- Decreased fetal movement or a change in the baby’s usual movement pattern needs prompt evaluation.
- Heavy vaginal bleeding, leaking greenish amniotic fluid, or sudden severe abdominal pain are urgent warning signs.
- Meconium-stained fluid with abnormal fetal heart rate patterns can signal a serious problem during pregnancy or labor.
Fetal distress is a general term used to describe signs that the fetus may not be getting enough oxygen during pregnancy or labor. In current medical practice, healthcare providers usually describe the specific finding, such as decreased fetal movement or an abnormal fetal heart rate pattern.
These signs may occur suddenly or develop gradually, depending on the underlying cause. Common causes include placental problems, umbilical cord issues, prolonged labor, or high-risk pregnancy conditions.
Treatment depends on the cause, severity, and gestational age. Management may include close monitoring and interventions to improve oxygen delivery, and in more severe cases, urgent delivery.
Potential signs
Signs that may indicate fetal compromise include:
1. Decreased fetal movement
A decrease in fetal movement, as reported by the pregnant person, may suggest a reduced oxygen supply.
Any decrease, change in the usual movement pattern, or absence of fetal movement should be evaluated.
If the baby is moving less, it is important to see your OB-GYN or midwife for assessment, which may include an ultrasound or other tests.
2. Abnormal fetal heart rate pattern
Changes in the baby’s heart rate may include patterns that are too fast, too slow, or otherwise not reassuring. These changes can happen when blood flow to the placenta is reduced, which may lower the baby’s oxygen supply.
According to the American College of Obstetricians and Gynecologists (ACOG), fetal heart rate patterns during labor are classified as Category I (reassuring), Category II (indeterminate), or Category III (nonreassuring) to help guide clinical management.
3. Meconium-stained amniotic fluid
Meconium in the amniotic fluid means the baby has passed its first stool (pooped) before being born.
This finding can be concerning, especially when combined with abnormal fetal heart rate patterns or decreased fetal movement.
However, meconium alone does not confirm that the fetus is not getting enough oxygen and should be interpreted in a clinical context.
Warning signs
The following signs may indicate complications that can affect the fetus and require immediate medical attention:
-
Heavy vaginal bleeding
-
Leaking greenish amniotic fluid
-
Sudden, severe abdominal pain
-
A pregnant belly measuring smaller than expected for gestational age
-
Too little weight gain during pregnancy or excessive weight gain
These findings may be associated with conditions such as placental abruption, fetal growth restriction (IUGR), or other pregnancy complications.
The mother may also notice that the baby is moving less than usual.
How can you tell the baby is in distress?
A pregnant person may suspect a problem based on changes in fetal movement or other concerning symptoms.
It is important to go to the emergency room or contact an obstetric provider as soon as possible for evaluation.
Confirming a diagnosis
Potential fetal distress is evaluated by an OB-GYN using clinical symptoms and tests that assess fetal well-being.
Tests for fetal well-being
According to ACOG, tests used to monitor fetal well-being include:
-
Fetal movement counts: to track how often the baby moves over a set period of time
-
Nonstress test (NST): to evaluate the fetal heart rate in response to movement
-
Biophysical profile (BPP): to assess movement, muscle tone, breathing, and amniotic fluid volume
-
Modified biophysical profile: combines a nonstress test with amniotic fluid assessment
-
Contraction stress test (CST): evaluates the fetal heart rate response to uterine contractions
-
Umbilical artery Doppler ultrasound: assesses blood flow in the umbilical cord in certain high-risk pregnancies
These tests may be performed during pregnancy, and some may also be used during labor, to help guide management decisions.
What causes fetal distress?
Fetal distress is caused by a reduced supply of oxygen to the fetus.
It may occur suddenly or develop gradually during pregnancy.
Risk factors
The main factors that increase the risk for fetal distress are:
-
Placental abruption or placental insufficiency
-
Umbilical cord compression
-
Anemia during pregnancy
-
Maternal infections
-
Gestational diabetes or high blood pressure during pregnancy
-
Prolonged or induced labor
-
Drug or alcohol use during pregnancy
It may also be associated with advanced maternal age, twin pregnancy, or other high-risk pregnancies.
What to do
If there are signs of possible fetal compromise, it is important to seek medical care immediately.
The healthcare provider will evaluate the cause and may take steps to improve oxygen delivery, such as maternal repositioning and close monitoring.
Is fetal distress serious?
Fetal distress can be serious because it may affect fetal development or lead to complications if not addressed promptly.
Treatment options
In many cases, the pregnant person will need to be monitored in a hospital setting for a period of time.
Treatment focuses on identifying and correcting the underlying cause and monitoring the baby’s condition.
If the condition does not improve or if there are signs of significant risk, delivery may be recommended.
If labor has already started, vaginal delivery may be possible, but in some cases a cesarean delivery (c-section) is required.
Possible complications
Potential complications of fetal distress are:
-
Brain injury
-
Seizures
-
Breathing problems in the baby
There is also a risk of fetal or neonatal death, especially in severe cases or when care is delayed.