intrauterine distress
Introduction
Introduction to intrauterine distress The fetus has signs of hypoxia in the uterus, endangering the health and life of the fetus, known as fetal distress. Fetal distress is a comprehensive symptom and is one of the main indications for current cesarean section. Fetal distress occurs mainly during the labor process and can also occur in the second trimester. Occurrence in the process of labor, can be the continuation and aggravation of the late pregnancy. Fetal distress is more common in the prenatal period, mainly due to the performance of placental insufficiency. Pathophysiological high-risk pregnancy, such as hypertensive disorder complicating pregnancy, chronic hypertension, nephritis, diabetes, heart disease, asthma, severe anemia, overdue pregnancy, etc., or uterine blood loss due to vascular disease, or due to the regression of the placenta, or due to The blood oxygen concentration is too low, so that the fetus does not get enough oxygen, causing fetal growth retardation, polycythemia, fetal movement reduction, and even severe fetal distress, causing fetal death. basic knowledge The proportion of sickness: 0.01% Susceptible population: pregnant women Mode of infection: non-infectious Complications: dystocia
Cause
Causes of intrauterine distress
Maternal factor (25%):
Insufficient oxygen content in the maternal blood is an important cause. In mild hypoxia, the mother has no obvious symptoms, but the maternal factors that affect the fetus and cause fetal hypoxia are:
1, small arterial blood supply: such as hypertension, chronic nephritis and pregnancy-induced hypertension.
2, red blood cells lack of oxygen: such as severe anemia heart disease and pulmonary heart disease.
3, acute blood loss: such as prenatal bleeding disorders and trauma.
4, uterus placental blood supply blocked: emergency or uterine inconsistent contraction: improper use of oxytocin caused by excessive contractions; prolonged labor, especially the second stage of labor extension; excessive uterine expansion, such as polyhydramnios and multiple pregnancy; Premature rupture of the umbilical cord may be stressed.
Fetal factors (20%):
1, fetal cardiovascular system dysfunction such as severe congenital cardiovascular disease intracranial hemorrhage.
2, fetal malformations.
Umbilical cord, placenta factor (15%):
The umbilical cord and placenta are the transmission and transmission channels of oxygen and nutrients between the mother and the fetus, and their dysfunction will inevitably affect the fetus's inability to obtain the required oxygen and nutrients.
1, cord blood supply is blocked.
2, placental function is low: such as expired pregnancy placental development disorder (too small or too large), abnormal placental shape (membranous placenta, contoured placenta, etc.) and placental infection.
Prevention
Intrauterine distress prevention
First, pregnant women preventive measures
1. Prenatal education
Prenatal education should be carried out for pregnant women. After entering the labor process, they should pay attention to lifting the unnecessary ideological concerns and fears of the mothers, so that pregnant women understand that childbirth is a physiological process and enhance their confidence in childbirth. Encourage more food before childbirth and add nutrients if necessary. Avoid excessive use of sedative drugs, pay attention to check whether the head basin is not called, etc., are effective measures to prevent uterine weakness.
2, pregnancy care
Active prevention and treatment of complications during pregnancy, such as heart disease, anemia, pregnancy-induced hypertension, tuberculosis, etc. Second, we must deal with expired pregnancy in a timely manner. In the third trimester of pregnancy, if it is determined by the doctor to determine the breech position, transverse position, etc., pregnant women should not use the method of correcting the fetal position. Instead, under the guidance of a doctor, the knee position should be used to correct the fetal position, avoiding umbilical cord entanglement and umbilical cord. The danger of knotting. Pregnant women should follow the doctor's advice to rest, prevent premature rupture of membranes, umbilical cord prolapse.
3, regular checkup
Timely discovery of various maternal factors that may cause intrauterine hypoxia, and timely diagnosis and treatment. The doctor can also find abnormal changes in fetal heart rate in time through fetal electrocardiogram examination, fetal heart rate electronic monitoring, B-ultrasound biophysical score, Doppler ultrasound umbilical blood flow examination, and timely take contingency measures.
4, should strengthen the perinatal health care work, especially for high-risk pregnancy and high-risk newborns must strengthen supervision, find abnormal conditions should take timely measures to ensure maternal and child health during childbirth or minimize the occurrence of asphyxia, caution in the use of anesthesia Or oxytocin and so on.
