All you need to know about foetal distress

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What does the term ‘distress’ mean?

It means that a baby isn’t coping in the uterus. Foetal distress usually occurs when the baby doesn’t receive enough oxygen or nutrients from his mother through the placenta. This can happen due to many reasons. “If a baby doesn’t receive enough oxygen, it can lead to significant damage of his neurological and cardiovascular system, and he may go on to develop cerebral palsy or many other neurological problems,” explains obstetrician and gynaecologist, Dr Judith Carter.

Causes of foetal distress

The main reasons for foetal distress are:

  • Cord prolapse (when the cord falls below the head and gets compressed)
  • Maternal hypertension (when the mother has low blood pressure)
  • Placenta detachment
  • Infection in the membranes and amniotic fluid
  • Over-stimulation – oxytocin or prostaglandin (when the mother has too many contractions in a short period.

The main reasons for foetal distress in a ‘small’ baby are:

  • Infection of the placenta
  • Pre-eclampsia
  • When parts of the placenta aren’t functioning
  • Hypertensive conditions, especially with proteinuria
  • Idiopathic placental insufficiency
  • Detachment of the placenta

How will my doctor know if my baby is in distress?

Foetal distress can occasionally be predicted. “We usually anticipate that babies of women who suffer from pre-eclampsia and diabetes, and babies who grow poorly during pregnancy, may develop distress during either pregnancy or labour. However, foetal distress can occur in low-risk pregnancies too, and these cases can be unpredictable,” says Carter.

Signs of foetal distress

Dr Carter says there are various ways to assess whether or not a baby is in distress:

  • During pregnancy, poor movement of the baby may indicate that all is not well. A non-stress test (NST) can be done to assess foetal well-being. This involves putting probes on the mother’s stomach to measure her baby’s heart rate and to show signs of contractions.
  • If the NST doesn’t reveal an obviously well baby, an ultrasound can be done and various criteria taken into account (called a biophysical profile), which assists in deciding if the baby is well or not.
  • During labour, foetal heart rate can initially be assessed with a stethoscope, but if there is any hint of an abnormality, then an NST in labour (called a cardiotocograph or CTG) must be performed.
  • The colour of the amniotic fluid can also be an indication of whether the baby is in distress or not. Distressed babies may pass meconium into the fluid and if the mother’s waters have broken, this will show up as the drainage of yellow or green fluid. (Note: not all babies who pass meconium are distressed.)

What will my doctor do?

Most doctors will suggest a C-section if there is evidence of distress and if delivery is not imminent. If the labouring mother is fully dilated, the doctor will most likely perform an assisted delivery with forceps or a ventouse vacuum in order to deliver the baby as soon as possible.

Dr Carter says doctors usually suggest an elective C-section if they’re worried that the baby has already been compromised during pregnancy (for example, babies who have grown poorly or have poor amniotic fluid or placental blood flow).

Should I be worried if my baby moves too little?

Dr Carter says a baby who doesn’t move well is sometimes an indicator that he could be in distress, but moms have to remember that while some babies are very active, others are less so. “If a baby had a certain pattern of movement and there is a sudden change or slowing down of that movement, you should contact your doctor immediately. This doesn’t always mean something is wrong though – your baby may just be having a lazy day. But it is best to get it checked out.

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