Fetal distress and birth scores in newborn infants.

The relation between fetal distress and the subsequent condition at birth was studied in 2791 pregnancies. Fetal distress was defined as a heart rate greater than 160 or less than 120/min between uterine contractions, with or without meconium-stained liquor. Infants of 28 to 42 weeks' gestational age were examined at 1 and 5 minutes after birth when the heart rate, respiration, and skin colour was recorded. Birth scores of 0, 1, or 2 were given respectively if respirations were absent, gasping, or regular; if the heart rate was undetectable, less than 100/min, or greater than 100/min; and if the colour was white, blue, or pink. Fetal distress was associated with low birth scores in infants at 1 and 5 minutes of age. Among those who had not suffered fetal distress a significantly greater proportion of preterm infants had low birth scores compared with term or post-term infants at 5 minutes of age. Infants did not score equally for colour, heart rate, and respiration at 1 and 5 minutes of age. Colour usually gave a birth score of 5 and heart rate was recordable when infants scored 0 for colour and respiration. The reduction in birth scores was greater in the presence of meconium-stained liquor and abnormal fetal heart rate than meconium-stained liquor alone; the latter being an early sign of fetal distress. Since fetal distress was not diagnosed by conventional methods in 93 term infants who probably suffered prenatal asphyxia, more sophisticated techniques are necessary for an accurate assessment of fetal condition during labour.