FETAL ACIDOSIS acute acidosis (minutes / hours) is usually associated with intra-partum events or accidents (cord prolapse, placental

l abruption) while chronic acidosis is associated with antenatal utero-placental insufficiency and fetal growth restriction. In chronic acidosis secondary to impaired placental gas exchange, umbilical arterial and venous blood gas values will both be abnormal and similar, whereas in acute cord compression or fetal bradycardia the hypoxia and acidosis will be predominantly in the umbilical artery, leading to a large arteriovenous difference. CAUSES ACUTE Maternal ypotension / hypovolaemia ypoxia - for instance, fitting !terine hypertonus Placental "bruption

Fetal #ord prolapse $epeated cord compression during labour / true %not in the cord. &etal blood flow must be reduced by at least '() to cause hypoxia based on animal studies CHRONIC Maternal *evere respiratory or cardiac disease $educed utero-placental perfusion - vascular disease, +,-. Placental Impaired placental oxygen transfer of oxygen. Fetal "naemia . thalassaemia FM! "hesus disease Parvovirus in#ection, "rterio-venous shunting in #etal tumours *erious cardiac abnormalities / arrh$thmias ASSESSME%T OF ACIDOSIS Antenatal &etal heart rate monitoring / biophysical profile

!mbilical artery /oppler - sensitive and s&eci#ic non-invasive way of detecting chronic acidosis. -here is a signi#icant association bet'een UA Do&&ler 'ave#orms and blood gases at deliver$. -here is a characteristic pattern of redistribution of fetal blood flow as the severity of acidosis increases with cardiac dysfunction and eventually abnormal venous blood flow patterns. "ntenatal #etal blood sam&ling is invasive and is not used routinely in the assessment of fetal wellbeing

Intra-partum & $ monitoring - #-0 - high sensitivit$ but lo' s&eci#icit$ &etal blood sampling - avoids intervention on the basis of false positive #-0s Contra-indications to FBS are: maternal HIV, fetal leedin! disorders and "remat#rit$ %&'( )ee*s !estation+ Post-partum - $#10 recommends that !" acid-base status should be assessed (as a minimum) after2 ,mergency #/* Instrumental delivery &3* has been performed in labour /elivery of a baby in a poor condition CO%SE(UE%CES OF ACIDOSIS the normal human fetus is adapted to survive labour and has compensatory mechanisms that allow it to withstand even severe hypoxia and acidosis for short periods of time. "lthough the cut-off p used to define severe acidosis at birth varies between studies, the evidence is that intra)&artum acidosis is associated 'ith a slight increase in &erinatal mortalit$ and is a &oor &redictor o# neurological im&airment in the term neonate. Onl$ * + ) ,- . o# cerebral &als$ in term singleton babies is associated 'ith intra)&artum events e/clusivel$ Chronic antenatal acidosis carries a greater ris0 of long-term morbidity. "cidosis inhibits surfactant production and increases pulmonary vascular resistance. " p 4 5.6' is associated with reduced myocardial contractility and diaphragmatic activity in animal studies. ydrogen ions cause the precipitation of bilirubin acid - acidosis my exacerbate %ernicterus. ,nd-organ damage including renal failure 7 hypoxic ischemic encephalopathy. 8ild . hyper alertness, high pitched cry, irritability9 moderate - depressed consciousness : / - sei;ures9 severe - depressed consciousness with abnormal brain stem function -he incidence of neonatal death and neonatal sei;ures does not increase until a p 4 5.('. -he absolute incidence of otherwise unexplained neonatal sei;ures is < 6.6) for p 4 5.(' and =.>) for p 4 5.((. -he mortality increased to 6.6) for p 4 5.(' and ?) at a p 4 5.((. Bo ro) C, Soot,ill Ca#ses and conse.#ences of fetal acidosis "rch /is #hild &etal @eonatal ,d 6===9?(2&>AB-&>A=