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At least 19 recordsLinked to original sources
PubMed1991

Diagnosis and management of intrapartum fetal distress.

Fetal distress is a frequent reason for obstetric intervention during labour. The final diagnosis generally is based upon the information in the cardiotocographic tracings, whether or not combined with the information from fetal scalp blood sampling. Reading, classification and interpretation of fetal heart rate (FHR) recordings is subject to considerable interobserver variation, even among experienced obstetricians. Far too often, individual decelerations in the heart rate are classified as early or late, merely on the basis of the relationship between the decelerations and the accompanying contraction. Hon's original flow sheet for classification of decelerations dictates assessment of the full tracing with, as a primary step: are decelerations uniform or not? Non-uniform decelerations should automatically be classified as variable. Comparison between the onset of the deceleration and the uterine contraction curve is the second step. Variable decelerations are the predominant type in the majority of intrapartum recordings. Features in the FHR rhythm to be assessed in case of variable decelerations include assessment of the baseline level, presence or absence of accelerations, variability in the baseline pattern and during the decelerative part of the tracing, initial and secondary acceleration, overshoot following the deceleration whether or not with smoothing, recovery from the deceleration, continuation of the baseline level and the time intervals between contractions or recurrent efforts of pushing activity. The paper further addresses pathophysiologic mechanisms of fetal distress, maternal and fetal risk factors and various alternatives in the management of intrapartum distress.

Female↗
PubMed1984

Fetal-neonatal status following caesarean section for fetal distress.

Fetal biochemical and neonatal clinical data were compiled in 126 emergency Caesarean sections performed for fetal distress. The choice of anaesthetic technique was determined by the wishes of the mother. General anaesthesia was administered to 71 parturients and regional analgesia to 55 (subarachnoid block 33, extension of extradural block 22). The aetiologies of fetal distress and the skin incision-delivery and uterine incision-delivery intervals were not significantly different between the two anaesthesia groups. Umbilical artery blood pH values were higher than the last scalp capillary blood pH values in 63% of the general anaesthesia and in 80% of the regional analgesia cases. Umbilical vein and artery blood-gas and pH data were similar in the two anaesthesia groups, but 1-min Apgar scores were significantly better following regional analgesia. Despite the presence of fetal distress, subarachnoid blockade was a most suitable method of anaesthesia in experienced hands.

Anesthesia, Conduction↗
PubMed1988

Acute fetal distress after fetal blood sampling (case report).

The authors report a case of acute fetal distress after fetal blood sampling, performed for fetal karyotype because of a precocious and symmetrical fetal growth retardation without maternal hypertension or ultrasonographic evidence of fetal malformation. A cesarean section performed because of acute fetal distress showed the newborn to be hypotrophic, with a major acidosis and a refractory hypoxemia. The new born died despite intensive care. Acute fetal anemia was assumed to be the cause of acute fetal distress. The authors emphasize the use of FHR in fetal survey after fetal blood sampling.

Adult↗
PubMed1990

What is fetal distress?

Fetal distress is a widely used but poorly defined term. This confusion of definition compounds the difficulty of making an accurate diagnosis and initiating appropriate treatment. The fetus reacts at the onset of asphyxia with a remarkable series of responses, primarily a complexly regulated redistribution of blood flow that serves to limit the deleterious effects of oxygen limitation in vital organs. This enables the fetus to survive asphyxia intact unless the insult is profound or prolonged. The most common asphyxial stresses imposed on the fetus during labor are insufficiency of uterine blood flow, or insufficiency of umbilical blood flow, and occasionally decrease in uterine arterial oxygenation. Each of these stresses produces characteristic fetal heart rate patterns: late decelerations, variable decelerations, or prolonged bradycardia. There is strong evidence that the presence of normal fetal heart rate variability represents normal central nervous system integrity, including adequate oxygenation. A decrease or loss of variability in the presence of these patterns is a sign that the physiologic compensations are overwhelmed as a result of the severity of asphyxia. Knowledge of the fetal responses to asphyxia, together with the known evolution of fetal heart rate patterns during asphyxia, should allow a more accurate definition of the onset of unacceptable asphyxia, and more rational management and timing of intervention.

Asphyxia↗
PubMed1994

Computerized analysis of fetal heart rate variation in postterm pregnancy: prediction of intrapartum fetal distress and fetal acidosis.

