POLICY NUMBER : MPG 045 EFFECTIVE DATE : JULY 06, 2015

TITLE : FETAL DISTRESS REVISION DUE : JULY 06, 2017

DEPARTMENT : MULTIDICIPLINARY
NO. OF PAGE : 4

1. PURPOSE :

1.1. To prevent fetal complication and for proper management;

1.2. To prevent long term damage to the baby and to the mother;

1.3. Early recognition of warning and signs is essential to protect the baby.

2. DEFINITION :

2.1. Fetal Distress:

2.1.1. It is an abnormal pattern of fetal heart rate;

2.1.2. Threatened fetal life after 24 weeks due to uteroplacental

insufficiency caused by maternal disorders or fetal anomalies;

2.1.3. CTG shows decelerations of 15 BPM or more from the baseline

which lasts more than 15 seconds.

3. APPLIED TO :

3.1. MNH Obstetricians;

3.2. MNH L&D midwives;

3.3. MNH Pediatrician;

3.4. MNH NICU staff;

3.5. MNH OB ward nurses;

4. POLICY :

4.1. To ensure that MNH L&D Staff have the appropriate knowledge and
information about CTG and the management of fetal distress;

4.2. Mother who is suspected to have fetal distress should be closely

monitored;

4.3. All equipment should be ready in case of emergency.

Page 1 of 4 July 2015

POLICY NUMBER : MPG 045 EFFECTIVE DATE : JULY 06, 2015
TITLE : FETAL DISTRESS REVISION DUE : JULY 06, 2017
DEPARTMENT : MULTIDICIPLINARY
NO. OF PAGE : 4

5. PROCEDURE :

5.1. If an Oxytocin drip is being administered it must be stopped and IV

fluid Ringer Lactate to be started to decrease strength and frequency
of uterine contractions which can improve uteroplacental blood flow;

5.2. The woman must be turned on her side (left lateral position) to remove
the weight of the fetus from the inferior venacava which allows them
better blood return to the heart increasing maternal cardiac output;

5.3. Oxygen must be given by oxygen face mask 8 to 10 liter/minute or as

ordered by the Obstetrician to increase fetal oxygen – saturation;
5.4. Obstetrician must be informed:

5.4.1. Telephone order may be taken at this time.

5.5. Keep the patient NPO;

5.6. Document the time, date, response of fetus, condition of patient’s CTG
readings;

5.7. Operating Room must be informed in case of Caesarian Section;

5.8. Monitor fetal heart rate continuously by Cardiotocograph, a FHR of 110

beats/min or below starting after the onset of contraction and the heart
rate continues to fall after the peak of the contraction indicates a fetal
distress;

5.9. Notify the Nursing Supervisor on duty if the patient is sent for CS;

5.10. The Pediatrician must be informed immediately before the delivery to

ensure that he is present to resuscitate the baby if needed;

5.11. During the First Stage of Labour, Caesarian Section it’s needed to
manage a fetal distress condition;

5.12. Second Stage of Labour, use forceps or vacuum extraction to avoid

further complications of the fetus due to hypoxia;
5.13. After the delivery of the baby, obtain blood sample from the cord for
sampling (and label the specimen then send with the baby to NICU. )
The blood will then be sent to Laboratory from NICU for routine
analysis such as:

Page 2 of 4 July 2015

POLICY NUMBER : MPG 045 EFFECTIVE DATE : JULY 06, 2015
TITLE : FETAL DISTRESS REVISION DUE : JULY 06, 2017
DEPARTMENT : MULTIDICIPLINARY
NO. OF PAGE : 4

5.13.1. TSH;

5.13.2. Hb, Hct;

5.13.3. ABO-Rh.

6. EQUIPMENT :

6.1. CTG Monitor;

6.2. IV fluids (Ringer Lactate);

6.3. Oxygen (Oxygen Flowmeter, Oxygen Face Mask);

6.4. Syringe (5 cc, 10cc);

6.5. Specimen Tube;

6.6. Biohazard Bag;

6.7. Alcohol Swab.

7. ATTACHMENT :

7.1. Risk Factors.

8. REFERENCES :

8.1. Reeder/Martin/Koniak- Griffin, Maternity Nursing – Lippincott, USA

1997;

8.2. V. Ruth Bennet/Linda K. Brown; Myles Textbook for Midwives, UK 2001.

9. APPROVAL :

SIGNATUR
PREPARED BY JOB TITLE/POSITION DATE
E

Page 3 of 4 July 2015

POLICY NUMBER : MPG 045 EFFECTIVE DATE : JULY 06, 2015
TITLE : FETAL DISTRESS REVISION DUE : JULY 06, 2017
DEPARTMENT : MULTIDICIPLINARY
NO. OF PAGE : 4

Ms. Lovelyn Mayo Perez Head Nurse OB Gyne/L&D

SIGNATUR
REVIEWED BY JOB TITLE/POSITION DATE
E
Ms. Analisa P. Bello Chief of Nursing Services
Dr. Atef Shata Head of OB - Gyne/L&D
Dr. Wael Zakaria Hassasn Medical Director
SIGNATUR
APPROVED BY JOB TITLE/POSITION DATE
E
Dr. Mohammed Taher Quality Manager
Dr. Khaled Abdelrahman Al
Chief Executive Officer
Musalami

Page 4 of 4 July 2015