Fetal Distress

Definition | Aetiology | Signs and Symptoms | APGAR Score | Management | References

Definition

Fetal Distress is a term used to describe signs before and during childbirth that the fetus is not well, often due to inadequate oxygen supply. Fetal distress can be identified by abnormal heart rate patterns, meconium-stained amniotic fluid, and other signs that indicate the fetus is struggling in the womb.

Aetiology

Fetal distress can occur due to various factors, including:

• Umbilical Cord Issues: Cord prolapse, cord compression, or a nuchal cord (cord wrapped around the neck) can limit oxygen supply.
• Placental Insufficiency: When the placenta does not deliver enough oxygen and nutrients to the fetus.
• Prolonged Labour: Extended labour can put stress on the fetus, leading to hypoxia.
• Maternal Health Conditions: Conditions such as preeclampsia, diabetes, or infection can affect fetal well-being.
• Uterine Hyperstimulation: Excessive contractions, often due to oxytocin use, can compromise fetal oxygenation.

Signs and Symptoms

• Abnormal Fetal Heart Rate Patterns: Tachycardia, bradycardia, or late decelerations on cardiotocography (CTG).
• Decreased Fetal Movements: A reduction in fetal movements may indicate distress.
• Meconium-Stained Amniotic Fluid: The presence of meconium in the amniotic fluid can be a sign of fetal distress, particularly in term or post-term pregnancies.
• Abnormal Fetal Biophysical Profile: Abnormalities in fetal breathing, movement, tone, amniotic fluid volume, and nonstress test results.

APGAR Score

The APGAR score is a quick test performed on a newborn baby at 1 and 5 minutes after birth to assess the baby's physical condition and determine the need for any immediate medical intervention. The APGAR score evaluates five criteria:

• Appearance (Skin Colour): 0 = Blue/pale, 1 = Pink body/blue extremities, 2 = Completely pink
• Pulse (Heart Rate): 0 = Absent, 1 = Below 100 beats per minute, 2 = Over 100 beats per minute
• Grimace (Reflex Irritability): 0 = No response, 1 = Grimace, 2 = Cough, sneeze, or vigorous cry
• Activity (Muscle Tone): 0 = Limp, 1 = Some flexion of extremities, 2 = Active motion
• Respiration (Breathing Rate and Effort): 0 = Absent, 1 = Slow/irregular, 2 = Good/crying

The APGAR score ranges from 0 to 10, with scores of 7 and above generally considered normal. Scores of 4 to 6 may indicate some distress, while scores of 3 and below suggest severe distress requiring immediate medical attention.

Management

• Initial Response: When fetal distress is suspected, immediate action is required to optimise oxygen delivery to the fetus. Interventions include:
  • Repositioning the mother (e.g., left lateral position) to improve uterine blood flow.
  • Administering supplemental oxygen to the mother.
  • Reducing or discontinuing oxytocin if uterine hyperstimulation is present.
  • Providing intravenous fluids to the mother to improve circulation.
• Continuous Monitoring: Continuous electronic fetal heart rate monitoring is essential to assess the fetus's response to interventions.
• Expedited Delivery: If the fetal distress persists or worsens, expedited delivery is indicated. This may involve:
  • Operative vaginal delivery using forceps or vacuum.
  • Emergency caesarean section if rapid delivery is necessary and vaginal delivery is not imminent.
• Neonatal Resuscitation: After delivery, if the newborn has a low APGAR score, immediate resuscitation measures should be taken, including clearing the airway, providing positive pressure ventilation, chest compressions, and medications if required.
• Postpartum Care: Monitor both the mother and baby closely for any complications arising from the distress or the delivery method. Provide necessary support and interventions based on their condition.

References

1. NHS (2024) Fetal Distress. Available at: https://www.nhs.uk/conditions/fetal-distress/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Intrapartum Care: Fetal Monitoring. Available at: https://www.nice.org.uk/guidance/ng121 (Accessed: 24 June 2024).
3. Royal College of Obstetricians and Gynaecologists (2024) Green-top Guideline No. 13: Fetal Monitoring in Labour. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg13/ (Accessed: 24 June 2024).

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