Fetal Distress

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Retrieved
2021-01-18
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Fetal distress refers to the presence of signs in a pregnant woman—before or during childbirth—that suggest that the fetus may not be well. Because of its lack of precision, the term is eschewed in modern American obstetrics.

Signs and symptoms

Generally it is preferable to describe specific signs in lieu of declaring fetal distress that include:

  • Decreased movement felt by the mother
  • Meconium in the amniotic fluid ("meconium stained fluid")
  • Non-reassuring patterns seen on cardiotocography:
    • increased or decreased fetal heart rate (tachycardia and bradycardia), especially during and after a contraction
    • decreased variability in the fetal heart rate
    • late decelerations
  • Biochemical signs, assessed by collecting a small sample of baby's blood from a scalp prick through the open cervix in labor
    • fetal metabolic acidosis
    • elevated fetal blood lactate levels (from fetal scalp blood testing) indicating the baby has a lactic acidosis

Some of these signs are more reliable predictors of fetal compromise than others. For example, cardiotocography can give high false positive rates, even when interpreted by highly experienced medical personnel. Metabolic acidosis is a more reliable predictor, but is not always available.

Causes

There are many causes of "fetal distress" including:

  • Breathing problems
  • Abnormal position and presentation of the fetus
  • Multiple births
  • Shoulder dystocia
  • Umbilical cord prolapse
  • Nuchal cord
  • Placental abruption
  • Premature closure of the fetal ductus arteriosus
  • Uterine rupture
  • Intrahepatic cholestasis of pregnancy, a liver disorder during pregnancy

Treatment

Instead of referring to "fetal distress", current recommendations hold to look for more specific signs and symptoms, assess them, and take the appropriate steps to remedy the situation through the implementation of intrauterine resuscitation. Traditionally the diagnosis of "fetal distress" led the obstetrician to recommend rapid delivery by instrumental delivery or by caesarean section if vaginal delivery is not advised.