Nonreassuring Fetal Status

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KEY POINTS

• Nonreassuring fetal status is a medical term used when test results suggest that your baby may be having problems late in pregnancy or during labor.
• Your healthcare provider may treat you with medicine, oxygen, or in some cases, decide to deliver the baby early.
• Getting regular checkups and tests when you need them can help you and your baby stay healthy.

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What is nonreassuring fetal status?

Nonreassuring fetal status (NRFS) is a medical term that is used when test results suggest that your baby may be having problems late in pregnancy or during labor.

What is the cause?

The placenta is tissue attached to the inside of the uterus and also attached to the baby by the umbilical cord. It carries oxygen and nutrition from your blood to the baby’s blood. NRFS usually happens when there is a problem with the placenta that keeps blood or oxygen from reaching your baby.

Your baby may have NRFS if:

• There is too much or too little amniotic fluid around the baby in the uterus.
• The umbilical cord is pinched, flattened, or twisted.
• Your baby has not developed normally.
• You have heart, lung, or kidney problems or high blood pressure.
• You have separation of the placenta from the wall of the uterus during pregnancy.
• Your labor contractions are too strong, too long, or too frequent.
• You have low blood pressure, which may be caused by medicines given during labor.
• You are lying on your back, putting pressure on the major blood vessels, which can change blood flow to the uterus.

What are the symptoms?

You may have no symptoms. The following signs may mean that your baby is not getting enough oxygen:

• The baby is moving less.
• The baby has a heart rate that is too slow, too fast, or irregular.
• Bowel movement from the baby (called meconium) is found in the amniotic fluid when your water breaks.

A baby’s heart rate that is too slow, too fast, or irregular doesn’t always mean there is a problem. The baby is usually OK.

How is it diagnosed?

The following tests of your baby's health might be done late in pregnancy:

• A nonstress test, which uses a monitor strapped to your belly to record how your baby's heart rate changes when your baby moves
• A biophysical profile, which uses sound waves (ultrasound) along with a nonstress test to check the baby's breathing, movements, heart rate, and muscle tone. It is also a way to see how much amniotic fluid there is.
• A contraction stress test, which uses a monitor strapped to your belly to record how your baby's heart rate changes after you are given medicine to cause contractions

During labor and delivery tests may include:

• External or internal fetal monitoring, which uses instruments placed on your belly or into your vagina to measure your baby's heart rate

How is it treated?

Treatment depends on what is causing NRFS.

• Your healthcare provider may ask you to change your position to take the pressure from you or the baby off blood vessels or the umbilical cord.
• You may be given IV fluids, medicine, or blood if your blood pressure drops during labor or if you are bleeding a lot.
• You may be given extra oxygen so more oxygen can get to your baby.
• You may be given medicine so that your contractions aren’t as close together or as long, or medicine to relax the uterus and stop contractions.
• If there is not enough fluid in the baby's sac, a salt solution may be put into the sac to cushion the umbilical cord.

If these treatments don't correct the problem, the baby may need to be delivered right away. Your baby will be examined and watched closely. Your baby may need to stay in the intensive care nursery for a few days.

For most babies, NRFS has no long-term effects after birth. However, a lack of oxygen over a long time may hurt a baby. This can very rarely cause the baby to have mild learning disabilities, or, even more rarely, it might cause more severe problems, such as cerebral palsy, intellectual disability, or even death.

How can I help prevent NRFS?

Getting regular checkups and tests when you need them can help you and your baby stay healthy.