From the Guidelines
The risk of intrapartum fetal death can be significantly reduced with continuous electronic fetal monitoring during labor, particularly in high-risk pregnancies, as it allows for early detection of fetal distress, although it has not been shown to decrease cerebral palsy or neonatal mortality 1.
Factors Influencing Intrapartum Fetal Death Risk
The risk of intrapartum fetal death is influenced by several factors, including:
- Post-term pregnancy (beyond 42 weeks)
- Maternal conditions like hypertension and diabetes
- Intrauterine growth restriction
- Placental abnormalities
- Previous stillbirth
Recommendations for Reducing Risk
To reduce the risk of intrapartum fetal death, the following are recommended:
- Continuous electronic fetal monitoring during labor for high-risk pregnancies
- Regular antenatal care with timely ultrasounds
- Kick counts in the third trimester
- Appropriate timing of delivery, with induction of labor typically recommended between 41-42 weeks for post-term pregnancies
- Maternal monitoring of fetal movements daily, with immediate medical evaluation if decreased fetal movement is noted or other concerning symptoms arise
Importance of Early Detection and Intervention
Early detection of fetal distress through continuous electronic fetal monitoring and prompt intervention with emergency cesarean delivery if necessary can significantly reduce the risk of intrapartum fetal death 1. However, it's crucial to weigh the benefits and risks of continuous electronic fetal monitoring, as it has led to an increase in cesarean delivery and instrumental vaginal births without a significant decrease in neonatal mortality or cerebral palsy.
From the Research
Risk Factors for Intrapartum Fetal Death
- Preterm delivery, placental abruption, uterine rupture, shoulder dystocia, congenital malformations, severe preeclampsia, and fetal malpresentation are significantly more common in pregnancies complicated by intrapartum death 2
- Shoulder dystocia, uterine rupture, preterm delivery, placental abruption, fetal malpresentation, and congenital malformations are independent risk factors for intrapartum fetal death 2
- Birth weight is inversely associated with intrapartum fetal death, and other significant factors include mothers older than 35 years, polyhydramnios, congenital malformations, pathologic presentation, abruptio placentae, and cord prolapse 3
Fetal Monitoring and Intrapartum Fetal Death
- Continuous electronic fetal monitoring has a false-positive rate of 99% and has increased operative and cesarean delivery rates without improved neonatal outcomes 4
- Structured intermittent auscultation can lower rates of operative and cesarean deliveries with neonatal outcomes similar to those of continuous electronic fetal monitoring 4
- The National Institute of Child Health and Human Development terminology is used to review continuous electronic fetal monitoring and delineates fetal risk by three categories 4
Prevention and Management of Intrapartum Fetal Death
- The main goals of fetal surveillance are to avoid fetal death and to recognize the fetus that will benefit from early intervention with resuscitation or delivery 5
- Multiple techniques are used once distress is noted in the fetus, with the ultimate resuscitation effort being delivery 5
- Approaches to preventing intrapartum fetal injury include electronic fetal monitoring, but clinical trials have failed to demonstrate improved immediate or long-term outcomes with this technique 6