Fetal Scalp Blood Sampling Scalp Stimulation Vibroacoustic Stimulation Fetal Pulse oximetry Fetal Electrocardiography Intrapartum Doppler
Velocimetry
pH
Normal Preacidemia Acidemia >7.25 7.20 7.25
<7.20
SCALP STIMULATION
VIBROACOUSTIC STIMULATION
The technique uses an electronic artificial larynx placed approximately 1 centimeter from or directly onto the maternal abdomen. Response: Normal if a fetal heart rate acceleration of atleast 15 beats/min for at least 15 seconds after the stimulation and with prolonged fetal movement.
This technique allow assessment of fetal oxyhemoglobin saturation once membranes are ruptured. The lower limit for normal fetal oxygen saturation is generally considered to be 30 percent.
Bloom and associates reported that brief, transient fetal oxygen saturations below 30 percent were common during labor. Saturation values below 30 percent, however, when persistent for 2 minutes or longer, were associated with an increased risk of potential fetal compromise.
Cesarean delivery for fetal distress was performed when pulse oximetry values remained less than 30 percent for the entire interval between two contractions.
The technique requires internal monitoring of the fetal heart rate and special equipment to process the fetal ECG. As fetal hypoxia worsens, there are changes in the T-wave and in the ST segment of the fetal ECG.
The mature fetus exposed to hypoxemia develops an elevated ST segment with a progressive rise in T-wave height that can be expressed as a T:QRS ratio.
P wave: Contraction of Atria QRS Complex: Contraction of ventricles T-wave: Heart prepares for next beat
NORMAL ST-WAVE
INCREASES T-WAVE AMPLITUDE
Increasing T:QRS ratios reflect fetal cardiac ability to adapt to hypoxia and appears before neurological damage.
Progression of hypoxia results in an increasingly negative ST-segment deflection such that it appears as a biphasic waveform.
Usually determined by evaluation of the fetal heart rate in labor using some form of fetal monitoring. Commonly used to describe fetal hypoxia It may also be suspected if there is meconium, fetal stool, in the amniotic fluid. Reasons for fetal distress are varied from cord issues, to fetal anomalies, reactions to medications or the stress of labor, and other complications of labor.
Passage of meconium is triggered by fetal stress, such as hypoxia or asphyxia, and that the presence of meconium in the fluid may be considered an indicator of fetal distress.
The presence of meconium in the amniotic fluid also may be a result of gastrointestinal maturity
Moving the mother to the lateral position
Correcting maternal hypotension caused by regional analgesia
Discontinuing oxytocin serve to improve uteroplacental perfusion.
Cervical examination to exclude prolapsed cord or impending delivery Tocolysis: A single intravenous or subcutaneous injection of 0.25 mg of terbutaline sulfate given to relax the uterus. Amnioinfusion
Treat intrapartum problems known to be associated with fetal compromise:
prophylactic treatment of
oligohydramnios during labor and after premature rupture of the membranes,
treatment of severe variable decelerations during labor and
aspiration during labor in patients with thick meconium fluid.
reducing the risk of meconium
Most used protocol includes continuous infusion of 500-800 ml bolus of warmed normal saline at approximately 3 ml/min.
For brain damage to occur, the fetus must be exposed to much more than a brief period of hypoxia. Most cerebral palsy is unrelated to labor events. Spastic quadriplegia and less commonly dyskinetic cerebral palsy are the only types of cerebral palsy associated with acute hypoxic intrapartum events.
Internal Uterine Pressure Monitoring External Monitoring
Patterns of Uterine Activity
An intrauterine catheter is placed to measure the intrauterine pressure.
A transducer is placed on the abdominal wall to measure the strength of uterine contraction with the help of transducer button or plunger.
As the uterus contracts, the button moves in proportion to the strength of the contraction. It measures onset, peak and end of contraction . Does not give an accurate measure of intensity.
Contractile waves of uterine activity were usually measured using intra-amnionic pressure catheters. Montevideo units concept were also introduced to define the uterine activity.
During the first 30 weeks, uterine activity is comparatively quiescent. Uterine activity increases gradually after 30 weeks.
