Fetal Distress

Introduction to Fetal Distress

Fetal distress is defined as the depletion of oxygen and accumulation of carbon dioxide, leading to a state of "hypoxia and acidosis" during intrauterine life.

Etiology

• Maternal factors
• Placental factors
• Fetal factors

1. Maternal factors

• Microvascular ischemia (PIH)
• Low oxygen carried by RBC (severe anemia)
• Acute bleeding (placenta previa, placental abruption)
• Shock
• Acute infection

2. Placenta, umbilical factors

• Obstructed umbilical blood flow
• Early rupture of the membranes.
• Early separation of the placenta
• Degeneration of the placenta
• Placenta previa

3. Fetal factors

• Post maturity
• Malformations of the cardiovascular system
• Intrauterine infection
• Prematurity

Clinical features

• Tachycardia (>180 bpm) is an early sign of fetal distress.
• Bradycardia (<100 bpm) after tachycardia.
• Irregular fetal heart rate (arrhythmia). Various FHR changes in CTG recording
• Excessive fetal movement, then very slow or no fetal movement.
• Meconium stained liquor amnii.

Management

• Fix dehydration using iv fluids like RL or NS. It aids in raising both the blood volume inside the body and the blood flow inside the uterus.
• If the mother's spine and growing uterus are pressing on her abdominal aorta, she should remain in the left lateral position. Increased cardiac output and uteroplacental perfusion are two benefits of this posture.
• Please contact a pediatrician and an obstetrician very once.
• Give 4-6 liters of oxygen through a mask or nasal cannula.
• If you are injecting oxytocin, stop right away.
• Prepare resuscitation equipment.
• Record uterine activity and fetal heart rate at 15-minute intervals.
• It is important to begin treatment as soon as possible if a maternal cause is discovered (such as a fever or medication the mother is taking).
• If the fetal heart rate is abnormal for at least three contractions and no maternal explanation can be determined, a vaginal examination should be performed.
• Antibiotics similar to those used for amnionitis should be used if infection symptoms (fever, offensive vaginal discharge) are present;
• The cord should be treated as prolapsed if it is found in the vagina or below the presenting section.
• Delivery should be planned if fetal heart rate problems continue or if other indicators of distress are present (such as thick meconium-stained fluid).
• Delivery via vacuum extraction or forceps if the cervix is completely dilated and the fetal head is no more than 1/5 above the symphysis pubis or the leading bony edge of the fetal head is at 0 stations;
• Delivery via cesarean section is recommended if the cervix is not fully dilated, the fetal head is more than 1/5 of the way up the symphysis pubis, or the fetal head's leading bony edge is above 0 stations.
• Suspect abruptio placentae if bleeding occurs with either intermittent or persistent discomfort