Introduction Placenta impaired or unable to provide oxygen and nutrients while removing products of metabolism and waste Caused by placenta previa or abruption placental edema from hydrops fetalis or Rh isoimmunization post-term pregnancy IUGR uterine hyperstimulation Fetus responds by shunting blood to brain, heart, adrenal glands Presentation If unrecognized, can progress to metabolic acidosis with accumulation of lactic acid and damage to vital organs Fetal heart monitoring late decelerations associated with uteroplacental insufficiency