens near the ventricles in
the center of the brain. A ventricles is a space in the
brain that’s filled with fluid.

26. Patent ductusarteriosis (PDA)- This is a heart problem that
happens in the connection (called the ductus arteriosus)
between two major blood vessels near the heart. If the
ductus doesn’t close properly after birth, a baby can have
breathing problems or heart failure. Heart failure is when
the heart can’t pump enough blood.
Necrotizing enterocolitis (NEC) - This is a problem with a
baby’s intestines. It can cause feeding problems, a swollen
belly and diarrhea. It sometimes happens 2 to 3 weeks after
a premature birth.
Retinopathy of prematurity (ROP)- This is an abnormal
growth of blood vessels in the eye. ROP can lead to vision
loss.

27. Jaundice- This is when a baby's eyes and skin look
yellow. A baby has jaundice when his liver isn't fully
developed or isn't working well.
Anemia - This is when a baby doesn’t have enough
healthy red blood cells to carry oxygen to the rest of
the body.
Bronchopulmonary dysplasia (BPD)- This is a lung
condition that can develop in premature babies as
well as babies who have treatment with a breathing
machine. Babies with BPD sometimes develop fluid
in the lungs, scarring and lung damage.

28. The infant may suffer:
 Hypoxic ischemic encephalopathy
 Meconium aspiration syndrome
 Acidosis with decompensation
 Cerebral palsy
 Neonatal seizures

29. prevent of RDS
 Betamethasone - 12 mg
i.m. every 24 hours, only
2 doses per course;
 We need 48h (T – 24mg)
 Dexamethasone - 6 mg
intramuscularly every 12
hours, a total of 4 doses
per course.
 We need 24h (T – 24mg)
All pregnant women at gestational age 23-34 weeks
with the threat of preterm birth undergo a course of hormonal
therapy with corticosteroids to prevent RDS of prematurity
and reduce the risk of possible adverse complications in the
child, such as IVH and NEC.
There are two alternative schemes for prenatal
prevention of RDS:

30. MANAGEMENT
 Caesarian Section
• Baby is delivered through an incision made
through abdomen and into the uterus.
• In the case of fetal distress, the caesarean
section will most likely be an emergency
caesarean section.
• This may take place if the cervix doesn’t dilate
fully, birth is not progressing as normal, or if
there is bleeding during labor.

32. • Forceps Delivery
• Forceps delivery is used during vaginal
delivery
• Typically done when the second stage of
labor is not progressing or the baby’s safety is
in question
• Forceps are an instrument shaped like spoons
or salad tongs
• Applied to baby’s head to guide it out of the
birth canal

34. Ventouse Delivery
 Instrument attached to baby’s head by a
suction cup
 During a contraction, the doctor pulls
gently on the device to deliver the baby
 Reduced risk of tearing with this
instrument as opposed to the forceps

36. Episiotomy
 A cut made to make the vaginal opening
bigger
 This will be repaired with stiches later

37. THANK YOU FOR YOUR ATTENTION