Fetal Distress Causes and Indicators

Fetal Distress

• Fetal distress is a condition where the fetus does not receive sufficient oxygen supply to meet its demands.
• Causes of fetal distress include:
  • Compression of the umbilical cord
  • Uteroplacental insufficiency caused by placental abnormalities or maternal condition
  • Decreased or absence of variability of heart rate

Fetal Heart Rate (FHR) Patterns

• Late deceleration pattern:
  • FHR slows following the peak of a contraction and slowly returns to baseline rate during the resting phase
  • Indicates fetal response to hypoxia from uteroplacental insufficiency
  • Considered an ominous pattern regardless of the depth of the deceleration of the FHR and requires immediate intervention
• Severe variable deceleration pattern:
  • FHR repeatedly decelerates below 90 beats/min for over 60 seconds before returning to baseline
  • Indicates interference of fetal blood flow from cord compression
  • Leads to fetal hypoxia and low APGAR scores unless steps are taken to correct it
• Tachycardia (above 160) is an early sign of distress, while bradycardia (below 110) is a late sign of distress.

Signs and Symptoms

• Meconium-stained amniotic fluid (excluding breech presentation)
• Changes in FHR baseline
• Decreased or absence of variability of heart rate
• HR varies less than 2-5 beats/min, causing a flattened appearance to the heart rate
• Indicates depression of the autonomic nervous system that controls heart rate

Assessment and Diagnoses

• Assess FHR baseline, variability, and pattern of periodic changes
• Assess contraction pattern and maternal response to labor
• Priority nursing diagnoses: Decreased cardiac output (fetal), Impaired gas exchange (fetal), Anxiety (maternal)

Planning and Implementation

• Institute emergency measures to correct fetal hypoxia based on FHR pattern
• For late deceleration, take steps to improve uteroplacental blood flow
• For severe variable deceleration, initiate actions to relieve cord compression

Late Deceleration (Uteroplacental Insufficiency)

• Goal is to improve maternal blood flow to the placenta
• Reposition the mother on her left side
• Administer oxygen by face mask at 8-10 L/min
• Increase IV fluids
• Discontinue oxytocin infusion, if labor is being induced
• Notify the health care provider immediately

Severe Variable Decelerations or Prolonged Bradycardia (Cord Compression)

• Goal is to relieve pressure on the umbilical cord
• Reposition the mother on either side
• If not corrected, reposition to opposite side
• Administer oxygen by face mask at 8-10 L/min
• Trendelenburg or knee-chest position, if not corrected
• Perform vaginal examination and apply upward digital pressure on the presenting part to relieve pressure on the umbilical cord

Medical Management

• Amnioinfusion: amniotic fluid may be replaced with warmed sterile saline through an intrauterine catheter when signs of cord compression are present during labor
• FHR monitoring is continued
• Intrauterine catheter is inserted
• Warmed sterile saline is delivered via the catheter using an infusion pump
• Infusion