FETAL DISTRESSIn medicine (obstetrics) it refers to the presence of signs in a pregnant woman before or during childbirth that suggest the fetus may not be well.

SIGNS AND SYMPTOMS

Decreased movement felt by the mother Meconium in the amniotic fluid Non-reassuring patterns seen in cardiotocography(is a technical means of recording(-graphy) the

fetal heartbeat (cardio-) and the uterine contractions(-toco-) during pregnancy, typically in the 3rd trimester.”*increased or decreased fetal heart rate (tachycardia and bradycardia) especially during and after contraction*decreased variability in the fetal heart rate

Biochemical signs, assessed by collecting a small sample of baby’s blood from a scalp prick through the open cervix in labor*fetal metabolic acidosis (is a condition that occurs when the body produces excessive quantities of acid or when kidneys are not removing enough acid from the body)*elevated fetal blood lactate levels (from fetal scalp blood testing) indicating the baby has a lactic acidosis (is a physiological condition characterized by low pH in body tissues and blood (acidosis) accompanied by the build up of lactate, esp. L-lactate and is considered a distinct form of metabolic acidosis.,the condition typically occurs when cells retrieve too little oxygen (hypoxia) for example, during vigorous exercise. In this situation, impaired cellular respiration leads to lower pH levels. Simultaneously, cells are forced to metabolize glucose anaerobically, which leads to lactate formation. Therefore, elevated lactate is indicative of tissue hypoxia, hypoperfusion, and possible damage.)

Some of these signs are more reliable predictors of fetal compromise than others. For example, cardiotocography can give high false positive rates, even when interpreted by highly experienced medical personnel. Metabolic acidosis ia a more reliable predictor, but is not always available.

CAUSES

There are many causes of “fetal distress” including:

Breathing problems Abnormal position and presentation of the fetus Multiple births Shoulder dystocia Umbilical cord prolapse Nuchal cord ( a loop of umbilical cord around the fetal neck) Placental abruption Premature closure of the fetal ductus arteriosus (is a blood vessel connecting the pulmonary

artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus’s fluid-filled non-functioning lungs. Upon closure at birth, it becomes the ligament arteiosum. There are two other shunts, the ductus venosus and the foramen ovale.

Uterine rupture Intrahepatic cholestasis of pregnancy, a liver disorder during pregnancy

TREATMENT

Instead of referring to “fetal distress” current recommendations hold to look for more specific signs and symptoms, assess them, and take the appropriate steps to remedy the situation. Traditionally the diagnosis of “fetal distress” led the obstetrician to recommend rapid delivery by instrumental delivery or by caesarian section if vaginal delivery is not advised.

REFERENCES

1. ^Fetal Distress at the US National Library of Medicine Medical Subject Headings (MeSH)2. ^a b ACOG. “ Committee Opinion, Number 326, December 2005:Inappropriate Use of Terms

Fetal Distress and Birth Asphyxia” Retrieved June 9,2010.