Fetal distress

I. Definition
 Hypoxia that may result in permanent fetal brain damage or death if not reversed by immediate
alleviation of the cause(to restore proper blood supply and oxygenation to the fetus) or the
fetus delivered immediately (often by caesarean section)
 It is made by indirect methods because Direct assessment of fetal oxygenation is under
investigation (which gives most meaningful, reliable and reproducible data).
 Occurs when your baby ‘s oxygen supply is compromised in utero, usually during labor but
occasionally in the third trimester of pregnancy.

II. Incidence

The overall risk of prompt caesarean delivery needed for fetal concern was shown to be 3.1% in
an unselected population[1]. The risk exceeded 20% in patients with severe pre-eclampsia, post-term or
fetal growth-restricted fetuses with abnormal Doppler studies and also in women with moderate/severe
asthma or severe hypothyroidism.

III. Risk factors

Includes women with a history of:

 Stillbirth.

 Intrauterine growth restriction (IUGR).

 Oligohydramnios or polyhydramnios.

 Multiple pregnancy.

 Rhesus sensitisation.

 Hypertension.

 Obesity.

 Smoking.

 Diabetes and other chronic diseases.

 Pre-eclampsia or pregnancy-induced hypertension.

 Decreased fetal movements.

 Recurrent antepartum haemorrhage.

 Post-term pregnancy.
  Maternal age over 35 years, and particularly over 40, is an independent risk factor for
uteroplacental insufficiency, fetal distress and stillbirth; the highest risk is in older women who
are also nulliparous.

IV. Manifestation
 Decresed fetal movement in the womb
 Abnormal fetal heart rate
 Abnormal amniotic fluid level
 Abnormal results of biophysical profile (BPP)
 Vaginal bleeding
 Cramping
 Insufficient or excessive maternal weight gain
V. Management

 Immediate delivery of a preterm fetus with suspected fetal distress may reduce the risk of
intrauterine hypoxia but increases the risks associated with prematurity. Benefit may be gained
by deferring delivery, especially if there is uncertainty; however, evidence is lacking to guide this
decision.

 Continuing fetal distress during labour may indicate the need for delivery to be expedited:

 The current accepted standard is that expedited delivery should occur as quickly and safely as
possible and within 30 minutes if there is an immediate threat to life of either the mother or the
fetus[14]. However, this is not achieved in a substantial proportion of cases, although it is
uncertain how significant this is clinically.

 sodium chloride or Ringer's lactate is infused transcervically or, if the membranes are still intact,
via a needle inserted under ultrasound guidance through the uterine wall.

 If significant meconium is present, fetal blood sampling and advanced neonatal life support may
be required at delivery.

 If there has been non-significant meconium, the baby should be observed at one and two hours.

 Amnioinfusion has been used to reduce the risk of meconium aspiration by diluting the
meconium present; however, it is unclear whether this is beneficial and it is not used in routine
practice.

Vb. Pharmacologic management

The common analgesic drug used is pethidine 50-100mg IM when the pains are well established
in the active stage of labor. If necessary, it is repeated after 4 hours.
Metoclopramide 10mg IM is commonly given to combat vomiting due to pethidine.

VI. Nursing management

 Examinstion for mother which covers vital signs, general examination, abdominal examination
every 4 hours.