Fetal Distress
UNDERSTANDING, DETECTION, AND
MANAGEMENT
PRESENTED BY: LEA MAE CABIGTING
Definition of Fetal Distress
Fetal distress refers to a condition where the unborn baby
is not receiving sufficient oxygen, which can lead to
potential harm. It is often characterized by abnormal fetal
heart rate patterns or other signs of distress.
Fetal distress may occur when the baby's heart rate slows
down during labor, indicating oxygen deprivation.
Importance of Fetal Monitoring
Fetal monitoring is the continuous or periodic assessment
of the baby's well-being during pregnancy and childbirth. It
is crucial for timely detection and management of fetal
distress.
Fetal monitoring during labor can detect abnormal heart
rate patterns, allowing healthcare providers to take
immediate action and improve outcomes for both the
mother and the baby.
Causes of Fetal Distress
A. Maternal Factors
Hypertension:
Refers to high blood pressure in the mother, which can
restrict blood flow to the placenta, affecting the baby's
oxygen supply.
A pregnant woman with chronic hypertension may
experience fetal distress if her blood pressure becomes
uncontrolled, leading to reduced oxygen delivery to the
baby.
Diabetes:
During pregnancy can affect blood sugar control,
potentially leading to fetal distress due to fluctuations in
the baby's blood sugar levels.
A mother with unmanaged gestational diabetes may put
her baby at risk of fetal distress if her blood sugar levels
become unstable.
Preeclampsia:
Is a pregnancy-related condition characterized by high
blood pressure and organ damage. It can affect placental
blood flow, leading to fetal distress.
A pregnant woman with severe preeclampsia may develop
fetal distress due to impaired placental function.
B. Placental Factors
Placental Insufficiency:
It occurs when the placenta cannot provide sufficient
oxygen and nutrients to the baby.
Placental insufficiency may result from a prematurely
aging placenta, leading to fetal distress as the baby's
oxygen supply diminishes.
Placental Abruption:
Is the premature separation of the placenta from the
uterine wall, which can cut off the baby's oxygen supply.
A traumatic injury to the abdomen, such as in a car
accident, can cause placental abruption, leading to fetal
distress.
C. Fetal Factors
Fetal Hypoxia:
Occurs when the baby's oxygen supply is compromised,
which can result from a variety of factors.
Fetal hypoxia may develop if the umbilical cord becomes
compressed during labor, reducing oxygen delivery to the
baby.
Fetal Anomalies:
Refers to structural or functional abnormalities in the
developing baby, which can affect its ability to tolerate
stress during labor.
A baby with a congenital heart defect may be at a higher
risk of experiencing fetal distress during labor due to its
heart's reduced capacity to cope with increased demand.
D. Other Factors
Infections:
Infections in the mother can potentially affect the baby's
health and lead to fetal distress.
Maternal infections like chorioamnionitis can trigger fetal
distress by causing inflammation and infection of the fetal
membranes.
Medications:
Certain medications taken by the mother can have adverse
effects on the developing baby, potentially causing fetal
distress.
Opioid use during pregnancy can lead to fetal distress in
the baby due to withdrawal symptoms or respiratory issues
after birth.
Risk Factors and Signs
A. Maternal Risk Factors
Maternal risk factors are health or lifestyle aspects in the
mother that increase the likelihood of fetal distress.
A mother who smokes during pregnancy exposes her baby
to a higher risk of fetal distress due to reduced oxygen
intake caused by carbon monoxide.
B. Fetal Risk Factors
Fetal risk factors are conditions or characteristics related
to the developing baby that can lead to fetal distress.
Premature birth is a fetal risk factor that increases the
likelihood of fetal distress since premature babies often
have underdeveloped organs, including the lungs, which
may struggle to handle labor stress.
C. Common Signs and Symptoms of Fetal Distress
Decreased Fetal Movement:
Decreased fetal movement refers to a reduction in the
baby's usual activity levels, which can be an indication of
fetal distress.
A pregnant woman notices that her baby is moving less
than usual, prompting her to seek medical attention for
evaluation.
Abnormal Heart Rate Patterns:
Abnormal fetal heart rate patterns, such as bradycardia
(slow heart rate) or tachycardia (fast heart rate), are
indicative of potential fetal distress.
A healthcare provider observes a prolonged episode of
fetal tachycardia during labor, which may signal fetal
distress.
Meconium-Stained Amniotic Fluid:
Meconium is the baby's first stool, and when it is present
in the amniotic fluid, it can suggest that the baby may
have experienced fetal distress.
During labor, the amniotic fluid appears greenish or
brownish, indicating the presence of meconium, which
requires close monitoring of the baby's well-being.
Diagnostic Tools and Tests
A. Fetal Heart Rate Monitoring
Electronic Fetal Monitoring (EFM):
EFM is a method for continuously tracking the baby's heart
rate and uterine contractions during labor.
EFM involves placing sensors on the mother's abdomen to
monitor the baby's heart rate and the timing and strength
of contractions.
Doppler Ultrasound:
Doppler ultrasound is a non-invasive technique that uses
sound waves to assess the baby's heart rate and blood
flow.
A Doppler ultrasound device can be used to measure blood
flow in the baby's umbilical artery, providing information
about oxygen delivery to the fetus.
B. Biophysical Profile (BPP)
A biophysical profile is a comprehensive assessment that
evaluates various aspects of fetal health, including fetal
movements, muscle tone, and amniotic fluid levels.
A BPP involves monitoring the baby's movements, muscle
tone, breathing, heart rate, and the amount of amniotic
fluid to assess fetal well-being.
C. Non-Stress Test (NST)
The NST is a test that assesses the baby's heart rate
response to its own movements, which provides insights
into fetal well-being.
