Fetal Distress

A nonreassuring fetal status (NRFS) indicating that the FETUS is compromised (American College of Obstetricians and Gynecologists 1988). It can be identified by sub-optimal values in FETAL HEART RATE; oxygenation of FETAL BLOOD; and other parameters.

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Networked: 2027 relevant articles (43 outcomes, 152 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Acidosis
2.	Dystocia
3.	Oligohydramnios
4.	Perinatal Death
5.	Birth Weight (Birth Weights)

Experts

1.	Hofmeyr, G Justus: 9 articles (01/2018 - 01/2010)
2.	Hofmeyr, G J: 9 articles (01/2003 - 01/2000)
3.	Nicolaides, K H: 8 articles (04/2019 - 07/2003)
4.	Akolekar, R: 6 articles (04/2019 - 04/2015)
5.	Mol, Ben Willem J: 6 articles (01/2018 - 01/2010)
6.	Gallo, D M: 5 articles (03/2016 - 04/2015)
7.	MacKenzie, I Z: 5 articles (05/2007 - 04/2000)
8.	Mazor, M: 5 articles (07/2002 - 01/2000)
9.	Kulier, R: 5 articles (01/2002 - 01/2000)
10.	Berghella, Vincenzo: 4 articles (01/2022 - 01/2017)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Fetal Distress:

