[CG] Intrauterine fetal resuscitation (IFR)


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IFR consists of specific measures aimed to increase the delivery of oxygen to the placenta in order to alleviate or treat fetal hypoxia and acidosis.

IFR should be employed in those women who qualify for a Category 1 Caesarean section for fetal distress. It should not substantially delay delivery and should be instituted as arrangements continue to transfer the woman to theatre.

1)   The anaesthetist, obstetric team and the senior midwife should be alerted:

CATEGORY 1 Caesarean Section.

2)   Inform neonatology to attend.

3)   The woman should be examined to exclude hypotension, hypovolaemia and cord accident.


4)   Any syntocinon infusion should be turned off.

5)   The woman should be placed in a left lateral position.

6)   Oxygen should ONLY be administered for maternal indication e.g. hypoxia / pre oxygenation – not routinely for IFR.

7)   1 litre of IV Compound Sodium Lactate should be run through (NOT if woman has pre- eclampsia or cardiac disease).

8)   If contracting consider Terbutaline 0.25mg subcutaneously from 0.5mg/ml ampoule dose of 0.25mg = 0.5ml. Contraindications include moderate/severe cardiac disease, hypovolaemia, abruption, maternal hypotension


9)   The woman should be transferred to theatre as the IFR is proceeding.


10)   The fetal heart rate should be assessed continuously. The decision to deliver the baby or not should be made by a senior obstetrician. – decision on type of anaesthetic will be made in theatre depending on the response to IFR.

If there are no contraindications to the use of propranolol a 1mg intravenous dose can be used to reverse the effects of terbutaline on the myometrium if required.




NICE CG 190 (2014 – updated 2017) Intrapartum care for healthy women and babies

Handbook of CTG interpretation – Edwin Chandraharan (2017) Cambridge University Press

ACOG Practice Bulletin 106 (July 2009)

Cochrane database Systems review (1998) Tocolysis for suspected intrapartum fetal distress Kulier and Hofmeyr

Last reviewed: 31 March 2018

Next review: 31 March 2023

Author(s): Dr F Mackenzie, Consultant Obstetrician PRM on behalf of GGC OGG

Approved By: Obstetric Guideline Group