1. Fetal distress LIN QI DE 2005.9.5

2. Fetal distress is defined as depletion of oxygen and accumulation of carbon dioxide,leading to a state of “ hypoxia and acidosis ” during intra- uterine life. Definition

3. Maternal factors 1) Microvascular ischaemia(PIH) 2) Low oxygen carried by RBC(severe anemia) 3) Acute bleeding(placenta previa, placental abruption) 4) Shock and acute infection 5) obstructed of Utero-placental blood flow Etiology

4. Placenta 、 umbilical factors 1) Obstructed of umbilical blood flow 2) Dysfunction of placenta 3) Fetal factors 4) Malformations of cardiovascular system 5) Intrauterine infection Etiology

5. Hypoxia 、 accumulation of carbon dioxide ￬ Respiratory Acidosis ￬ FHR ￪ → FHR ￬ → FHR ￪ ￬ Intestinal peristalsis ￬ Relaxation of the anal sphincter ￬ Meconium aspiration ￬ Fetal or neonatal pneumonia Pathogenesis Acute fetal distress

6. Chronic Fetal distress Pathogenesis IUGR (intrauterine growth retardation)

7. Clinical manifestation Acute fetal distress (1)FHR FHR>180 beats/min (tachycardia) <100 beats/min (bradycardia) (LD) Repeated Late deceleration Placenta dysfunction (VD) Variable deceleration Umbilical factors

8. FHR:120~160 bpm / FHR variability

9. Early deceleration ， ED

10. Late deceleration ， LD

11. Variable deceleration ， VD ）

12. Clinical manifestation Acute fetal distress (2) Meconium staining of the amniotic fluid grade I 、 II 、 III (3) Fetal movement Frequently → decrease and weaken (4) Acidosis FBS (fetal blood sample) pH<7.20 pO 2 <10mmHg (15~30mmHg) CO 2 >60mmHg (35~55mmHg)

13. Clinical manifestation Chronic fetal distress (1) Placental function (24h E 3 <10mg or E/C<10) (2) FHR (3) BPS (4) Fetal movement (5) Amnioscopy

14. Management  Remove the induced factors actively  Correct the acidosis: 5%NaHCO 3 250ML  Terminate the pregnancy (1) FHR>160 or <120 bpm meconium staining (II~III) (2) Meconium staining grade III amniotic fluid volume<2cm (3) FHR<100 bpm continually

15. Management  Terminate the pregnancy (4) Repeated LD and severe VD (5) Baseline variability disappear with LD (6) FBS pH<7.20 Forceps delivery Caesarean section