foetal distress ppt, basic knowledge and information

1. FOETAL DISTRESS
DR S MOHAN
MBBS
MAHATHMA GHANDI MEMORIAL HOSPITAL

3. WHAT IS FETAL DISTRESS?
FETAL DISTRESS DESCRIBES A CONDITION WHEN THE FETUS SHOWS SIGNS OF
DISTRESS DURING LATE PREGNANCY OR LABOR.
MOST HEALTHCARE PROVIDERS HAVE REPLACED THE TERM FETAL DISTRESS WITH
NON-REASSURING FETAL STATUS (NRFS). THERE ARE MANY REASONS WHY THE
FETUS COULD SHOW SIGNS OF DISTRESS, SUCH AS LABOR, REACTIONS TO
MEDICATIONS OR ISSUES WITH THE UMBILICAL CORD OR PLACENTA. FETAL
DISTRESS CAN BE DANGEROUS AND CAUSE COMPLICATIONS FOR BOTH MOTHER
AND THE FETUS.
THE OBSTETRICIAN LOOKS FOR SIGNS OF DISTRESS AS PART OF PREGNANCY
CARE.

4. WHAT ARE THE SIGNS OF FETAL DISTRESS?
THE MOST COMMON SIGNS OF FETAL DISTRESS ARE:
CHANGES IN THE FETAL HEART RATE (LOWER OR HIGHER RATE THAN NORMAL).
ABNORMAL FETAL HEART ( FETAL HEART <120/MIN OR >160 BEAT/ MIN )
THE FETUS MOVES LESS FOR AN EXTENDED PERIOD OF TIME.
LOW AMNIOTIC FLUID.

5. • ABNORMAL CARDIOTOCOGRAPHY ( NON REASSURING FETAL STATUS)
• -FETAL TACHYCARDIA OR BRADYCARDIA ESPECIALLY DURING & AFTER
CONTRACTION
• -DECREASED BEAT-BEAT VARIABILITY IN BASE LINE FETAL HEART
• - LATE DECELERATION

6. BIOCHEMICAL SIGN- FETAL SCALP BLOOD PH <7.2 OR SHOWING ELEVATED
LACTATE LEVEL
METABOLIC ACIDOSIS IS MORE RELIABLE PREDICTOR OF FETAL DISTRESS BUT IS
NOT ALWAYS AVAILABLE

7. WHAT CAUSES FETAL DISTRESS?
• THE MOST COMMON CAUSE OF FETAL DISTRESS IS THE FETUS NOT GETTING
ENOUGH OXYGEN.
• THE FETUS GETS OXYGEN FROM THE MOTHER.
• SHE TAKES IN OXYGEN INTO HER LUNGS, THEN THE BLOOD CARRIES IT TO THE
PLACENTA.
• IT’S HANDED OFF TO THE PLACENTA AND TRANSFERRED TO THE FETUS'S
BLOOD. ANYTHING THAT INTERRUPTS THIS PROCESS MAY LEAD TO FETAL
DISTRESS.

8. OTHER CONDITIONS THAT MAY LEAD TO
NON-REASSURING FETAL STATUS ARE:
• TOO FREQUENT CONTRACTIONS (TACHYSYSTOLE).
• FETAL ANEMIA.
• OLIGOHYDRAMNIOS (LOW AMNIOTIC FLUID).
• PREGNANCY-INDUCED HYPERTENSION.
• PREECLAMPSIA.
• ABNORMALLY LOW BLOOD PRESSURE.

9. • LATE-TERM PREGNANCIES (41 WEEKS OR MORE).
• FETAL GROWTH RESTRICTION (VERY SMALL BABY).
• PLACENTAL ABRUPTION.
• PLACENTAL PREVIA.
• UMBILICAL CORD COMPRESSION.
• A CHRONIC CONDITION LIKE DIABETES, KIDNEY DISEASE OR HEART DISEASE.
• EXPECTING IDENTICAL TWINS.

