Fetal distress is an emergency pregnancy, labor, and delivery complication in which a baby experiences oxygen deprivation (birth asphyxia).
Signs of fetal distress may include:
- Changes in the baby’s heart rate (as seen on a fetal heart rate monitor)
- Decreased fetal movement
- Meconium in the amniotic fluid (increasing risk for meconium aspiration)
Medical staff should monitor for these signs, among others. They must immediately address and manage fetal distress to avoid serious complications, such as hypoxic-ischemic encephalopathy (HIE), and other birth injuries, which can lead to conditions like cerebral palsy (CP).
Often, the only way to stop fetal distress is to deliver a baby, allowing doctors and nurses to administer medical care. This is usually accomplished by emergency C-section delivery.
Expectant mothers aren’t always with their physician when signs of fetal distress occur, so it’s important to recognize the following signs that indicate a baby is in trouble.
- Signs of Fetal Distress
- A Note on Terminology
- Causes of Fetal Distress
- Mismanaged Fetal Distress, Birth Injury, and Medical Malpractice
- Get Legal Help
Common Signs of Fetal Distress
Decreased Fetal Movement in the Womb
Beyond bringing joy to the family, movement within the womb is an important indicator of the baby’s health. Regular pauses in movement are normal, such as when babies sleep in the womb. However, if the baby becomes less active or completely ceases movement, this may be a cause for concern. Physicians should ask expectant mothers about fetal movement and conduct additional testing if patterns are abnormal.
Abnormal Fetal Heart Rate
Some fetal heart rate patterns indicate distress. To observe an unborn baby’s heart rate, medical professionals can use either an external or internal fetal monitoring device. External monitoring is done through a belt-like device that can be strapped around a mother’s abdomen, while internal monitoring involves attaching an electrode to the baby’s scalp. In a healthy labor and delivery, the baby’s heart rate will drop slightly during a contraction, and quickly return to normal once the contraction is over. Some variability in heart rate is to be expected and shows as a jagged line on the monitor.
The following fetal heart rate patterns are examples of nonreassuring patterns and warrant further investigation and/or medical intervention:
- An abnormally fast heart rate (tachycardia)
- An abnormally slow heart rate (bradycardia)
- Abrupt decreases in heart rate (variable decelerations)
- Late returns to the baseline heart rate after a contraction (late decelerations)
- Decreased heart rate variability
- Lack of fetal heart rate accelerations
In addition to fetal monitoring, an abnormal fetal heart rate may be recognized in a non-stress test (NST) or a contraction stress test (CST).
During an NST, a medical professional looks at how the baby’s heart rate changes when the fetus moves. A normal NST is called “reactive,” meaning that the baby’s heart rate went up and down as expected. “Non-reactive” means that the baby’s heart rate did not increase enough at times during the test. Physicians may also classify NST results into these categories:
- Requiring further testing and possibly delivery
- An emergency C-section is necessary
A CST helps predict how the baby will cope during the labor process and determines whether it is safe to proceed with a vaginal delivery. Uterine contractions temporarily restrict oxygen flow. A healthy baby can tolerate this temporary restriction, but it may be very dangerous for a baby in distress. During a CST, physicians record the baby’s heart rate in response to contractions.
If conducting a CST on a woman not yet in labor, the physician may give her Pitocin (synthetic oxytocin), to make the uterus contract. It is important to note that there are certain risks associated with this medication. Pitocin can cause uterine tachysystole (excessively strong, frequent, or long contractions), which can severely restrict oxygen flow to the baby and sometimes leads to uterine rupture.
Abnormal Amniotic Fluid Level
The amount of amniotic fluid can also be an indication of fetal distress. If there is abnormally low amniotic fluid, this is a condition called oligohydramnios, which can lead to oxygen deprivation and birth injuries like HIE and cerebral palsy (CP). A trending decrease in amniotic fluid may also warn of oligohydramnios, and should be watched closely. If there is an abnormally high amniotic fluid volume, this is known as polyhydramnios. Polyhydramnios can also cause oxygen deprivation and subsequent birth injuries.
