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Nonreassuring Fetal Status

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Nonreassuring Fetal Status, Fetal Distress, Fetal Hypoxia, Birth Asphyxia

  • Causes
  1. Uterine Rupture
  2. Uterine Hyperstimulation
  3. Placental Abruption
  4. Umbilical Cord accident
  5. Uteroplacental Insufficiency
  • Definition
  • Nonreassuring Fetal Status (preferred term)
  • Evaluation
  1. Fetal status
    1. Confirm findings with alternative monitoring
      1. Consider fetal scalp electrode
    2. Response to acoustic or scalp stimulation
    3. Consider Fetal Scalp pH (pH < 7.20 is abnormal)
  2. Maternal status
    1. Maternal Vital Signs
      1. Temperature
      2. Blood Pressure
      3. Heart Rate
    2. Vaginal examination
      1. Vaginal Bleeding (e.g. Placental Abruption)
      2. Cervical examination
        1. Cervical dilation
        2. Rapid head descent
        3. Umbilical Cord Prolapse
  1. NICHD Category 1: Normal
    1. Reassuring Fetal Heart Tracing
    2. Fetal Heart Rate 110-160 bpm with moderate variability and no variable or Late Decelerations
    3. Continue current management
  2. NICHD Categry 2: Indeterminate
    1. Non-reassuring Fetal Heart Tracing (lacking category 1 criteria without category 3 criteria)
    2. See interventions below
  3. NICHD Category 3: Abnormal
    1. Ominous Fetal Heart Tracing
    2. Recurrent variable or Late Decelerations, Fetal Bradycardia or sinusoidal pattern with loss of FHT Variability
    3. See interventions below
    4. Expedite delivery
  4. References
    1. (2009) Obstet Gynecol 114(1):192-202 +PMID:19546798 [PubMed]
  1. Maternal position change
  2. Oxygen 8-10 liters per minute by Non-Rebreather Mask
  3. Intravenous Fluid Resuscitation
  4. Suppress labor
    1. Discontinue Oxytocin
    2. Consider holding pushing
    3. Consider Terbutaline SQ 0.25 mg
  5. Consider Amnioinfusion
  6. Consider expedited delivery
    1. Vacuum Assisted Delivery
    2. Forceps Assisted Delivery
    3. Cesarean Section
  7. Consider Consultation
    1. Obstetrics
    2. Neonatology or Pediatrics