10. HOW IS FETAL DISTRESS DIAGNOSED?
• THE HEALTH CARE PROVIDER DIAGNOSES FETAL DISTRESS BY READING THE
FETAL HEART RATE. A LOW HEART RATE, OR UNUSUAL PATTERNS IN THE HEART
RATE, COULD SIGNAL FETAL DISTRESS.
• CHECKING THE FETAL HEART RATE IS A GOOD WAY TO FIND OUT IF IT'S
TOLERATING PREGNANCY AND LABOR WELL.
• DURING PREGNANCY THE OBSTETRICIAN MAY RECOMMEND OTHER TESTS TO
MONITOR THE FETAL HEART RATE:

11. NONSTRESS TEST.
AN ELECTRONIC FETAL MONITOR MEASURES THE FETAL HEART RATE WHILE
SITTING OR LAYING DOWN. A BELT WITH AN ELECTRONIC SENSOR IS PLACED
AROUND THE BELLY. DURING THAT TIME, THE FETAL HEART RATE IS MEASURED
AND RECORDED. THE TEST CAN ALSO MEASURE THE UTERINE CONTRACTIONS.
THE RESULTS ARE EITHER REACTIVE OR NOT REACTIVE BASED ON HOW ACTIVE
THE FETUS IS.
BIOPHYSICAL PROFILE.
AN ULTRASOUND THAT MEASURES FETAL MOVEMENT, MUSCLE TONE, BREATHING
MOVEMENT AND AMNIOTIC FLUID VOLUME. IT’S SOMETIMES COMBINED WITH A
NONSTRESS TEST.

12. WHEN IS A NST PERFORMED
• NST ARE GENERALLY PERFORMED AFTER 28 WEEKS OF GESTATIONAL AGE.
• BEFORE 28 WEEKS, THE FETUS IS NOT DEVELOPED ENOUGH TO RESPOND TO THE
TEST PROTOCOL.
• BEFORE 28 WEEKS OF GESTATIONAL AGE 50% OF NST ARE NON-REACTIVE IN
NEUROLOGICALLY HEALTHY FETUS.
• AT 28-32 WEEKS GESTATION NST IS NONREACTIVE IN 15% CASES OF HEALTHY
FETUS

13. WHAT ARE THE LONG-TERM EFFECTS OF
FETAL DISTRESS?
FETAL DISTRESS CAN HAVE LASTING EFFECTS ON THE BABY.
PROLONGED LACK OF OXYGEN DURING DELIVERY CAN LEAD TO BRAIN INJURY,
CEREBRAL PALSY OR EVEN STILLBIRTH.
IF BABY IS IN DISTRESS, HEALTH CARE PROVIDERS WILL MAKE EVERY ATTEMPT TO
DELIVER THE BABY SAFELY AND BEFORE SEVERE COMPLICATIONS ARISE.

14. INTERPRETATION
• NORMAL / REASSURING -
• SUSPICIOUS -ONE NON REASSURING CATEGORY AND REMINDER ARE
REASSURING.
• PATHOLOGICAL / NON REASSURING -2 OR MORE NON-REASSURING
CATEGORIES OR ONE OR MORE ABNORMAL CATEGORIES.
• TERMINAL- VARIABILITY <2

16. AT 32WEEKS OR BELOW ACCELERATION OF AT LEAST 10 BEATS LASTING FOR 10
SECONDS
SHOULD BE TAKEN NORMAL INSTEAD OF 15 BEATS OR MORE LASTING FOR 15
SECONDS AFTER
32 WEEKS OF GESTATIONAL AGE

19. DURING LABOR

20. LATE DECELERATIONS

25. ETIOLOGY OF FETAL DISTRESS
• 1)RESPIRATORY DEPRESSION - CARDIAC FAILURE
- CHEST INFECTION
- ECLAMPSIA
• 2)HYPOTENSION - HAEMORRHAGE & SHOCK
- SPINAL ANAESTHESIA
- SUPINE HYPOTENSIVE SYNDROME

26. • HYPERTENSION
• SEVERE ANEMIA
• MATERNAL ACIDOSIS

27. • PLACENTAL – ABRUPTIO PLACENTAE
- PLACENTAL INSUFFICIENCY DUE TO ANY CAUSE
• 3)CORD - CORD PROLAPSE
- CORD ENTANGLEMENT TIGHTLY AROUND NECK
• 4) UTERUS - UTERINE HYPER STIMULATION
- UTERINE RUPTURE OR SCAR DEHISCENCE
5) FETAL - EXCESSIVE MOULDING
- FETAL CONGENITAL HEART LESIONS

