II. Causes

  1. Uterine Rupture
  2. Uterine Hyperstimulation
  3. Placental Abruption
  4. Umbilical Cord accident
  5. Uteroplacental Insufficiency

III. Definition: Nonreassuring Fetal Status (preferred term)

IV. 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

V. Management: Based on Fetal Monitoring

  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]

VI. Management: Interventions for Non-reassuring Fetal Heart Tracing

  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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Fetal Hypoxia (C0349489)

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