Written by Dr.M.D.Mazumdar, MD

Foetal Distress is not a complication but a symptom of an underlying complication.

Signs of Fetal Distress

The fetus may show signs of distress at any time in the first stage or the second stage of labour. The signs of fetal distress are:

• Passage of meconium (fetal stool) in the liquor amnii.
• Increase of fetal heart rate above 160 per minute.
• Deceased oxygen saturation in the fetal blood as diagnosed by fetal scalp blood sampling.
• Decrease of fetal heart rate below 100 per minute.

Fetal Monitoring

There are two main methods of monitoring the baby:

• Intermittent Auscultation - By this method, the heart beat of the fetus is checked by either a stethoscope or a handheld doppler monitor. The heartbeats are counted and manually recorded at least every two hours.

• Continuous Electronic Fetal Monitoring (EFM) - Two sensors are placed on the abdomen - one measuring the uterine contractions and the other measuring the baby's heartbeats. Comparison of the graphs produced by these sensors can help identify fetal distress. A fetal scalp electrode (FSE) may also be placed on the fetal scalp for a more accurate reading of the fetal heartbeat.

Causes of Fetal Distress

• Prolonged Labour: Prolonged Labor can cause fetal distress by putting excessive stress on the fetus or by causing decreased blood supply to the placenta.

  Causes of prolonged labour like CPD, breech presentation, or failure of the cervix to dilate properly can all cause fetal distress.

• Placental Insufficiency: Decreased blood flow through the placenta can be secondary to prolonged labor or due to conditions like hypertension (high blood pressure), diabetes, thyroid problems, infections etc.

• Fetal problems: Certain problems that affect the fetus may also cause fetal distress. A small for date fetus or a fetus with heart problems, kidney problems or other congenital defects are more likely to develop fetal distress.

• Placental problems: Developmental defects in the placenta can also lead to fetal distress in labor.

Conditions which increase the Risks of Fetal Distress

Some conditions may increase the risks of development of fetal distress:

• Anemia.
• Oligohydraminos (a condition in which there is a lower level of amniotic fluid)
• Pregnancy induced hypertension or Pre-eclamptic toxemia (PET)
• Post term pregnancy in which the pregnancy is of more than 42 weeks duration.
• Intra-uterine growth Retardation.

Management / Treatment of Fetal Distress

The immediate aim of treatment is to increase oxygen supply to the fetus. This is done by:

• Ensuring that the mother has adequate oxygen, preferably with an oxygen mask.
• Turning the mother to her left side - this removes pressure on the blood vessels carrying blood to the uterus.
• Ensuring that the mother is adequately hydrated - preferably with an IV line.
• Tocolysis - this is a method in which drugs are used to decrease the intensity and frequency of uterine contractions. This will cause increased blood flow to the fetus.
• Intravenous hypertonic dexctrose infusion.

Further Management of a women with fetal distress depends on what stage the distress is discovered.

• Fetal Distress in the First Stage of labor: If fetal distress is diagnosed in early first stage , there is no other option but an operative delivery. Cesarian section has to be done as early as possible.

  If fetal distress is diagnosed in late first stage with the cervix almost fully dilated and the head well descended in the vagina, forceps delivery or vacuum aspiration may be possible in very expert hands.

  But if the head is not well descended, and the doctor or midwife not very experienced, a cesarian section is safer.

• Fetal Distress in Second Stage of labor: If fetal distress is diagnosed in the second stage of labour, forceps delivery or vacuum aspiration is the first option to be considered.

  This is due to the fact that by this time the head has usually descended deep into the vagina and delivery through an abdominal incision will be riskier than a vaginal delivery. The labor needs to be accelerated with medicines like syntocinon or drotaverine and the baby delivered as early as possible.

Also Read-

• The Three stages of Normal Labor
• What to do Immediately after Childbirth.
• The Pregnancy Test .
• Problems in the Postpartum Period.