Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation.[1] Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics.[2][1][3] The term "non-reassuring fetal status" has largely replaced it.[4] It is characterized by changes in fetal movement, growth, heart rate, and presence of meconium stained fluid.[4]
Risk factors for fetal distress/non-reassuring fetal status include anemia, restriction of fetal growth, maternal hypertension or cardiovascular disease, low amniotic fluid or meconium in the amniotic fluid, or a post-term pregnancy. The condition is detected most often with electronic fetal heart rate (FHR) monitoring through cardiotocography (CTG), which allows clinicians to measure changes in the fetal cardiac response to declining oxygen.[1][5][4] Specifically, heart rate decelerations detected on CTG can represent danger to the fetus and to delivery.[4]
Treatment primarily consists of intrauterine resuscitation, the goal of which is to restore oxygenation of the fetus.[6] This can involve improving the position, hydration, and oxygenation of the mother, as well as amnioinfusion to restore sufficient amniotic fluid, delaying preterm labor contractions with tocolysis, and correction of fetal acid-base balance.[1] An algorithm is used to treat/resuscitate babies in need of respiratory support post-birth. [7]
Some of these signs are more reliable predictors of fetal compromise than others. For example, cardiotocography can give high false positive rates, even when interpreted by highly experienced medical personnel. Fetal acid-base status is a more reliable predictor, but is not always available.[8]
If there is too little amniotic fluid around the baby in the uterus, the baby can have trouble moving around in the uterus and its growth and temperature can be impacted. Low amniotic fluid can be caused by placental issues, high gestational blood pressure, some medications, as well as problems with the fetal kidney or urinary tract.[9]
If a fetus has meconium in their lungs when they are born, this prevents the pressure in their lungs from falling, which normally facilitates the transition to independent breathing. Since aspiration of meconium can lead to improper oxygenation due to obstruction and carries the potential risk for inflammatory pneumonitis, this is an important diagnosis to make in the setting of newborn respiratory distress.[10]
If hypertension in the mother occurs after the 20th week and meets certain criteria, this is considered preeclampsia/eclampsia. The mechanism of preeclampsia/eclampsia is unknown, but consequences if left untreated can include fetal growth restriction or death, as well as pose medical risks to the mother. Signs and symptoms of preeclampsia can include swelling, protein in the urine, headaches, vomiting, and abnormal labs that assess kidney and liver function, some of which may be considered severe preeclampsia or eclampsia.[11]
Monitoring of the mother and fetus prior to birth is critical to avoid complications after birth. This is often done via electronic fetal heart rate (FHR) monitoring, which helps providers monitor the fetus' heart rate to ensure it is receiving enough oxygen, monitor the mother's contractions, and monitor the mother's blood pressure and systemic symptoms for gestational hypertension, preeclampsia, or eclampsia.[1]
TreatmentEdit
Newborn receiving positive pressure ventilation
Instead of referring to "fetal distress", current recommendations hold to look for more specific signs and symptoms, assess them, and take the appropriate steps to remedy the situation[1] through the implementation of intrauterine resuscitation.[13] Traditionally the diagnosis of "fetal distress" led the obstetrician to recommend rapid delivery by instrumental delivery or by caesarean section if vaginal delivery is not advised.[citation needed]
An algorithm is used to treat/resuscitate babies in need of respiratory support post-birth. The algorithm steps include: clearing the airways and warming, stimulating, and drying the baby, positive-pressure ventilation (PPV), supplementary oxygen, intubation, chest compressions, and pharmacological therapy. The order of these interventions is set, and each step is done for 30 seconds with heart rate monitoring and assessment of chest movement prior to escalating to the next step in the algorithm.[14]
ReferencesEdit
^ abcdefg"Fetal Distress". American Pregnancy Association. 2014-08-28. Retrieved 2021-09-09.
^Committee on Obstetric Practice, American College of Obstetricians and Gynecologists (Dec 2005). "ACOG Committee Opinion. Number 326, December 2005. Inappropriate use of the terms fetal distress and birth asphyxia". Obstetrics and Gynecology. 106 (6): 1469–1470. doi:10.1097/00006250-200512000-00056. ISSN 0029-7844. PMID 16319282.
^ abcdeGravett C, Eckert LO, Gravett MG, Dudley DJ, Stringer EM, Mujobu TB, Lyabis O, Kochhar S, Swamy GK (December 2016). "Non-reassuring fetal status: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data". Vaccine. 34 (49): 6084–6092. doi:10.1016/j.vaccine.2016.03.043. PMC5139811. PMID 27461459.
