Fetal Distress: Causes, Signs, Symptoms, Diagnosis, Treatment and Complications

It is an indication that the baby is not well in the womb, it is a rare complication of childbirth.

It normally occurs when the fetus has not been getting enough oxygen.

When a baby is in distress, it may require immediate intervention, a cesarean delivery, or certain methods of intrauterine resuscitation to avoid any harm or injury to the baby.

If fetal distress is not managed, more serious injuries can occur, such as hypoxic-ischemic encephalopathy .

It is a widely applicable term that refers to the symptom of a problem, not the cause.

Many people confuse the term “fetal distress” with a different condition, asphyxia at birth, in which a baby does not have an adequate supply of oxygen.

While birth asphyxia is extremely serious and often leads to fetal distress, many other problems that are not related to oxygen supply can also cause symptoms of fetal distress.

Doctors can miss critical, life-threatening signs of fetal distress. Confusion about the meaning of “fetal distress” has led to inaccurate diagnoses and inadequate treatment, which can be fatal for both mother and child.

Common causes of fetal distress

Some causes of fetal distress are maternal. Mothers who are expecting multiples (twins, triplets, etc.) have a higher risk of fetal distress.

Gestational diabetes occurs when the mother exhibits high blood sugar levels during pregnancy, which can result in a larger baby, which makes delivery difficult and prevents the supply of oxygen.

Preeclampsia is a common cause of fetal distress. It is evidenced by higher levels of protein in the urine and blood pressure.

Diagnosing this condition in the mother is critical, otherwise it can turn into eclampsia, which is much more serious.

Complications of eclampsia can include placental abruption, heart failure, stroke, seizures, and even death.

Oligohydramine, or low amniotic fluid, is another condition that can interfere with the baby’s oxygen supply. Although it can occur at any time during pregnancy, it occurs most often in the last trimester.

On the other hand, too much amniotic fluid can also interfere with oxygen levels.

Other possible precursors to fetal distress or non-reassuring fetal state may include:

  • Anemia (the most prevalent obstetric condition seen behind a fetal distress state).
  • Full-term pregnancies (42 weeks or more).
  • Intrauterine growth retardation.
  • Meconium-stained amniotic fluid (a condition in which meconium, a baby’s first stool, is present in amniotic fluid that can block the fetal airways).
    Abnormal positioning of the baby.
  • Contractions that are too strong or too close together.
  • Dystocia.
  • Misuse of forceps.
  • Intrauterine growth retardation.
  • Macrosomia (unusually large baby).
  • Detachment of the placenta.
  • Problems during labor (for example, prolonged labor, delayed labor).
  • Uterine rupture.

Signs and symptoms of fetal distress

Fetal distress can cause changes in the baby’s heart rate, including fetal heart rate slowdowns and decreased variability.

A fetal heart rate monitor will often detect the presence of abnormal fetal heart rate traces when the baby is in distress.

Aside from changes in fetal heart rate, common signs of fetal distress include:

Decreased fetal movement

Fetal movement is an important sign that a baby is in good health.

A baby’s movements are generally established around 28 weeks of pregnancy, during this time there is movement and stillness, while the babies sleep and rest in the womb.

If the baby’s movements have stopped, or slowed down, it may be a sign of fetal distress. The doctor should perform prenatal tests, such as biophysical profiles, ultrasounds to observe the baby in the womb.

Cramps

As the baby grows and the uterus expands, mothers often experience cramps during pregnancy.

Doctors should inform mothers of the report of cramps as soon as they occur, especially if the cramps are severe and back pain is also present.

Severe cramps can be an indication of several serious complications, such as placental abruption, that can cause fetal distress.

Vaginal bleeding

Certain conditions, such as placenta previa and placental abruption, can cause bleeding during pregnancy.

Depending on the severity of these problems, they can all cause fetal distress.

Mother’s high blood pressure

Often times, high blood pressure during pregnancy can lead to a maternal health condition called pre-eclampsia.

The mother’s high blood pressure can cause a baby to be deprived of oxygen due to placental problems.

Diagnosis

Fetal distress occurs in varied forms and to varying degrees.

The clinician has clinical suspicion when decreased fetal movements are perceived by the mother or if there is a decrease or arrest of growth in the height of the symphysis fundus in series.

The tests that are usually performed are:

  • Doppler ultrasound.
  • Cardiotocography.
  • The biophysical profile.
  • Blood samples from the fetal scalp.

Treatment of fetal distress

Doctors should instruct mothers on how to detect signs and symptoms of fetal distress and what to do when they detect any of these signs, or what to do if they are concerned about any other aspect of the pregnancy.

The doctor must monitor high-risk pregnancies and continually assess the health of the mother and her babies.

The source of what is causing the distress must first be diagnosed.

During pregnancy, a fetal monitor can be used to monitor the baby’s heart rate.

When doctors detect signs of fetal distress, they can monitor the baby and decide how to proceed in the safest way.

Once the baby experiences signs of fetal distress on monitoring, the main goal is to return the baby to an oxygen-rich state as soon as possible to avoid the risk of any injury.

Intravenous fluids may be needed to help increase the oxygen in the mother’s blood.

Amnioinfusion has been shown to be beneficial in suspected umbilical cord compression (especially when oligohydramnios are present), with a reduced risk of caesarean section.

In this process, sodium chloride or Ringer’s lactate is infused transcervically or, if the membranes are still intact, through a needle inserted ultrasound through the uterine wall.

Possible adverse effects include umbilical cord prolapse, uterine scar rupture, and amniotic fluid embolism.

Signs of prenatal fetal distress require monitoring with a view to induction of labor or planned caesarean section.

Sometimes the best way to alleviate fetal distress is by cesarean section, which removes the baby’s oxygen-deprived environment.

Immediate delivery of a preterm fetus with suspected fetal distress may reduce the risk of intrauterine hypoxia, but increases the risks associated with prematurity.

Profit can be made by deferring delivery, especially if there is uncertainty; however, evidence is lacking to guide this decision.

Continued fetal distress during labor may indicate the need to expedite labor.

The speed of delivery should take into account the severity of the fetal heart rate and abnormalities in blood sampling and relevant maternal factors.

The current accepted standard is that delivery should occur as quickly and safely as possible, and within 30 minutes if there is an immediate threat to the life of the mother or fetus.

Full-term or postmature fetuses can produce meconium-stained amniotic fluid. Meconium can be harmful to the lungs of the fetus by causing chemical pneumonitis if inhaled.

Significant meconium is defined as dark green or black amniotic fluid that is thick or tough, or any amniotic fluid that is meconium stained or contains meconium clumps.

If significant meconium is present, fetal blood samples and advanced neonatal life support may be required at the time of delivery.

If there has been no significant meconium, the baby should be observed at one and two hours.

Complications

Fetal distress leads to oxygen deprivation. Clinicians must address signs of fetal distress immediately to prevent the development of hypoxic-ischemic encephalopathy.

If fetal distress is left untreated, it can lead to long-term permanent brain damage in the baby. Additionally, hypoxic-ischemic encephalopathy is associated with an increased risk of other long-term health problems including:

  • Cerebral palsy.
  • Epilepsy and seizure disorders.
  • Intellectual and developmental disabilities.
  • Behavioral and emotional disorders.
  • Hearing and visual impairment.