Foetal Distress in Labour

Question 1

What is Foetal Distress in Labour?

Answer 1

Fetal hypoxia +/- acidosis in labor. Doagnosis by intermittent ascultation, continuous CTG ot FBS.

Question 2

What would you find in the history and exam of Foetal Distress in Labour?

Answer 2

Detected via monitoring. Features of underlying condition: HTN, abruption.

General: assess maternal pulse (high HR may cause fetal high HR) BP (maternal hypovolaemia), temperature (Signs of infection)

Mbdomen: check for hypertonic/irritable uterus (hyperstimulation, abruption), clinical assessment of fetal growth and liquor (IUGR/OHD)

Vaginal: assess dilation, color of liquor, bleed, cord prolapse.

Question 3

What is the pathology of Foetal Distress in Labour?

Answer 3

Impaired O2 transfer due to placental insufficiency/pathology -> hypoxia. Excess CO2 -> acidosis. Can recover if O2 re established, hypoxic insult and profound acidosis occurs if persists.

Question 4

What are the investigations of Foetal Distress in Labour?

Answer 4

Blood: FBC, GS.

CTG continuous

FBS: Ph>7.25 is reassuring. <7.25 repeat at 30 mins. <7.20 requires immediate delivery.

Question 5

What is the management of Foetal Distress in Labour?

Answer 5

General: left tilt, IV acces, stop oxytocin infusion.

Fetal bradycardia>6min: EMERGENCY DELIVERY.

Persistent CTG abnormalities: FBS.

Delivery: if fully dilated, <1/5 palpable and vertex at/below spines, consider instrumental. Otherwise C section.

Question 6

What are the complications/ prognosis of Foetal Distress in Labour?

Answer 6

complications of instrumental/surgical delivery, F: HIE, death. PGX depends on time.

Question 7

What is the aetiology and epidemiology of Foetal Distress in Labour?

Answer 7

Insufficient o2 transfer from mother to fetus resulting in asphyxia.

2-10% incidence.

Question 8

What are the RFs of Foetal Distress in Labour?

Answer 8

Hypertonic uterus, placental insufficiency, IUGR, infection, cord prolapse, placental abruption, OHD, post-dates pregnancy, HTN