OBJECTIVE: Our purpose was to evaluate whether computerized analysis of fetal heart rate variation may improve fetal surveillance in postterm pregnancy. STUDY DESIGN: Three hundred thirty-seven pregnant women who were delivered after 41 weeks' gestation and who had 610 antenatal tests were included in this study. Fetal tests included a nonstress test with a computerized analysis of the fetal heart rate, Doppler examination of the umbilical artery, and a biophysical profile, performed every 2 to 4 days. Induction of labor was performed when the fetal heart rate variation was reduced (< 30 msec), when fetal heart rate decelerations appeared, or when the amniotic fluid index was < or = 5. The results of the fetal surveillance tests were compared with the results of the intrapartum fetal heart rate monitoring and with the metabolic status of the babies at delivery. Sensitivity and specificity of the various tests in predicting intrapartum fetal distress and acidosis at delivery were described by means of the receiver-operator characteristic curve. RESULTS: Ten of 12 fetuses with reduced fetal heart rate variation had a trial of labor. Nine of these 10 fetuses had fetal distress during labor. Seven of the 12 fetuses with reduced fetal heart rate variation were acidotic at delivery (umbilical artery pH < 7.2). Overall, there were 10 acidotic fetuses at delivery in the study group. Only two of them had an umbilical systolic/diastolic ratio > 95th percentile, three had an amniotic fluid index < or = 5, and five had fetal heart rate decelerations before labor. Fetuses who demonstrated an abnormal intrapartum fetal heart rate tracing or who were acidotic at delivery had a significantly higher rate of reduced fetal heart rate variation or decelerations before labor. The largest area under the receiver-operator curve curve for predicting fetal acidosis at delivery or fetal distress during labor was achieved by means of computerized analysis of fetal heart rate variation. CONCLUSION: A computerized numeric analysis of fetal heart rate variation may improve fetal surveillance in postterm pregnancy.

Acidosis↗
PubMed1987

Acute fatty liver of pregnancy: etiology of fetal distress and fetal wastage.

Acute fatty liver is a rare complication of pregnancy occurring in approximately one in 13,000 deliveries. This disease has been associated with high maternal and fetal mortality rates in the past. Advances in medical care and early recognition and delivery are credited with recent reductions in the maternal and fetal loss seen with this disease. Maternal death is associated with hypoglycemia, hepatic failure, or coagulopathy. The etiology of fetal mortality is not well delineated. Reported is a patient with histologically proved acute fatty liver who developed fetal distress during therapy for coagulopathy. Review of the fetal monitor tracing in conjunction with examination of the placenta have led us to propose that uteroplacental insufficiency may be the cause for fetal distress and fetal wastage in fatty liver of pregnancy.

Acute Disease↗
PubMed2000

Maternal oxygen administration for fetal distress.

BACKGROUND: Maternal oxygen administration has been used in an attempt to lessen fetal distress by increasing the available oxygen from the mother. OBJECTIVES: The objective of this review was to assess the effects of maternal oxygenation for fetal distress during labour and to assess the effects of prophylactic oxygen therapy during the second stage of labour on perinatal outcome. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: December 1997. SELECTION CRITERIA: Randomised trials comparing maternal oxygen therapy for fetal distress during labour and prophylactic oxygen therapy during the second stage of labour with a control group (dummy or no oxygen therapy). DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by the reviewer. MAIN RESULTS: No trials addressing maternal oxygen therapy for fetal distress could be located. One trial of 85 women which addressed prophylactic oxygen therapy during labour was included. Cord blood pH values of less than 7.2 were more frequently recorded in the oxygenation group than the control group (relative risk 4.83, 95% confidence interval 1.11 to 21.04). There were no other statistically significant differences between the groups. Within the oxygenation group, those receiving oxygenation for less than 10 minutes had higher umbilical artery pH values than those receiving oxygen for longer than 10 minutes. REVIEWER'S CONCLUSIONS: There is not enough evidence to support the use of prophylactic oxygen therapy for women in labour, nor to evaluate its effectiveness for fetal distress.

Female↗
PubMed2000

Piracetam for fetal distress in labour.

BACKGROUND: Piracetam is thought to promote the metabolism of brain cells when they are hypoxic. It has been used to prevent adverse effects of fetal distress. OBJECTIVES: The objective of this review was to assess the effects of piracetam for suspected fetal distress in labour on method of delivery and perinatal morbidity. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: February 1999. SELECTION CRITERIA: Randomised trials of piracetam compared with placebo or no treatment for suspected fetal distress in labour. DATA COLLECTION AND ANALYSIS: Both reviewers assessed eligibility and trial quality. MAIN RESULTS: One study of 96 women was included. Piracetam compared with placebo was associated with a trend to reduced need for caesarean section (relative risk 0.57, 95% confidence interval 0.32 to 1.03). There were no statistically significant differences in relative risk between the piracetam and placebo group for neonatal morbidity (measured by neonatal respiratory distress) or Apgar score. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of piracetam for fetal distress in labour.

