Fetal Gas Exchange & pH Regulation in relation to

Metabolic & Respiratory Acidosis

 Outline
Objectives
Terminologies
Introduction to fetal gas exchange & pH regulation
Respiratory Acidosis & Metabolic Acidosis (fetal
acidosis)
• Fetal Acidosis (RA & MA) – Causes
Management and treatment
Complications of Acidosis
Conclusion
References
Objectives
To understand:
•Key terms
•Fetal gas exchange and pH regulation
•Respiratory & metabolic acidosis
•Factors that contributes to RA and MA
•Management or treatment
•Complications/outcomes of Fetal Acidosis
 Key terms
• Gas exchange- delivery of O2 from the lungs to the
bloodstream and the elimination of CO2 from the
Bloodstream to the lungs.
• Hypoxia- inadequate O2 in the body tissues
• Fetus hypoxia- Inadequate O2 in the fetal body
• Buffer(s)- Neutralizer(s)
• Anaerobic metabolism- metabolism of glucose without
oxygen
• Lactic acid-by product of anaerobic metabolism
• Acidosis- increase amount of acid in the body fluids (high
[H+]).
King, Brucker, Kriebs, Fehey, Gregor & Varney, 2015.
 Fetal Gas exchange
The human fetus exchanges gases with the mother’s bloodstream
• A human fetus- Exchanges gases with maternal blood in the placenta
Placenta, containing
maternal blood vessels
and fetal capillaries
Umbilical cord,
containing fetal
blood vessels
Amniotic
fluid

Uterus
Fetal Gas Exchange
Placenta
• supply oxygen and
nutrients via the
umbilical vein
• Removes waste from the
fetus via umbilical
arteries
 Fetal pH regulation

•pH- the [+] of H+ in the blood (fetal)

 regulated by buffer system (buffers) –
neutralize the acidity or basicity of the
blood
 common buffers : bicarbonate and
hemoglobin
 characterizes by H+ receptors- receive
access H+
 Fetal Acidosis: Metabolic & Respiratory

High level of acids in the fetal blood

content
 pH Falls below 7.35 on the pH scale
 Decreased O2 capacity in the fetal blood
 increased CO2 in fetal blood content
(more than needed)
Causes of Fetal acidosis – (Respiratory/ Metabolic
factors)
•The initial cause of fetal acidosis is usually
respiratory, but without improvement in oxygenation,
the fetus will resort to anaerobic metabolism in order
to maintain basic bodily functions.
•Anaerobic metabolism yields less energy than aerobic
metabolism, and also results in the production of lactic
acid.
•Metabolic acidosis occurs when there is a buildup of
lactic acid.
Acute fetal Acidosis (Lasting for hours)
• Maternal factors include:
 Complications that lead to low blood pressure (such as improper epidural use) or
low blood volume (such as hemorrhage).
excessively strong or frequent uterine contractions can also lead to hypoxia and
acidosis. Sometimes, this is caused by misuse of the labor-enhancing
drugs (Pitocin & Cytotec).
• Placental: Placental issues that disrupt utero-placental circulation
 Placental abruption or uterine rupture, can have fast and profound impacts on
the baby.
• Fetal: Various umbilical cord complications,
True knot or cord prolapse, (Cord prolapse is sometimes caused by early
amniotomy).
Chronic fetal acidosis
1. Maternal: Respiratory or cardiac disease in the mother
• Reduced blood flow to the placenta
• 2. Placental:
compressed umbilical cord
 wrapped umbilical cord around fetus neck
Reduced placental transfer of oxygen in pregnancies with
intrauterine growth restriction (IUGR) can lead to fetal
hypoxia and acidosis.
3. Fetal:
• feto-maternal hemorrhage
• Infections
• serious heart abnormalities.
Causes of fetal acidosis- Placental

