Fetal Distress, Medical Malpractice, and Cerebral Palsy
Fetal distress is a term used to describe what occurs when your baby's oxygen supply is compromised in utero, either during your pregnancy or during your labor.
What causes fetal distress?
There are many things that can cause fetal distress, including maternal illness, placental abruption (detachment of part or all of the placenta from the uterine wall), uterine rupture, umbilical cord prolapse (appearance of the umbilical cord in the birth canal before the baby appears), umbilical cord entrapment (umbilical cord around the fetus's neck, also called a nuchal cord), fetal infection, and inadequate amniotic fluid levels.
What are the signs and symptoms of fetal distress?
The primary signs of fetal distress are decreased fetal movement, abnormalities in fetal heart rate, and the passing of the baby's first stool (meconium) in utero.
How common is fetal distress?
The exact incidence of fetal distress is uncertain. The estimates range from 1 in every 25 births to 1 in every 100 births. There are certain conditions that increase the risk of fetal distress. These conditions include intrauterine growth restriction, hydramnios, oligohydramnios, preeclampsia, and gestational diabetes.
How is fetal distress diagnosed?
The primary method of diagnosing fetal distress is with a fetal heart monitor. Fetal heart monitoring lets the health care provider monitor the baby's heart rate in the uterus, including during labor. The procedure can be done with monitors outside the body (external monitoring) or in the uterus (internal monitoring).
External fetal heart rate monitoring is done through the mother's skin. You will sit with knees and back partially elevated with a cushion under the right hip, which moves your uterus to the left. Sensitive electrodes (connected to monitors) are placed on your abdomen over conducting jelly. The electrodes can sense the fetal heart rate. Usually, the results of this test are continuous and are printed out, or they appear on a computer screen.
Internal fetal monitoring involves placing an electrode directly on the fetal scalp through the cervix. A vaginal examination will be performed, and the electrode will be introduced with its plastic sheath into the vaginal canal. This plastic guide is moved through the cervix and placed on the fetus's scalp, then removed. The electrode's wire is strapped to your thigh, and attached to the monitor.
Fetal distress can also be diagnosed by collecting a small sample of fetal blood from a scalp prick through the open cervix during labor. If this blood, when tested, shows elevated fetal blood lactate levels, it means the baby has "lactic acidosis", a clear sign that the fetus is not getting adequate amounts of oxygen and is in fetal distress.
What does fetal distress look like on the fetal heart rate monitor?
If your baby has fetal distress, their heart rate will not respond normally to your contractions or to their own movements.
Normal fetal heart rate is between approximately 110 and 160 beats per minute. When you begin to have a contraction, your baby's heart rate may decrease (at least 15 bpm lower than normal) for the duration of the contraction, and then return to the normal 120-160 range as soon as the contraction is finished. This is called an "early deceleration" because it begins at the beginning of your contraction and ends as soon as the contraction is over. It is considered normal form of fetal heart rate variability and is a reassuring sign that the fetus is not in distress.
A "late deceleration", on the other hand, is not normal and when occurring repeatedly is strong evidence of fetal distress. A late deceleration occurs when the fetal heart rate does not begin to decelerate until the contraction has reached its peak of intensity, and the deceleration does not end until long after the contraction has ended, hence the name "late" when compared to "early" decelerations, which begin when the contraction begins and end as soon as the contraction ends. Late decelerations are an ominous sign of fetal distress. They are the most worrisome form of deceleration.
"Variable decelerations" are decelerations that have no relationship to your contractions. They are a sign of possible umbilical cord compression, a circumstance that can lead to fetal distress.
"Persistent tachycardia", when fetal heart rate is greater than 160 for more an extended period, is another sign of possible fetal distress, as is "persistent bradycardia", when the fetal heart rate is less than 110 for an extended period.
One of the most ominous signs of fetal distress or fetal compromise is a persistent lack of fetal heart rate variability, in other words, the fetal heart rate is not decreasing with contractions or increasing with fetal scalp stimulation.
If all of the following are present, the fetal heart rate is considered normal, i.e., reassuring: a baseline fetal heart rate between 110-160 bpm; moderate variability in fetal heart rate; accelerations may or may not be present; no late or variable decelerations; early decelerations may be present.
How is fetal distress treated?
If fetal distress is present, your baby needs to be delivered as quickly as possible, either via immediate vaginal delivery or emergency C-section. Once fetal distress is present, any delay in the delivery of your baby can constitute medical malpractice and can cause death or serious brain damage, including cerebral palsy.
If your baby died or suffered serious injury during birth, and you suspect that fetal distress was involved, you should contact a law firm experienced in handling birth injury cases, such as Berger & Lagnese. The lawyers at Berger & Lagnese will be able to determine whether medical malpractice caused your baby's death or brain injury.