1. Fetal Distress in labor Dr.Maysara Mohamed

2. What is fetal distress? Fetal distress is the term commonly used to describe fetal hypoxia. Hypoxia may result in fetal damage or death if not reversed or the fetus delivered immediately. Intrapartum hypoxia is thought to be the leading cause of cerebral palsy

3. risk factors Diabetes Hypertensive disorders in pregnancy Maternal infection haemoglobinopathy Chronic substance abuse Post-term multiple pregnancy IUGR Prolonged labor Uterine hyperstimulation,precipitate labor

4. Cord prolapse Placental abruptio Maternal pyrexia Chorioamnionitis Meconium Antenatal & intrapartum haemorrhge

5. Pathophysiology Hypoxia –Results in anaerobic metabolism---lactic acid--- metabolic acidosis----sympathetic nerve stimulation---- tachycardia –profound acidosis-----vagus nerve---- bradycardia,hyperperistalsis----meconium discharge –In extreme condition, acidosis result in neurological damage & even death

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

7. Effects of Asphyxia Fetal hypoxia is associated with severe complications in all systems. The infant may suffer: Hypoxic ischemic encephalopathy Meconium aspiration syndrome Cerebral palsy Neonatal seizures

8. Intrapartum Testing Tests utilized to assess fetal well being during labor include: Intermittent auscultation of the fetal heart rate Continuous electronic fetal monitoring Scalp pH measurement Assessment colour of liqour

9. Intermittent auscultation of the fetal heart rate is performed immediately after a contraction for at least 1 minute every 15 min in the first stage of labor & every 5 min in the second stage in low risk deliveries either by pinard or hand-hold doppler. Routine electronic fetal monitoring is not recommended for low-risk women in labor.

10. Continuous intrapartum fetal monitoring High risk group,Intrapartum indications:oxytocin,meconium,VB,maternal pyrexia, abnormal FHR in intermittent monitoring

11. Normal CTG heart rate 110-160 BPM Absence of deceleration Baseline variability 5-25BPM Presence of acceleration If one of these parameters is non-reassuring--- suspicious CTG If two or more parameters are non-reassuring--- pathological CTG

12. Absence of acceleration is of uncertain significance Simple variable deceleration or early deceleration later on in labor are not usually signs of fetal compromise If CTG is suspicious----continue CTG monitoring If it is pathological----look for reversible causes & perform VE:if the cervix fully dilated -----instrumental delivery,if not----fetal blood sampling

16. Fetal blood sampling Scalp pH measurement if more than 7.25(normal)---allow labor to continue & repeat after 30-60 min If pH less than 7.20---immediate delivery

17. Resuscitation of the fetus in labor Maternal dehydration corrected with IV fluid Correction of hypotention due to epidural analgesia by IV fluid Maternal positioning on the left side maternal oxygenation Pelvic exam to identify cord presentation

18. If there is uterine hyperstimulation---stop oxytocin infution & give sc terbutalin Acceleration of delivery