📌 NCLEX Topic: Fetal Distress

📌 NCLEX Topic: Fetal Distress

NCLEX Topic: Fetal Distress

Description:

Fetal distress occurs when the fetus shows signs of compromised oxygenation or inadequate perfusion, which can lead to hypoxia and acidosis. This is a medical emergency that requires immediate intervention to prevent adverse outcomes for the fetus.

Assessment Findings (Signs of Fetal Distress):

1️⃣ Fetal Heart Rate (FHR) Abnormalities:

  • Bradycardia: FHR <110 bpm for at least 10 minutes.
  • Tachycardia: FHR >160 bpm for at least 10 minutes.

2️⃣ Decelerations:

  • Late Decelerations: Caused by uteroplacental insufficiency, occur after the peak of contractions.
  • Severe Variable Decelerations: Caused by cord compression, lead to abrupt decreases in FHR.

3️⃣ Baseline Variability:

  • Progressive decrease or absent variability indicates compromised fetal oxygenation.

4️⃣ Amniotic Fluid Abnormalities:

  • Meconium-stained fluid: Indicates fetal distress, as the fetus may have passed meconium due to hypoxia.

5️⃣ Fetal Activity Changes:

  • Hypoactivity or hyperactivity can be a sign of fetal distress.

Causes of Fetal Distress:

  • Umbilical cord prolapse or compression
  • Uteroplacental insufficiency (e.g., preeclampsia, post-term pregnancy)
  • Hyperstimulation of the uterus (e.g., excessive oxytocin administration)
  • Maternal hypotension (e.g., supine hypotensive syndrome)
  • Infection (e.g., chorioamnionitis)
  • Placental abruption or previa

Nursing Interventions for Fetal Distress:

🚨 PRIORITY: Restore fetal oxygenation and prevent hypoxia.

  1. Discontinue Oxytocin Infusion:
    • Stops uterine hyperstimulation and allows the placenta to perfuse better.
  2. Reposition the Client:
    • Place the client in a lateral position (left or right) to relieve pressure on the inferior vena cava and improve uterine blood flow.
  3. Administer Oxygen:
    • Use 8-10 L/min via face mask to improve maternal and fetal oxygenation.
  4. Administer IV Fluids:
    • Give a bolus of IV fluids to improve maternal circulation and placental perfusion.
  5. Notify the Healthcare Provider:
    • If fetal distress persists, the provider may decide on an emergency cesarean delivery.
  6. Monitor Fetal Heart Rate Continuously:
    • Watch for changes in FHR patterns (e.g., persistent bradycardia, late decelerations).
  7. Prepare for Emergency Cesarean Delivery:
    • If distress is unresolved, cesarean delivery is often the next step.

Complications of Untreated Fetal Distress:

  • ⚠️ Hypoxia and Acidosis:
    • Can lead to fetal brain injury or death.
  • ⚠️ Meconium Aspiration Syndrome:
    • Occurs when the fetus inhales meconium-stained fluid, leading to respiratory distress.
  • ⚠️ Stillbirth:
    • In severe cases of unresolved distress.

NCLEX Test-Taking Strategy:

  • “Fetal distress”
  • “Late decelerations” or “Severe variable decelerations”
  • “FHR abnormalities (bradycardia or tachycardia)”

💡 Prioritize based on the ABCs:

  • Administer oxygen.
  • Reposition the client (lateral).
  • Discontinue oxytocin.

Summary for NCLEX:

  • ✅ Fetal distress = Medical Emergency.
  • 🩺 Key Interventions: Discontinue oxytocin, administer oxygen, reposition, and prepare for cesarean delivery if needed.
  • ⚠️ PRIORITY: Restore fetal oxygenation to prevent hypoxia and acidosis.