Fetal distress nursing interventions
Fetal Distress - American Pregnancy Association
Historically, the term fetal distress has been used to describe when the fetus does not receive adequate amounts of oxygen during pregnancy or labor. It is oftentimes detected through an abnormal fetal heart rate. However, while the term fetal distress is commonly used, it is not well defined. This makes it more difficult to make an accurate diagnosis and provide proper treatment. Because of the term’s ambiguity, its use has the potential to lead to improper treatment.
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.
As many have incorrectly used fetal distress and birth asphyxia as interchangeable terms, the Committee on Obstetric Practice of the American Congress of Obstetricians and Gynecologists (ACOG) has expressed concern regarding the use of the two terms. ACOG recommends that the term fetal distress be replaced with “non-reassuring fetal status.”
Along with this new term, ACOG further recommends physicians add to the diagnosis a list of additional findings such as fetal tachycardia, bradycardia, repetitive variable decelerations, low biophysical profile, and late decelerations. ACOG’s Committee on Obstetric Practice has also stated that the term birth asphyxia should no longer be used as it is too vague of diagnosis for medical use.
Fetal Distress Diagnosis
It is important for physicians to monitor the fetus throughout pregnancy to detect any potential complications. One of the more widely used methods of monitoring is electronic fetal heart rate (FHR) monitoring.
Benefits of FHR monitoring include:
- The ability to recognize the development of hypoxia (when the fetus does not receive adequate amounts of oxygen) by analyzing patterns in the fetal heart rate
- The ability to monitor the mother’s contractions
- The ability to monitor the response of the fetus to hypoxia
- A more positive outcome for high-risk deliveries
Nonetheless, FHR monitoring does come with risks as well, including an increased likelihood of having a cesarean section due to misinterpretation of FHR monitoring results.
Conditions Behind Fetal Distress
Potential precursors to fetal distress or non-reassuring fetal status may include:
- Anemia (the most prevalent obstetric condition seen behind non-reassuring fetal status)
- Oligohydraminos (a condition in which there is a lower level of amniotic fluid around the fetus)
- Pregnancy Induced Hypertension (PIH)
- Post-term pregnancies (42 weeks or more)
- Intrauterine Growth Retardation (IUGR)
- Meconium-stained amniotic fluid (a condition in which meconium, a baby’s first stool, is present in the amniotic fluid which can block fetal airways)
Treatment
The primary treatment used for non-reassuring fetal status is intrauterine resuscitation. This will help prevent any unnecessary procedures.
Some means of intrauterine resuscitation include:
- Changing the mother’s position
- Ensuring the mother is well-hydrated
- Ensuring the mother has adequate oxygen
- Amnioinfusion (the insertion of fluid into the amniotic cavity to alleviate compression of the umbilical cord)
- Tocolysis (a therapy used to delay preterm labor by temporarily stopping contractions)
- Intravenous hypertonic dextrose
Nonetheless, there are cases in which an emergency cesarean section is necessary.
However, due to the over-diagnosis of fetal distress and potential misinterpretation of the fetal heart rate, it is recommended to confirm a potential fetal distress diagnosis with a fetal blood acid-base study. Overall, this condition points to the importance of prenatal care and proper monitoring of the mother and fetus throughout pregnancy.
Want to Know More?
- Most Common Pregnancy Complications
- What is a High-Risk Pregnancy?
Compiled from the following References:
ACOG Committee on Obstetric Practice. (2005). Inappropriate use of the terms of fetal distress and birth asphyxia. Committee Opinion, 326.
Beckmann, C. R. B., Ling, F. W., Barzansky, B. M., Herbert, W. N. P., Laube, D. W., & Smith, R. P. (2010). Obstetrics and gynecology (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Bucklin, B. A., Gambling, D. R., & Wlody, D. J. (2009). A practical approach to obstetric anesthesia.
Gravlee, G. P. (Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Kaur, J., & Kaur, K. (2012). Conditions behind fetal distress. Annals of Biological Research, 3(10). Retrieved from https://scholarsresearchlibrary.com/ABR-vol3-iss10/ABR-2012-3-10-4845-4851.pdf
Mayo Clinic. (2012). Biophysical profile: Why it’s done.
Merck Manuals. (n.d.) Fetal distress.
The American Congress of Obstetricians and Gynecologists (ACOG). (2013, October 22). Ob-gyns redefine the meaning of “term pregnancy.”
University of California San Francisco Benioff Children’s Hospital. (n.d.). Birth asphyxia. Retrieved from https://www.ucsfbenioffchildrens.org/conditions/birth_asphyxia/
The Role of Fetal Heart Monitoring in Identifying the Need for a C-Section
The clinical practice of auscultating fetal heart tones began in 1818 when a Swiss surgeon reported hearing the fetal heart rate by placing his ear against a pregnant woman’s abdomen.
In 1888, an American physician, Dr. Killian, suggested that Fetal Heart Rate information could be used to identify the need for intervention for fetal distress. FHR was first introduced to the public by Yale in 1958 but did not become widely used in obstetric care until the 1970’s. Since then, it has become an accepted standard in the management of ob gyn patients who are in labor and close to delivery.
