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Etiology
Fetal oxygen supplied from:
maternal circulation-----placenta------umbilical
cord------fetus
maternal factors
cardiovescular diseases
acute bleeding
uterus
Etiology
Fetal factors
cardiovescular dysfunction
deformity
Causes of Hypoxia*
risk factors
Maternal risk factors
Diabetes
Pregnancy-induced or chronic hypertension
Maternal infection
Sickle cell anemia
Chronic substance abuse
Asthma
Seizure disorders
Post-term or multiple-gestation pregnancy
Maternal hypoventilation
Maternal hypoxia
Hypotension can be caused by either
epidural anaesthesia or the supine position,
which reduces inferior vena cava return of
blood to the heart. The decreased blood
flow in hypotension can be a cause of fetal
distress (supine hypotension syndrome**).
Pathophysiology
Hypoxia!
Acidosis----sympathetic nerve excited--- hypertension,
tachycardia (initial signs)
chronic condition:
nutritional deficiency----FGR
Clinical manifestation
Chronic fetal distress
FGR
dysfunction of maternal-placental-fetal unit
fetal heart monitoring
fetal movement calculation
amnioscopy
Clinical manifestation
Acute fetal distress
Effects of Asphyxia
Fetal hypoxia is associated with severe
complications in all systems. The infant may
suffer:
Hypoxic ischemic encephalopathy
Meconium aspiration syndrome
Acidosis with decompensation
Cerebral palsy
Neonatal seizures
Mecunium
Normal condition: mature of colon
Fetal hypoxia can stimulate fetal colonic
contraction that leads to evacuation of meconium
(fetal stool) into the amniotic fluid
How meconium is dealt with will depend on what
it looks like and what your provider's approach is.
Old meconium is yellow and less likely to be a
problem .
Meconium
Thick, green, particulate meconium which may have
already caused baby to "gasp" in utero.
If the meconium is accompanied by decreased heart rates
that do not recover well, a c-section will be the safest
approach.
Fetal gasping due to the lack of oxygen which then causes
aspiration of the meconium into the lungs.
The presence of this material can produce bronchial
obstruction and a chemical pneumonitis and treatment must
be initiated during delivery. If not adequately removed, the
meconium blocking the airways can lead to further
hypoxia.
Term infants
Growth-retarded infants
Post-term infants
Breech presentation delivery
The degree of meconium aspiration and the length of
exposure to meconium determines the severity of the
hypoxia suffered by the fetus. Staining of the umbilical
cord, skin, or nails of the infant indicates exposure to
meconium 3 to 6 hours in utero prior to delivery.
Assessment
**
Antepartum Testing:
Tests for antepartum fetal evaluation include:
Fetal movement count
Non stress test
Contraction stress test
Biophysical profile
Fetal movement
Fetal movement counts are performed by the
mother and are an inexpensive, noninvasive
method of assessing fetal well-being. The patient
records the number of times she feels fetal
movement within a designated time period. The
exact number of normal perceived movements has
not been determined, however approximately 10
movements should be felt within a 12 hour period.
Biophysical profile
fetal movement
amniotic fluid volume
respiratory movement
movement of extremity
NST
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
Treatment of Hypoxia
Mothers condition must be treated to prevent
hypoxia to the fetus including:
Blood pressure stabilization
Maternal positioning on the left side
Monitoring maternal oxygenation
Pelvic exam to identify cord presentation
Treatment of Hypoxia
Oxygen administration to the mother may provide
additional availability of oxygen to the fetus.
Trained neonatal resuscitation staff should be
available at all times and should be present in the
delivery suite for those patients with known risk
for fetal distress or hypoxia.
Cesarean sections are performed if all else fails,
and are the last alternative when faced with the
possibility of fetal distress.
Incidence
Varied greatly 2.7%--17%
PROM is causally related to about 10%
perinatal deaths regardless of gestation age.
Its occurrence before term adds the risk of
neonatal respiratory distress syndrome
(NRDS) from hyaline membrane disease to
the risk of chorioamnionitis , neonatal
sepsis associated with ascending infection.
Incidence (%)
50 to 75
32 to 76
Chorioamnionitis
13 to 60
Abruptio placentae
4 to 12
1 to 2
Management
Hospitalization
expectant management (in some cases of
PPROM, the membranes may seal over and
the fluid may stop leaking without treatment)
monitoring for signs of infection such as fever,
pain, increased fetal heart rate, and/or
laboratory tests
Management
corticosteroids that may help mature the lungs of the
fetus (lung immaturity is a major problem of premature
babies). However, corticosteroids may mask an infection
in the uterus.
antibiotics (to prevent or treat infections)
tocolytics - medications used to stop preterm labor.
delivery (if PROM endangers the well-being of the
mother or fetus, then an early delivery may be necessary
to prevent further complications)