1.	Dinoprostone (PGE2)FDA Link 12/01/2017 - "IoL failure rate was 20.1% (213/1062) - 76% for unfavorable Bishop-score after PGE2 removal; 5.2% for failed induction and 18.8% for fetal-distress while on PGE2. " 12/01/2017 - "IoL failure was defined as: (1) Bishop-score ≤7 after 24 hours of PGE2; (2) cesarean delivery due to failed induction; (3) fetal distress followed by PGE2 removal and emergent cesarean. " 08/01/2007 - "The Caesarean delivery rate for fetal distress was higher in the dinoprostone group (21 vs. 10.8%, P = 0.15). " 10/01/1994 - "Uterine hyperstimulation and fetal distress during ripening occurred only in the prostaglandin E2 group, at a rate of 4.8%. " 12/15/1990 - "The only significant difference between the groups was the higher frequency of uterine hypertonicity (29 v. 5 : PGE2 v. tent) and consequent fetal distress (5 v. 1 : PGE2 v. tent) in the PGE2 group. "
2.	Misoprostol (Cytotec)FDA LinkGeneric 01/01/2002 - "Some trials also indicate increased frequencies of meconium passage, neonatal acidaemia and caesarean delivery for fetal distress in women receiving higher doses of vaginally applied misoprostol. " 08/01/1999 - "Some trials also indicate increased frequencies of meconium passage, neonatal acidemia, and cesarean delivery for fetal distress in women receiving higher doses of misoprostol. " 01/01/2019 - "The rate of cesarean deliveries for nonreassuring fetal status was 3.3% for the vaginal misoprostol group and 9.5% for the buccal misoprostol group (P = .033). " 04/01/2014 - "Although cases of "fetal distress" between the four induction agents was not significantly different amongst multipara women, the cesarean delivery indication for "fetal distress" was higher among multipara receiving misoprostol (p = 0.004). " 07/01/2005 - "Misoprostol was associated with significant decrease in mean time to delivery (4.5 +/- 4.1 versus 7.4 +/- 5.2 days; P = 0.008), earlier gestational age at delivery (40.6 +/- 0.6 versus 41.4 +/- 0.05 weeks; P < 0.001) and shorter duration of active labor (6.1 +/- 4.0 versus 8.2 +/- 5.3 h; P = 0.028), without any significant increase in fetal distress, low Apgar score at delivery or other side-effects. "
3.	Oxytocin (Pitocin)FDA LinkGeneric 08/01/1993 - "In group 1 (n = 42), the ripening process was repeated every day until spontaneous onset of labor occurred or induction with oxytocin was decided (for improved Bishop score above 5, or maternal or fetal distress). " 08/01/2020 - "85.6% of the participants who answered the question of possible effects of oxytocin as contraction, 57.9% of the possible side effects as fetal distress. " 09/02/2019 - "Oxytocin is an effective drug for induction of labour, but is associated with serious adverse effects of which uterine tachysystole, fetal distress and the need of immediate delivery are the most common. " 08/01/2019 - "Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress." 08/01/2019 - "Women with high-dose oxytocin had: shorter labours (-23.4min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). "
4.	Terbutaline (Brethaire)FDA LinkGeneric 09/01/1990 - "One patient in terbutaline group was excluded of the study because we found a severe fetal distress. " 08/01/1987 - "A randomized study on the effect of terbutaline on fetal distress was carried out in 20 patients who showed evidence of ominous fetal heart rate patterns and fetal scalp blood pH values of less than 7.25. " 09/01/1989 - "We conclude that intravenous terbutaline administered as a bolus injection at the time of fetal distress in labor improves infant outcome as evidenced by more vigorous Apgar scores and less acidemia without significant adverse physiologic effects on the mother." 03/01/1989 - "Terbutaline (intravenous bolus) for the treatment of acute intrapartum fetal distress." 08/01/1987 - "These results suggest that terbutaline may become a useful agent in the treatment of intrauterine fetal distress."
5.	Magnesium Sulfate (Sulfate, Magnesium)FDA LinkGeneric 01/01/2000 - "In summary, magnesium sulfate may be useful in the management of acute intrapartum fetal distress when there is evidence of increased uterine activity." 07/01/1988 - "The good fetal outcome seen in both study populations suggests that the effect of magnesium sulfate on FHR variability is a transient, reversible phenomenon that should not be considered as a sign of fetal distress." 01/01/2000 - "Intrapartum fetal distress and magnesium sulfate." 07/01/1984 - "The use of magnesium sulfate in the management of acute fetal distress." 01/01/1984 - "Magnesium sulfate in the management of acute intrapartum fetal distress."
6.	HexoprenalineIBA 01/01/1997 - "The objective of the study was to investigate if a single dose of Hexoprenaline administered to patients diagnosed as having fetal distress improves neonatal outcome and whether there are any side effects and complications related to hexoprenaline injection. " 02/01/1982 - "The conclusion, therefore, is that the rapid improvement in fetal heart rate after the administration of a single maternal intravenous injection of hexoprenaline in the treatment of fetal distress is due to the action on the uterus and/or on maternal cardiovascular function, and not to direct stimulation of the fetus." 12/07/1991 - "A fetus developed extreme supraventricular tachycardia (210/min) after intravenous hexoprenaline 10 micrograms was administered to the mother for intrapartum fetal distress. " 11/01/1986 - "Hexoprenaline tocolysis for intrapartum fetal distress and acidosis." 04/01/2004 - "Women in labour with acute intrapartum fetal distress detected by cardiotocography were randomly assigned to receive intravenous atosiban or hexoprenaline. "
7.	Hydrocortisone (Cortisol)FDA LinkGeneric 01/01/1995 - "Use of an algorithm for assessment of the severity of antenatal fetal distress and prediction of intranatal complications helped choose the optimal mode of delivery individually for each parturient and develop the strategy of rational management of spontaneous labor, which was confirmed by measurements of hydrocortisone levels in umbilical blood during delivery by different modes. " 03/01/1993 - "Increased cortisol levels in cord plasma were associated with spontaneous vaginal delivery but not with chronic fetal distress. " 06/24/1990 - "Both parameters showed association with the fetal distress in term babies (cortisol: 17.2 vs 12.3 ug/100 ml, coeruloplasmin: 29.7 vs 11.9 U/l). " 11/01/1984 - "The cortisol levels in UA and UV blood in the fetal distress group were significantly higher than those in the non-fetal distress group among spontaneous vaginal delivery cases. " 11/01/1984 - "Serum cortisol levels in maternal venous, umbilical arterial and umbilical venous blood at delivery in the cases of fetal distress."
8.	alpha-Fetoproteins (alpha-Fetoprotein)IBA 12/01/1981 - "Bovine alpha-fetoprotein (AFP) was determined in maternal plasma, using radioimmunoassay in an attempt to detect and monitor fetal distress in pregnant cows. " 12/01/1976 - "Maternal serum and amniotic fluid alpha-fetoprotein as a marker of acute fetal distress in a midtrimester abortion model." 01/01/1973 - "Alpha fetoprotein in maternal serum: a new marker for detection of fetal distress and intrauterine death." 05/01/1998 - "During the second trimester of pregnancy, the presence of free-floating particles in the amniotic fluid on ultrasonography has been associated with aggregates of cells or fetal blood and with unexplained elevation of maternal serum alpha-fetoprotein and the later development of abruptio placentae and fetal distress. " 09/01/1973 - "Detection of alpha-fetoprotein in adult sera has proved helpful in diagnosis of primary liver carcinoma; detection of trace amounts in maternal sera during pregnancy can signal fetal distress and/or fetal death. "
9.	Sodium Bicarbonate (Baking Soda)FDA LinkGeneric 06/01/2006 - "[Significance of infusion of sodium bicarbonate in amniotic cavity under continuous internal fetal heart rate monitoring for management of fetal distress during labor]." 06/01/2006 - "Infusion into amniotic cavity and exchange of amniotic fluid is effective therapy for fetal distress due to oligohydramnios and can prevent meconium aspiration syndrome; infusion of antacids medicine (5% sodium bicarbonate) into amniotic cavity is effective and safe therapy for fetus with acidosis."
10.	AntacidsIBA 06/01/2006 - "Infusion into amniotic cavity and exchange of amniotic fluid is effective therapy for fetal distress due to oligohydramnios and can prevent meconium aspiration syndrome; infusion of antacids medicine (5% sodium bicarbonate) into amniotic cavity is effective and safe therapy for fetus with acidosis."

