What is fetal distress?

Article Abstract:

Fetal distress is a term often used by physicians to indicate the need for cesarean section or mechanically assisted delivery (use of forceps). Although most practitioners agree that fetal distress is related to decreases in the exchange of oxygen and carbon dioxide (asphyxia), some define it as an altered fetal heart rate pattern or increased blood acidity. Appropriate treatment of fetal distress is hampered by the lack of agreement concerning its diagnosis. To help clarify the nature of fetal distress, the cardiopulmonary (heart and lung) responses of the fetus during labor are described. When the oxygen supply to the fetus is compromised, the fetus can redistribute its blood supply to regulate the amount of oxygen reaching vital organs. Fetuses compensate for asphyxia in different ways depending on how profound or prolonged the deficit of oxygen is. Some fetuses have severe damage, such as cerebral palsy, and some have little or no neurological damage. Oxygen deprivation of greater than 25 minutes usually results in fetal death. There are three ways the fetus can be deprived of oxygen: insufficient blood flow through the placenta (the organ of fetal nutrition and oxygen supply); insufficient blood supply through the umbilical cord; and insufficient oxygen content in the mother's blood. During labor, contractions of the uterus produce characteristic fetal heart rate (FHR) patterns. It is believed that FHR patterns are strongly associated with fetal vitality at birth. When the uterus contracts, the fetal heart slows down, presumably because of umbilical cord compression. The presence of late decelerations, variable decelerations or persistent slow FHR (bradycardia) during contractions indicates oxygen insufficiency. If the FHR patterns are variable, then the heart and nervous system are receiving normal amounts of oxygen. If the patterns lose their variability, that is they become more static, it indicates that these organs are not receiving adequate oxygen. However, FHR variability can differ from fetus to fetus. Therefore, fetal distress can be defined as progressive fetal asphyxia as measured by decreased FHR variability. The clinical implications are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physiological aspects, Fetal heart rate, Labor, Complicated, Labor complications

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Validity of indication for transabdominal cervicoisthmic cerclage for cervical incompetence

Article Abstract:

Pregnant women with histories of incompetent cervix may benefit from transabdominal cervicoisthmic cerclage if they cannot receive a vaginal cerclage. Cerclage is a surgical technique where the cervix is held shut by a suture. Researchers performed 24 transabdominal cerclages on 23 patients, 14 of whom had previously undergone failed transvaginal cerclage, and nine of whom could not have transvaginal cerclage because of the anatomy of their cervix or cervical defects. Each patient delivered at least one live baby, for a total of 29 live babies, including two sets of twins. Two fetuses were lost, for an overall live birth rate of 93%. A drawback to the transabdominal cerclage procedure is the risk of large blood loss.

Surgery, Cervix uteri, Pregnancy, Complications of, Pregnancy complications, Cervical conization

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Screening for fetal well-being in a high-risk pregnant population comparing the nonstress test with umbilical artery Doppler velocimetry: a randomized controlled clinical trial

Article Abstract:

Doppler ultrasound scans of an unborn baby's umbilical cord is more effective in detecting fetal distress than nonstress tests, according to a study of 1,340 pregnant women. The ultrasound scan detects abnormal blood flow in the umbilical cord, which is a sign of fetal distress.

Methods, Fetal monitoring

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