Fetal Distress Case Studies

FETAL DISTRESS

The terms fetal distress and birth asphyxia are broad terms which may point at an adverse condition affecting the fetus.

Fetal distress is a a term used to describe a situation where the clinician feels that the fetus is hypoxic or acidotic or is at risk of becoming so and this concern is significant enough to warrant intervention, usually in the form of operative delivery100.

Fetal asphyxia is clinically defined as progressive hypoxaemia and hypercapnia with significant metabolic acidemia100.

In practice, obstetricians put great emphasis on monitoring of the fetal heart rate patterns as the main means of assessing fetal well- being in labour, whether done by intermittent auscultation or continuous electronic methods. However,

Importantly, the fetus is tethered by an umbilical cord, whereby blood flow is constantly in jeopardy. Thus, normal labor is a process where repeated fetal hypoxic events may occur, which may lead to academia in the baby.

Diagnosis-

Identification of “fetal distress” based on fetal heart rate patterns is imprecise and controversial due to intra and interobserver variations.

Because of high interobserver and intraobserver variability in the interpretation of fetal heart rate (FHR) tracings101, the American College of Obstetricians and Gynecologists (ACOG), and the United States National Institute of Child Health and Human Development (NICHD) convened a workshop to standardize definitions and interpretation for electronic fetal monitoring (EFM), propose management guidelines, and develop research questions. Major outputs from this workshop were a clear standard for FHR interpretation and a three-tier system for the categorization of intrapartum EFM10,12. This system has been widely adopted in the United States and elsewhere, and is the basis for this

Considering all of labor, the FHR pattern was category I in 77.9 percent of the time, category II 22.1 percent of the time, and category III 0.004 percent of the time. In the two hours before delivery, category I tracings were less commonly observed (60.9%) and both category II and category III tracings became more common (39.1% and 0.006%, respectively). They concluded that category I and II fetal heart rate patterns are more common in labour than category III. Increasing time in labour with a category II tracing in last 2 hours of labour is associated with increased short term newborn morbidity as seen by a low 5-minute Apgar score and increased NICU