Death in the uterus

Many women deliver stillborns, without getting to know the cause of their baby’s death. Even though Angelina lost her baby, she was lucky to know the reason behind her baby’s death—foetal distress. Knowing the cause of death of a loved one is part of the healing process, and puts the mind to rest.

Causes Of Foetal Distress

The foetus can develop distress during pregnancy, labour or delivery. Some cases are more urgent than others. How the doctor or midwife handles each case, determines the outcome. It also depends on available facilities for diagnosis, and care available to the expectant mother. Babies can get distressed due to various reasons. These include:

•  Any condition causing maternal distress; for example maternal respiratory, cardiac or metabolic abnormalities. In such situations a mother may not be getting enough oxygen, or the heart may not be pumping blood sufficiently. With a metabolic problem (liver, renal), there may be too much acidity in maternal blood.
• Poor blood supply to the placenta due to abnormalities of the mother’s blood vessels, for example if she has hypertension, pre-eclampsia or eclampsia.
• An abnormal placenta, for instance a small placenta, an old placenta which has gone beyond 42 weeks of pregnancy, a diseased placenta such as one infected with syphilis, and a placenta attached to a site in the uterine wall, with poor blood supply.
• Congenital foetal abnormality affecting blood circulation in the foetus, for instance, severe congenital heart defect.
• Difficult labour such as prolonged or obstructed labour. This can be due to a big foetus, or foetus lying in the wrong position.
• Powerful or prolonged uterine contractions, for example; during induced labour.
• Problems with the umbilical cord, such as the cord around the foetal neck or cord prolapse —a condition where the umbilical cord precedes the baby, through the vagina during delivery. It may constrict so that the foetal blood supply of oxygen is cut off. Another cord problem can be a knotted cord; where the cord has a knot like a rope.
• Maternal bleeding, for example; vaginal bleeding in pregnancy.
• Foetal haemolytic (blood disorder) diseases, for instance, in severe rhesus incompatibility.

Signs And Symptoms of Foetal Distress

The most sensitive indicator of foetal distress is an abnormal heart rate pattern, in the foetus. When the baby’s heart rate pattern demonstrates foetal distress, the baby must be delivered immediately. An abnormal foetal heart rate can be one that is either increased (too fast) or decreased (too slow). When the variation of the heart rate exceeds the normal expected variation (referred to as the baseline variability), the foetal heart rate is considered unusual.

Foetal distress can be detected during pregnancy through an ultrasound. If noted, the doctor can consider induction, or a Caesarean section to save the baby’s life.

The baby’s heart rate should be monitored frequently, to recognise any changes in oxygen supply. A distressed foetus exhibits decreased foetal movement. The mother can easily tell when her baby becomes less active or completely inactive.

A distressed baby may pass stool in the womb. This stool— referred to as meconium—is the material present in the baby’s intestines, which is excreted by the baby during the first few days after birth. It is greenish-black in colour and contains salts, mucus, bile (a dark green substance released by the liver), pigments and other substances.

Treating Foetal Distress

In all cases of foetal distress, the mother and foetus must be properly evaluated, and appropriate action taken. The right management must be put in place, like monitoring the baby’s heartbeat. The doctor managing the condition must urgently deliver the baby. The baby is usually delivered through a Caesarean section, unless vaginal delivery can be immediate.

The mother can also be induced to accelerate childbirth, and eliminate foetal distress from setting in. This is especially so if the mother is two weeks past her EDD (expected date of delivery), or labour is not progressing well. An episiotomy can also be made in the perineum (area between the vagina and anus), to help deliver the baby and thus shorten second stage delivery. A vacuum extractor can also be applied to quicken the baby’s delivery, in case delay is noted during a vaginal delivery. As soon as the baby is delivered, resuscitation facilities must be in place, to support the newborn.

Some Effects Of Foetal Distress

Most babies survive foetal distress, and have no long-term defects after birth. A case of mild foetal distress, responds well to post-deliver resuscitation. However, a severe deficiency of oxygen can harm the baby. It can cause neonatal death (newborn death), brain injury, increased risk of neonatal infections, and neonatal asphyxia (not establishing breathing at birth).

END: PG 4/19