Intrauterine fetal resuscitation

Oxygen transport from the atmosphere to the fetus is dependent on oxygen delivery to the maternal side of the placenta, placental transfer and fetal circulation. Oxygen transport is reduced physiologically during labour, but significant impairment, either temporary or permanent, may cause fetal distress. Intrauterine fetal resuscitation (IUFR) aims to restore oxygen delivery to baseline if the placenta is functioning normally, and also maximize oxygen delivery until the fetus can be delivered if there is placental disruption. IUFR consists of: left lateral position to relieve aortocaval compression; tocolysis with subcutaneous terbutaline, 250 μg, to reduce uterine contraction frequency and baseline tone; high-flow oxygen administration with a Hudson mask and reservoir bag to increase fetal oxygen saturation; and a rapid intravenous fluid infusion to improve uterine blood flow. IUFR measures are easy to perform, do not require extensive resources, and can result in significant improvements in fetal wellbeing. The anaesthetist has an important role to play in the application of IUFR.