Intrauterine resuscitation: active management of fetal distress

Acute fetal distress in labour is a condition of progressive fetal asphyxia with hypoxia and acidosis. It is usually diagnosed by finding characteristic features in the fetal heart rate pattern, wherever possible supported by fetal scalp pH measurement. Intrauterine resuscitation consists of applying specific measures with the aim of increasing oxygen delivery to the placenta and umbilical blood flow, in order to reverse hypoxia and acidosis. These measures include initial left lateral recumbent positioning followed by right lateral or knee-elbow if necessary, rapid intravenous infusion of a litre of non-glucose crystalloid, maternal oxygen administration at the highest practical inspired percentage, inhibition of uterine contractions usually with subcutaneous or intravenous terbutaline 250 microg, and intra-amniotic infusion of warmed crystalloid solution. Specific manoeuvres for umbilical cord prolapse are also described. Intrauterine resuscitation may be used as part of the obstetric management of labour, while preparing for caesarean delivery for fetal distress, or at the time of establishment of regional analgesia during labour in the compromised fetus. The principles may also be applied during inter-hospital transfers of sick or labouring parturients.