28. HOW IS FETAL DISTRESS TREATED?
IF IN LABOR, SOME OF THE THINGS WE MAY DO TO HELP DURING FETAL DISTRESS
INCLUDE:
• CHANGING THE POSITION. THIS MAY INCREASE THE BLOOD RETURN TO YOUR
HEART AND OXYGEN SUPPLY TO THE FETUS.
• GIVING OXYGEN THROUGH A MASK.
• GIVING FLUIDS THROUGH IV LINE.
• GIVING MEDICINE TO SLOW OR STOP CONTRACTIONS.
• AMNIOINFUSION.

29. • ADMINISTRATION OF OXYGEN TO MOTHER (6-8 L/MIN)
• DECREASE UTERINE ACTIVITY (STOP OXYTOCIN DRIP IF USED)
• TOCOLYTIC TO BE GIVEN WHEN UTERUS IS HYPER TONUS
• AMNIOINFUSION – IT IS A PROCESS TO INCREASE INTRA-UTERINE FLUID VOLUME
BY INTRODUCING 500ML OF NORMAL SALINE IN THE UTERUS IN CASE OF THICK
MECONIUM AND OLIGOHYDRMNIOS
IT DILUTES OR WASHOUT MECONIUM & PREVENTS MECONIUM ASPIRATION AND
CORD COMPRESSION

30. IF BABY IS IN TROUBLE
THE PROVIDER MAY NEED TO DELIVER IT RIGHT AWAY.
THEY MAY USE FORCEPS OR A VACUUM EXTRACTOR IF FULLY DILATED AND THE
BABY IS LOW ENOUGH IN UTERUS.
OTHERWISE, PERFORM AN EMERGENCY C-SECTION.
PROVIDER WILL COUNCIL PT THROUGH WHAT IS HAPPENING AND WHY THEY ARE
CONCERNED. THEY WILL ASK FOR CONSENT BEFORE ANY PROCEDURE.

31. • REMOVAL OF THE FETUS FROM ITS UNFAVORABLE ENVIRONMENT IF THE FETAL
HEART RATE PATTERN REMAINS NON REASSURING
• IF FACILITIES ARE AVAILABLE, IT IS IDEAL IS TO PERFORM FETAL SCALP BLOOD
SAMPLE PH → ACIDOSIS → IMMEDIATE DELIVERY.
• THE METHOD OF DELIVERY WILL DEPEND ON CERVICAL DILATION, THE POSITION
AND PRESENTATION OF THE FETUS
• IF FETAL DISTRESS IN 2ND STAGE OF LABOR AND PREREQUISITES OF FORCEPS OR
VACUUM ARE FULFILL THEN VAGINAL DELIVERY OTHERWISE C.S

32. REFERENCES
• WORLD HEALTH ORGANIZATION. GUIDELINES ON BASIC NEWBORN RESUSCITATION. 2012.
• BHUTTA ZA, DAS JK, BAHL R, LAWN JE, SALAM RA, PAUL VK, ET AL. CAN AVAILABLE INTERVENTIONS END
PREVENTABLE DEATHS IN MOTHERS, NEWBORN BABIES, AND STILLBIRTHS, AND AT WHAT COST? LANCET.
2014;384(9940):347–70.
• WORLD HEALTH ORGANIZATION. THE WHO APPLICATION OF ICD-10 TO DEATHS DURING THE PERINATAL PERIOD:
ICD-PM. 2016.
• GOOGLE SCHOLAR
• WORLD HEALTH ORGANIZATION. GUIDELINES ON BASIC NEWBORN RESUSCITATION. GENEVA: WORLD HEALTH
ORGANIZATION; 2012.
HTTPS://APPS.WHO.INT/IRIS/BITSTREAM/HANDLE/10665/75157/9789241503693_ENG.PDF;JSESSIONID=AE98884
DC6B54A390246FA7DA013D07D?SEQUENCE=1.