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Fetal Distress - Women's Health Issues

By

Julie S. Moldenhauer

, MD, Children's Hospital of Philadelphia

Full review/revision Jul 2021 | Modified Sep 2022

VIEW PROFESSIONAL VERSION

GET THE QUICK FACTS

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 Postterm Pregnancy and Postmaturity A postterm pregnancy is one that lasts 42 weeks or more. In postmaturity, the placenta can no longer maintain a healthy environment for the fetus because the pregnancy has lasted too long. On... read more ).

• 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 Fetal monitoring Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world... read more . 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.

If a significant abnormality in the heart rate is detected, it can usually be corrected by the following:

• Giving the woman oxygen

• Increasing the amount of fluids given intravenously to the woman

• Turning the woman on one side or the other

Did You Know.

Contractions that are too strong and/or too close together may cause fetal distress. If oxytocin Induction of Labor was used to stimulate contractions, it is stopped immediately. The woman may be repositioned and given analgesics. If no drug was used to stimulate contractions, the woman may be given a drug that can slow labor (such as terbutaline, given by injection) to stop or slow the contractions.

If these measures to correct the fetus's heart rate or control contractions are not effective, the baby is delivered as quickly as possible by a vacuum extractor Operative Vaginal Delivery Operative vaginal delivery is delivery using a vacuum extractor or forceps. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted... read more , forceps Operative Vaginal Delivery Operative vaginal delivery is delivery using a vacuum extractor or forceps. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted... read more , or cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery of a baby by incision through a woman’s abdomen and uterus. In the United States, up to 30% of deliveries are cesarean. Doctors use a cesarean delivery... read more .

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Copyright © 2023 Merck & Co. , Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

Test your knowledge

Fetal distress - all you need to know about fetal distress

Sometimes at the last moment of pregnancy, unpleasant things happen that can be very sad. Fetal distress is one such complication that, if not addressed, can lead to problems for both the mother and the baby.

Fetal distress

Fetal distress is subdivided into intrauterine and birth distress. Distress is usually determined by monitoring the child's heart rate. The presence of meconium (the baby's first stool) may also indicate that the fetus is unwell in the womb.

Often referred to as hypoxia or threatened asphyxia, fetal distress occurs when an infant does not receive enough oxygen in the womb or during labor.

What causes fetal distress?

The reason why your unborn baby faces the problem of lack of oxygen can be different. These could be umbilical cord problems, fetal abnormalities, the stress of childbirth, or reactions to certain medications. This can happen due to abnormal fetal development, problems with the placenta, or even multiple births.

Fetal monitoring during labor

When a pregnant woman gives birth, the baby is constantly monitored. One of the most common methods for monitoring a baby is the use of an electronic fetal monitor (EFM). In this technique, two straps are wrapped around the abdomen, one measures the baby's heart rate, and the other assesses contractions or uterine activity. Monitors are also used to determine if the baby is having problems with each contraction.

For monitoring, doctors may also use a device that is applied to the baby's scalp.

What should be the ideal fetal heart rate?

The results of the electronic fetal monitor are shown on the monitor in diagrammatic form. The doctor and nurses constantly monitor the numbers on the graphs and check if the heart rate is within adequate parameters. The ideal range should be between 110 and 160 beats per minute.

A temperature that is too high may indicate that the child is unwell or has a fever. While too low a temperature "speaks" of a lack of oxygen. Monitoring divides indications into 2 categories: accelerated heartbeat and slow heartbeat.

Rapid heartbeat

This means a short-term increase in heart rate, say 15 beats per minute, which can last 15 seconds or more. Accelerated, quite normal, it indicates an abundance of oxygen. For most babies, the heartbeat can speed up several times during the entire birth process.

