9 Managing fetal distress

57. What is the management of a woman with fetal distress?

Fetal distress due to severe hypoxia is present. Therefore, you should immediately do the following:

1. Turn the mother onto her side to correct any supine hypotension (a low blood pressure which some pregnant women can develop in late pregnancy when they lie flat on their back).
2. If the woman is receiving an oxytocin infusion, this must be stopped immediately to prevent any uterine overstimulation.
3. If the fetal heart rate returns to normal, allow labour to proceed, but monitor the fetal heart rate very carefully and frequently. If possible, monitor with a CTG.
4. If the fetal bradycardia persists, the fetus must be delivered as soon as possible, which will be by Caesarean section in most cases. While preparing for Caesarean section, fetal resuscitation must be performed.

58. What is fetal resuscitation?

This is an effort to increase the amount of oxygen reaching the fetus while plans to deliver the fetus as soon as possible are put into place:

1. Keep the mother lying on her side to improve maternal blood flow to the placenta.
2. Start an intravenous infusion of Ringer’s lactate and give an intravenous beta stimulant (e.g. salbutamol) to relax the uterus and, thereby, improve maternal blood flow to the placenta. Contractions can also be stopped if 30 mg nifedipine (Adalat) is given by mouth. It is very important to stop uterine contractions.

The value of giving the mother 40% oxygen via a face mask is controversial and probably not helpful.

If the fetal heart rate pattern returns to normal after fetal resuscitation, it is still important to deliver the fetus without delay. This may involve moving the mother to a hospital where a CTG and safe Caesarean section can be performed. It is very important to continue with fetal resuscitation and monitoring of the fetal heart rate during transport.

It is important to always exclude reversible causes of fetal distress like supine hypotension (mother lying on her back) and overstimulation of the uterus with oxytocin.

Prepare for resuscitation of the newborn infant.

Further details of monitoring the fetus in labour and managing a woman with fetal distress can be viewed in both the Maternal Care and Intrapartum Care course books on the open website www.bettercare.co.za.