Second, fetal preventive measures
It can be monitored by the following indicators:
1, fetal heart monitoring
Pregnant women can learn to use the stethoscope to directly listen to the fetal heart rate under the guidance of a doctor. The normal fetal heart rate should be 120-160 beats / min. The fetal heart rate should be increased by >10 beats/min during fetal movement, or the fetal heart rate is irregular. If the fetal heart rate slows down less than or more than this number, it indicates that the fetal hypoxia should go to the hospital in time.
2, fetal movement monitoring
Fetal movement is a good indicator of fetal survival and the most sensitive indicator of intrauterine hypoxia. Fetal movement count is a simple method for monitoring intrauterine conditions during pregnancy and can be used for a long time. Generally, the expectant mother should learn to count the number of fetal movements after 28 weeks: if the fetal movement is completed after 1 time, the interval will be counted again, and so on. Pregnant women take the left side for one hour each morning, middle and night. The pregnant women record the number of fetal movements in the three hours according to their subjective feelings. The number of fetal movements in the early, middle and late times is multiplied by 4, and the number of fetal movements is 12 hours. . Fetal movement count 12 hours 30 times is normal, if 12 hours < 10 times is abnormal. The fetal movement count is recorded day by day. If you find that the fetal movement is too frequent or too little, it may indicate that the fetus has intrauterine hypoxia, and should go to the hospital for examination.
Complication
Intrauterine distress complications Complications, dystocia, death, intrauterine
Intrauterine distress is a common cause of fetal perinatal death and neonatal nervous system sequelae, accounting for the first cause of perinatal death, causing cerebral ischemia and hypoxia syndrome for a long time, causing a series of neuropsychiatric symptoms, serious Affect the child's body and future life.
Symptom
Fetal intrauterine distress symptoms Common symptoms Fetal intrauterine asphyxia fetal movement over-frequency fetal movement changes purpura and blood hypoxia fetal heart rate changes meconium-contaminated placenta blood perfusion poor fetal bradycardia placenta aging umbilical cord around neck
The main symptoms
1, fetal heart rate changes
It is the first symptom of fetal distress. The fetal heart sounds first become faster, but powerful and regular, then slow, weak and irregular. Therefore, you should be vigilant when you find that your fetal heart rate is getting faster. When the uterus contracts, the fetal heart is slowed due to temporary disturbance of the uterus-placental blood circulation, but it returns to normal soon after the uterine contraction stops. Therefore, the fetal heart between the two uterine contractions should be taken as the standard. The fetal heart sound is abnormal more than 160 times per minute or less than 120 times per minute. Less than 100 times indicates severe hypoxia. If there are conditions, fetal heart monitoring should be carried out.
2, amniotic fluid meconium pollution
In the absence of oxygen, the fetus causes vagus nerve excitement, which increases intestinal peristalsis and relaxes the anal sphincter and causes meconium to escape. At this time, the amniotic fluid is grassy green. When the head is first exposed, it has a diagnostic significance; when the hip is first exposed, the fetal abdomen is pressed to squeeze the meconium, so the meconium in the amniotic fluid when the hip is first exposed is not necessarily a sign of fetal distress.
3, fetal movement is very active
It is a struggle phenomenon in the case of fetal hypoxia, which can be reduced or even stopped with hypoxia.
Chronic symptoms
It occurs mostly in the end of pregnancy and often continues to be labored and aggravated. The reason is mostly due to maternal systemic diseases or pregnancy-induced diseases caused by placental insufficiency or fetal factors. In addition to the disease that can cause the placental blood supply to be insufficient in the mother, the fetal intrauterine development occurs with the prolonged fetal chronic hypoxia. slow.
Acute symptoms
Mainly occurs during childbirth, mostly due to umbilical factors (such as prolapse, neck knotting, etc.), placental abruption, excessive uterine contractions and long duration and maternal hypokalemia. The clinical manifestations were changes in fetal heart rate, amniotic fluid meconium contamination, fetal movement was too frequent, fetal movement disappeared and acidosis.
Examine
Fetal intrauterine distress
1, fetal heart rate changes, fetal heart sounds per minute more than 160 times or less than 120 times are abnormal.
2, amniotic fluid meconium contamination, amniotic fluid is grass green.
3, fetal movement is very active.
4, fetal scalp blood pH measurement.
5, B-ultrasound: B-ultrasound is a kind of ultrasound examination, is a non-surgical diagnostic examination, is an emerging discipline, has become an indispensable diagnostic method in modern clinical medicine.