^Kwon JY, Park IY (March 2016). "Fetal heart rate monitoring: from Doppler to computerized analysis". Obstet Gynecol Sci. 59 (2): 79–84. doi:10.5468/ogs.2016.59.2.79. PMC4796090. PMID 27004196.
^Kither H, Monaghan S (Jul 2019). "Intrauterine fetal resuscitation". Anaesthesia & Intensive Care Medicine. 20 (7): 385–388. doi:10.1016/j.mpaic.2019.04.006. ISSN 1472-0299.
^"Respiratory Support in Neonates and Infants - Pediatrics". MSD Manual Professional Edition. Retrieved 2021-09-13.
^Omo-Aghoja L (January 2014). "Maternal and fetal Acid-base chemistry: a major determinant of perinatal outcome". Ann Med Health Sci Res. 4 (1): 8–17. doi:10.4103/2141-9248.126602. PMC3952302. PMID 24669324.
^"Respiratory Support in Neonates and Infants - Pediatrics". MSD Manual Professional Edition. Retrieved 2021-09-10.
External linksEdit
October 23, 2023
fetal, distress, also, known, reassuring, fetal, status, condition, during, pregnancy, labor, which, fetus, shows, signs, inadequate, oxygenation, imprecision, term, fetal, distress, fallen, american, obstetrics, term, reassuring, fetal, status, largely, repla. Fetal distress also known as non reassuring fetal status is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation 1 Due to its imprecision the term fetal distress has fallen out of use in American obstetrics 2 1 3 The term non reassuring fetal status has largely replaced it 4 It is characterized by changes in fetal movement growth heart rate and presence of meconium stained fluid 4 Risk factors for fetal distress non reassuring fetal status include anemia restriction of fetal growth maternal hypertension or cardiovascular disease low amniotic fluid or meconium in the amniotic fluid or a post term pregnancy The condition is detected most often with electronic fetal heart rate FHR monitoring through cardiotocography CTG which allows clinicians to measure changes in the fetal cardiac response to declining oxygen 1 5 4 Specifically heart rate decelerations detected on CTG can represent danger to the fetus and to delivery 4 Treatment primarily consists of intrauterine resuscitation the goal of which is to restore oxygenation of the fetus 6 This can involve improving the position hydration and oxygenation of the mother as well as amnioinfusion to restore sufficient amniotic fluid delaying preterm labor contractions with tocolysis and correction of fetal acid base balance 1 An algorithm is used to treat resuscitate babies in need of respiratory support post birth 7 Contents 1 Signs and symptoms 1 1 Complications 2 Causes 3 Prevention 4 Treatment 5 References 6 External linksSigns and symptoms EditGenerally it is preferable to describe specific signs in lieu of declaring fetal distress that include citation needed nbsp Cardiotocography is used to monitor fetal heart rate Decreased movement felt by the mother Meconium in the amniotic fluid meconium stained fluid Non reassuring patterns seen on cardiotocography increased or decreased fetal heart rate tachycardia and bradycardia especially during and after a contraction decreased variability in the fetal heart rate late decelerations Biochemical signs assessed by collecting a small sample of baby s blood from a scalp prick through the open cervix in labor fetal metabolic acidosis elevated fetal blood lactate levels from fetal scalp blood testing indicating the baby has a lactic acidosisSome of these signs are more reliable predictors of fetal compromise than others For example cardiotocography can give high false positive rates even when interpreted by highly experienced medical personnel Fetal acid base status is a more reliable predictor but is not always available 8 Complications Edit Complications are primarily those associated with insufficient fetal oxygenation most notably increased mortality risk Other complications include fetal encephalopathy seizures cerebral palsy and neurodevelopmental delay 4 Causes EditSeveral conditions and risk factors can lead to fetal distress or non reassuring fetal status 1 including Low amniotic fluid oligohydramnios If there is too little amniotic fluid around the baby in the uterus the baby can have trouble moving around in the uterus and its growth and temperature can be impacted Low amniotic fluid can be caused by placental issues high gestational blood pressure some medications as well as problems with the fetal kidney or urinary tract 9 Meconium in the amniotic fluid If a fetus has meconium in their lungs when they are born this prevents the pressure in their lungs from falling which normally facilitates the transition to independent breathing Since aspiration of meconium can lead to improper oxygenation due to obstruction and carries the potential risk for inflammatory pneumonitis this is an important diagnosis to make in