IMPAC FEtal distress in labour WHO Home | Reproductive Health Home | HRP | What's new | Resources | Contact | Search Department of Reproductive Health and Research (RHR), World Health Organization z Abbreviations Managing Complications in Pregnancy and Childbirth z Index A guide for midwives and doctors z List of diagnoses z MCPC Home Section 2 - Symptoms Clinical principles Rapid initial assessment Fetal distress in labour Talking with women and their families Emotional and psychological support PROBLEMS Emergencies z Abnormal fetal heart rate (less than 100 or more than 180 beats per minute). General care principles Clinical use of blood, blood products and z Thick meconium-stained amniotic fluid. replacement fluids Antibiotic therapy Anaesthesia and analgesia GENERAL MANAGEMENT Operative care principles z Prop up the woman or place her on her left side. Normal Labour and childbirth Newborn care principles z Stop oxytocin if it is being administered. Provider and community linkages ABNORMAL FETAL HEART RATE Symptoms BOX S-7 Abnormal fetal heart rate Shock Vaginal bleeding in early pregnancy z A normal fetal heart rate may slow during a contraction but usually recovers to normal as Vaginal bleeding in later pregnancy and soon as the uterus relaxes. labour z A very slow fetal heart rate in the absence of contractions or persisting after contractions is Vaginal bleeding after childbirth suggestive of fetal distress. Headache, blurred vision, convulsions or loss of consciousness, elevated blood z A rapid fetal heart rate may be a response to maternal fever, drugs causing rapid maternal pressure heart rate (e.g. tocolytic drugs), hypertension or amnionitis. In the absence of a rapid maternal Unsatisfactory progress of Labour heart rate, a rapid fetal heart rate should be considered a sign of fetal distress. Malpositions and malpresentations z If a maternal cause is identified (e.g. maternal fever, drugs), initiate appropriate management. Shoulder dystocia http://www.who.int/reproductive-health/impac/Symptoms/Fetal_distress_S95_S96.html IMPAC FEtal distress in labour Labour with an overdistended uterus z If a maternal cause is not identified and the fetal heart rate remains abnormal throughout at least three contractions, perform a vaginal examination to check for explanatory signs of distress: Labour with a scarred uterus Fetal distress in Labour Prolapsed cord - If there is bleeding with intermittent or constant pain, suspect abruptio placentae; Fever during pregnancy and labour Fever after childbirth - If there are signs of infection (fever, foul-smelling vaginal discharge) give Abdominal pain in early pregnancy antibiotics as for amnionitis; Abdominal pain in later pregnancy and - If the cord is below the presenting part or in the vagina, manage as prolapsed after childbirth cord. Difficulty in breathing Loss of fetal movements Prelabour rupture of membranes z If fetal heart rate abnormalities persist or there are additional signs of distress (thick meconium- stained fluid), plan delivery: Immediate newborn conditions or problems - If the cervix is fully dilated and the fetal head is not more than 1/5 above the Procedures symphysis pubis or the leading bony edge of the head is at 0 station, deliver by vacuum extraction or forceps; Paracervical block Pudendal block - If the cervix is not fully dilated or the fetal head is more than 1/5 above the Local anaesthesia for caesaran section symphysis pubis or the leading bony edge of the head is above 0 station, deliver by Spinal (subarachnoid) anaesthesia caesarean section. Ketamine External version MECONIUM Induction and augmentation of labour Vacuum extraction z Meconium staining of amniotic fluid is seen frequently as the fetus matures and by itself is not an indicator Forceps delivery of fetal distress. A slight degree of meconium without fetal heart rate abnormalities is a warning of the Caesarean section need for vigilance. Symphysontomy Craniotomy and craniocentesis z Thick meconium suggests passage of meconium in reduced amniotic fluid and may indicate the need for Dilatation and curettage expedited delivery and meconium management of the neonatal upper airway at birth to prevent meconium Manual vacuum aspiration aspiration (page S-143). Culdocentesis and colpotomy Episiotomy z In breech presentation, meconium is passed in labour because of compression of the fetal abdomen Manual removal of placenta during delivery. This is not a sign of distress unless it occurs in early labour. Repair of cervical tears Top of page Repair of vaginal and perinetal tears Correcting uterine inversion http://www.who.int/reproductive-health/impac/Symptoms/Fetal_distress_S95_S96.html IMPAC FEtal distress in labour Repair of ruptured uterus Uterine and utero-ovarian artery ligation Postpartum hysterectomy Salpingectomy for ectopic pregnancuy Appendix Essential drugs for managing complications in pregnancy and childbirth Index http://www.who.int/reproductive-health/impac/Symptoms/Fetal_distress_S95_S96.html.