Managing Complications in Pregnancy and Childbirth: - IAWG

S-96 Fetal distress in labour- If the cord is below the presenting part or in the vagina,manage as prolapsed cord (page S-97).• If fetal heart rate abnormalities persist or there are additionalsigns of distress (thick meconium-stained fluid), plan delivery:- If the cervix is fully dilated and the fetal head is not more than1/5 above the symphysis pubis or the leading bony edge of thehead is at 0 station, deliver by vacuum extraction (page P-27)or forceps (page P-33);- If the cervix is not fully dilated or the fetal head is more than1/5 above the symphysis pubis or the leading bony edge of thehead is above 0 station, deliver by caesarean section (page P-43).MECONIUM• Meconium staining of amniotic fluid is seen frequently as the fetusmatures and by itself is not an indicator of fetal distress. A slightdegree of meconium without fetal heart rate abnormalities is awarning of the need for vigilance.• Thick meconium suggests passage of meconium in reducedamniotic fluid and may indicate the need for expedited delivery andmeconium management of the neonatal upper airway at birth toprevent meconium aspiration (page S-143).• In breech presentation, meconium is passed in labour because ofcompression of the fetal abdomen during delivery. This is not asign of distress unless it occurs in early labour.