Fetal Distress – Causes, Diagnosis and Treatment

During pregnancy, the mother always keeps an eye on the movement of the fetus inside the womb. Sometimes, the fetus might not receive proper oxygen, leading to Fetal Distress. The fetal distress might occur due to the many complications that the mother could suffer.

Fetal distress is a medical condition that usually occurs when due to compression or twisting of the umbilical cord leading to a reduction in blood flow to the fetus. This can happen during labor, vaginal delivery, or labor induction.
This article will discuss Fetal Distress, the types, causes, signs and symptoms, and available treatment options. Let us get started.

In This Article

What is Fetal Distress?

Fetal Distress is when the baby does not receive adequate oxygen through the placenta. This very often occurs during the later stages of pregnancy or during labor. It is vital to address and treat fetal distress on time. Else, it might lead to the situation where the baby might breathe the amniotic fluid that contains meconium (Poo of the baby).

Breathing the meconium might make it challenging for the baby to breathe or be life-threatening.

What Are The Causes of Fetal Distress?

Causes of Fetal Distress

Fetal Distress mainly occurs due to the disruption of oxygen supply to the baby through the placenta. It can happen due to the insufficiency or abruption of the placenta and any issues with the umbilical cord. For Example, cord compression might happen if it comes out of the cervix first.

Other conditions include mother’s pre-existing medical conditions, such as diabetes, cholestasis, or kidney disease. If the contractions are very strong or closer, it might also lead to fetal distress.

The following conditions of the mother may also lead to fetal distress.

  • Obesity
  • Smoking
  • High blood pressure or pre-eclampsia
  • Diabetes or Kidney problems
  • Multiple Pregnancies
  • Intra-Uterine growth restriction for the baby
  • Previous Stillbirth.

Signs And Symptoms of Fetal Distress

Symptoms

It is important to identify fetal distress on time or else it can be life-threatening for the fetus and mother too. Here are some signs to look out for.

  • Decrease in the fetal movement felt by the mother.
  • Meconium in the amniotic fluid
  • Volatility in the heart rate (either increase or decrease) during and after the contraction
  • Tachycardia (abnormally faster heart rate)
  • Bradycardia (abnormally slow heart rate)
  • Variable decelerations (abrupt reduction in the heart rate)
  • Late Decelerations (delayed return to baseline rate after a contraction)
  • Decrease in the variation of the fetal heart rate
  • Prolonged Decelerations
  • Metabolic Acidosis

Diagnosis of Fetal Distress

Diagnosis of Fetal Distress

When the mother recognizes or identifies unusual fetal movement, a clinical suspicion will start the process of diagnosing fetal distress. Fetal Distress can be diagnosed through the following methods.

  • Abnormal Sonographic Biometric parameters help diagnose in case of IUGR or Macrosomnia.
  • Doppler Ultrasound
  • The Umbilical Artery Doppler helps identify the changes that show high placental vascular resistance.
  • Fetal arterial Doppler may help detect the reduction of resistance to maintain blood flow to the fetal brain when the placenta cannot function properly.
  • Fetal Venous Doppler helps identify impaired cardiac functions and fetal acidosis.
  • Cardiotocography (CTG) helps detect the fetal heart rate response and the fetal movement to the contractions. The results might be classified as reassuring, non-reassuring, or abnormal. It is reactive when the fetal heart rate and fetal movement are active.
  • The CTG results can differ with both inter and intra-observer, but they can be interpreted only using computerized analysis.
  • The Fetal Scalp Blood sampling can be used during labor to check the pH levels of the lactate to identify the indications for abnormal intrapartum CTG.

Other methods that help detect and diagnose fetal distress include

Biophysical Profile (BPP)

This process takes a lot of time. It combines the CTG, Fetal movement, tone, breathing (also known as fetal behavior), and amniotic fluid volume. A BPP score helps detect the degree of fetal distress. No evidence ensures the routine use of BPP in high-risk pregnancies. But the past data suggests that it has a negative predictive value for fetal distress.

Amniotic Fluid Volume

The Amniotic Fluid Volume also helps identify fetal outcomes. There are two Amniotic Fluid Volumes – Oligohydramnios and Polyhydramnios. The oligohydramnios is associated with urogenital malformations

and growth restriction in the intra-uterine. The outcomes associated with oligohydramnios are often poor. Polyhydramnios is associated with poor neonatal results, but mild polyhydramnios can be detected only on ultrasound, which is not associated with adverse outcomes.

What Are The Treatment Options Available For Fetal Distress?

Treatment Options Available

The treatment for Fetal Distress could be either operative or conservative. However, no studies have proven which is better among the two. The following are some of the treatment options available for fetal distress.

1. Delivering The Baby

  • After proper monitoring of the fetal distress, the doctor may decide to induce labor or perform a C section.
  • In case of intrauterine hypoxia, the doctor may decide to do a preterm delivery, but the risks of pre-term birth will be present.

If there is continuous fetal distress during labor, the doctor may decide to do the delivery at the earliest. But, the severity of the fetal heart rate, blood sample abnormalities, and other factors relating to the mother must be taken into consideration. If there is an urgent need to perform C-section, doctors generally follow the following order to ensure clear communication between the doctors.

  • Class I – If there is an immediate threat of life to the mother or the fetus, perform the C-section after the decision. 30 minutes is the usual audit standard.
  • Class II – If there is no immediate life threat to the life of the mother or the fetus, the C-section can be performed after 75 minutes of taking the decision.

2. Amnioinfusion

In the case of suspected Umbilical Cord Compression, the Amnioinfusion will be beneficial with a lesser risk of C-section. The Sodium Chloride or Ringer`s lactate is transcervical infused through the uterine wall. Sometimes, they are injected through a needle with the help of an ultrasound. The adverse effect could be Umbilical Cord Prolapse or Amniotic Fluid embolism. The Amnioinfusion also helps to reduce the risk of meconium aspiration by dilution.

To sum up, fetal distress is a dangerous condition and can be life-threatening. Despite the risks involved, early medical intervention can help mitigate the risk factor and save the life of the mother and the baby. The mother should understand how to recognise the signs of fetal distress so that she can take necessary measures and rush to the hospital in case signs of distress start to show up.

FAQ’s

1. Can Fetal Distress Cause Death?

Fetal distress can lead to complications, such as long-term injury, physical deformities or disabilities, and in the worst-case scenario, severe death of the fetus. In some rare cases, fetal distress can also lead to the death of the mother. Fetal Distress indicates that something is not right with the fetus. If the mothers identify any signs of fetal distress, they must immediately contact their doctor or rush to the emergency.

2. Can Too Much Movement Mean Fetal Distress?

Fetal movements often indicate the well-being of the fetus in the uterus. If there is a sudden increase in fetal movement, it can mean that there is fetal distress. Some cases that can cause excessive movement due to fetal distress include cord complications and abruption of the placenta.

3. How is Fetal Distress Treated?

Treatment for fetal distress includes

  • Changing the position of the mother
  • Ensuring that the mother is well hydrated.
  • Checking if the mother is getting adequate oxygen levels.
  • Amnioinfusion
  • Tocolysis to delay pre-term labor by stopping the contractions temporarily.

4. When Should I be Concerned About Fetal Movement?

If your baby gives a kick count of 10 before the second hour, you and the baby are good to go. But, if you have good kick counts daily and suddenly feel the kick counts drop drastically, you should immediately call the doctor for their assistance.


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