Fetal Distress

BY:
B U EN A F E , D REX L E R JU S T I NE A .
 What is fetal distress?

 Fetal distress is the term commonly used to

describe fetal hypoxia. It is a clinical diagnosis
made by indirect methods and should be defined
as:
- Hypoxia that may result in fetal damage or death
if not reversed or the fetus delivered immediately.
 Etiology

 Fetal oxygen supplied from:

 maternal circulation-----placenta------umbilical cord------fetus

 maternal factors
 cardiovascular diseases

 Gestational Diabetes

 acute bleeding

 uterus
 Etiology

 Fetal factors
 cardiovascular dysfunction
 deformity

 Umbilical cord and placental factors

 abnormal cord: entanglement,
nuchal umbilical cord,
prolapse of cord
 abnormal placenta
 Causes of Hypoxia*
risk factors
Maternal risk factors
 Diabetes
 Pregnancy-induced or chronic hypertension
 Maternal infection
 Sickle cell anemia
 Chronic substance abuse
 Asthma
 Seizure disorders
 Post-term or multiple-gestation pregnancy
 Intrapartum causes of fetal hypoxia**

 Abnormal presentation of the fetus (i.e. breech)

 Premature onset of labor
 Rupture of membrane more than 24 hours prior to
delivery
 Prolonged labor
 Administration of narcotics and anesthetics
 Maternal hypoventilation
 Maternal hypoxia
 Hypotension can be caused by either epidural
anaesthesia or the supine position, which
reduces inferior vena cava return of blood to the
heart. The decreased blood flow in hypotension
can be a cause of fetal distress (supine
hypotension syndrome**).
 Clinical manifestation

 Chronic fetal distress

 FGR (fetal growth restriction)

 dysfunction of maternal-placental-fetal unit

 fetal heart monitoring

 fetal movement calculation

 amnioscopy
 Clinical manifestation

 Acute fetal distress

 fetal heart rate  Acidosis
 >180 bpm (tachycardia) FBS (fetal blood
 <100 bpm (bradycardia) sample, pH<7.20)
 LD-repeated Late
Deceleration pO2<10 mmHg (15-
 Placenta dysfunction
30mmHg)
 VD-Variable deceleration CO2>60mmHg (35-
 Umbilical factors 55mmHg)
 characteristics of fluid
(meconium staining)
 fetal movement (decrease
and weaken)
How to define the newborn asphyxia

 Usually with fetal distress.

 Apgar score: 8-10 normal
 4-7 mild asphyxia
 0-3 severe asphyxia
 Effects of Asphyxia
 Fetal hypoxia is associated with severe
complications in all systems. The infant may
suffer:

 Hypoxic ischemic encephalopathy

 Meconium aspiration syndrome
 Acidosis with decompensation
 Cerebral palsy
 Neonatal seizures
 Meconium aspiration most often occurs in

 Term infants
 Growth-retarded infants
 Post-term infants
 Breech presentation delivery
 The degree of meconium aspiration and the length of
exposure to meconium determines the severity of the
hypoxia suffered by the fetus. Staining of the umbilical cord,
skin, or nails of the infant indicates exposure to meconium
3 to 6 hours in utero prior to delivery.
 Assessment
**
Antepartum Testing:
Tests for antepartum fetal evaluation include:
 Fetal movement count
 Non stress test
 Contraction stress test
 Biophysical profile
 Non Stress Test (NST)

 The is an indirect measurement

of uteroplacental function and
requires specialized equipment
and trained personnel.
 This test measures the detection
of heart rate accelerations
associated with perceived fetal
movements.
 A reactive or normal stress test
will exhibit at least two
accelerations in the fetal heart
rate in a 20-minute period.
 Contraction Stress Test (CST)

 CST or oxytocin challenge test, is more costly and

presents more of a risk to the fetus. but identifies
fetal reserve during contractions. The test measures
late decelerations during contractions induced by
either nipple stimulation or oxytocin infusion. The
test is negative if no late decelerations are observed.
 Biophysical profile

 fetal movement
 amniotic fluid volume
 respiratory movement
 movement of extremity
 NST
 Intrapartum Testing
Tests utilized to assess fetal well being during labor
include:
 Intermittent auscultation of the fetal heart rate
 Continuous electronic fetal monitoring
 Scalp pH measurement
 Scalp pH measurement helps to
determine the presence of acidosis and
fetal hypoxia and may influence the
decision of whether to continue
observation or to perform a cesarean
delivery. Neurologic deficits usually
occur when there is a severe acidosis,
due to hypoxia, present at birth.
Severe hypoxia will often cause
hypoxic-ischemic encephalopathy in
the infant.
 Treatment of Hypoxia

Mother’s condition must be treated to prevent

hypoxia to the fetus including:
 Blood pressure stabilization
 Maternal positioning on the left side
 Monitoring maternal oxygenation
 Pelvic exam to identify cord presentation
 Treatment of Hypoxia
 Oxygen administration to the mother may
provide additional availability of oxygen to the
fetus. Trained neonatal resuscitation staff
should be available at all times and should be
present in the delivery suite for those patients
with known risk for fetal distress or hypoxia.
 Cesarean sections are performed if all else
fails, and are the last alternative when faced
with the possibility of fetal distress.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATION
N
SUBJECTIVE: Anxiety related to After 8 hrs of >Explain the >Information and After 8 hrs of
“Sobrang perceived or nursing procedures, knowledge of the nursing
kinakabahan na ko actual threats to intervention, the nursing reasons of these intervention, the
sa sitwasyon namin self and fetus as patient will be interventions, and activities can patient was able
ng baby ko.” as
evidenced by able to verbalize treatment decrease fear of to verbalize
verbalized by the
sympathetitc understanding of regimen. Keep the unknown. understanding of
patient.
stimulation. individual communication individual
OBJECTIVE: situation and open; discuss with situation and
• Vital signs: possible outcome the client the possible outcome
BP-130/80 and with vital possible side and with vital
RR-17 cpm signs within effects and signs within
PR-100bpm normal limits. outcomes while normal limits.
T°-37.5 maintaining an
optimistic
• FHR- 95 bpm attitude.
• Late
deceleration
>Orient client and >Helps client
noted.
partner to labor and/or significant
suite environment others feel at ease
and more
comfortable in
their
surroundings.

>Answer >Provision of
questions clear information
honestly, can help the client
especially or couple
information understand what
regarding is happening and
contraction may reduce
pattern and fetal anxiety
status.
>Encourage use >Enables the
of relaxation client to obtain
techniques. maximum benefit
from rest periods;
prevents muscle
fatigue and
improves uterine
blood flow.

>Can help reduce

>Encourage anxiety and
verbalization of stimulate
fears or concerns. identification of
coping behaviors.

>Monitor >Vital signs of

maternal and fetal client and fetus
vital signs. may be altered by
anxiety.
Stabilization may
reflect reduction
anxiety level.