If the doctor has any suspicions that the fetus is deteriorating, he may cause an increase in the fetal heart rate. Suspicion may arise from:

• Gently touching the mother's abdomen
• As a result of pressing the child's head, with a finger, through the cervix

Slow heart rate

Slow refers to temporary drops in heart rate. It can be divided into three types:

1. Early Deceleration

This is usually normal and nothing to worry about. Early deceleration occurs when the baby's head contracts. It mostly happens in the later stages of labor as the baby descends through the birth canal. Sometimes this happens during childbirth when the baby is premature or in a state of breech presentation.

2. Late Deceleration

They only happen when contractions are at their peak. Typically, late slows are smooth and shallow dips in heart rate that reflect the contraction that causes them. As long as the baby's heart rate shows an accelerated rhythm, late slowdowns are not a cause for concern. Late decelerations can also be a sign that the baby is not getting the amount of oxygen it needs.

3. Variable Deceleration

Variable decelerations are sudden dips in the fetal heart rate that can lead to serious consequences. These slowdowns mostly occur during childbirth when the umbilical cord temporarily contracts, indicating a decrease in blood flow. Such variable changes in heart rate can be unsafe.

What to expect from a medical team?

In principle, the procedure for monitoring a child's heart rate is often painless. However, there are several risks associated with difficult birth situations that result in the medical team doing the following:

• Oxygen supply to mother
• Instillation of fluid into the amniotic sac to thicken the meconium (Amnioinfusion is the infusion of Ringer's solution or normal saline into the amniotic sac using a catheter.)
• Instrumentation (forceps/vacuum)
• Caesarean section

Before giving birth, be sure to consult with your doctor, ask him all the necessary and interesting questions. Get your medical card. And go to birth!!!

And remember, vigilance is the Key to a successful birth of your baby!!!

Fetal distress

The term "fetal distress" appeared in obstetric practice relatively recently. Fetal distress syndrome is spoken about in the presence of any changes in the functional state of the fetus, including acute and chronic intrauterine fetal hypoxia, and the threat of fetal asphyxia.

Fetal distress is most often manifested as hypoxia, which is a pathological physiological process. There are no symptoms that directly indicate that the child develops hypoxia. The baby's heartbeat does not directly indicate a lack of oxygen, the heart rate can also change reflexively.

If a pregnant woman has a suspicion of fetal distress, then she undergoes ultrasound, CTG, and other studies that evaluate the biophysical profile of the fetus.

Signs of distress also include tachycardia or a slow heartbeat, a decrease in the number of movements of the child, special reactions to contractions.

Types of fetal distress

According to the time of occurrence, fetal distress is divided into those that occur:

• during pregnancy;
• during childbirth.

Symptoms of distress can develop at any stage of pregnancy. The earlier the distress syndrome occurs, the worse it is for the fetus. In terms of prognosis, distress after 30 weeks of gestation is the safest, since an emergency caesarean section is possible.

If fetal distress occurs already in early pregnancy (eg, due to retrochorial hematoma), then this may well lead to malformations in the child, developmental disorders or miscarriage.

Antenatal fetal distress in the 2nd trimester can cause intrauterine growth retardation and subsequently lead to miscarriage, pregnancy failure, or premature birth.

Fetal distress during childbirth, especially in their second stage, is a serious obstetric problem, since it leads to an emergency caesarean section. In the event that the fetus in the uterus is already too low and fixed in the exit from the small pelvis, it is too late to resort to surgery. In this case, obstetricians speed up labor with vacuum extraction, perineotomy, and other methods that reduce the second stage of labor.

According to the severity of fetal suffering, distress is divided into:

1. Distress in the stage of compensation - chronic distress, accompanied by hypoxia, developmental delay, lasts for several weeks.
2. Distress in the stage of subcompensation - the presence of hypoxia, help is needed in the coming days.
3. Distress in the stage of decompensation - the onset of intrauterine asphyxia, immediate assistance is required.

Sequelae of fetal distress

With timely intervention, the effects of distress are minimized. Otherwise, the child may die or be born in severe asphyxia, which cannot but affect his health in the future.

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