The amount of amniotic fluid can be determined using a variety of ultrasound methods, including a qualitative assessment, the single deepest pocket (SDP), and the amniotic fluid index (AFI). The qualitative assessment is fairly subjective. The ultrasonographer scans the uterus and reports whether the amniotic fluid volume appears to be low, normal, or high, based on their own experience. THE SDP, sometimes called the maximum vertical pocket (MVP), is the vertical measurement (in centimeters) of the largest pocket of amniotic fluid that doesn’t contain parts of the fetal body or umbilical cord. The AFI is calculated by measuring the depth of the amniotic fluid in four sections of the womb and adding the numbers together.
Abnormal Results of Biophysical Profile (BPP)
A baby’s biophysical profile (BPP) is often taken if the results of an NST are non-reactive or nonreassuring. The BPP includes the NST results as well as an ultrasound to assess fetal movement, breathing, tone, and amniotic fluid volume. The nonstress test and each of the four ultrasound parameters are assigned a score of either zero or two points. A score of four or lower indicates fetal distress and requires immediate action. A total score of eight or higher is considered normal, unless the zero score relates to low amniotic fluid (oligohydramnios), which can put the baby at risk for umbilical cord compression. In that circumstance, admission to the hospital, close fetal monitoring, and delivery are required, otherwise the cord compression puts the baby at risk of not getting enough oxygen.
Small amounts of vaginal bleeding are fairly common during pregnancy. However, bleeding can also be an indication that something is wrong with the pregnancy. One particularly dangerous example is placental abruption, when the placenta tears away from the womb. Placental abruption deprives the baby of oxygen. Depending on the location and size of the abruption, it may not initially cause fetal distress, but the health of both mother and baby could still be in jeopardy, especially if the tear grows.
It is important to note that a placental abruption can be present with no vaginal bleeding (bleeding can be retained behind the placenta), but may still pose a serious risk.
A placental abruption and other placental problems that cause bleeding require very close monitoring, and in many cases, the mother should be admitted to the hospital and given an emergency C-section.
Some cramping is relatively normal during pregnancy. As the baby grows, the uterus needs to expand, which can cause cramping. However, in some cases, cramping is an indication of something more serious, such as miscarriage, placental abruption, preeclampsia, a urinary tract infection, or preterm labor. It is crucial that physicians appreciate cramping and perform proper tests to ensure the health of the mother and baby.
Insufficient or Excessive Maternal Weight Gain
Experts believe that for women with a healthy pre-pregnancy weight, a weight gain of anywhere between 25 and 35 pounds is normal during pregnancy (the ranges are different for women who were under or overweight before becoming pregnant, as well as for those who are carrying twins or multiples).
If a mother gains much less than what is typical, the fetus may be in distress and have a condition called intrauterine growth restriction (IUGR), where they are smaller than is developmentally appropriate, which can be associated with other problems. IUGR requires careful physician monitoring and testing, and often early delivery prior to labor. A mother should have regular prenatal visits, and her physician should know that abnormal weight changes may necessitate additional fetal monitoring.
Excessive maternal weight gain is associated with giving birth to a baby that is abnormally large, a condition known as macrosomia. Macrosomia can create a risky birth situation, such as cephalopelvic disproportion (CPD), where the mother’s pelvis is too small to accommodate the size of the baby’s head, or shoulder dystocia, in which the baby’s shoulder gets stuck on the mother’s pelvic bone during delivery.
Macrosomia is especially dangerous if the physician is unaware of the condition. An unaware physician may try to deliver the baby vaginally, and when delivery doesn’t progress the way it should , may use dangerous delivery devices. These may include birth-assisting tools like forceps and vacuum extractors, or labor induction drugs, such as Pitocin and Cytotec. Forceps and vacuum extractors can cause head trauma and brain bleeds, and labor induction drugs can cause contractions to be so strong, long, and frequent that the baby becomes deprived of oxygen. These issues can cause permanent brain damage in a baby, such as hypoxic-ischemic encephalopathy, which can lead to cerebral palsy, and periventricular leukomalacia (PVL). Often, the best way to deliver a macrosomic baby is by C-section.
A Note On Terminology
The American College of Obstetricians and Gynecologists (ACOG) cautions that the term fetal distress is “imprecise and nonspecific.” Instead, they recommend that “fetal distress” be replaced with “nonreassuring fetal status” and that a baby’s status should be further categorized into three separate groups that describe the extent to which the baby is affected.
