FETAL DISTRESS

Definition:

Compromise of a fetus during the antepartum period (before labor) or intrapartum period
(during the birth process).Fetal distress refers to signs before and during childbirth indicating that the
fetus is not well.

Fetal distress is an uncommon complication of labor. It typically occurs when the fetus has not
been receiving enough oxygen.

Fetal distress may occur when:

 The pregnancy lasts too long (postmaturity).

 Other complications of pregnancy or labor (such as difficult or rapid labor) occur.

Usually, doctors identify fetal distress based on an abnormal heart rate pattern in the fetus.
Throughout labor, the fetus’s heart rate is monitored. It is usually monitored continuously with
electronic fetal heart monitoring. Or a handheld Doppler ultrasound device may be used to check the
heart rate every 15 minutes during early labor and after each contraction during late labor.

Fetal distress is commonly confused with the term birth asphyxia. Birth asphyxia occurs when the
baby does not have adequate amounts of oxygen before, during, or after labor. This may have multiple
causes, some of which include low oxygen levels in the mother’s blood or reduced blood flow due to
compression of the umbilical cord.

Incident

The health care provider will make an incision in the abdomen wall first. In an emergency
cesarean, this will most likely be a vertical incision (from the navel to the pubic area) which will allow the
health care provider to deliver the baby faster.

In the 1340 subjects recruited, 193 pregnancies (14.4 percent) were complicated with
oligohydramnios. There was an increased incidence of fetal distress in the oligohydramnios group (OR
40.24 Cl 20.66-78.36), but there was no statistically significant difference in the risk for preterm labor
(OR 0.63 Cl 038-1.06), low apgar scores (OR 1.21 CI 0.46-3.2) and intrauterine growth restriction
compared with controls. Meconium staining and congenital anomalies have also been associated with
oligohydramnios.

Risk Factors:

The distress may be caused by a number of factors, including:

 Maternal illness
 Placental abruption
 Umbilical cord compression
 Fetal infection
  Meconium staining
 Depriving the baby of oxygen-Because the mother is in a position that puts pressure on major
blood vessels.

Several conditions that may put your baby at increased risk for fetal distress, including:
 Intrauterine growth restriction
 Hydramnios or oligohydramnios
 Preeclampsia or eclampsia
 Gestational diabetes
 Multiple pregnancy

Manifestation:

1. Signs of fetal distress: decreased fetal movement in the womb

Fetal movement within the mother’s womb is one of the most exciting parts of pregnancy. Beyond
bringing joy to the family, movement within the womb is an important indicator of the baby’s health.
Some regular pauses in movement are normal because babies sleep in the womb. However, if the baby
becomes less active or completely ceases to move, this may be a cause for concern. Physicians should
ask expectant mothers about fetal movement and conduct additional testing if patterns are abnormal.

2. Signs of fetal distress: abnormal fetal heart rate

Some fetal heart rate patterns indicate distress. To observe an unborn baby’s heart rate, medical
professionals can use either an external or internal fetal monitoring device. External monitoring is done
through a belt-like device that can be strapped around a mother’s abdomen, while internal monitoring
involves attaching an electrode to the baby’s scalp. In a healthy labor and delivery, the baby’s heart rate
will drop slightly during a contraction, and then quickly return to normal once the contraction is over.

Therefore, some variability in heart rate is to be expected: this shows as a jagged line on the monitor.
The following fetal heart rate patterns are examples of nonreassuring patterns and warrant further
investigation and medical intervention:

 An abnormally fast heart rate (tachycardia)

 An abnormally slow heart rate (bradycardia)
 Abrupt decreases in heart rate (variable decelerations)
 Late returns to the baseline heart rate after a contraction (late decelerations)

In addition to fetal monitoring, an abnormal fetal heart rate may be recognized in a non-stress test (NST)
or a contraction stress test (CST).
3. Signs of fetal distress: abnormal amniotic fluid level

The amount of amniotic fluid can be determined using a variety of ultrasound methods, including a
qualitative assessment, the single deepest pocket (SDP), and the amniotic fluid index (AFI). The
qualitative assessment is fairly subjective. The ultrasonographer scans the uterus and reports whether
the amniotic fluid volume appears to be low, normal, or high, based on their own experience. THE SDP,
sometimes called the maximum vertical pocket (MVP), is the vertical measurement (in centimeters) of
the largest pocket of amniotic fluid that doesn’t contain parts of the fetal body or umbilical cord. The AFI
is calculated by measuring the depth of the amniotic fluid in four sections of the womb and adding the
numbers together.

