WHAT IS FETAL DISTRESS?

An unborn baby needs an uninterrupted flow of oxygen to remain healthy. While in the mother's womb, the baby receives oxygen from the maternal blood supply through the placenta. Sometimes, the normal supply of blood is diminished or interrupted. If during the pregnancy or labor, the baby's blood supply is reduced or the amount of oxygen in the blood is diminished (conditions that are termed ischemia and hypoxia, respectively), the baby enters a state of "fetal distress" and is at risk for permanent brain damage and even death. Depending on the cause of the fetal distress, the mother's life may also be at risk. Because of the high risk that fetal distress presents, it is a condition that requires immediate resolution by either the alleviation of the cause or the immediate delivery of the baby.

When fetal distress is present, immediate action must be taken in order to restore proper blood supply and oxygenation to the baby. If conservative measures are unsuccessful, immediate delivery of the baby (often by cesarean section) is required in order to avoid prolonged periods of oxygen deprivation that cause permanent brain damage and may even lead to death.

WHAT CAUSES FETAL DISTRESS?

Fetal distress can be caused by any of several factors, including inadequate uteroplacental support or improper exchange by either the mother or the baby of oxygen and carbon dioxide; severe placental problems caused by high blood pressure (pre-eclampsia) and by diabetes; infection of the uterus or surrounding area; umbilical cord compression; a placental abruption (separation of the placenta from the uterine wall); or a uterine rupture. A uterine rupture is itself a life or death condition for both mother and baby in which every second that delivery is delayed results in additional permanent injury.

WHAT ARE THE SIGNS OF FETAL DISTRESS?

Throughout pregnancy and labor, the doctors, nurses, and other health care providers involved should monitor the development of the fetus for normal, healthy development. Typically, they look for:

• A normal baseline (120-160);
• Moderate Fetal Bradycardia (100-120), with good variability;
• Good beat-to-beat variability (STV);
• Accelerations;
• Heart Rate increases by 15-25 bpm over baseline;
• Increase persists for 15-25 seconds;
• Early decelerations; and
• Mild Variable Decelerations

as indicators that the fetus is healthy, and is not experiencing any form of distress during pregnancy or labor.

If the mother receives oxytocin, has a difficult labor, or is post-term, it may be appropriate to have a heightened concern that the pregnancy has become high-risk.

In addition, warning signs may appear suggesting that an unborn baby may be suffering from fetal distress. These warning signs include:

• Fetal Tachycardia (>160);
• Moderate Fetal Bradycardia (100-120) with lost variability ;
• Absent beat-to-beat variability (STV);
• Marked Fetal Bradycardia (90-100 bpm);
• Moderate Variable Decelerations;
• Variable Decelerations; and/or
• Early decelerations and slow return baseline.

In certain cases, there may also be indicators that the unborn baby is in distress and requires immediate delivery. Such indicators include:

• Meconium-stained amniotic fluid;
• Fetal Tachycardia with loss of variability;
• Prolonged marked Fetal Bradycardia with less than 90 bpm;
• Late decelerations;
• Severe Variable Decelerations;
• Fetal Heart Rate drops below 70 beats per minute; and/or
• Deceleration persists for 1 minute or more.

Your doctor, nurse, and other health care providers involved in caring for the mother and child during the pregnancy and delivery, should immediately respond to any sign of fetal distress. In the presence of one or more of the above warning signs, this means commencing proper monitoring of the fetus and when appropriate, beginning treatment of the mother and fetus to eliminate the complication that is causing fetal distress. If the treatment fails, or one or more of the signs that

indicate the need for cesarean become present, labor must be immediately induced through cesarean to prevent injury to mother and child. The failure to take these steps may amount to substandard medical care and constitute negligence.

TREATMENTS OF FETAL DISTRESS

When fetal distress is present, immediate action must be taken to restore proper blood supply and oxygenation to the baby.

If there are signs of fetal distress, the healthcare provider may choose to deliver the baby immediately (often by cesarean section). Often, however, he or she will take other steps first to try to improve and confirm the baby's condition. If mother is receiving oxytocin (a drug that induces labor), the healthcare provider may stop giving it because oxytocin can affect the baby's heart rate. If mother have been lying on her back, she may need to switch to your side. When the mother lies on her back, the uterus can press on a large vein or the umbilical cord, thereby interrupting blood flow to the baby. The healthcare provider also may give mother oxygen, which sometimes improves the baby's heart rate. If the fetal heart rate still seems too slow, tests can be performed to confirm the baby's condition. For example, the amniotic fluid may be checked for meconium (the baby's first stool). Its presence in the amniotic fluid is a sign of fetal distress. The response of the fetal heart to scalp stimulation also may be evaluated. Sometimes drugs are also used to try to improve the condition of the fetus in the uterus.

If conservative measures are unsuccessful, immediate delivery of the baby (often by cesarean section) is required to avoid prolonged periods of oxygen deprivation and permanent brain damage. In certain situations, it may be appropriate to resuscitate the baby in the uterus before performing the cesarean delivery in order to decrease the risk that the baby will suffer from oxygen deprivation. This is done through the use of medication to slow down the contractions, which will increase oxygen to to the fetus; to dilate the mother's blood vessels and raise her heart rate, which will also enhance the flow of blood. Even when this approach is appropriate, the fetus must continue to be monitored closely for signs that the treatment is not working, which would require the immediate commencement of the cesarean delivery.

The negligent failure of a healthcare provider to implement an appropriate treatment plan can result in permanent injury, or even death, to baby and mother.