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Fetal Distress 





  • Emergency situation with little time to optimize 

  • Considerations of pregnancy, full stomach, 2 patients 

  • Need for intra-uterine resuscitation & possible need to expedite delivery 

  • Differential diagnosis to consider: 

    • Maternal shock: excessive epidural/total spinal, sepsis, hemorrhage, cardiomyopathy

    • Maternal Fever

    • Cord prolapse

    • Placental abruption

    • Uterine hypertonus

    • Intrathecal narcotics (avoid CSE in women whose fetuses have decels)

    • Pregnancy induced hypertension 

    • Uterine rupture

    • Footling breech

  • Need discussion with obstetrics regarding urgency of the distress & need for STAT delivery, maternal safety is the guiding factor 



Intra-uterine Resuscitation 


  • Fluid bolus (1-2 L crystalloid)

  • Supplemental O2

  • Left uterine displacement 

  • Tocolysis: Stop oxytocin, consider nitroglycerine (1-2 sprays sublingual or 50-400 mcg IV)

  • Vasopressors to maintain uteroplacental perfusion 



Reassuring (CLASS I or NORMAL) FHR Pattern


  • A baseline fetal heart rate of 110 to 160 bpm

  • Absence of late or variable FHR decelerations

  • Moderate FHR variability (6 to 25 bpm)

  • Early decelerations & accelerations may be present or absent



Non-reassuring (Class III or ABNORMAL) FHR Pattern: WORRISOME!


  • Absent baseline FHR variability 

  • Recurrent late decelerations 

  • Recurrent variable decelerations 

  • Bradycardia 

  • Sinusoidal pattern 



Indeterminate (Class II) FHR Patterns: WATCH & SEE 


  • The fetus may not be acidotic; however, continuation or worsening of the clinical situation may result in fetal acidosis

  • Examples: tachycardia, minimal or marked variability, absent variability without recurrent decelerations, absence of accelerations without absent variability, recurrent late or variable decelerations without absent variability, & prolonged decelerations 

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