Therapies and Procedures

1.	Cesarean Section (Caesarean Section) 10/01/2018 - "Admission CTG was deemed beneficial in 74% of both low- and high-risk pregnancies that were delivered by emergent cesarean section within one hour of admittance due to suspected fetal distress." 07/01/2012 - "The CTG+Doppler group had significantly lower rates of cesarean section for fetal distress, and improved neonatal outcomes. " 05/01/2009 - "There was significant relief of variable decelerations in group I and no difference in overall cesarean section rate but significant reduction in cesarean section rate for fetal distress in group I, and significant reduction in cesarean section rate for fetal distress in nulliparous women of group I. Neonatal acidemia was also significantly reduced in the nulliparous women receiving AI. " 08/01/2005 - "The amnioinfusion group showed a significant reduction in the rate of cesarean section for fetal distress (relative risk [RR], 0.7; 95% confidence interval [CI], 0.6-0.83), and a 30% reduction in abnormal fetal heart rate patterns (RR, 0.7; 95% CI, 0.6-0.83). " 06/01/1998 - "The total population showed no statistical difference in outcome parameters between groups 1 and 2. However, a subgroup of patients evaluated for suspected uteroplacental insufficiency did show a significant reduction in caesarean section for fetal distress in group 2 patients. "
2.	Therapeutics 10/03/2006 - "Beta-blocker therapy did not influence the prevalence of fetal distress. " 12/01/2004 - "This case report presents the difficulty of therapy choice in front of fetal immobility and acute fetal distress. " 01/01/1990 - "Mean Apgar scores were 8.3 and 9.1 at 1 and 5 min. Only 1 newborn had an Apgar score less than 7. Three newborns suffered from fetal distress and 1 from threat for causes not related to therapy. " 10/01/1985 - "In addition to the protective effect on the mother, such therapy may allow delivery of the fetus to be deferred; this should be considered only if the fetus is significantly premature (e.g., less than 34 weeks), there is no other evidence of maternal or fetal distress, and there can be meticulous monitoring of the maternal and fetal state proceeding to prompt delivery if deterioration occurs. " 01/01/1980 - "Such therapy thus does not seem contraindicated when uterine contractions should be rapidly suppressed in cases of fetal distress before operation."
3.	Resuscitation 08/01/2015 - "We systematically searched the electronic PubMed, EMBASE, and CENTRAL databases for studies on intrauterine resuscitation for suspected fetal distress during term labor until February 2015. " 11/28/1992 - "The study groups did not differ in number of antenatal admissions or cardiotocographs, gestational age at delivery, method of delivery, frequency of deliveries with fetal distress, or need for resuscitation or admission to the neonatal intensive care unit. " 01/01/1992 - "The authors report a study involving 90 infants born at term or close to term and who required resuscitation at birth for per-natal fetal distress. " 12/01/1985 - "The predictive accuracy of the criteria used in the study was: the most sensitive criteria were the fetal distress and umbilical artery pH, the most specific criteria were the need for immediate neonatal resuscitation and a 5 minute Apgar score less than or equal to 6, and the most efficient criteria were the need for immediate neonatal resuscitation and fetal pH less than or equal to 7.20." 01/01/2019 - "Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. "
4.	Tocolysis 02/01/2008 - "Acute tocolysis may be helpful in cases of intrapartum fetal distress related to uterine hyperactivity (level of evidence 2). " 12/01/2019 - "The purpose of this study was to evaluate the association between tocolysis for preterm uterine contraction and the risk of nonreassuring fetal status.This" 01/01/2018 - "Randomised controlled trials (RCTs) evaluating acute tocolysis for uterine tachysystole, intrapartum fetal distress, or both. " 01/01/2022 - "Acute tocolysis for intrapartum nonreassuring fetal status: how often does it prevent cesarean delivery? " 12/01/2019 - "After adjusting for covariates, pregnant women receiving tocolysis more than one time during pregnancy were found to have significantly higher risk of the nonreassuring fetal status when compared with pregnant women who did not receive tocolysis for uterine contraction (Odds Ratio = 2.70, 95% Confidence Interval: 1.13-6.49).Pregnant women with more frequent tocolysis for preterm uterine contraction during pregnancy had an increased risk of nonreassuring fetal status. "
5.	Surgical Instruments (Clip) 06/01/1990 - "In both the midforceps and low-forceps groups, there was a significant increase of neonates with cord arterial pH less than 7.10, and an increase of base deficit, even when cases of fetal distress were eliminated. " 06/01/1975 - " manoeuvre was helpful with mothers unable to resist premature bearing down, and especially valuable for reducing delay before applying forceps for fetal distress. " 05/01/1968 - "[Studies and comparisons of the degree of fetal distress after the use of the vacuum extractor and forceps]." 01/01/2021 - "As this damage is associated with functional and anatomical problems in later life, minimizing pelvic floor damage during pregnancy and vaginal delivery may serve as an important factor in the prevention of these unwanted sequelae. Operative vaginal delivery using forceps or vacuum extractor is common practice to achieve or expedite vaginal birth for maternal or fetal indications such as maternal exhaustion or fetal distress. However, operative vaginal delivery is associated with more extensive damage to the pelvic floor and perineal structures with forceps carrying a stronger risk compared to vacuum. The evidence on this subject is discussed with possible suggestions to minimize pelvic floor damage as much as possible." 01/01/2019 - "The main indications of forceps increased use in our hospital from high to low were fetal distress, abnormal occipital position, prolongation of the second stage of labor and shortening of the second stage of labor. "