Definition

Fetal distress is a condition where a fetus shows signs of distress during late pregnancy or labor. This indicates that the baby is in distress. This condition can sometimes occur during pregnancy but is more common during labor. Fetal distress can pose risks to both the mother and the fetus.

Causes

The most common cause of fetal distress is a lack of oxygen. The fetus receives oxygen and nutrients from the mother through the blood vessels in the umbilical cord, which connects to the placenta attached to the mother's uterus. Any disruption in this process, such as problems with the placenta or umbilical cord, can lead to fetal distress.

Other conditions that can cause fetal distress include:

• Frequent or strong contractions
• Anemia, or a lack of red blood cells
• Hypertension during pregnancy
• Hypotension, or abnormally low blood pressure
• Identical twin pregnancies
• Placenta previa, where the placenta covers the birth canal

For additional information about placenta previa, click this link: Placenta Previa - Definition, Causes, Symptoms and Treatment.

Risk Factor

Several conditions can increase the risk of fetal distress, including:

• Intrauterine growth restriction (IUGR)
• Excessive or insufficient amniotic fluid
• Preeclampsia
• Uncontrolled chronic conditions in the mother, such as diabetes, kidney disease, liver disease during pregnancy, or heart disease
• Placental abruption, where the placenta detaches from the uterus
• Umbilical cord problems, such as cord compression
• Prolonged or complicated labor
• Post-term pregnancy, which is over 42 weeks of gestation
• Maternal obesity

The most common signs of fetal distress include:

• Changes in the fetal heart rate (FHR), such as it being slower or faster than normal
• Reduced fetal movements over an extended period
• Oligohydramnios, or low levels of amniotic fluid

Another sign of fetal distress is the presence of meconium, the baby's first stool, in the amniotic fluid, turning it greenish or brown. Meconium is the fecal matter of newborns, which can be expelled in utero if the fetus experiences stress.

Symptoms

The most common signs of fetal distress include:

• Changes in the fetal heart rate (FHR), such as it being slower or faster than normal
• Reduced fetal movements over an extended period
• Oligohydramnios, or low levels of amniotic fluid

Another sign of fetal distress is the presence of meconium, the baby's first stool, in the amniotic fluid, turning it greenish or brown. Meconium is the fecal matter of newborns, which can be expelled in utero if the fetus experiences stress.

Diagnosis

Doctors diagnose fetal distress by monitoring the fetal heart rate (FHR). A slow or abnormal heart rate can indicate fetal distress. Monitoring FHR is an effective way to assess fetal well-being.

During pregnancy, your doctor may recommend additional tests to monitor the fetal heart rate, such as:

• Non-stress test: This test uses an electronic device to measure the fetal heart rate while you sit or lie down. A belt with electronic sensors is placed around your abdomen. The baby's heart rate is measured and recorded, along with your uterine contractions. The results are classified as reactive or non-reactive, depending on how active the fetus is.
• Biophysical profile: An ultrasound measures the fetus's movements, muscle tone, breathing movements, and amniotic fluid levels. This test is sometimes combined with a non-stress test.

During labor, your doctor will monitor the fetal heart rate, either continuously or intermittently. Continuous monitoring means wearing a device around your abdomen that records the fetal heart rate at all times (the most common method). Intermittent monitoring involves checking the fetal heart rate at regular intervals, such as every 30 minutes.

The most common methods for monitoring the fetal heart rate and identifying fetal distress are:

• Electronic fetal heart rate monitoring: The mother wears a device with sensors around her abdomen to continuously monitor the fetal heart rate during labor. The sensors send the fetal heart sounds to a computer, which the doctor can read.
• Doppler ultrasound: The doctor places a device on your abdomen that detects the fetal heart rate using sound waves. Doppler ultrasound can be used throughout pregnancy but is most commonly employed during routine prenatal checkups. During labor, the fetal heart rate is checked every 15 minutes and after each contraction.

Management

If you are not in delivery process, depending on your situation, your doctor may recommend interventions such as medication or intravenous fluids. If these treatments do not help, your doctor may suggest a cesarean section to deliver the baby as soon as possible.

If you are in labor, your doctor may take the following steps to treat fetal distress:

• Change your position to lie on your left side. This can improve blood flow back to your heart and oxygen supply to the fetus.
• Administer oxygen.
• Provide intravenous fluids.
• Administer medications to slow down or stop contractions. If you have been taking medications to speed up labor, they may be discontinued if there are signs of fetal distress.
• Amnioinfusion: This procedure involves inserting fluid into the amniotic sac to relieve umbilical cord compression.

Immediate Delivery

If the fetus is in distress, your doctor may recommend immediate delivery. Forceps or a vacuum device may be used if the cervix is fully dilated and the baby is low in the birth canal. Otherwise, an emergency cesarean section will be performed. Your doctor will ask for your consent before any procedure.

Complications

Fetal distress can have long-term effects on the baby after birth. Prolonged oxygen deprivation during pregnancy and labor can lead to serious complications if not promptly detected and treated. These complications may include brain injury, cerebral palsy, or even stillbirth.

Experiencing fetal distress in one pregnancy does not necessarily mean you will have the same issue in subsequent pregnancies. Each pregnancy is different. If you have concerns about future pregnancies, you should consult your doctor.

Prevention

If your baby is in distress, your doctor will try all possible measures to deliver the baby safely before severe complications arise. Device-assisted delivery or surgery may be performed. While these interventions are generally safe, they do carry some risks and potential complications.

Regular prenatal checkups and maintaining a healthy pregnancy can help reduce the risk of conditions that cause fetal distress. Additionally, discussing pregnancy and labor symptoms with your doctor can help identify signs of fetal distress. For example, monitor fetal movements and inform your doctor if you experience vaginal bleeding, a large amount of fluid discharge from the vagina, or frequent or continuous contractions.

When to See a Doctor?

If you do not feel your baby move, notice changes in fetal movement patterns, or see that your amniotic fluid is greenish or brownish, contact your doctor immediately, as these could be signs of fetal distress.