Fetal distress refers to signs of fetal hypoxia (oxygen deprivation) during pregnancy or labor, indicating impaired fetal well-being.
Synonyms:
- Non-reassuring fetal status.
- Intrauterine fetal hypoxia.
Causes of Fetal Distress
1. Maternal Causes:
- Preeclampsia & Hypertension → Placental insufficiency.
- Maternal Hypoxia (Anemia, Respiratory Disease).
- Dehydration & Hypotension (Epidural anesthesia, Shock).
2. Placental Causes:
- Placental Abruption (Premature separation).
- Placenta Previa (Placental attachment over cervix).
- Post-Term Pregnancy (Aging placenta reduces oxygen transfer).
3. Fetal Causes:
- Cord Compression (Nuchal cord, True knots, Cord prolapse).
- Intrauterine Growth Restriction (IUGR).
- Multiple Pregnancy (Twin-to-Twin Transfusion Syndrome).
Clinical Features of Fetal Distress
- Decreased fetal movements (<10 movements in 2 hours).
- Meconium-stained amniotic fluid (Indicates fetal hypoxia).
- Abnormal fetal heart rate patterns on CTG (Cardiotocography).
Diagnosis of Fetal Distress
1. Fetal Heart Rate (FHR) Monitoring (CTG Interpretation)
|
FHR Pattern |
Normal |
Fetal Distress |
|
Baseline Rate |
110–160 bpm |
Bradycardia (<110 bpm),
Tachycardia (>160 bpm) |
|
Variability |
5–25 bpm |
Absent or minimal
variability (<5 bpm) |
|
Accelerations |
Present |
Absent |
|
Decelerations |
None or early |
Late decelerations,
Recurrent variable decelerations |
Late decelerations = Uteroplacental insufficiency.
Variable decelerations = Cord compression.
2. Biophysical Profile (BPP) (Score Out of 10)
- Fetal breathing movements.
- Fetal movements.
- Fetal tone.
- Amniotic fluid volume.
- Non-stress test (FHR variability).
BPP <4 = Severe fetal distress → Immediate delivery.
3. Doppler Studies (For IUGR & Hypoxia)
- Abnormal Umbilical Artery Doppler → High resistance or reversed flow.
- Middle Cerebral Artery Doppler → Low resistance (Brain-sparing effect).
Management of Fetal Distress
1. Intrauterine Resuscitation (Immediate Measures)
- Left lateral position (Improves placental perfusion).
- Oxygen via face mask (High flow O₂).
- IV Fluids (To correct maternal dehydration).
- Stop oxytocin (If hyperstimulation is present).
2. Delivery (If Persistent Fetal Distress)
- Vaginal Delivery (If cervix fully dilated).
- Emergency Cesarean Section (If no improvement or severe distress).
Complications of Fetal Distress
Short-Term Risks:
- Neonatal Hypoxia.
- Meconium Aspiration Syndrome.
- Emergency C-section.
Long-Term Risks:
- Hypoxic-Ischemic Encephalopathy (HIE).
- Cerebral Palsy.
- Neurodevelopmental Delay.
Summary Table: Fetal Distress Essentials
|
Feature |
Details |
|
Definition |
Fetal hypoxia or non-reassuring status |
|
Causes |
Preeclampsia, Abruption, Cord compression |
|
Signs |
Decreased movements, Abnormal CTG, Meconium-stained
fluid |
|
Diagnosis |
CTG, Biophysical Profile, Doppler Studies |
|
Management |
Oxygen, Left lateral position, C-section if needed |
Key Takeaways
- Fetal distress is diagnosed via CTG & Doppler studies.
- Late decelerations suggest uteroplacental insufficiency.
- Immediate interventions include oxygen, fluids, and stopping oxytocin.
- Emergency C-section is needed if distress persists.
