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Fetal Distress

The Causes of Fetal Distress

By Katherine Bontrager

At Anita Lavine's 40-week checkup, an ultrasound determined her amniotic fluid was low, so her
doctor decided this Seattle mom should be induced.

"I was given Pitocin that afternoon, which started contractions, but none that I could feel," says
Lavine. "As it turned out, the more Pitocin I was given and the stronger the contractions got, the
worse it was for the baby. Because the fluid was low, my uterus would squeeze down on him and the
cord each time, causing his heart rate to drop considerably."

An exhausting night passed, with nurses occasionally rushing into the room to turn Lavine on her
side in attempts to get the baby's heart rate back up. "In the morning, the doctor decided to insert a
tube that not only measured the strength of my contractions, but was able to supply me with more
fluid," says Lavine. "That immediately seemed to stabilize the baby so they could turn the Pitocin
back up to the point where my contractions were causing dilation. Everything took off from there."

Lavine says that once she was fully dilated, she only had to push for about 15 minutes. But as she
struggled, the baby's heart once again dropped, forcing her doctor to use a vacuum to extract her
little one at the end of the delivery.

What Is Fetal Distress?


Lavine's alarming experience is surprisingly common and was once referred to as fetal distress –
though that terminology seems to be changing.

"Fetal distress is a term that's really falling out of favor," says Dr. Jennifer Ashton, an OB/GYN at
Englewood Hospital and Medical Center in Englewood, N.J. "Now we say 'nonreassuring fetal heart
tracing.' What this means is that on the fetal heart monitor, the baby's heart pattern is such that it
may have lost its highly variable pattern (i.e., it becomes flat) or that it has a lot of decelerations.
This means that the heart rate drops to a low level for a time being; if this happens repeatedly, it can
stress the fetus."

Dr. Julie Lo, an OB/GYN at the University of Texas Southwestern Medical Center in Dallas, says when
a mother is laboring, her infant's heart rate is constantly monitored for such fetal heart rate
decelerations.

"There are three types of fetal heart rate decelerations: early, variable and late," says Dr. Lo. "Early
decelerations are indicative of head compression and are commonly seen in labor. Variable
decelerations are indicative of cord compression, which are commonly seen in labor and the pushing
stage of labor."

Dr. Lo says late decelerations are the most worrisome. "A single late deceleration without any other
findings can be common; however, if the late decelerations are persistent, there's concern for the
well-being of the fetus," she says. "But such decelerations will happen. There really is nothing the
parents can do prenatally to prevent the occurrence of decelerations of any kind."

Causes of Distress
Dr. Ashton says a variety of factors can cause this stress on the fetus, including "a loop of the
umbilical cord around the baby's neck [this is common – about 30 percent of babies have a cord
around the neck]; if the mom has a fever from a uterine infection during labor, during pushing and/or
contractions; or worse and much more rare events such as placental abruption or uterine rupture."

While some type of change in the fetal heart pattern is fairly common at some time during labor or
delivery, Dr. Ashton reports that true fetal distress resulting in an emergency C-section is not really
that common. In fact, she estimates this occurs less than 10 percent of the time.

"There are various maneuvers that can be done to minimize or correct fetal distress during labor or
delivery," says Dr. Ashton. "These include giving the mother extra IV fluid (which eventually
increases the blood flow to the baby), giving the mother extra oxygen, turning the mom on her side
(to relieve the compression of the big blood vessels in the abdominal cavity by the uterus) and even
an injection that temporarily stops contractions so that the baby has time to recover."

But should the fetal distress be severe, accompanied by other high-risk factors or occur for a long
enough time, Dr. Ashton says the baby can suffer metabolic effects that come from not having
enough oxygen. "This can result, in its worst form, in seizures after birth and possibly permanent
neurological injury," she says. "Premature babies may be more susceptible to this since they are
thought to be more fragile and less able to handle the normal stress of birth than a full-term baby."

For the vast majority of moms and newborns, such severe complications are relatively rare, says Dr.
Lo. "Pregnancies with early and variable decelerations commonly do well," she says. "Pregnancies
with late decelerations still do well so long as the physician recognizes the situation and promptly
addresses the situation – whether or not it is correcting the etiology or proceeding with delivery."

Because the only way to know if a baby is under stress is to monitor the heart rate over the entire
labor and delivery, people who don't want their baby's heart checked during labor are at higher risk,
in theory, for undiagnosed fetal distress, says Dr. Ashton. "A trained obstetrician will know what
types of changes in the heart pattern are concerning and which are not," she says. "Not every drop
in the baby's heart rate is a sign of distress. Sometimes, it can even be a sign of imminent delivery!"

And thankfully for Lavine, her stressful delivery has given way to a very joyous homecoming. "Long
story short, our little guy, Owen, is home and we're all doing well," she says. "It was just a scary first
20 hours or so."

Source

http://www.pregnancytoday.com/articles/labor-delivery/fetal-distress-4151/

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