Fetal Distress

Overview

What is fetal distress?

Fetal distress describes a condition when the fetus shows signs of distress during late pregnancy or labor. Most healthcare providers have replaced the term fetal distress with non-reassuring fetal status (NRFS). There are many reasons why the fetus could show signs of distress, such as labor, reactions to medications or issues with the umbilical cord or placenta. Fetal distress can be dangerous and cause complications for both you and the fetus. Your obstetrician looks for signs of distress as part of your pregnancy care.

Symptoms and Causes

What are the signs of fetal distress?

The most common signs of fetal distress are:

  • Changes in the fetal heart rate (lower or higher rate than normal).
  • The fetus moves less for an extended period of time.
  • Low amniotic fluid.

What causes fetal distress?

The most common cause of fetal distress is the fetus not getting enough oxygen. The fetus gets oxygen from you. You breathe oxygen into your lungs, then your blood carries it to the placenta. It’s handed off to the placenta and transferred to the fetus's blood. Anything that interrupts this process may lead to fetal distress.

Other conditions that may lead to non-reassuring fetal status are:

  • Too frequent contractions (tachysystole).
  • Fetal anemia.
  • Oligohydramnios (low amniotic fluid).
  • Pregnancy-induced hypertension (high blood pressure when you didn't have it before pregnancy).
  • Preeclampsia.
  • Abnormally low blood pressure.
  • Late-term pregnancies (41 weeks or more).
  • Fetal growth restriction (very small baby).
  • Placental abruption.
  • Placental previa.
  • Umbilical cord compression.
  • You have a chronic condition like diabetes, kidney disease or heart disease.
  • You’re expecting identical twins.

Diagnosis and Tests

How is fetal distress diagnosed?

Your pregnancy care provider diagnoses fetal distress by reading the fetal heart rate. A low heart rate, or unusual patterns in the heart rate, could signal fetal distress. Checking the fetal heart rate is a good way to find out if it's tolerating pregnancy and labor well.

During pregnancy your obstetrician may recommend other tests to monitor the fetal heart rate:

  • Nonstress test. An electronic fetal monitor measures the fetal heart rate while you're sitting or laying down. A belt with an electronic sensor is placed around your belly. During that time, the fetal heart rate is measured and recorded. The test can also measure your uterine contractions. The results are either reactive or not reactive based on how active the fetus is.
  • Biophysical profile. An ultrasound that measures fetal movement, muscle tone, breathing movement and amniotic fluid volume. It’s sometimes combined with a nonstress test.

During labor, your obstetrician monitors the fetal heart rate either continuously or intermittently. Continuous monitoring means you wear a device around your belly that reads the fetal heart rate at all times (this is the most common method). Intermittent monitoring means your provider checks the fetal heart rate at set times (like every 30 minutes).

The two most common ways to monitor fetal heart rate for fetal distress are:

  • Electronic fetal heart rate monitor. You wear a device with an attached sensor around your belly continuously during labor and birth. It sends the sounds of the fetal heart to a computer that your healthcare team can read.
  • Doppler devise. Your obstetrician places a hand-held device on your belly that detects the fetal heartbeat using sound waves. Your obstetrician uses a Doppler throughout your pregnancy, most likely at your routine prenatal checkups.

Management and Treatment

How is fetal distress treated?

If you’re in labor, some of the things your obstetrician may do to help during fetal distress include:

  • Changing your position. This may increase the blood return to your heart and oxygen supply to the fetus.
  • Giving you oxygen through a mask.
  • Giving fluids through your IV line.
  • Giving you medicine to slow or stop contractions.
  • Amnioinfusion (a procedure that places fluid in your amniotic sac to relieve umbilical cord compression).

If your baby is in trouble, your provider may need to deliver it right away. They may use forceps or a vacuum extractor if you're fully dilated and the baby is low enough in your uterus. Otherwise, they may need to perform an emergency c-section. Your provider will talk you through what is happening and why they are concerned. They will ask for your consent before any procedure.

What are the long-term effects of fetal distress?

Fetal distress can have lasting effects on your baby. Prolonged lack of oxygen during delivery can lead to brain injury, cerebral palsy or even stillbirth. If your baby is in distress, your provider will make every attempt to deliver your baby safely and before severe complications arise.

Prevention

How can I prevent fetal distress in pregnancy?

There's usually nothing you can do to prevent fetal distress. However, attending all of your prenatal appointments and maintaining a healthy pregnancy can help decrease your risk of conditions that lead to fetal distress. Additionally, discussing your pregnancy and labor symptoms with your obstetrician can help them identify fetal distress. For example, pay attention to fetal movement and let your provider know about vaginal bleeding, gushes of vaginal fluid or continuous and frequent contractions.

Outlook / Prognosis

What can I do if my baby is in distress?

If your baby is in distress, listening to your obstetrician and following their instructions is important. Don't be afraid to ask them what's going because sometimes things change quickly. In most cases, your provider will rely on you to let them know how you're feeling.

A note from Cleveland Clinic

Obstetricians know how to spot a baby experiencing distress during pregnancy and labor. Listening to the fetal heart rate and noting signs like decreased movement are ways to detect non-reassuring fetal status (fetal distress). Sometimes your baby may need to be delivered sooner to prevent serious complications. Listening to your body and telling your provider about your pregnancy and labor symptoms is the best thing you can do to lower the risk of fetal distress.

Last reviewed by a Cleveland Clinic medical professional on 08/11/2022.

References

  • American Pregnancy Association. Fetal Distress. (https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/fetal-distress/) Accessed 8/11/2022.
  • Merck Manual. Fetal Distress. (https://www.merckmanuals.com/home/women-s-health-issues/complications-of-labor-and-delivery/fetal-distress) Accessed 8/11/2022.
  • Pregnancy, Birth and Baby. Fetal Distress. (https://www.pregnancybirthbaby.org.au/fetal-distress) Accessed 8/11/2022.
  • Gravett C, Eckert LO, Gravett MG, et al. Non-reassuring fetal status: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. (https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5139811/) Vaccine. 2016;34(49):6084-6092. Accessed 8/11/2022.

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