CHAPTER

15

Fetal Assessment During Labor

KEY POINTS
Because labor is a period of physiologic stress for the fetus, frequent monitoring of fetal status is part of the nursing care during
labor. The fetal oxygen supply must be maintained during labor
to prevent fetal compromise and promote newborn health after
birth.
The goals of intrapartum FHR monitoring are to identify and
differentiate the normal (reassuring) patterns from the abnormal
(nonreassuring) patterns, which can indicate fetal compromise.
Fetal well-being during labor is gauged by the response of the
FHR to UCs.
Standardized definitions for many common FHR patterns have
been adopted for use in clinical practice by the ACNM, ACOG,
and AWHONN.
The monitoring of fetal well-being includes FHR and UA assessment and assessment of maternal vital signs.
Intermittent auscultation (IA) involves listening to fetal heart
sounds at periodic intervals to assess the FHR. IA of the fetal
heart can be performed with a Pinard stethoscope, Doppler
ultrasound, an ultrasound stethoscope, or a DeLee-Hillis fetoscope. IA is easy to use, inexpensive, and less invasive than EFM.
It is often more comfortable for the woman and gives her more
freedom of movement.

The purpose of EFM is the ongoing assessment of fetal oxygenation. FHR tracings are analyzed for characteristic patterns
that suggest fetal hypoxic events and metabolic acidosis during
labor.
The technique of continuous internal FHR or UA monitoring
provides a more accurate appraisal of fetal well-being during
labor than external monitoring because it is not interrupted by
fetal or maternal movement or affected by maternal size.
The five essential components of the FHR tracing are baseline
rate, baseline variability, accelerations, decelerations, and changes
or trends over time.
Assessing FHR and UA patterns, implementing independent
nursing interventions, and reporting abnormal patterns to the
physician or nurse-midwife are the nurses responsibilities.
The AWHONN and ACOG have established and published
health care provider standards and guidelines for FHR
monitoring.
The emotional, informational, and comfort needs of the woman
and her family must be addressed when the mother and her fetus
are being monitored.
Documentation of fetal assessment is initiated and updated
according to institutional protocol.

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