Fetal distress refers to a condition where the baby receives insufficient oxygen in the womb. It should not be confused with “birth asphyxia,” where the baby does not receive enough oxygen during labor or delivery. Fetal heart rate abnormalities are often responsible for fetal distress. It is categorized as an antepartum or intrapartum diagnosis, whereas birth asphyxia is a neonatal diagnosis.
As the term “fetal distress” is nonspecific and imprecise, in 1998, the American College of Obstetricians and Gynecologists (ACOG) committee recommended it be replaced with “nonreassuring fetal heart rate tracing” (1).
Read this post to know more about fetal distress, what causes it, and how it can be treated or managed.
What Is Fetal Distress?
Fetal distress refers to the condition caused due to certain abnormal events during the pregnancy and child birth, leaving the baby with limited oxygen. This fetal hypoxia can lead to abnormal fetal heart pattern and sometimes even fetal death.
This usually happens when the fetal oxygen supply gets compromised in utero, especially during labor, and sometimes earlier even without the onset of labor (2). Find out why or what causes this condition.
What Causes Fetal Distress?
Fetal distress usually occurs if your pregnancy lasts for an extended period (postmaturity), or due to other complications related to pregnancy or labor. The possible causes are listed below (3):
- Hypertensive disorder or preeclampsia could alter the placental function by hindering the oxygen and nutrition supply to the fetus (4).
- Too little amniotic fluid might raise the risk of umbilical cord compression. This, in turn, could hinder the blood flow, ultimately the oxygen and nutrients to the fetus (5).
- Maternal anemia, or maternal hypotension (fluid loss due to diarrhea or vomiting can cause stress to the fetus) (6).
- Umbilical cord compression or prolapsed umbilical cord could be a reason for fetal hypoxia leading to fetal distress.
- Premature separation of the placenta from the uterine wall (abruption).
- Any chronic illness including diabetes, hypertension, heart disease, collagen vascular disease, renal disease. These causes are internal, which means you should be observant of the changes that you experience externally to know if it is indeed fetal distress.
Signs And Symptoms Of Fetal Distress
Babies who are having a stable heart rate respond to stimuli with proper movements. It is advisable for pregnant women to keep a daily count of fetal kicks, especially after the three major meals (breakfast, lunch, dinner). Total count of more than 10 kicks a day is normal. Decreased fetal movement might warrants further evaluation by a doctor (7).
The fetus may show signs of distress at any time during the first stage or second stage of labor. This is monitored by your doctor using a handheld Doppler or an electronic fetal monitor. Signs of fetal distress could be:
- Reduced fetal movements
- Heart rate below 110bpm for ten minutes or more (fetal bradycardia), while the normal fetal heart rate ranges between 110 and 160 beats per minute (8)
- Variable decelerations (sudden dips in fetal heart rate) and late decelerations (transient decrease in heart rate after a peak in uterine contraction) on cardiotocograph (10)
Fetal Distress Treatment And Management
The medical team monitors fetal well-being during prenatal visits. If they recognize the signs of fetal distress, appropriate medical intervention is administered. Management depends on the gestational age of the baby, cause of fetal distress and maternal condition.
The primary aim of the treatment is to improve oxygen supply to the baby. Usually, intrauterine resuscitation is used for the purpose (11). Other ways of managing or treating fetal distress are mentioned next.
- Oxygen supplementation through a mask in an attempt to ensure good oxygen supply to the baby
- Intravenous fluid administration for increasing hydration levels
- Changing the mother’s position during labor or while preparing her for labor, preferably to her left side, to remove the pressure on the blood vessels that carry blood to the uterus (12)
- Tocolysis if the fetal distress is due to hyperstimulation of the uterus or excessive uterine contractions
If the above interventions do not improve the condition, further management is suggested depending on the stage of labor (13).
- During the first stage of labor: If the fetal heart does not settle even after the maternal resuscitation measures, the doctor does an abdominal examination to asses the tone and uterine contraction and vaginal examination to assess the cervical dilatation. During the vaginal examination, it is also seen whether or not a cord is prolapsed in vagina, which is an emergency. If the delivery is not imminent and and the fetal heart still does not settle, an emergency cesarean section may be needed.
- During the second stage of labor: If the cervix is fully dilated and delivery is imminent, vacuum extraction or forceps delivery is done. Else, emergency c-section might be an option.
Next, we answer a few common queries about fetal distress.
Frequently Asked Questions
1. Are fetal hiccups a sign of fetal distress?
Fetal hiccups are normal and healthy signs that the baby is developing normally. They are rarely a sign of something being wrong with the pregnancy or baby.
2. Why is meconium a sign of fetal distress?
One of the signs of fetal distress could be the meconium (the baby’s first stool) in the amniotic fluid. But it is not always the sign of baby distress since meconium is common in the case of the overdue baby. Usually, the thick meconium could be a concern as it gets into the baby’s air passages (14).
Although fetal distress is serious, it can be monitored for a successful outcome. The condition is based on the effective prenatal care and monitoring of the mother and fetus. Your healthcare provider works closely with you to give you a healthy baby. Try not to panic even if the doctors detect fetal distress, as there are ways to manage it and keep the baby and you safe.
Have you also experienced fetal distress? At which stage of labor was it detected, and how was your delivery? If you have any experiences, do share them with us in the comment section below.
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3. 4.8.2 Causes of fetal distress; The Open University
4. Janee S. Perry; The Association Between Maternal Hypertensive Disorders and Perinatal Mortality in Kigoma Region, Tanzania: 2011-2015; Georgia State University (2018)
5. Gisela Ghosh et al.; Amniotic fluid index in low-risk pregnancy as an admission test to the labor ward; Acta Obstetricia et Gynecologica Scandinavica (2002)
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7. Joy Bryant et al.; Fetal Movement; Treasure Island (FL) – StatPearls Publishing (2019)
8. Pildner von Steinburg S et al.; What is the “normal” fetal heart rate; PeerJ (2013)
9. 4.8.1 Fetal heart rate as an indicator of fetal distress; The Open University
10. Amir Sweha et al.; Interpretation of the Electronic Fetal Heart Rate During Labor; American Academy of Family Physicians (1999)
11. Thurlow JA and Kinsella SM; Intrauterine resuscitation: active management of fetal distress; Int J Obstet Anesth (2002)
12. Intrapartum Intra-uterine resuscitation (IUR); NHS
13. G Sharmila and Sindhuri G.K; A prospective study of immediate maternal and neonatal effects of forceps and vacuum assisted deliveries; International Archives of Integrated Medicine (2016)
1. Meis PJ et al.; Late meconium passage in labor–a sign of fetal distress; Obstet Gynecol (1982)