Upload
rusul-albeer
View
243
Download
0
Embed Size (px)
Citation preview
7/25/2019 Fetal Distress and DFM
1/17
Fetal DistressSong weiwei
Cell phone:13591441088
mailto:[email protected]:[email protected]7/25/2019 Fetal Distress and DFM
2/17
What is fetal distress?
Fetal distress is the term ommonl! "sed todesri#e $etal h!po%ia. &t is a linial diagnosis
made #! indiret methods and sho"ld #e de$inedas:-
'!po%ia that ma! res"lt in $etal damage ordeath i$ not re(ersed or the $et"s deli(ered
immediatel!. )ore ommonl! a $etal salp p' o$ less than *.+ is"sed to indiate distress
7/25/2019 Fetal Distress and DFM
3/17
)aternal h!potensionCord prolapse and ompression
,terine h!perontratilit!,teroplaental ins"$$iien!)aternal dr"gs#normal presentation o$ the $et"s i.e. #reeh/remat"re onset o$ la#or
"pt"re o$ mem#rane more than +4 ho"rs prior to deli(er!rolonged la#ordministration o$ narotis and anesthetis
Causes of fetal distress
7/25/2019 Fetal Distress and DFM
4/17
Maternal risk factors for fetal
distress.
)aternal ris2 $ators ia#etes regnan!-ind"ed or hroni h!pertension
)aternal in$etion Si2le ell anemia Chroni s"#stane a#"se sthma Sei"re disorders ost-term or m"ltiple-gestation pregnan!
7/25/2019 Fetal Distress and DFM
5/17
Pathophysiology
'!po%ia idosis----s!mpatheti ner(e e%ited----
h!pertension6
tah!ardia initial signs/
pro$o"nd aidosis-----(ag"s ner(e----
h!potension6
#rad!ardia6
h!perperistalsis----meoni"m disharge
hroni ondition:
n"tritional de$iien!----F7
7/25/2019 Fetal Distress and DFM
6/17
Whats the typical signs of fetal
distress?**
!pial signs o$ $etal distress inl"de :
ate heart rate deelerations
aria#le deelerations rolonged #rad!ardia
)eoni"m staining.
7/25/2019 Fetal Distress and DFM
7/17
)eas"rement o$ the $etal heart rate: a#normaldeelerations and dereased (aria#ilit! d"ringontrations are s"ggesti(e o$ $etal distress.
&ntermittent a"s"ltation o$ the $etal heart rate is arelia#le indiator o$ $etal well #eing and an #e"sed in low ris2 deli(eries. o"tine eletroni$etal monitoring is not reommended $or low-ris2
women in la#or when ade;"ate linial monitoringinl"ding intermittent a"s"ltation #! trained sta$$is a(aila#le .
7/25/2019 Fetal Distress and DFM
8/17
Contin"o"s intrapart"m $etal monitoring is
the mainsta! in most modern o#stetri "nits.
he heart rate o$ the $et"s is monitored todetet inreases or dereases d"ring
ontrations. he (aria#ilit! and trends are
interpreted to determine $etal distress or
well #eing.
7/25/2019 Fetal Distress and DFM
9/17
Salp p' meas"rement helps to determinethe presene o$ aidosis and $etal h!po%iaand ma! in$l"ene the deision o$
whether to ontin"e o#ser(ation or toper$orm a esarean deli(er!.
7/25/2019 Fetal Distress and DFM
10/17
Treatment
)other=s ondition m"st #e treated to pre(ent
h!po%ia to the $et"s inl"ding:
>lood press"re sta#iliation
)aternal positioning on the le$t side
)onitoring maternal o%!genation el(i e%am to identi$! ord presentation
7/25/2019 Fetal Distress and DFM
11/17
Treatment
?%!gen administration to the mother ma! pro(ideadditional a(aila#ilit! o$ o%!gen to the $et"s.
rained neonatal res"sitation sta$$ sho"ld #e
a(aila#le at all times and sho"ld #e present in the
deli(er! s"ite $or those patients with 2nown ris2$or $etal distress or h!po%ia.
Cesarean setions are per$ormed i$ all else $ails6
and are the last alternati(e when $aed with the
possi#ilit! o$ $etal distress.
7/25/2019 Fetal Distress and DFM
12/17
Decreased fetal movment
ereption o$ $etal mo(ement t!piall! #egins in
the seond trimester6 and o"rs earlier in paro"s
women than n"lliparo"s women6 he mothers $irst
pereption o$ $etal mo(ement6 termedA;"i2eningB )aternal pereption o$ $etal
mo(ement is reass"ring to pregnant women6
whereas dereased $etal mo(ement F)/ is a
ommon reason $or onern.
7/25/2019 Fetal Distress and DFM
13/17
7/25/2019 Fetal Distress and DFM
14/17
ereption o$ at least 10 F)s d"ring 1+ ho"rs o$ normal maternal
ati(it!
ereption o$ least 10 F)s o(er two ho"rs when the mother is at
rest and $o"sed on o"ntingereption o$ at least 4 F)s in one ho"r when the mother is at
rest and $o"sed on o"nting
ereption o$ at least 10 F)s within +5 min"tes in pregnanies ++
to 3 wee2s and 35 min"tes in pregnanies 3* or more wee2s o$
gestation
Normal fetal movments
7/25/2019 Fetal Distress and DFM
15/17
&n$re;"ent $etal mo(ement does not neessaril! mean the $et"s isompromised or e(en inati(e. oor pereption o$ $etal ati(it!
ma! #e d"e to earl! gestational age6dereasedDinreased amnioti
$l"id (ol"me6 maternal position sitting or standing (ers"s l!ing/6
$etal position anterior position o$ the $etal spine/6 anterior
plaenta6 and maternal ph!sial ati(it! or j"st #eing mentall!
distrated/6 ransient dereases in $etal ati(it! an #e d"e to $etal
sleep states6 maternal dr"g "se eg6 sedati(es/6 or maternal
smo2ing.
7/25/2019 Fetal Distress and DFM
16/17
Evaluation
Nonstress test/cardiotocography:ro(ides immediatereass"rane o$ $etal (ia#ilit! and well-#eing
Ultrasound:al"a#le assessment tool6 o$ pregnanies
ompliated #! persistent F) despite a reati(e et2e stain or $low !tometr!/ to detet
$etomaternal hemorrhage sho"ld #e per$ormed in the e(al"ation
o$ the pregnant patient who presents with F) and a
sin"soidal $etal heart rate pattern6 "ne%plained $etal
tah!ardia6 or $etal h!drops on "ltraso"nd assoiated with
ele(ated middle ere#ral arter! oppler (eloit!.
7/25/2019 Fetal Distress and DFM
17/17
Thank you