Fetal Heart Rate

Signs and symptoms
1.Decreased movement felt by the mother
2.Meconium in the amniotic fluid
3.Cardiotocography signs
a.increased or decreased fetal heart rate (tachycardia and bradycardia),
especially during and after a contraction
b.decreased variability in the fetal heart rate
4.Biochemical signs, assessed by collecting a small sample of baby's blood from a
scalp prick through the open cervix in labour
a.fetal acidosis
b.elevated fetal blood lactate levels indicating the baby has a lactic acidosis.

Abnormal Fetal Heart Rate :
a.A normal fetal heart rate may slow during a contraction but usually recovers to
normal as soon as the uterus relaxes.
b.A very slow fetal heart rate in the absence of contractions or persisting after
contractions is suggestive of fetal distress.
c.A rapid fetal heart rate may be a response to maternal fever, drugs causing rapid
maternal heart rate (e.g. tocolytic drugs), hypertension or amnionitis. In the
absence of a rapid maternal heart rate, a rapid fetal heart rate should be
considered a sign of fetal distress.

Some of these signs are more reliable predictors of actual distress than others. For example, cardiocartography can give high false positive rates, even when interpreted by highly experienced medical personnel. Acidosis is a highly reliable predictor, but is not always available. A highly effective method of assessment of distress would be to use fetal heart rate as a first indicator of distress, to be confirmed with a more reliable method of diagnosis before radical treatment is performed.

Causes
There are many causes of fetal distress:
a.Breathing problems
b.Abnormal position and presentation of the fetus
c.Multiple births
d.Shoulder dystocia
e.Umbilical cord prolapse
f.Nuchal cord
g.Placental abruption
h.Premature closure of the fetal ductus arteriosus

Risk Factors
Women with a history of:
a.Stillbirth
b.Intrauterine growth retardation (IUGR)
c.Oligohydramnios or polyhydramnios
d.Multiple pregnancies
e.Rhesus sensitization
f.Hypertension
g.Diabetes and other chronic diseases
h.Decreased fetal movements
i.Posterm pregnancy.

There is some evidence that maternal age over 35 years is an independent risk factor for uteroplacental insufficiency and fetal distress.

Complication
a.Asfiction
b.Fetal death

In many situations fetal distress will lead the obstetrician to recommend steps to urgently deliver the baby. This can be done by induction, or in more urgent cases, a caesarean section may be performed.

General Management
a.Prop up the woman or place her on her left side.
b.Stop oxytocin if it is being administered.

Something must be done by the midwife if there are any indications like the text below :
a.If a maternal cause is identified (e.g. maternal fever, drugs), initiate
appropriate management.
b.If a maternal cause is not identified and the fetal heart rate remains abnormal
throughout at least three contractions, perform a vaginal examination to check
for explanatory signs of distress:
c.If there is bleeding with intermittent or constant pain, suspect abruptio
placentae;
d.If there are signs of infection (fever, foul-smelling vaginal discharge) give
antibiotics as for amnionitis;
e.If the cord is below the presenting part or in the vagina, manage as prolapsed
cord.
f.If fetal heart rate abnormalities persist or there are additional signs of
distress (thick meconium-stained fluid), plan delivery:
g.If the cervix is fully dilated and the fetal head is not more than 1/5 above the
symphysis pubis or the leading bony edge of the head is at 0 station, deliver by
vacuum extraction or forceps;
h.If the cervix is not fully dilated or the fetal head is more than 1/5 above the
symphysis pubis or the leading bony edge of the head is above 0 station, deliver
by caesarean section.

Meconeum
a.Meconium staining of amniotic fluid is seen frequently as the fetus matures and
by itself is not an indicator of fetal distress. A slight degree of meconium
without fetal heart rate abnormalities is a warning of the need for vigilance.
b.Thick meconium suggests passage of meconium in reduced amniotic fluid and may
indicate the need for expedited delivery and meconium management of the neonatal
upper airway at birth to prevent meconium aspiration (page S-143).
c.In breech presentation, meconium is passed in labour because of compression of
the fetal abdomen during delivery. This is not a sign of distress unless it
occurs in early labour.