the setting of newborn respiratory distress 10 Gestational Hypertension If hypertension in the mother occurs after the 20th week and meets certain criteria this is considered preeclampsia eclampsia The mechanism of preeclampsia eclampsia is unknown but consequences if left untreated can include fetal growth restriction or death as well as pose medical risks to the mother Signs and symptoms of preeclampsia can include swelling protein in the urine headaches vomiting and abnormal labs that assess kidney and liver function some of which may be considered severe preeclampsia or eclampsia 11 Post term pregnancy Breathing problems Anemia 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 Uterine rupture Intrahepatic cholestasis of pregnancy a liver disorder during pregnancy Maternal diabetes Type 1 or 2 or gestational diabetes GDM 12 Prevention EditMonitoring of the mother and fetus prior to birth is critical to avoid complications after birth This is often done via electronic fetal heart rate FHR monitoring which helps providers monitor the fetus heart rate to ensure it is receiving enough oxygen monitor the mother s contractions and monitor the mother s blood pressure and systemic symptoms for gestational hypertension preeclampsia or eclampsia 1 Treatment Edit nbsp Newborn receiving positive pressure ventilationInstead of referring to fetal distress current recommendations hold to look for more specific signs and symptoms assess them and take the appropriate steps to remedy the situation 1 through the implementation of intrauterine resuscitation 13 Traditionally the diagnosis of fetal distress led the obstetrician to recommend rapid delivery by instrumental delivery or by caesarean section if vaginal delivery is not advised citation needed An algorithm is used to treat resuscitate babies in need of respiratory support post birth The algorithm steps include clearing the airways and warming stimulating and drying the baby positive pressure ventilation PPV supplementary oxygen intubation chest compressions and pharmacological therapy The order of these interventions is set and each step is done for 30 seconds with heart rate monitoring and assessment of chest movement prior to escalating to the next step in the algorithm 14 References Edit a b c d e f g Fetal Distress American Pregnancy Association 2014 08 28 Retrieved 2021 09 09 Committee on Obstetric Practice American College of Obstetricians and Gynecologists Dec 2005 ACOG Committee Opinion Number 326 December 2005 Inappropriate use of the terms fetal distress and birth asphyxia Obstetrics and Gynecology 106 6 1469 1470 doi 10 1097 00006250 200512000 00056 ISSN 0029 7844 PMID 16319282 Parer JT Livingston EG June 1990 What is fetal distress Am J Obstet Gynecol 162 6 1421 5 discussion 1425 7 doi 10 1016 0002 9378 90 90901 i PMID 2193513 a b c d e Gravett C Eckert LO Gravett MG Dudley DJ Stringer EM Mujobu TB Lyabis O Kochhar S Swamy GK December 2016 Non reassuring fetal status Case definition amp guidelines for data collection analysis and presentation of immunization safety data Vaccine 34 49 6084 6092 doi 10 1016 j vaccine 2016 03 043 PMC 5139811 PMID 27461459 Kwon JY Park IY March 2016 Fetal heart rate monitoring from Doppler to computerized analysis Obstet Gynecol Sci 59 2 79 84 doi 10 5468 ogs 2016 59 2 79 PMC 4796090 PMID 27004196 Kither H Monaghan S Jul 2019 Intrauterine fetal resuscitation Anaesthesia amp Intensive Care Medicine 20 7 385 388 doi 10 1016 j mpaic 2019 04 006 ISSN 1472 0299 Respiratory Support in Neonates and Infants Pediatrics MSD Manual Professional Edition Retrieved 2021 09 13 Omo Aghoja L January 2014 Maternal and fetal Acid base chemistry a major determinant of perinatal outcome Ann Med Health Sci Res 4 1 8 17 doi 10 4103 2141 9248 126602 PMC 3952302 PMID 24669324 Low Amniotic Fluid Michigan Medicine www uofmhealth org Retrieved 2021 09 13 Meconium Aspiration Syndrome Pediatrics MSD Manual Professional Edition Retrieved 2021 09 10 Preeclampsia and Eclampsia Gynecology and Obstetrics MSD Manual Professional Edition Retrieved 2021 09 13 Tarvonen M Hovi P Sainio S Vuorela P Andersson S Teramo K November 2021 Intrapartal cardiotocographic patterns and hypoxia related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus Acta Diabetol 58 11 1563 1573 doi 10 1007 s00592 021 01756 0 PMC 8505288 PMID 34151398 S2CID 235487220 Garite TJ Simpson KR March 2011 Intrauterine resuscitation during labor Clin Obstet Gynecol 54 1 28 39 doi 10 1097 GRF 0b013e31820a062b PMID 21278499 Respiratory Support in Neonates and Infants Pediatrics MSD Manual Professional Edition Retrieved 2021 09 10 External links Edit Retrieved from https en wikipedia org w index php title Fetal distress amp oldid 1170061473, wikipedia, wiki, book, books, library,
