Signs of acute fetal distress during labor

This article was professionally consulted by Specialist Doctor II Bui Thi Thu and Specialist Doctor II Tran Thi Mai Huong- Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.

Acute fetal distress during labor is a condition that threatens the life of the fetus, fetal health and the child's future mental and motor development. Acute fetal distress is responsible for one-third of all perinatal deaths. The consequences of acute fetal distress are difficult to assess because there are consequences of irreversible brain damage that manifests only after many years, in school age.

Uterine spasms may be primary, may be secondary to fetal-pelvic disproportion (common), may be due to incorrect administration of oxytocin. Aggressive uterine contractions can be: increased frequency of contractions (rapid contractions), increased intensity of contractions (strong contractions), and increased frequency and intensity (fast contractions). Intense uterine contractions reduce blood flow in the corpus callosum, prolonging the time of stagnation of blood in the lake to O2 deficiency and CO2 stagnation in the fetus.

In some cases, uterine contractions are normal, there is no fetal-pelvic disproportion, but the cervix dilates very slowly, even not at all. Usually seen in the back of the head, the head is not well bowed. If this condition is left to the patient, the patient will be tired, anxious, the uterine contractions will be disturbed and cause fetal distress.

Insufficient blood supply to the blood lake:
Chronic (fetal failure during pregnancy) pregnancy toxicity, preterm pregnancy, pre-existing high blood pressure... these diseases often make the fetus malnourished. nursing, at risk of acute fetal distress during labor. Acute fetal distress due to shock conditions (placenta placenta, placenta previa...). Hypotension due to supine position, overdose of antihypertensive drugs, shock due to analgesic methods (epidural anesthesia may cause hypotension due to vasomotor paralysis). The mother's blood O2 saturation is not enough: the mother has anemia, severe heart disease, lung disease (bronchial asthma).

Placenta: The exchange area is reduced (abruption, choroidal angiomas...). Umbilical cord: Prolapse of the umbilical cord in front of the throne, on the side, knotted umbilical cord, tight umbilical cord around the neck, abnormal anatomy of the umbilical cord.

Prematurity, old-term pregnancy, malnourished fetus, twin pregnancy, anemia, infection.

Acute fetal distress can occur at any time during labor. Signs of acute fetal distress during labor:
Amniotic fluid and meconium: Detecting when amniotic fluid breaks, it is necessary to actively detect amniotic fluid and meconium at the beginning of labor, the membranes have not broken by amniocentesis. Amniotic fluid mixed with meconium is a witness of past or present fetal distress. Amniotic fluid mixed with meconium can enter the respiratory tract causing infection, a severe prognosis when the child inhales meconium. Meconium and amniotic fluid alone are not enough to diagnose fetal distress. Some authors found that only 1/3 of the cases of fetal acidosis had amniotic fluid mixed with meconium and only 20% of the cases of amniotic fluid and meconium had acidosis in the fetus. Changes in fetal heart rate: Listen to the fetal heart rate with an obstetric stethoscope. Normal fetal heart rate ranges from 120 beats/min to 160 beats/min. If there is fetal distress can be seen: fetal tachycardia (over 160 beats/min); Slow fetal heart rate (less than 120 beats/minute), irregular fetal heart rate. Weak, faint, distant fetal heart sounds can be heard. Since there is an electronic monitoring of labor (monitor), the method of auscultation of the fetal heart has many disadvantages because it cannot continuously monitor the fetal heart rate, cannot hear the fetal heart during uterine contractions, therefore, no fetal heart rate changes associated with uterine contractions were observed. Therefore, detecting fetal distress by stethoscope is often slow and inaccurate. Symptom Monitoring: is a method of using a machine to continuously monitor both uterine contractions and fetal heart rate at the same time. The uterine contractions and fetal heart rate were recorded on paper as the basis for the analysis of the results. Fetal heart rate curve shows: basal fetal heart rate, fetal heart rate variability and fetal heart rate variability associated with uterine contractions. Diagnosis of fetal distress is mainly based on symptoms on obstetric monitoring. At Vinmec International General Hospital, pregnant women will be examined and consulted carefully to detect early warning signs of fetal distress in the uterus. During labor, pregnant women will be monitored and cared for according to standard procedures and protocols, especially relatives will be allowed to enter the delivery room to accompany the mother. In addition, the clinic and delivery room are always fully equipped with fetal heart monitors and have an oxygen system available to immediately supply to the mother when needed.