If there is abnormally low amniotic fluid, this is a condition called oligohydramnios, which can lead to
oxygen deprivation and birth injuries like HIE and cerebral palsy (CP). A trending decrease in amniotic
fluid may also warn of oligohydramnios, and should be watched closely. If there is an abnormally high
amniotic fluid volume, this is known as polyhydramnios. Polyhydramnios can also cause oxygen
deprivation and subsequent birth injuries.

4. Signs of fetal distress: abnormal results of biophysical profile (BPP)

A baby’s biophysical profile (BPP) is also often taken if the results of an NST are nonreassuring. In
addition to taking into account NST results, the BPP includes an ultrasound to assess fetal movement,
breathing, tone, and amniotic fluid volume. The nonstress test and each of the four ultrasound
parameters are assigned a score of either zero or two points (there is no one point). A total score of
eight or higher is considered normal, unless the zero score relates to low amniotic fluid. A score of four
or lower indicates fetal distress and requires immediate action.

5. Signs of fetal distress: vaginal bleeding

Small amounts of vaginal bleeding are fairly common during pregnancy. However, bleeding can be an
indication that something is wrong with the pregnancy. One particularly dangerous example is placental
abruption, which occurs when the placenta tears away from the womb. This causes the baby to be
deprived of oxygen. Depending on the location and size of the abruption, it may not initially cause fetal
distress, but the health of both mother and baby could still be in jeopardy.

Likewise, it is important to note that a placental abruption can be present with no vaginal bleeding
(bleeding can be retained behind the placenta), but may still pose a serious risk.

A placental abruption and other placental problems that cause bleeding require very close monitoring,
and in many cases, the mother should be admitted to the hospital and given an emergency C-section.

6. Signs of fetal distress: cramping

Some cramping is relatively normal during pregnancy. This is because as the baby grows, the uterus
needs to expand. However, in some cases cramping is an indication of something more serious, such as
miscarriage, placental abruption, preeclampsia, a urinary tract infection, or preterm labor. It is crucial
that physicians appreciate cramping and perform proper tests to ensure the health of the mother and
baby.

7. Signs of fetal distress: insufficient or excessive maternal weight gain

Experts believe that for women with a healthy pre-pregnancy weight, a weight gain of anywhere
between 25 and 35 pounds is normal during pregnancy (the ranges are different for women who were
under or overweight before becoming pregnant, as well as for those who are carrying twins or multiples.

If a mother gains much less than what is typical, the fetus may be in distress and have a condition called
intrauterine growth restriction (IUGR), which means they are smaller than is developmentally
appropriate (among other problems). IUGR requires careful physician monitoring and testing, and often
early delivery prior to labor (10). A mother should have regular prenatal visits, and her physician should
know that abnormal weight changes may necessitate additional fetal monitoring.

Excessive maternal weight gain is associated with giving birth to a baby that is abnormally large, which is
a condition known as macrosomia. Macrosomia can be very dangerous for a baby. Macrosomia can
create a risky birth situation, such as cephalopelvic disproportion (CPD), wherein the mother’s pelvis is
too small to accommodate the size of the baby’s head, or shoulder dystocia, which is when the baby’s
shoulder gets stuck on the mother’s pelvic bone during delivery. Often, the best way to deliver a
macrosomic baby is by C-section.

Management:

 Surgical Management:
1. There are cases in which an emergency cesarean section is necessary. Cesarean birth
happens through an incision in the abdominal wall and uterus rather than through the
vagina. The health care provider will make an incision in the abdomen wall first. In an
emergency cesarean, this will most likely be a vertical incision (from the navel to the pubic
area) which will allow the health care provider to deliver the baby faster.
 Nursing Management:
1. Turn the mother onto her side to correct any supine hypotension (a low blood pressure
which some pregnant women can develop in late pregnancy when they lie flat on their
back).
2. Ensuring the mother is well-hydrated
3. Ensuring the mother has adequate oxygen
4. Amnioinfusion (the insertion of fluid into the amniotic cavity to alleviate compression of the
umbilical cord)
5. Tocolysis (a therapy used to delay preterm labor by temporarily stopping contractions)
6. Intravenous hypertonic dextrose
Reference:

Moldenhauer, J. (Jan 2020). Fetal Distress. Merck & Co., Inc., Kenilworth, NJ, USA. Retrieved from
https://www.msdmanuals.com/home/women-s-health-issues/complications-of-labor-and-
delivery/fetal-distress

Brown, W. (n.d). Fetal Intolerance to Labor. BirthInjurySafety.org, N.Y, USA. Retrieved from
https://www.birthinjurysafety.org/birth-injuries/causes-of-birth-injuries/labor-intolerance.html

Payne, J. (28 Sep 2016). Fetal Distress. Retrieved from https://patient.info/doctor/fetal-distress