Delivery, Obstetric↗
PubMed1979

[A fetal distress signal: decreased fetal movements. A case of antenatal anaemia (author's transl)].

The authors report an observation of antenatal anaemia which showed as fetal distress found by a decrease of fetal movements and confirmed by cardiotocography. At birth, the baby was very pale and has a severe anaemia. The authors have investigated the method introduced by Sadovsky for analysing fetal activity in which the woman counted her fetal movements in accordance with a time schedule. Normal fetal movements are an indication of fetal well-being. Decreased fetal movements may be an indication of chronic fetal asphyxia. In this case, cardiotocography has to be undertaken. Analysis of their results demonstrated the value of this method which appears to be useful particularly for the assessment of chronic fetal distress.

Adult↗
PubMed1992

Intrauterine resuscitation in the severely distressed fetal dog.

Severe fetal distress was produced in 16 fetal dogs by successive and/or prolonged occlusion of the maternal abdominal aorta in an acute surgical preparation, and was characterized in fetal arterial blood of 7.06 for pH, 10 mm Hg for O2, 127 mm Hg for CO2, and fetal heart rate decelerations. Five fetuses recovered spontaneously in utero and delivered normally; 3 needed maternal oxygenation before delivery; 3 suddenly died in utero; 5 fetuses were delivered while still alive in utero when the tpH reached 6.85, and eventually expired. Intrauterine recovery and resuscitation was effective in some fetuses.

Animals↗
PubMed1997

Acute physiopathological and histopathological effects of fetal distress on the fetal stomach: an experimental study.

Although effects of stress on the stomach have been extensively investigated in children and adults, our knowledge about effects of fetal distress (FD) on the fetal stomach is quite limited. Therefore, an experimental study was planned to evaluate the effects of FD on fetal gastric physiology and histology. In this study, a model of FD was created by way of intermittent maternal aortic occlusion in pregnant rabbits. In total, 21 fetuses of 6 pregnant rabbits were available for surgical and laboratory procedures. Laboratory examinations showed that (1) fetal gastric acid secretion was 4.24 +/- 2.68 muEq/h in the control group and 18.08 +/- 6.34 muEq/h in the distress group (p < 0.01) and (2) fetal gastric PGE2 level was 16.59 +/- 6.15 mg/g wet weight in the control group and 9.86 +/- 3.46 mg/g wet weight in the distress group (p < 0.05). Histopathologically, there were mild hemorrhagic and errosive changes in the distressed fetuses, but not in control fetuses. These findings support that FD adversely affects fetal gastric physiology through two mechanisms consisting of increased gastric acid secretion and decreased fetal gastric protection in rabbits. Consequently, gastric injury should be noted as a potential problem among hypoxia-associated abnormalities encountered in the distressed fetus.

Animals↗
PubMed1977

Use of a beta 2-sympathomimetic drug as a temporizing measure in the treatment of acute fetal distress.

Severe fetal distress in labor is an obstetric emergency which may result in the delivery of a severely asphyxiated baby or even death of the fetus. This problem may be compounded by a hurried mechanical vaginal delivery or by delay before a cesarean section can be performed. The rationale for using a beta sympathomimetric drug as a temporizing measure in the treatment of fetal distress to prevent deterioration in and even to improve the condition of the fetus before delivery is discussed. Six cases are described in which hexoprenaline (Ipradol), a beta2-selective sympathomimetic drug, has been administered as a 10 microgram intravenous bolus in the treatment of acute fetal distress in labor.

Apgar Score↗
PubMed2002

Intrauterine resuscitation: active management of fetal distress.

Acute fetal distress in labour is a condition of progressive fetal asphyxia with hypoxia and acidosis. It is usually diagnosed by finding characteristic features in the fetal heart rate pattern, wherever possible supported by fetal scalp pH measurement. Intrauterine resuscitation consists of applying specific measures with the aim of increasing oxygen delivery to the placenta and umbilical blood flow, in order to reverse hypoxia and acidosis. These measures include initial left lateral recumbent positioning followed by right lateral or knee-elbow if necessary, rapid intravenous infusion of a litre of non-glucose crystalloid, maternal oxygen administration at the highest practical inspired percentage, inhibition of uterine contractions usually with subcutaneous or intravenous terbutaline 250 microg, and intra-amniotic infusion of warmed crystalloid solution. Specific manoeuvres for umbilical cord prolapse are also described. Intrauterine resuscitation may be used as part of the obstetric management of labour, while preparing for caesarean delivery for fetal distress, or at the time of establishment of regional analgesia during labour in the compromised fetus. The principles may also be applied during inter-hospital transfers of sick or labouring parturients.

Journal Article↗