What is Fetal Distress?
What is Fetal Distress? Fetal distress is a condition of the fetus that is not conducive to meeting the demands of labor. The condition of fetal distress is characterized by fetal hypoxia, a condition in which the fetus is not getting enough oxygen supply. This condition may occur before labor (antepartum period) or during labor (intrapartum period).
Fetal distress can be caused by many things, either from the condition of the fetus (umbilical cord, uterine infection, past delivery date) or mother’s condition (diabetes, high blood pressure or preeclampsia, pregnancy at age 35 and pregnancy with Twin or more fetuses).
Fetal distress itself can be detected through abnormal changes before delivery, such as changes in fetal movements that are slowing down. Doctors can also monitor fetal heart rate and amniotic fluid changes. If the observation shows the fetus in a state of emergency, the doctor can immediately perform the appropriate treatment in accordance with the condition of the mother and fetus. If untreated or not immediately born, the fetus may experience death. However, most cases with fetal distress can be delivered safely.
Symptoms of Fetal Distress
Fetal distress symptoms can be shown through abnormal conditions before delivery. Symptoms include:
- The fetal movement is less than usual. Movement of the baby may slightly decrease before delivery because the fetal space in the womb is reduced, but normally the movement of the fetus can still be felt.
- Heart rate grows slowly. The normal fetal heart rate is 110 to 160 per minute. If the heart rate is less than 110 or more than 160 per minute, then this condition may be considered abnormal. Fetal heart rate may slow temporarily when the uterus is at the beginning of contraction. Fetal distress can be ascertained if the heart rate continues to slow or decline after contraction.
- The color of amniotic water becomes brown or green. Amniotic fluid color in amniotic fluid is usually clear with slight pink, yellow, or red spots. But if the color of the liquid becomes green or brown, then the amniotic fluid has been mixed with meconium (stool from the fetus). The color of green meconium signifies the dirt just came out, while the brown color means meconium has long been out with amniotic fluid. This amniotic fluid change may present the risk of meconium aspiration syndrome (Meconium aspiration syndrome).
Causes of Fetal distress
The main cause of fetal distress is the lack of oxygen supply to the fetus (fetal hypoxia). This condition can occur related to the condition of the fetus itself or the condition of the mother. Conditions related to the fetus include:
- Low intrauterine growth restriction (IUGR), in which the fetal weight is less than the 10th percentile of normal weight in the same gestational age.
- The supply of oxygen through the umbilical cord is reduced. One cause is oligohydramnios, ie the volume of amniotic fluid slightly.
- Experiencing meconium aspiration syndrome This syndrome can cause irritation of the fetus’s lungs, infection, and block the fetal airway.
While the fetal distress associated with conditions in the mother, among them are:
- Pregnancy period of more than 42 weeks.
- Has anemia, diabetes, high blood pressure during pregnancy or preeclampsia.
- Pregnancy at age above 35 years.
- Pregnancy with twins or more
Fetal Death Diagnosis
Examination of the condition of fetal distress can begin after the movement of the baby is felt to decrease. Furthermore, several more detailed examinations are needed to establish a diagnosis of fetal distress, such as:
- Doppler ultrasound. This tool is used to see the blood flow, either the arteries or veins in the fetus. Scanning with a new Doppler ultrasound can be performed after 34 weeks of gestation or more.
- Observation of fetal heart rate. This observation can be done in two ways, namely periodically (intermittent auscultation) or continuously (continuous electronic fetal monitor). Periodic observations are performed every 15 minutes in the early stages of labor or every uterine contraction is over. Ongoing observations are made if pregnancy requires special care. This observation uses electronic fetal monitoring (EFM) devices that can show fetal heart rate pattern and heart rate response to fetal movement, fetal hypoxia, and mother uterine contractions. There are two sensors in the EFM mounted on the mother’s abdomen, one to observe uterine contractions and one to observe the fetal heart rate.
The diagnosis of fetal distress is established if the observations show decreased heart rate and fetal oxygen levels.
Fetal distress treatment
Once the fetus is diagnosed with fetal distress, the doctor needs to be treated promptly. Treatment includes resuscitation in utero and birth effort.
Resuscitation in the womb
This initial treatment aims to overcome the condition of fetal distress. Some of the ways that are performed in uterine resuscitation include:
- Ensure mother gets enough oxygen supply. This supply is provided by wearing the oxygen mask on the mother.
- Ensuring maternal fluid intake is adequate with intravenous fluids.
- Change the position of the mother by asking her to lie on the left side. It aims to reduce uterine pressure in the large vein in the body (vena cava) that can reduce blood flow to the placenta and fetus.
- Administration of intravenous hypertonic dextrose (intravenous hypertonic dextrose) solution.
- Tokolisis, a therapy to inhibit early labor by stopping the temporary contractions of the uterus.
- Amnioinfusion, ie the addition of fluids in the amniotic cavity to reduce cord pressure.
This action can be done if the way of resuscitation in the womb can not cope with the condition of fetal distress. Birth should be sought for at least 30 minutes if fetal distress is known.
Birth can be pursued through the vagina with the help of a vacuum on the baby’s head. If this method can not be done, then the fetus must be born through a caesarean section.
Baby’s condition will be closely monitored for an hour or two after birth, and every 2 hours during the first 12 hours after birth. Baby checks include general circumstances, chest movements, skin color, bones and muscles, body temperature, and baby’s heart rate.
If the baby is seen to have meconium aspiration syndrome, then the doctor needs to clear the baby’s airway to keep his breathing undisturbed. Observation still needs to be done although there is no meconium aspiration, especially those associated with infant respiratory distress.