Understanding Foetal Distress-
Signs that a baby is unwell and is being compromised before or during labor is called foetal distress. The term commonly means that the foetus is not receiving adequate amounts of oxygen during pregnancy or labor. It can also be termed as a “non-reassuring foetal status", a status that causes concern as it can result in foetal damage or death if it is not reversed or if the foetus is not promptly delivered.
Foetal distress is fairly common. About one in four labours or births are complicated by foetal distress. Many of these babies will have been affected by a pre-existing pregnancy complication, such as pre-eclampsia which affects how the placenta functions.
Other potential precursors to fetal distress or non-reassuring fetal status may include:
- Anemia ( the most common reason)
- Pregnancy Induced Hypertension (PIH)
- Gestational diabetes
- Post-term pregnancies (42 weeks or more)
- Small for date babies (if baby has not been receiving enough oxygen through the placenta)
- Twin pregnancy
- Rhesus sensitivity
Signs of Foetal Distress:
The foetus exhibits signs of distress when it's heart rate either accelerates or slows down.
The normal range of a full-term baby's heart rate is between 110 beats and 160 beats per minute.
A faster heart rate could be because the mother has a fever or is dehydrated. A slower heart rate during contractions could be caused by the maternal position, such as lying on her back. The doctor may ask the mother to change her position or to get up and move around while in labour.
Even if heart rate is lower or higher than the normal there should be other signs to help decide whether there really is a problem.
Other signs may be an abnormal slowing down of labour. The baby may pass meconium (dark green faecal material) into the amniotic cavity. This and other abnormal substances may be detected in the amniotic fluid when the waters break.
Amniotic fluid is usually clear, with a hint of pink, yellow or red. But if it's brown or green-coloured, this is a sign that the baby has passed meconium. Old meconium tends to be brown, and more recently passed meconium is greenish.
The colour and thickness of the meconium is important. Thick meconium can cause problems if it gets into the baby's airways.
What can be done?
The doctor will monitor the baby by either auscultating for the foetal heart at intervals with a a hand-held Doppler ultrasound (Sonicaid) or ear trumpet (Pinard stethoscope) on the belly.
Electronic foetal monitoring can also be done to give a continuous record of the foetal heart rate. This is usually done if complications such as gestational diabetes, high blood pressure or infection are present. It will also be done in induced labour or if a drip is being given to the mother.
* If the waters have broken a foetal scalp electrode can be placed on the head of the foetus for a more accurate reading of the baby's heartbeat. If the foetal electrode shows an acceleration of the heartbeats further tests are done. The doctor should be absolutely sure that the baby is in distress before taking any further action.
Foetal monitoring with an electronic device shows a foetal scalp pH of less than 7 if baby is in distress.
The doctor can touch the baby's scalp to see if the baby responds to the stimulation. A tiny sample of blood from the baby's scalp (a fetal blood sample) can be drawn and be tested for oxygen levels. This is the best indicator of how the baby is coping with labour.
If the sample is well-oxygenated, the labour is likely to carry on as it is. If oxygen levels are at a lower level than they should be, the test may be repeated.
The doctor will also pay attention to increasing the maternal fluid levels by oral or I/V drips.
The mother may be asked to lie down on her left side to improve the blood flow to the placenta. She may be given oxygen and medicines to bring down her fever.
If the baby still shows signs of foetal distress, despite these efforts, the baby will need to be delivered as soon as possible.
The method of delivery opted for would depend partly on the stage of labour and whether the cervix is fully dilated. The baby may need to be born vaginally, with the aid of a sucker-cap on her head (ventouse), or with forceps.
If neither of these types of assisted birth is suitable, the baby may need to be born by caesarean section.
After birth, the baby's airways need to be cleared immediately. If there has been meconium in the amniotic fluid, and the baby has inhaled it, there's a small risk that his airways may be affected. This is called meconium aspiration syndrome (MAS).
Meconium aspiration can irritate the baby's lung tissues and/or cause infections. At worse it can block the baby's airways.
If the baby shows signs of respiratory distress she will be admitted to the neonatal unit. Most babies improve with treatment and recover completely from MAS.
Even if there are no symptoms of respiratory distress, the baby will be kept under observation for any signs of breathing problems. It's general wellbeing, chest movements, skin colour, feeding, muscle tone, temperature and heart rate will be carefully monitored for a while.
So be aware of foetal distress and know the requisites on your own. Download LAIMA, stay healthy, stay updated.