扬州大学：《妇产科学》课程教学课件（PPT讲稿）16 胎儿宫内窘迫 Fetal distress

Fetal distress

Fetal distress

DefinitionFetal distress is defined as depletionof oxygen and accumulation ofcarbon dioxide,leading to a state of“hypoxia and acidosis酸中毒“duringintrauterinelife

Definition Fetal distress is defined as depletion of oxygen and accumulation of carbon dioxide,leading to a state of “hypoxia and acidosis酸中毒“during intrauterine life

Etiology>Maternalfactors（1）Microvascular微血管的ischaemia（属郁缺血）（PIH)(2)LowoxygencarriedbyRBC(severeanemia)(3)Acutebleeding(placentaprevia,placentalabruption)(4)Shockandacuteinfection(5)obstructedofUtero-placentalbloodflow

Etiology ➢Maternal factors (1) Microvascular微血管的ischaemia（局部缺血）(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

Placenta、umbilical factors:(1)Obstructedofumbilicalbloodflow(2)Dysfunctionofplacenta>Fetal factors:(1)Malformationsof cardiovascularsystem(2)Intrauterineinfection

➢Placenta、umbilical factors: (1) Obstructed of umbilical blood flow (2) Dysfunction of placenta ➢Fetal factors: (1) Malformations of cardiovascular system (2) Intrauterine infection

PothogenesisHypoxia、accumulationof carbon dioxiderespiratoryAcidosisAcuteFHR+FHR-→FHRtfetaldistressIntestinalperistalsisRelaxationoftheanalsphincter肛门括约肌meconium胎粪aspiration误吸fetalorneonatalpneumonia

Pothogenesis Hypoxia、accumulation of carbon dioxide ￬ respiratory Acidosis ￬ FHR￪ FHR ￬ FHR￪ ￬ Intestinal peristalsis ￬ Relaxation of the anal sphincter肛门括约肌 ￬ meconium胎粪aspiration误吸 ￬ fetal or neonatal pneumonia Acute fetal distress

ChronicIUGRfetal(intrauterinegrowthdistressretardation)

Chronic fetal distress IUGR (intrauterine growth retardation)

ClinicalmanifestationAcutefetaldistress(1)FHRFHR>180 beats/min(tachycardia，心动过速)<100 beats/min(bradycardia，心动过缓)(LD)RepeatedLatedeceleration:Placentadysfunction(VD)Variabledeceleration:Umbilicalfactors

Clinical manifestation Acute fetal distress (1)FHR FHR>180 beats/min( tachycardia， 心动过速) <100 beats/min(bradycardia， 心动过缓) (LD)Repeated Late deceleration ： Placenta dysfunction (VD)Variable deceleration ： Umbilical factors

FHR:120~160 bpm /FHR Variability150→wwmw是家舰）每分钟胎心率胎心率周期性变化营尔精学团替90-夏华您广玖育国是全时人华30北强鸿惠光脑啤共改世小山宫腔压力507红护处内烟馆(mmHg)新圆901鲜饼用产车#用30-欢50等宫腔压力开的吸凯城欢(mmHg)心率基线与基线搜摆动（心率周期性变化）期商频用泰银置制公店卖啤图6-12胎心率与基线摆动时抛单，海常小眼mmHg0.133kPa得件善随水年敏

FHR :120~160 bpm / FHR Variability

LDLate deceleration,自创同地高生数基线显示心动过速形态一致一惠-图每分钟胎心率160AOM逐渐下降逐恢复120测造业80-下降幅度小开始晚（少于50bpm）持续时间长（30~60秒）宫腔压力50恢复慢(mmHg）（30-60秒）全动注：1mmHg=0.133kPa责创面能力地图6-15PFHR晚期减速

Late deceleration，LD

Variable deceleration, VD)创回书#游价卖健方贵阳道形态变化不定心率基线正常160-每分钟胎心率yaMawwwhn自试取用游下降幅度大120（超过70营奥底出bpm)80恢复快下降快开始早晚不定周6常做维浴本学1官腔压力50通周网协西费银装内mmlg更单儿美购饮佰瀚鲜热香新州贝，<10送/24h尿为危验值免多次2活桌欧质瑞电学期医不计腾美康命道注：1mmHg=0.133kPa的摄时便，爱天体清10为危险题屏效能计吉（图6-14PFR变异减速：（S-a来，1-8表）患长率sm）

Variable deceleration，VD）