2 - Symptoms
distress in labour
ABNORMAL FETAL HEART RATE
BOX S-7 Abnormal fetal heart rate
normal fetal heart rate may slow during a contraction but usually recovers to normal as soon as the uterus relaxes.
very slow fetal heart rate in the absence of contractions or persisting after contractions is suggestive of fetal distress.
rapid fetal heart rate may be a response to maternal fever, drugs causing rapid maternal heart rate (e.g. tocolytic drugs), hypertension or
amnionitis. In the absence of a rapid maternal heart rate, a rapid fetal heart rate should be considered a sign of fetal distress.
If a maternal cause is identified (e.g. maternal fever, drugs), initiate appropriate management.
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
- If there is
bleeding with intermittent or constant pain, suspect abruptio placentae;
- If there are
signs of infection (fever, foul-smelling vaginal discharge) give antibiotics as for amnionitis;
- If the
cord is below the presenting part or in the vagina, manage as
- If the
cervix is fully dilated and the fetal head is not more than 1/5 above the symphysis pubis or the leading bony edge of the
head is at 0 station, deliver by vacuum extraction
- If the
cervix is not fully dilated or the fetal head is more than 1/5 above the symphysis pubis or the leading bony edge of the
head is above 0 station, deliver by caesarean section.
Meconium staining of amniotic fluid is seen frequently as the fetus matures and by itself is not an indicator of fetal distress. A slight degree of meconium without fetal heart rate
abnormalities is a warning of the need for vigilance.
Thick meconium suggests passage of meconium in reduced amniotic fluid and may indicate the need for expedited delivery and meconium management of the neonatal upper
airway at birth to prevent meconium aspiration (page S-143).
breech presentation, meconium is passed in labour because of compression of the fetal abdomen during delivery. This is not a sign of distress unless it occurs in early labour.
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