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Concept
Fetal distress
Summary
Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics. The term "non-reassuring fetal status" has largely replaced it. It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.
Risk factors for fetal distress/non-reassuring fetal status include anemia, restriction of fetal growth, maternal hypertension or cardiovascular disease, low amniotic fluid or meconium in the amniotic fluid, or a post-term pregnancy. The condition is detected most often with electronic fetal heart rate (FHR) monitoring through cardiotocography (CTG), which allows clinicians to measure changes in the fetal cardiac response to declining oxygen. Specifically, heart rate decelerations detected on CTG can represent danger to the fetus and to delivery.
Treatment primarily consists of intrauterine resuscitation, the goal of which is to restore oxygenation of the fetus. This can involve improving the position, hydration, and oxygenation of the mother, as well as amnioinfusion to restore sufficient amniotic fluid, delaying preterm labor contractions with tocolysis, and correction of fetal acid-base balance. An algorithm is used to treat/resuscitate babies in need of respiratory support post-birth.
Generally it is preferable to describe specific signs in lieu of declaring fetal distress that include:
Decreased movement felt by the mother
Meconium in the amniotic fluid ("meconium stained fluid")
Non-reassuring patterns seen on cardiotocography:
increased or decreased fetal heart rate (tachycardia and bradycardia), especially during and after a contraction
decreased variability in the fetal heart rate
late decelerations
Biochemical signs, assessed by collecting a small sample of baby's blood from a scalp prick through the open cervix in labor
fetal metabolic acidosis
elevated fetal blood lactate levels (from fetal scalp blood testing) indicating the baby has a lactic acidosis
Some of these signs are more reliable predictors of fetal compromise than others.
Official source
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