There are external and internal fetal monitors. External monitors (also known as ultrasound transducers) are usually composed of a belt with a doppler ultrasound that is strapped to the pregnant woman’s belly. Internal monitors consist of an electrode attached to the fetal scalp. The fetal membranes must be ruptured to apply an internal monitor. External monitoring is subject to loss of signal related to maternal positioning, fetal positioning, maternal body fat.
A normal fetal heart rate range is 115-150 beats per minute (much faster than a normal adult heart rate). A slow heart rate, or bradycardia, may indicate the baby is not getting enough oxygen delivery to the brain.
A fast heart rate, or tachycardia, may indicate oxygen deprivation. There is an acceptable range of acceleration and deceleration – or speeding up and slowing down – of fetal heart rates during contractions and labor. “Variable deceleration” or “late deceleration”, however, may be signs that the baby is not doing well. Variable decelerations are irregular dips in the fetal heart rate that may indicate cord compression, a potentially dangerous condition for the baby. Late decelerations begin with a uterine contraction and continue for too long after the contraction has resolved. This may be a sign that the baby is distressed.
Obstetricians and nurses must carefully review fetal monitor strips throughout labor and delivery to ensure fetal heart tones are reassuring and the baby is getting enough oxygen. If non-reassuring conditions occur, appropriate and timely actions must be taken. Generally, nursing interventions are attempted first to restore normal oxygenation to the baby. These include the administration of supplemental oxygen, changes in maternal position, increasing intravenous fluids, and the administration of medications that subdue contractions and maximize placental blood flow.
If fetal heart tones remain non-reassuring despite nursing interventions, the fetus should be delivered by emergency cesarean section. Emergency cesarean section should be performed within 5 to 30 minutes depending on the circumstances.
It is hard to help a distressed baby in the uterus: a C-section is the best and fastest way to handle a baby in distress. Resuscitation, oxygen, fluids, and other lifesaving interventions may be quickly administered once the baby is born.
What to look for in the medical records:
- Fetal heart monitoring strips
- Maternal vital signs
- Maternal Oxygen saturation
- Maternal blood sugar
- Types of medications used during labor such as Pitocin
- Dose and rate of infusion of Pitocin. Sometimes the rate of infusion is stopped, slowed down or increased according to the pattern of contractions.
- Pharmacy records showing amounts of Pitocin charged to the patient chart
- Volume and rate of intravenous fluids administered to the mother
- Documentation on maternal anxiety which could create abnormal breathing patterns that would impact the fetus
- Anesthesia records regarding epidural administration and any effects on the mother
http://www.
aafp.org/afp/1999/0501/p2487.html
https://www.abclawcenters.com/practice-areas/prenatal-birth-injuries/labor-and-delivery-complications-and-errors/improper-fetal-monitoring/
http://perifacts.eu/cases/Case_680_Fetal_Heart_Rate_Interpretation.php
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Research work Students and staff of the Ryazan Medical College have long and fruitfully engaged in research.
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The winners of the contest for the best organization of military registration have been announced The award ceremony took place in the Ryazan City Duma. Commemorative gifts for many... -->
Creation and implementation of a set of measures for long-term care in the Ryazan region As part of the pilot project "Creation and implementation of a set of measures for long-term care.
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Round table "Issues of tuberculosis prevention" The Center for Continuing Professional Education hosted a round table "Issues of prevention... -->
Joint educational and research conference of the Ryazan Medical College and the Ryazan Regional Clinical Psychiatric Hospital. N.N. Bazhenova With a welcoming speech, the lecturer of the highest qualification ... -->
Lecturer of the Ryazan Medical College, psychiatrist-narcologist Igor Sviridov took part in the All-Russian scientific and practical conference "Community-oriented psychiatry: current problems and ways to solve them" At the Federal State Budgetary Scientific Institution "Scientific Center for Mental Health" ... -->
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Project "iLearning" In the nomination "Technological transformation of education" of the Regional Festival-competition of educational organizations of the Ryazan region "Innovation. Education. Mastery” Diploma of the 1st degree at... -->
A demonstration exam according to WorldSkills standards was held at the Ryazan Medical College On June 5 and 6, the Ryazan Medical College successfully passed a demonstration exam according to the WorldSkills standards - an independent assessment of the quality of personnel training with international requirements for competenc.
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Competition of professional skills "The best in the profession" In accordance with the work plan of the Board of Directors of medical and pharmaceutical professional educational organizations of the Central Federal District ... -->
Open Day at GBU RO On April 10, 2019, Ryazan Medical College took part in the Open Doors Day, which was held at the Regional Clinical Hospital. The participants of the meeting were... -->
IV Interregional competition of professional skills "My future profession is a nurse" On December 14, 2018, the Bryansk Basic Medical College reopened its doors to participants of the IV Interregional Competition of Professional Excellence "My future profession is a nurse... -->
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