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Fetal Compromise ....



Excluding premature infants, up to 23% of cases of cerebral palsy are related to intrapartum asphyxia .

The consequences of unrecognized or poorly managed emergencies can be devastating.

 A well-coordinated team that consists of an anesthesiologist, obstetrician, neonatologist/pediatrician, and nurses is one of the most important elements in the care of a compromised fetus.

There must be uniform agreement on the terms used to describe the fetus at risk.

The American College of Obstetrician and Gynecologists (ACOG) has suggested that the term “fetal distress” be replaced with the term “nonreassuring fetal status,” which describes the clinician's interpretation Clinicians rely on indirect parameters such as fetal heart rate, fetal acid-base status, and, more recently, fetal pulse oximetry.

All of these parameters are subject to interpretation. Nonreassuring status describes compromised fetal gas exchange (asphyxia) and, at the extreme, there can be a complete cessation of fetal gas exchange (ie, fetal anoxia). Complete cord occlusion, sustained bradycardia, uterine rupture, and ongoing tetanic uterine contractions are examples of complete cessation of gas exchange (anoxia).

 Fetal anoxia can be lethal in less than 10 minutes . All hospitals need a well-planned emergency protocol to distinguish the different kinds of “unplanned” or “emergency” cesarean sections to help delineate an optimal time frame for delivery.
  1. Truwit CL, Barkowich AJ, Koch TK, et al.  Cerebral palsy: MR findings in 40 patients. AJNR Am J Neuroradiol. 1992;13:67–78
  2. American College of Obstetricians and Gynecologists . Inappropriate use of the terms fetal distress and birth asphyxia. ACOG Committee Opinion. Washington, DC: American College of Obstetricians and Gynecologists; 1998
  3. Frölich MA. Anesthesia for presumed fetal jeopardy. In:  Birnbach DJ,  Gatt SP,  Datta S editor. Textbook of obstetric anesthesia. New York: Churchill-Livingstone; 2000;p. 267–280
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