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Fetal Well-Being

International

FETAL WELL BEING


IN LABOUR
Fetal Well-Being
International

Objectives
• Definition of fetal distress
• Fetal monitoring in labour
–Auscultation
–Guidelines
• Intrauterine resuscitation
Fetal Well-Being
International

FETAL DISTRESS
is
PERSISTENT FETAL BRADYCARDIA
that if not corrected
will result in
DECOMPENSATION OF PHYSIOLOGIC RESPONSES
and cause
PERMANENT CNS AND OTHER DAMAGE AND DEATH
Fetal Well-Being
International

Etiology of fetal distress- Maternal


• decreased maternal oxygen carrying capability
– significant anemia
• decreased uterine blood flow
– supine or other hypotension, preeclampsia
• chronic maternal conditions
– hypertension
Fetal Well-Being
International

Etiology of fetal distress - Uteroplacental


• uterine hypertonus
– hyperstimulation, abruption
• uteroplacental dysfunction
– placental infarction
– chorioamnionitis
– placental dysfunction marked by IUGR,
oligohydramnios
Fetal Well-Being
International

Etiology of fetal distress - Fetal


• cord compression
– oligohydramnios
– cord prolapse
– cord entanglement
• decreased fetal oxygen carrying capability
–significant anemia
• e.g. isoimmunization, feto-maternal bleed
Fetal Well-Being
International

The Fetal
Circulation
Fetal Well-Being
International
Fetal Well-Being
International
Fetal Well-Being
International

‘FETAL DISTRESS’
is not
a ‘bad’ fetal monitor strip*
or
meconium stained liquor

* this should be referred to as a ‘non-reassuring monitoring strip’


Fetal Well-Being
International

FETAL DISTRESS
is
PROGRESSIVE FETAL ASPHYXIA
that if not corrected or circumvented
will result in
DECOMPENSATION OF PHYSIOLOGIC RESPONSES
and cause
PERMANENT CNS AND OTHER DAMAGE AND DEATH
Fetal Well-Being
International
Fetal Well-Being
International
Fetal Well-Being
International
Fetal Well-Being
International
Fetal Well-Being
International
Fetal Well-Being
International
Fetal Well being in Labour

Fetal Well-Being
International
Fetal Well-Being
International

Increased Fetal Susceptibility to


Hypoxemia
• intrauterine growth restriction
• preterm fetus
• intrauterine infection
Fetal Well-Being
International

Criteria for Effective Auscultation


• maternity care giver experienced in:
– auscultation technique
– palpation of contractions
Fetal Well-Being
International

Suggested Method for Auscultation


• for one full minute following a contraction
– every 30 minutes in the latent phase
– every 15 - 30 minutes in the active phase
– every 15 minutes in the second stage before pushing
– every 5 minutes in the second stage when pushing
Fetal Well-Being
International

MECONIUM
• Is present in 10% of all deliveries
• In most cases the fetus is not hypoxic
• Premature babies < 34 weeks may not pass
meconium if hypoxic
Fetal Well-Being
International

MECONIUM
• Fresh, thick, green Meconium may be indicative of
fetal hypoxia until proved otherwise
• The passage of Meconium during labor should be
taken as an indicator for careful fetal heart rate
monitoring
Fetal Well-Being
International

Response to Non-reassuring Intermittent


Auscultation
• left lateral positioning of mother
• assess woman’s hydration
• discontinue oxytocin
• vaginal exam to rule out prolapsed cord
• check maternal pulse and BP
• if abnormal findings persist (FHR<100)
consider amniotic infection
Fetal Well-Being
International

Conclusions
1) Every woman should have a caring companion with her in
labor

2) A method of auscultation should be in place in every unit


that delivers babies

3) Consider increase fetal susceptibility to hypoxemia for


close monitoring and early transfer