Fetal distress describes signs that the baby is not getting enough oxygen, usually seen as an abnormal fetal heart rate pattern during labor. Today it is graded with the three-category tracing system, and the response is to correct the cause fast and deliver if the tracing does not improve.
Key symptoms
- Fewer fetal movements reported by the mother
- Meconium-stained amniotic fluid
- Abnormal tracing during labor, often found on the monitor
- Risk factors: preeclampsia, growth restriction, placental abruption, cord problems
What you find on exam
- Fetal heart rate baseline, variability and decelerations
- Maternal vital signs: low blood pressure, fever, fast pulse
- Uterine tone and contraction frequency (tachysystole)
- Vaginal exam for cord prolapse and labor progress
Tests
- Continuous electronic fetal monitoring, category I to III
- Biophysical profile before labor
- Ultrasound for fetal position and the placenta
- Umbilical cord blood gas after delivery
Treatment basics
- Turn the mother on her side and give IV fluids
- Stop oxytocin, and give terbutaline for too many contractions
- Treat low blood pressure and fever
- Prepare for urgent cesarean or assisted vaginal delivery if category III persists
- Call the neonatal team for the birth
Red flags
- Prolonged bradycardia, or absent variability with recurrent late decelerations
- Cord seen or felt at the cervix
- Heavy bleeding with constant abdominal pain (abruption)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.