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In medicine (obstetrics), fetal distress is the presence of signs in a pregnant woman^[1]—before or during childbirth—that the fetus is not well or is becoming excessively fatigued.

Signs and symptoms

Signs and symptoms of fetal distress include:

• Decreased movement felt by the mother
• Meconium in the amniotic fluid
• Cardiotocography signs
  • increased or decreased fetal heart rate (tachycardia and bradycardia), especially during and after a contraction
  • decreased variability in the fetal heart rate
• Biochemical signs, assessed by collecting a small sample of baby's blood from a scalp prick through the open cervix in labour
  • fetal acidosis
  • elevated fetal blood lactate levels indicating the baby has a lactic acidosis

Some of these signs are more reliable predictors of actual distress than others. For example, cardiocartography can give high false positive rates, even when interpreted by highly experienced medical personnel. Acidosis is a highly reliable predictor, but is not always available. A highly effective method of assessment of distress would be to use fetal heart rate as a first indicator of distress, to be confirmed with a more reliable method of diagnosis before radical treatment is performed.

Causes

There are many causes of fetal distress:

• Breathing problems
• Abnormal position and presentation of the fetus
• Multiple births
• Shoulder dystocia
• Umbilical cord prolapse
• Nuchal cord
• Placental abruption
• Premature closure of the fetal ductus arteriosus

Treatment

In many situations fetal distress will lead the obstetrician to recommend steps to urgently deliver the baby. This can be done by labor induction, or in more urgent cases, a caesarean section may be performed.

References