Fetal distress

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]

  1. ^ a b c d "Fetal Distress". American Pregnancy Association. 2014-08-28. Retrieved 2021-09-09.
  2. ^ 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.
  3. ^ 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.
  4. ^ a b c d 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 & 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.
  5. ^ 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.
  6. ^ 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.
  7. ^ "Respiratory Support in Neonates and Infants - Pediatrics". MSD Manual Professional Edition. Retrieved 2021-09-13.