What to Do When Fetal Distress Occurs During Pregnancy

Fetal distress is a perilous condition for expectant mothers, posing a severe threat to the well-being of the baby. Detecting signs of fetal distress is crucial, and immediate medical attention is required to minimize the risk of serious complications. This article explores the concept of fetal distress, its types, and the actions pregnant women should take when they suspect it.

1. Understanding Fetal Distress

Fetal distress is a pathological condition that arises when the fetus experiences a deficiency of oxygen in the blood or tissues while still in the womb. It is now widely recognized as an unstable state of the fetus, encompassing symptoms such as reduced oxygen levels in the blood, diminished oxygen supply to organ systems, increased hydrogen ion concentration (electrolyte imbalances), fetal acidosis, and the potential for stillbirth.

Clinical indications of fetal distress are characterized by alterations in fetal heart rate, typically assessed using a stethoscope or fetal heart rate monitor. These alterations may include repetitive or variable hyporhythmias, late hyporhythmias, rapid heart rate, slow heart rate, or irregular heartbeats. Abnormal fetal movements also serve as signs of fetal distress, warranting immediate hospitalization.

There are two primary types of fetal distress:

• Acute Fetal Distress: Occurs suddenly during labor. Timely detection and intervention are crucial, as untreated acute fetal distress can adversely affect the baby's physical and cognitive development and even jeopardize the infant's life during childbirth. Early assessment during labor is essential for ensuring a safe delivery for both mother and baby. Acute fetal distress occurs in less than 20% of births.
• Chronic Fetal Distress: Develops gradually during pregnancy, often with subtle symptoms that may not be immediately noticeable. However, chronic fetal distress can rapidly transform into an acute crisis when the pregnant woman goes into labor and gives birth.

The severity of fetal distress hinges on factors such as the degree of oxygen deprivation, whether it is acute or chronic, and the promptness of diagnosis and treatment. So, what should a pregnant woman do when she suspects fetal distress?

2. Steps for Pregnant Women with Fetal Distress

The fundamental principle of managing fetal distress in pregnant women is to create a more favorable environment for the fetus by adjusting their condition. However, these interventions must be executed judiciously, taking into account the mother's health and ensuring they occur at the right time to avoid premature delivery complications.

2.1. Fetal Distress During Pregnancy

For pregnant women experiencing fetal distress during pregnancy, the following actions are recommended:

• Regular prenatal check-ups are crucial, especially for women with risk factors for fetal distress.
• Monitoring fetal heart rate using a stethoscope, particularly after contractions, to detect any deviations. Low oxygen levels may lead to rapid or slow fetal heart rates (over 160 beats per minute or fewer than 120 beats per minute).
• Periodically assess the color of amniotic fluid for signs of meconium staining.
• Conduct oxytocin or nipple stimulation tests and utilize obstetric monitoring, if available, to identify fetal heart rate abnormalities, such as early or late bradycardia.
• Evaluate fetal maturity and consider the possibility of terminating the pregnancy if warranted.
• Utilize fetal ultrasound measurements, such as biparietal and abdominal diameters, placental calcification grade, and amniotic fluid index, to assess the need for intervention.

In cases where the amniotic fluid index exceeds 28mm, a cesarean section is often recommended. For levels between 28-40mm, labor may be induced, followed by a cesarean section if unsuccessful. Levels from 40-60mm require close monitoring, while levels exceeding 60mm are typically considered normal.

2.2. Fetal Distress During Labor

During labor, vigilant monitoring is essential to promptly identify signs of fetal distress. The decision to deliver the baby may be made if deemed necessary:

• Monitor the mother's overall condition, existing medical conditions, and potential complications.
• Record fetal heart rate every 10-15 minutes and observe uterine contractions for appropriate intensity and rhythm. If contractions intensify, tocolytic drugs may be administered.
• Employ continuous fetal heart rate monitoring to identify early or late bradycardia, variable heart rate, or inadequate fetal heart rate fluctuations. Forceps-assisted delivery may be indicated in cases of fetal distress meeting specific criteria. If forceps are not suitable, a cesarean section should be considered.

In all instances, expectant mothers should maintain regular prenatal care to minimize the risk of adverse scenarios. High-risk pregnancies should be closely monitored, utilizing labor charts to detect fetal distress early and intervene promptly, ensuring the best possible outcome for both mother and baby.