妇产科学课件胎儿窘迫英文版VIP免费

FetaldistressFetaldistressisdefinedasdepletionofoxygenandaccumulationofcarbondioxide,leadingtoastateof“hypoxiaandacidosis”duringintra-uterinelife.fetaldistressdividedintoacuteandchronicfetaldistressDefinitionChronicfetaldistressoccursusuallyinantepartumAcutefetaldistressoccursusuallyinintrapartum.MaternalbloodoxygenshortageMaternal-fetaloxygentransportandexchangeobstacleAbnormalfetalownfactorsEtiologyMaternalfactors1)Hypertensivedisorder2)LowoxygencarriedbyRBC(severeanemia,Minorarterialinsufficiency:heartdiseasewithheartfailure;pregnancywithlungdisease)3)Acutebleeding(placentaprevia,placentalabruption)4)ShockandacuteinfectionEtiologyMaternal-fetaloxygentransportandexchangeobstacle1）Poorfunctionoftheplacenta(hypertensivedisorder；chronichypertension,chronicnephritis,posttermpregnancy,diabetes)2）Abnormalumbilicalcord(prolapse,edema,long,short,torsion,knot,wraptheneck)EtiologyFetalfactors1)Abnormalityingrowth(heart,liver,lung)2)Intrauterineinfection3)Incompatibilityofmotherandfetusbloodgroup4)IntracranialhemorrhageEtiologyHypoxia、accumulationofcarbondioxide￬RespiratoryAcidosis￬FHR￪→FHR￬￬Intestinalperistalsis（蠕動）￬Relaxationoftheanalsphincter￬Meconiumstaining￬FetalorneonatalpneumoniaPathogenesisAcutefetaldistressChronicfetaldistressPathogenesisFGR(Fetalgrowthrestriction)PathophysiologyFetaldistressisphysiologicandpathophysiologicresponsestoanasphyxiatedstateinuterus,progressivefetalasphyxiawillresultin:1)decompensationofthepathophysiologicresponses2)permanentcentralnervoussystemdamage3)otherorgansdamageordeathClinicalmanifestationAcutefetaldistress(1)Abnormalfetalheartrate(FHR)：Importantcriteriatodiagnosefetaldistress(FHR)>160beats/min(tachycardia)<110beats/min(bradycardia)(LD)RepeatedLatedecelerationPlacentadysfunction(VD)VariabledecelerationUmbilicalfactorsClinicalmanifestationAcutefetaldistressiftheFHR<100beats/min,accordingwithFHRvariabilitylessthan5bpmandfrequentlatedeceleration,itindicatesthefetalhasseveredistress,maybedieintheuterus.FHRandFHRvariabilityEarlydeceleration(ED)Latedeceleration(LD)Variabledeceleration(VD)ClinicalmanifestationAcutefetaldistress(2)Meconiumstainingoftheamnioticfluid,dividedinto3grades:I、Lightgreen.II、Yellow-green.III、Brown(3)FetalmovementFrequentReduceDisappear(4)AcidosisFBS(fetalbloodsample)(rarelyused)pH<7.20(7.25-7.35)pO2<10mmHg(15~30mmHg)PCO2>60mmHg(35~55mmHg)ClinicalmanifestationChronicfetaldistress1)Fetalmovement:Normal：>30/12hAbnormal：FrequentReduceDisappear,if<10/12h,thefetalmaybehasthedistress.ClinicalmanifestationChronicfetaldistress2)FHR:NST,OCTorCSTteststodeterminetheintrauterineconditionoffetus.NST:Non-stresstestOCT:OxytocinchallengetestCST:ContractionstresstestFHRvariabilityFHR-base-line-variability:oscillationamplitudeoscillationfrequencyClinicalmanifestationChronicfetaldistress3)Fetalbiophysicalmonitoring(BPS)NSTFetalrespiratorymovementFetalactivityMuscletensionVolumeofamnioticfluidEverytopichas2score,ifthewholescorelessthan8,maybetherehasfetaldistress.ClinicalmanifestationChronicfetaldistress4)UltrasoundS/Dincreasestepbystep,maybetherehasfetaldistress.5)Meconiumstainingoftheamnioticfluid：byAmnioscopywecandetectitlightgreenyellowgreenbrownTreatment(Acutefetaldistress)1.Oxygenmasks(10L/min):20-30min.5-10minintervalThoughDecreasedmaternalPaO2israrelytheprimarycauseforfetaldistress.Butincreasi...