Vasoconstriction
of the umbilical
cord arteries
occurs at birth
in response to
increasing
PaO2. This
prevents blood
flow from the
baby to the
placenta
2
Fetal response to hypoxia
• During the time of decreased placental flow, the fetus has
mechanisms to maintain normal aerobic metabolism.
Blood flow is redistributed to supply the vital organs at the
expense of flow to the gut, kidneys and limbs.
• Insufficient mechanisms result in metabolic needs
unmet. Thus, the fetus will change to use anaerobic
metabolism producing energy in the form of ATP:
results in production of lactic acid.
• lactic acid is slow to diffuse across the placenta and can
accumulate to cause metabolic acidosis in the fetus.
Factors contributing to Fetal Hypoxia
1. Hyperactivity of the uterus
• When contractions are excessively strong, too long or
if there is poor resting tone between contractions, the
flow of O2-riched blood to the baby can be
substantially decreased leading to fetal hypoxia.
2. Valsalva pushing during 2rd stage of labor:
3. Maternal supine position- decreases blood flow
back to the lungs (inferior vena cava).
Clinical manifestation of fetal acidosis.
•Stressful and painful labour
•Compromised O2 supply
•Fetal distress
•Little or no fetal movement
•Respiratory distress
Diagnosis
Risk for fetal injury related to poor
maternal-fetal oxygenation and high
acidity in fetal blood content.
Nursing intervention
 Oxygen therapy to increase maternal O2
saturation- increase fetal O2 content in the
blood.
 Nursing Management
• Encourage women to slow her respiration rate and
prompting deep breathing between contractions can
help reduce alkalosis
• Monitoring of fetal wellbeing is essential.
Fetal heart-rate monitoring provides a measure of fetal
well-being during labor
Monitoring can be via intermittent auscultation or
continuous electronic monitoring.

Blackburn, 2013 as cited in Pairman, Pincombe, Thorogood & Tracy, 2015.

Treatment/management of fetal acidosis
•Fetus experiencing Hypoxia and acidosis
need to be delivered via emergency C-
Section
•While preparing for surgery,
 administer Oxygen- 8-10 L
 change position- side lying (left
lateral) position
 increase intravenous fluid
 Complications
Normal fetus have coping mechanisms to withstand acidosis for
short periods of time. However, if acidosis is very sever or
chronic, and not managed immediately or well, it can cause death
or lead to lifelong disabilities.
These includes:
1. Hypoxic-ischemic encephalopathy (deprivation of O2 in the
brain but not total).
2. Prolong- labour
3. Cerebral palsy (CP)
4. Intracranial hemorrhages (brain bleeds)
5. Seizures disorder
6. Developmental delays
 Conclusion
• Fetus gas exchange occurs in the maternal placenta, and it regulates its
blood pH through buffer system.
• Maternal-fetal problematic occurs are due to alteration of the normal
mechanism of gas exchange and pH regulatory processes
• Fetal acidosis is caused by fall in the blood pH making it too acidic for
metabolic and respiratory functioning
• Early detection is essential as it aids in early treatment and management
for the purpose of saving both maternal and fetus lives.
• Prevention of chronic fetal acidosis, depends on detection of placental
dysfunction antenatally by clinical fetal growth assessment, ultrasound
scanning and Doppler ultrasonography.
• In fetus, detection of poor oxygenation and such, an emergency
Caesarean section is performed to avoid acute on chronic acidosis.
Self-Learning activity
Define and understand the following
 Fetal gas exchange
 pH regulation
 fetal acidosis: respiratory & Metabolic Acidosis
 Causes of Fetal acidosis
 Fetal hypoxia
 Treatment and management
 Complications of fetal acidosis
References
• Aghoja, L.O. (2014). Maternal and fetal acid-base Chemistry. A major determinant of
perinatal outcome. Annals of Medical and Health Sciences research, 4(1), pp. 1-15.
• Carter, M.A. (2015). Placental Gas Exchange and the oxygen supply to the Fetus. American
Physiological Society, 5(3).
• Daves, L. & McDonald, S. (2008). Examination of the Newborn and Neonatal health. A
multidimensional approach. (1st ed.). Churchill Livingstone: Elsevier.
• Huether, S.E. (2012). Fluids and Electrolytes. Acids and Base. In Huether, S.E. & McCance,
K.L. (Eds), Understanding Pathophysiology (5th ed.). (pp98-100). St. Louis, MO: Elsevier.
• Leifer, G. (2015). Introduction to Maternity and Pediatric Nursing. (7th ed.). Saunders;
Elsevier.
• Lockwood, J.C. & Barss, A.V. (Eds). (2011). Fetal acid-base physiology. Retrieved on 26 March
2018 from https://www.acid-base.physiology.gov.
• King, L.T., Brucker, C.M,. Kriebs, M.J., Fahey, O.J., Gregor, L.C. & Varney, H. (2015). Varney’s
Midwifery. (5th ed.). Bartlett Learning; USA.
• Pairman, S., Pincombe, J., Thorogood, C., Tracy, S. (2015). Midwifery Preparation for
Practice. (3rd ed.).Churchill Living stone: Elsevier. 2015.