Fetal distress, also known as non-reassuring fetal status, describes a situation where an unborn baby shows signs of not receiving adequate oxygen or nutrients. This condition can develop at any point during pregnancy or labor. Recognizing these signs promptly is important for the well-being of both the pregnant individual and the baby, guiding when to seek medical attention.
Recognizing Potential Signs
Changes in fetal movement are noticeable signs a pregnant individual can monitor at home. While fetal activity varies, a significant decrease, absence of movement, or unusually erratic movements warrant immediate concern. Normal fetal movement typically feels like kicks, flutters, or rolls, with a general pattern becoming established by the third trimester. A common recommendation is to feel at least 10 movements within a two-hour period past 28 weeks gestation.
Other potential signs that necessitate urgent medical evaluation include any vaginal bleeding or spotting, which can range from light to heavy. Severe abdominal pain or persistent cramping that does not subside could also indicate a problem. Sudden, significant swelling in the hands, face, or ankles, especially if accompanied by persistent or severe headaches or vision changes like blurred vision or seeing spots, should be reported to a healthcare provider.
A fever, particularly if it is high, can signal an infection that might affect the baby. Additionally, a sudden gush or continuous trickle of fluid from the vagina, indicating a rupture of membranes, requires immediate medical assessment. While these signs can sometimes be benign, they are potential indicators of fetal distress and require professional medical consultation rather than self-diagnosis to ensure the safety of the pregnancy.
Medical Evaluation and Confirmation
Once suspected fetal distress prompts medical attention, healthcare professionals employ various diagnostic tools to assess the baby’s well-being. Fetal heart rate monitoring is a primary method, often performed using a non-stress test (NST). During an NST, two belts are placed around the abdomen: one tracks the baby’s heart rate, and the other monitors uterine contractions. The baby’s heart rate is observed to increase with movement, a reassuring sign of adequate oxygen supply.
An ultrasound is a diagnostic tool that allows providers to assess the baby’s growth, amniotic fluid volume, and blood flow through the umbilical cord and other vessels using Doppler studies. Low amniotic fluid (oligohydramnios) can indicate issues like umbilical cord compression, which restricts blood flow and oxygen to the baby.
A biophysical profile (BPP) combines the non-stress test with an ultrasound examination. This comprehensive assessment evaluates five indicators of fetal health: fetal heart rate, breathing movements, body movements, muscle tone, and amniotic fluid volume. Each component is scored, and a total score helps determine the baby’s overall condition. These evaluations help confirm or rule out fetal distress, guiding subsequent management decisions.
Understanding Underlying Causes
Fetal distress can stem from factors affecting the baby’s oxygen and nutrient supply. Placental issues are common. Placental insufficiency occurs when the placenta fails to deliver enough nutrients and oxygen due to insufficient blood flow. Placental abruption, where the placenta detaches from the uterine wall before birth, also leads to oxygen deprivation.
Umbilical cord problems can compromise fetal well-being. Umbilical cord compression, where pressure on the cord restricts blood flow, is a frequent cause of distress. This can happen if the cord is wrapped around the baby’s neck (nuchal cord), tangled, or prolapsed, meaning it descends into the birth canal before the baby.
Maternal health conditions play a role. Conditions such as pre-eclampsia, characterized by high blood pressure in pregnancy, and uncontrolled diabetes can reduce blood flow to the placenta. Infections affecting the uterus or amniotic fluid, and severe maternal anemia can also lead to fetal distress by impacting oxygen delivery or increasing the baby’s metabolic demands.
Fetal conditions like intrauterine growth restriction (when the baby is smaller than expected) or congenital anomalies can predispose a baby to distress. Complications during labor, such as prolonged labor or excessively strong and frequent contractions (uterine hyperstimulation), can also reduce the oxygen supply to the baby, leading to signs of distress.
Management and Intervention
Once fetal distress is confirmed, medical professionals initiate interventions to improve the baby’s condition. Initial conservative measures involve repositioning the pregnant individual to improve blood flow to the placenta. Administering oxygen via a mask and providing intravenous fluids can also enhance the baby’s oxygen supply.
Medications may be used to relax the uterus, particularly if contractions are too frequent or intense, which can compromise oxygen flow. If low amniotic fluid contributes to umbilical cord compression, amnioinfusion might be performed. This involves introducing a saline solution into the uterus to increase fluid volume, cushioning the umbilical cord and potentially alleviating pressure.
If conservative measures do not resolve the distress or if the baby’s condition is severe, expedited delivery becomes necessary. This might involve inducing labor, assisting vaginal delivery with tools like forceps or a vacuum extractor, or performing a Cesarean section. The choice of delivery method depends on the urgency and clinical assessment for the safest outcome for both the pregnant individual and the baby. The goal of all interventions is to ensure the best health outcome for the newborn.