Diagnosis
Diagnosis and diagnosis of intrauterine distress
diagnosis method
Chronic fetal distress
1, placental function test: Determination of 24-hour urine E3 value and dynamic continuous observation if the acute aggregation decreased by 30% to 40%, or repeated 24 hours after the end of pregnancy, urine E3 value below 10mg, indicating fetal placental dysfunction.
2, fetal heart rate monitoring: continuous description of pregnant women fetal heart rate 20 ~ 40 minutes normal fetal heart rate baseline 120 ~ 160 beats / min. If the fetal heart rate does not accelerate significantly during fetal movement, a baseline variability of <3 beats/min indicates fetal distress.
3, fetal movement count: fetal movement near full-term 20 times / 24 hours. The calculation method can detect the number of fetal movements in the first hour and the middle of the morning, and the number of fetal movements is multiplied by 4, which is the number of fetal movements close to 12 hours. The reduction of fetal movement is an important indicator of fetal distress. Daily monitoring of fetal movement The safety of the fetus can be predicted. After the fetal movement disappears, the fetal heart will disappear within 24 hours, so you should pay attention to this to avoid delay in rescue. Excessive frequency of fetal movement is often a precursor to the disappearance of fetal movement should also be taken seriously.
4, amniocentesis: see amniotic fluid turbid yellow stained to dark brown to help the diagnosis of fetal distress.
Acute fetal distress
1, fetal heart rate changes: fetal heart rate is an important sign to understand whether the fetus is normal:
(1) Fetal heart rate > 160 beats / min, especially > 180 beats / min, for the initial performance of fetal hypoxia, pregnant women with unhappy heart rate.
(2) Fetal heart rate <120 beats / min, especially <100 beats / divided into fetal risk.
(3) There is a late fetal heart rate deceleration, variability deceleration or (and) baseline lack of variation, which indicates that the cause of fetal distress fetal heart rate abnormality needs to be examined in detail. Fetal heart rate changes can not be determined by only one auscultation. Multiple examinations should be performed and the position should be changed to the lateral position for a few minutes.
2, amniotic fluid meconium pollution: fetal hypoxia caused by vagus nerve excitement, intestinal peristalsis, anal sphincter relaxation, meconium discharge into amniotic fluid, amniotic fluid is green, yellow green and then turbid brown, that is, amniotic fluid I degree, II degree III Degree of pollution. After the membrane is broken, the amniotic fluid can be directly observed. If the amniotic fluid is not ruptured, it can be seen through the amniotic membrane and through the membrane to understand the characteristics of amniotic fluid. If the first exposed part of the fetus has been fixed, it can be different from the amniotic fluid after the first exposed part of the fetus. When the anterior amniotic fluid sac is clear and the fetal heart rate is not normal, if the rupture of the membrane can be broken, the scalp can be removed upwards after disinfection. The amniotic fluid above it can understand the water content of the upper part of the amniotic cavity.
Amniotic fluid I degree or even II degree pollution, fetal heart rate is always good, should continue to closely monitor fetal heart is not necessarily fetal distress, amniotic fluid III degree polluting, should end early delivery even if the newborn Apgar score may be 7 points should also be vigilant Because of the high chance of newborns. Mildly contaminated fetal heart disease with abnormal monitoring of the fetal heart for about 10 minutes should still be diagnosed as fetal distress.
3, fetal movement: the early stage of acute fetal distress first manifested as fetal movement frequency, and then weakened and the number of times decreased, and then disappeared.
4, acidosis: after the rupture of the membrane to check the fetal scalp blood for blood gas analysis. The indicators for diagnosing fetal distress are blood pH <7.20, PO2 <1.3 kPa (10 mmHg) PCO2 > 8.0 kPa (60 mmHg).
Differential diagnosis
1, lung hyaline membrane disease: premature infants often see poor general condition, dyspnea and bruising are progressively worse, the disease has a poor prognosis, lung maturity check and chest) X-ray examination have special changes.
2, aspiration pneumonia: more history of asphyxia and inhalation history often after the resuscitation of shortness of breath, clinical symptoms, X-ray showed bronchial pneumonia changes with less interlobular and / or pleural effusion, the lesion disappeared longer.
3, amniotic fluid inhalation syndrome: this disease has a history of asphyxia or respiratory distress, shortness of breath occurs after resuscitation, while neonatal wet lungs are normal at birth, and late X-ray examination of respiratory distress can also help identify.
4, Cerebral hyperventilation (Cerebral hyperventilation): This is caused by cerebral edema is common in term infants with asphyxia, shortness of breath, but the prognosis of lungs without signs is related to the cause.
