Maternal and Fetal Distress

This refers to maternal exhaustion. It does not occur in good midwifery practice. It usually associated with Prolonged labour, Starvation and Prolonged dehydration.

Signs

· Increase pulse rate (90 -120) or more. Rise in temperature 37.20C or more. Increase Respiration (24 beats) or more. Signs of dehydration – furred tongue, dry skin Pres ence of acetone in breath and urine.

· Distension of the bowel with gass. Vomiting may occur. Restlessness, weakness, sweating. Patient looks ill, worried & anxious.

All these signs must not be allowed to be present in a woman before interfering.

Management:

· Inform Doctor,Adequate rest ,Sedation and avoidance of Prolonged labor.

· 20mls 50% dextrose, followed by 5-10% Dext .I.V drip to correct dehydration & ketosis. Termination of labour: Caesarean Section if in 1st stage. Episiotomy in second stage of labour.

Fetal Distress

This refers to fetal hypoxia in-utero, and it occurs the when there is interference with the supply of oxygen to the fetus. Conditions that can predispose to fetal Distress.

· Maternal conditions:- Pre-eclampsia, Eclampsia, severe hypertension, chronic nephritis, chronic pyelonephritis, Diabetes: These conditions may lead to placenta insufficiency.

· Severe Anaemia in pregnancy.

· Abnormal uterine Actions e.g. hypertonic type

· Prolonged labour.

· APH due to premature separation of placenta.

· Prolapse of the cord or presentation which compression.

· True knots in the umbilical cord.

· Prematurity

· Post maturity – degeneration of the placenta

· Congenital fetal abnormalities.

Diagnosis:

1. Increase FH (increase of 20 beats) is on early sign of mild hypoxia. A rate of over 160 beats should cause concern.

2. Slow fetal heart rate – sign of severe hypoxia.

3. Irregular heart rate

4. Passage of meconium – cephalic presentation

5. Fetal blood sampling.

Management

Prophylaxis:

1. Good screening of all pregnant women.

2. Complicated case should have Hospital bed.

3. All women with high head should be on bed.

4. Frequent observation of FH in susceptible cases. a. Inform Dr. tell the woman to lie on one side.

· Stop oxytocic drug if any.

· Give O2 to the mother.

· Immediate delivery – (C/S, Episiotomy, Forceps)

· Notify Paediatrician.

· Get resuscitation tray ready.

Complication of fetal Distress

Asphyxia, Still birth, Mental retardation and Sapstic paralysis.