Académique Documents
Professionnel Documents
Culture Documents
Uterus
Fetal Gas Exchange
Placenta
• supply oxygen and
nutrients via the
umbilical vein
• Removes waste from the
fetus via umbilical
arteries
Fetal pH regulation
Vasoconstriction
of the umbilical
cord arteries
occurs at birth
in response to
increasing
PaO2. This
prevents blood
flow from the
baby to the
placenta
2
Fetal response to hypoxia
• During the time of decreased placental flow, the fetus has
mechanisms to maintain normal aerobic metabolism.
Blood flow is redistributed to supply the vital organs at the
expense of flow to the gut, kidneys and limbs.
• Insufficient mechanisms result in metabolic needs
unmet. Thus, the fetus will change to use anaerobic
metabolism producing energy in the form of ATP:
results in production of lactic acid.
• lactic acid is slow to diffuse across the placenta and can
accumulate to cause metabolic acidosis in the fetus.
Factors contributing to Fetal Hypoxia
1. Hyperactivity of the uterus
• When contractions are excessively strong, too long or
if there is poor resting tone between contractions, the
flow of O2-riched blood to the baby can be
substantially decreased leading to fetal hypoxia.
2. Valsalva pushing during 2rd stage of labor:
3. Maternal supine position- decreases blood flow
back to the lungs (inferior vena cava).
Clinical manifestation of fetal acidosis.
•Stressful and painful labour
•Compromised O2 supply
•Fetal distress
•Little or no fetal movement
•Respiratory distress
Diagnosis
Risk for fetal injury related to poor
maternal-fetal oxygenation and high
acidity in fetal blood content.
Nursing intervention
Oxygen therapy to increase maternal O2
saturation- increase fetal O2 content in the
blood.
Nursing Management
• Encourage women to slow her respiration rate and
prompting deep breathing between contractions can
help reduce alkalosis
• Monitoring of fetal wellbeing is essential.
Fetal heart-rate monitoring provides a measure of fetal
well-being during labor
Monitoring can be via intermittent auscultation or
continuous electronic monitoring.