上海交通大学医学院：《妇产科学》（双语） 9 Fetal distress

Fetal distress LIN QI DE 20059.5

Fetal distress LIN QI DE 2005.9.5

Definition Fetal distress is defined as depletion of oxygen and accumulation of carbon dioxide, leading to a state of "hypoxia and acidosis" during intra uterine life

Fetal distress is defined as depletion of oxygen and accumulation of carbon dioxide,leading to a state of “hypoxia and acidosis ” during intra￾uterine life. Definition

Etiology Maternal factors 1)Microvascular ischaemia(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

Maternal factors 1) Microvascular ischaemia(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 Etiology

Etiology Placenta umbilical factors 1)Obstructed of umbilical blood flow 2)Dysfunction of placenta 3)Fetal factors 4) Malformations of cardiovascular system 5)Intrauterine infection

Placenta、umbilical factors 1) Obstructed of umbilical blood flow 2) Dysfunction of placenta 3) Fetal factors 4) Malformations of cardiovascular system 5) Intrauterine infection Etiology

Pathogenesis Hypoxia accumulation of carbon dioxide Respiratory Acidosis Acute fetal FHR→FHR↓→FHR↑ distress Intestinal peristalsis Relaxation of the anal sphincter Meconium aspiration Fetal or neonatal pneumonia

Hypoxia、accumulation of carbon dioxide ￬ Respiratory Acidosis ￬ FHR￪ → FHR ￬→ FHR ￪ ￬ Intestinal peristalsis ￬ Relaxation of the anal sphincter ￬ Meconium aspiration ￬ Fetal or neonatal pneumonia Pathogenesis Acute fetal distress

Pathogenesis Chronic TUGR Feta (intrauterine growth distress retardation)

Chronic Fetal distress Pathogenesis IUGR (intrauterine growth retardation)

clinical manifestation Acute fetal distress (1)FHR FHR>180 beats/min(tachycardia) <100 beats/min(bradycardia) (LD) Repeated Late deceleration Placenta dysfunction (VD) Variable deceleration Umbilical factors

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

FHR: 120N160 bpm /FHR variability 1501 mwwmmMwwwwnw 每胎90胎心率周期性变化 分心 钟率 50 宫腔压力 (mmHg o 每胎901m%m 分心 钟率 30 50 (am0心率基线与基线摆动(心率周期性变化) 图6-12胎心率与基线摆动 C MmhG= 0. 133kPa

FHR:120~160 bpm / FHR variability

Early deceleration, ED 心率基线正常 形态一致 每160 分 映1m201 胎 下降幅度小 率804 传续时!}+恢复快 少于50bm) 间短沙少 时间短 11②少于15秒) 官 于15秒 腔 50 压(mmHg 开始早 力 下0 注:1mlg=0.133 图613PFHR早期减速

Early deceleration，ED

Late deceleration, LD 基线显示心动过速形态一致 每160 分 钟 逐渐下降 逐渐恢复 胎 120 心 率80开始晚 下降幅度小 少于50bpm) 持续时间长(30-60 宫腔压力 50 mm 恢复慢 (30-60秒 0 注:lmg=0.13kPa 图615PFHR晚期减速

Late deceleration，LD