Fetal distress is a condition where the baby does not get sufficient oxygen in the womb. It is usually confused with “birth asphyxia,” where the baby cannot receive enough oxygen during labor or delivery, due to issues such as placental abruption, cord compression or other birth complications. Fetal distress, however, is based on fetal heart rate abnormalities.
The American College of Obstetricians and Gynecologists (ACOG) committee opinion in 1998 recommended the term fetal distress to be replaced with “nonreassuring fetal heart rate tracing” as the former term is nonspecific and imprecise (1).
Read this MomJunction post to find out more about fetal distress, what causes it, and how it is treated or managed.
What Is Fetal Distress?
Fetal distress refers to the condition caused due to certain abnormal events during the birthing process, leaving the baby with limited oxygen and trauma. This could have a long-term impact on the child and may cause a variety of birth defects and cognitive delays.
This usually happens when the fetal oxygen supply gets compromised in utero, especially during labor, and sometimes from the third trimester too (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, diabetes, or fluid loss due to diarrhea or vomiting can cause stress to the fetus.
- Living in higher altitudes, or maternal heart or lung illnesses could cause maternal hypoxia (absence of sufficient oxygen to sustain body functions) (6).
- Umbilical cord compression or prolapsed umbilical cord could lead to changes in fetal blood pressure, leading to changes in oxygen supply.
- Premature separation of the placenta from the uterine wall.
- Maternal age and multiple pregnancies might put the baby at the risk of developing stress.
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. Babies with distress have a lower heart rate and react with a change in movements. It is, therefore, essential to keep track of kicks (at least ten movements in two to three hour period) to detect fetal distress (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:
- Heart rate below 120bpm for ten minutes or more (fetal bradycardia), while the normal fetal heart rate ranges between 120 and 160 beats per minute (8)
- Heart rate above 160bpm for ten minutes or more (fetal tachycardia) (9)
- Decreased fetal oxygen saturation, determined by fetal scalp blood sampling (10)
- Variable decelerations (sudden dips in fetal heart rate) and late decelerations (transient decrease in heart rate after a peak in uterine contraction) (11)
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.
The primary aim of the treatment is to improve oxygen supply to the baby. Usually, intrauterine resuscitation is used for the purpose (12). Other ways of managing or treating fetal distress are mentioned next.
- Oxygen supplementation through a mask, if the mother has inadequate oxygen levels
- 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 (13)
- Amnioinfusion (insertion of fluid into the amniotic cavity) to reduce compression of the umbilical cord
- Tocolysis, where drugs are used to delay preterm labor by temporarily stopping the intensity and frequency of contractions
- Intravenous hypertonic dextrose (14)
If the above interventions do not improve the condition, further management is suggested depending on the stage of labor (15).
- During the first stage of labor: If the cervix is fully dilated, or the fetal head has adequately descended into the vagina, delivery is carried out by vacuum aspiration or forceps. If the cervix is not fully dilated, or the fetal head is not descended properly, cesarean section is the only option.
- During the second stage of labor: Vacuum aspiration or forceps delivery are the first options because the head descends into the vagina by this time, and an abdominal incision will be risky. The labor will be accelerated using medications, such as syntocinon and drotaverine, to deliver the baby soon.
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 (16).
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.
2. Parer JT and Livingston EG; What is fetal distress; Am J Obstet Gynecol (1990)
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)
6. Ahmad F Bakr and Mohammad M Abbas; Severe respiratory distress in term infants born electively at high altitude; BMC Pregnancy Childbirth (2006)
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. Silvia Vannuccini et al.; Diagnosis of Fetal Distress; Springer Link Journals (2016)
11. Amir Sweha et al.; Interpretation of the Electronic Fetal Heart Rate During Labor; American Academy of Family Physicians (1999)
12. Thurlow JA and Kinsella SM; Intrauterine resuscitation: active management of fetal distress; Int J Obstet Anesth (2002)
13. Intrapartum Intra-uterine resuscitation (IUR); NHS
14. Philipson EH et al.; Effects of maternal glucose infusion on fetal acid-base status in human pregnancy; Am J Obstet Gynecol (1987)
15. 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)
16. Meis PJ et al.; Late meconium passage in labor–a sign of fetal distress; Obstet Gynecol (1982)
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