Intrauterine fetal resuscitation

Abstract

Oxygen transport from the atmosphere to the fetus is dependent on maternal, placental and fetal factors. If any of these are disturbed, progressive fetal hypoxia and acidosis occur. Electronic fetal heart rate (FHR) monitoring is considered the primary method to assess fetal condition. Fetal distress refers to the presence of a non-reassurance heart trace, irrespective of the presence or absence of fetal acidosis. Intrauterine fetal resuscitation (IUFR) is a practice designed to enhance oxygen delivery to the placenta and maintain umbilical blood flow to counteract fetal hypoxia and acidosis, enabling safe delivery. IUFR measures might include: (i) re-positioning of the parturient to left lateral or alternative to relieve aortocaval compression; (ii) reducing uterine contractions by stopping oxytocics and using tocolytics (iii) correcting maternal hypotension and maximizing uterine blood flow via rapid intravenous crystalloid infusion; and (iv) maternal oxygen administration to reduce fetal hypoxaemia. IUFR measurements are simple to implement, do not need extensive resources and can lead to considerable improvements in fetal health. Anaesthetists play a pivotal role in IUFR and should be familiar with the process as they will be actively involved in the management of parturient during labour and before emergency surgical interventions.