Regardless of what terminology they prefer, it is important that medical professionals be very familiar with specific warning signs of fetal oxygen deprivation in order to prevent permanent harm.
Causes of Fetal Distress
The following are just a few underlying causes of fetal distress:
- Abnormal fetal presentation
- Forceps and vacuum extractor misuse
- Placental abruption
- Prolonged and arrested labor
- Umbilical cord problems
- Uterine rupture
Treating Fetal Distress
The medical team must skillfully and continuously monitor fetal well-being throughout pregnancy, labor, and delivery. They are responsible for recognizing and responding to signs of fetal distress.
If a baby is in distress, appropriate interventions may include the administration of oxygen, fluids, and medication to the mother, or a change in the mother’s position.
Often, an emergency C-section is required in order to remove the baby from the conditions causing the fetal distress, especially if earlier interventions did not cause fetal heart tones to become reassuring. An emergency C-section should be performed within 3 to 18 minutes, depending on the circumstances, and sometimes a lot sooner.
Mismanaged Fetal Distress Leading to a Birth Injury
Signs of fetal distress should always be taken seriously. It is critical that medical professionals promptly recognize and address these signs in order to prevent permanent injury and disability in a newborn baby.
They must be especially careful in assessing maternal and fetal health in high-risk pregnancies. If physicians dismiss signs of fetal distress or fail to follow standards of care for high-risk pregnancies, this constitutes medical negligence. If this negligence leads to injury, it is medical malpractice.
About ABC Law Centers
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Birth injury is a challenging area of law to pursue due to the complex nature of the medical records. The award-winning attorneys at ABC Law Centers (Reiter & Walsh, P.C.) have decades of joint experience with birth injury, hypoxic-ischemic encephalopathy (HIE), and cerebral palsy cases. To find out if you have a case, contact our firm to speak with one of our birth trauma attorneys. We have numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm unless we win your case. We give personal attention to each child and family we help, and are available 24/7 to speak with you.
“My experience with Jesse Reiter and his staff was amazing. I had been to two different law firms regarding my son and was told there was no case. I heard about Jesse and his firm from a newspaper article and thought I would give it another shot. Within 30 minutes of talking with Jesse while he was going over my sons hospital reports, he told me there was definitely a case. Jesse and his staff never made me wonder what was ‘happening with the case.’ They always filled me in on everything. I felt included. Any questions that I had were answered very quickly. Jesse and his team became to be like an extended family to us. I will forever be grateful for the hard work, dedication and the fight they fought for my son.”
-Client review from 10/16/2016
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Disclaimer: Please know that our website is owned by a birth injury law firm that focuses exclusively on birth injury cases. We try to provide useful medical information to our readers, but we cannot provide treatments or medical advice or treatments. If you might be having a medical emergency, please call 911 and seek immediate medical attention.
- Hofmeyr, G. J., & Novikova, N. (2012). Management of reported decreased fetal movements for improving pregnancy outcomes. The Cochrane database of systematic reviews, 4, CD009148.
- Fetal Heart Monitoring: What’s Normal, What’s Not?.
- Fetal Distress: Diagnosis, Conditions & Treatment
- Monitoring your baby before labor: MedlinePlus Medical Encyclopedia
- Assessment of amniotic fluid volume
- Biophysical profile test for antepartum fetal assessment
- Placental abruption: Pathophysiology, clinical features, diagnosis, and consequences
- Cramping During Pregnancy: Causes, Treatment & Prevention
- CDC: Reproductive Health
- Fetal Growth Restriction– Stanford Children’s Health11. Fetal Macrosomia
- Committee on Obstetric Practice. (2005). ACOG Committee Opinion. Number 326, December 2005. Inappropriate use of the terms fetal distress and birth asphyxia. Obstetrics and gynecology, 106(6), 1469.
- Intrapartum category I, II, and III fetal heart rate tracings: Management
Video: Attorneys discuss mismanaged fetal distress, delayed delivery, and birth injuries
In this video, birth injury attorneys Jesse Reiter and Rebecca Walsh discuss how a lack of oxygen to a baby’s brain (asphyxia) can cause birth injuries such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy. When a baby is in distress and experiencing birth asphyxia, they must be delivered right away to prevent brain injury.