During an NST, a healthcare provider observes the baby's
heart rate as it accelerates in response to the baby's
natural movements.
D. Contraction Stress Test (CST)
The CST evaluates the baby's heart rate response to
uterine contractions, helping determine its ability to
withstand the stresses of labor.
A CST involves inducing contractions through medication
or nipple stimulation while closely monitoring the baby's
heart rate.
E. Umbilical Artery Doppler Flow Studies
Umbilical artery Doppler flow studies use ultrasound to
assess blood flow in the umbilical artery, which can reveal
information about the baby's oxygenation.
A healthcare provider may perform umbilical artery
Doppler flow studies to assess blood flow and determine
whether the baby is receiving adequate oxygen through the
placenta.
Management and Interventions
A. Immediate Actions
Repositioning the mother:
Repositioning the mother involves changing her position to
optimize blood flow to the placenta and the baby.
If a pregnant woman is lying flat on her back during labor,
a healthcare provider may instruct her to roll onto her side
to improve blood flow to the baby.
Providing Oxygen:
Providing supplemental oxygen to the mother can help
ensure that the baby receives an adequate oxygen supply
during labor.
If fetal distress is suspected, the healthcare team may
administer oxygen to the mother through a mask.
IV Fluids:
Intravenous (IV) fluids are given to the mother to maintain
hydration and blood pressure, which can support the
baby's well-being.
IV fluids are often administered to a woman in labor,
particularly if her blood pressure is low and the baby's
heart rate is concerning.
B. Cesarean Section
Indications and Timing:
A cesarean section is a surgical procedure to deliver the
baby through an incision in the mother's abdomen and
uterus, typically performed when the health of the baby or
mother is at risk.
A cesarean section may be indicated when the baby's
heart rate does not improve with other interventions, or if
there is placental abruption.
Emergency vs. Elective:
Cesarean sections can be classified as emergency (urgent
due to immediate health risks) or elective (planned in
advance for non-urgent reasons).
An emergency cesarean section may be performed when
fetal distress is severe, whereas an elective one may be
scheduled for other non-urgent reasons, such as a breech
presentation.
C. Assisted Delivery
Vacuum Extraction:
Vacuum extraction is a method of assisted vaginal delivery
using a vacuum cup on the baby's head to guide and assist
the baby down the birth canal.
In cases where the baby is in fetal distress and needs to be
delivered quickly, a vacuum extraction may be employed to
avoid a prolonged delivery.
Forceps Delivery:
Forceps delivery is another assisted delivery technique that
involves using forceps to gently guide the baby out of the
birth canal.
If the baby is experiencing fetal distress and is not
descending effectively, forceps may be used to facilitate
the birth.
D. Medications
Tocolytics:
Tocolytics are medications that can be used to temporarily
stop or slow down uterine contractions.
Tocolytics may be administered if fetal distress is caused
or exacerbated by premature contractions, allowing
healthcare providers to manage the situation.
Corticosteroids:
Corticosteroids are medications given to the mother to
accelerate fetal lung maturation, particularly when
preterm birth is anticipated.
In cases of fetal distress and a high likelihood of preterm
birth, corticosteroids may be administered to help the
baby's lungs develop faster and improve their breathing
ability.
E. Neonatal Resuscitation
Neonatal resuscitation involves a set of medical
procedures and interventions to revive and stabilize a
newborn's vital functions, particularly when the baby is
born in a distressed state.
If a baby exhibits poor muscle tone, difficulty breathing, or
a low heart rate at birth due to fetal distress, neonatal
resuscitation is initiated to support the baby's transition to
life outside the womb.
Long-Term Effects and
Complications
A. Neonatal Outcomes
Neonatal outcomes refer to the health and well-being of
the baby following fetal distress and birth.
Neonatal outcomes can vary, with some babies
experiencing short-term issues related to fetal distress,
such as respiratory problems, and others having long-term
consequences like developmental delays.
B. Maternal Complications
Maternal complications are health issues that may arise in
the mother because of experiencing fetal distress and the
associated interventions.
Maternal complications may include postpartum
hemorrhage or emotional distress resulting from the
traumatic experience of fetal distress during labor.
C. Emotional and Psychological Impact
The emotional and psychological impact relates to the
emotional and mental well-being of both the parents and
healthcare providers involved in managing fetal distress.
Parents may experience feelings of anxiety, guilt, or
trauma related to fetal distress, while healthcare providers
may grapple with the emotional toll of managing high-
stress situations.
Prevention and Risk Reduction
A. Prenatal Care
Prenatal care encompasses a range of medical and
lifestyle measures taken during pregnancy to reduce the
risk of fetal distress.
Regular prenatal check-ups, screenings, and following the
recommended prenatal care schedule are essential for
preventing and managing fetal distress.
B. Lifestyle Factors
Lifestyle factors involve modifying the mother's habits and
behaviors during pregnancy to promote a healthy
gestational experience.
Avoiding smoking and alcohol consumption, maintaining a
healthy diet, and getting regular exercise are lifestyle
factors that can reduce the risk of fetal distress.
C. Monitoring During Labor
Continuous monitoring during labor involves tracking the
baby's heart rate and the progress of labor to promptly
detect and address signs of fetal distress.
Continuous fetal monitoring by healthcare providers
ensures that any concerning changes in the baby's heart
rate are identified in real time, allowing for timely
interventions.
D. Birth Planning
Birth planning involves preparing for the possibility of fetal
distress during labor by discussing preferences and
interventions with healthcare providers.
Birth planning might involve discussing the circumstances
under which the mother and healthcare team would opt
for a cesarean section in the event of fetal distress.
Thank you
