II. Causes
- Uterine Rupture
- Uterine Hyperstimulation
- Placental Abruption
- Umbilical Cord accident
- Uteroplacental Insufficiency
III. Definitions
- Nonreassuring Fetal Status (preferred term)
- Fetal Heart Tracing suggestive of Fetal Hypoxia or acidosis
IV. Evaluation
- Fetal status
- Confirm findings with alternative monitoring
- Consider fetal scalp electrode
- Response to acoustic or scalp stimulation
- Consider Fetal Scalp pH (pH < 7.20 is abnormal)
- Confirm findings with alternative monitoring
- Maternal status
- Maternal Vital Signs
- Vaginal examination
- Vaginal Bleeding (e.g. Placental Abruption)
- Cervical examination
- Cervical dilation
- Rapid head descent
- Umbilical Cord Prolapse
V. Management: Based on Fetal Monitoring
- See NICHD Category
-
NICHD Category 1: Normal
- Reassuring Fetal Heart Tracing
- Fetal Heart Rate 110-160 bpm with moderate variability and no variable or Late Decelerations
- Continue current management
-
NICHD Category 2: Indeterminate
- Non-reassuring Fetal Heart Tracing (lacking category 1 criteria without category 3 criteria)
- Variability or accelerations present
- Perform interventions as below
- Reassess after 30 minutes, and resume close monitoring
- Cesarean delivery (or Vaginal Delivery if progressing in active labor) Indications
- Significant decelerations with >50% of contractions for 60 minutes
- Variability of accelerations absent
- Perform interventions as below
- Reassess after 30 minutes, and resume close monitoring
- Cesarean delivery (or Vaginal Delivery if progressing in active labor) Indications
- Significant decelerations with >50% of contractions for 30 minutes
- Persistent NICHD Category 2 tracing with poor variability or accelerations >1 hour
- Deep Decelerations to Heart Rate <70 bpm
-
NICHD Category 3: Abnormal
- Ominous Fetal Heart Tracing
- Recurrent variable or Late Decelerations, Fetal Bradycardia or sinusoidal pattern with loss of FHT Variability
- See interventions below
- Expedite delivery
VI. Management: Interventions for Non-reassuring Fetal Heart Tracing
- Maternal position change
- Lateral recumbent or
- Hands and Knees
- Evaluate maternal Vital Signs for serious findings
- Oxygen 8-10 liters per minute by Non-Rebreather Mask
- Intravenous Fluid Resuscitation with 1 Liter crystalloid
- Suppress labor
- Remove Cervadil
- Discontinue Oxytocin
- Consider holding pushing
- Consider Terbutaline SQ 0.25 mg
- Vaginal examination for acute cause
- Consider Amnioinfusion
- Indicated in repeat Variable Decelerations
- Consider expedited delivery
-
Consultation
- Obstetrics for expedited delivery
- Neonatology or Pediatrics
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Definition (NCI_FDA) | Caused by conditions such as inadequate placental function (often abruptio placentae), preeclamptic toxicity, prolapse of the umbilical cord, or complications from anesthetic administration. |
Definition (NCI) | Hypoxia in utero, caused by conditions such as inadequate placental function (often abruptio placentae), preeclamptic toxicity, prolapse of the umbilical cord, or complications from anesthetic administration. |
Definition (MSH) | Deficient oxygenation of FETAL BLOOD. |
Concepts | Disease or Syndrome (T047) |
MSH | D005311 |
SnomedCT | 276638004 |
English | In Utero Hypoxia, Fetal Hypoxia, fetal hypoxia (diagnosis), fetal hypoxia, Fetal Hypoxia [Disease/Finding], fetus hypoxia, HYPOXIA IN UTERO, Fetal hypoxia, Fetal hypoxia (disorder), Hypoxia, Fetal |
Portuguese | Hipóxia Fetal |
Swedish | Syrebrist hos foster |
Czech | fétus - hypoxie, fetální hypoxie |
Finnish | Sikiön hypoksia |
Russian | PLODA GIPOKSIIA, GIPOKSIIA PLODA, KISLORODNAIA NEDOSTATOCHNOST' PLODA, KISLORODNOE GOLODANIE PLODA, ГИПОКСИЯ ПЛОДА, КИСЛОРОДНАЯ НЕДОСТАТОЧНОСТЬ ПЛОДА, КИСЛОРОДНОЕ ГОЛОДАНИЕ ПЛОДА, ПЛОДА ГИПОКСИЯ |
Polish | Niedotlenienie płodu |
Japanese | 低酸素症-胎児, 胎児酸素欠症, 胎児酸欠症, 無酸素症-胎児, 酸素欠乏症-胎児, 胎児酸素欠乏症, 胎児無酸素症, 胎児低酸素症, 胎児酸欠乏症 |
Norwegian | Føtal hypoksi |
Spanish | hipoxia fetal (trastorno), hipoxia fetal, Hipoxia Fetal |
German | Fetale Hypoxie |
Italian | Ipossia fetale |
French | Hypoxie foetale, Hypoxie intra-utérine |