Chapter 19: Fetal Health Surveillance in Labour

Fetal Health Surveillance in Labour begins by contrasting intermittent auscultation (IA), which involves periodically listening to the fetal heartbeat using tools like a Doppler or fetoscope, with electronic fetal monitoring (EFM), which provides a continuous record of the fetal heart rate (FHR) and uterine activity. Following the Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines, the text advocates for the use of IA in healthy, low-risk pregnancies at term, reserving EFM for higher-risk scenarios where adverse outcomes are more likely. A significant portion of the discussion is dedicated to assessing uterine activity, which includes evaluating the frequency, duration, intensity, and resting tone of contractions through palpation or internal pressure catheters. Nurses must identify patterns such as tachysystole—defined as greater than five contractions in a ten-minute window—as these can impact fetal oxygenation. The chapter provides a rigorous framework for interpreting FHR patterns, focusing on the baseline rate, which normally ranges between 110 and 160 beats per minute, and the concept of variability, which serves as a vital indicator of fetal oxygenation and central nervous system integrity. It details various periodic and episodic changes, such as accelerations, which typically signal fetal well-being, and different types of decelerations. Early decelerations are generally benign results of fetal head compression, whereas late decelerations suggest uteroplacental insufficiency and variable decelerations often indicate umbilical cord compression. The text classifies these findings into three categories—normal, atypical, and abnormal—to guide nursing actions. When concerning patterns emerge, nurses are responsible for initiating intrauterine resuscitation, which includes changing the patient's position, improving hydration, or modifying oxytocin administration. Furthermore, the chapter covers advanced diagnostic adjuncts like fetal scalp blood sampling for pH or lactate levels, amnioinfusion to alleviate cord compression, and post-delivery umbilical cord acid-base analysis to evaluate the newborn's immediate condition. Ultimately, the chapter underscores the legal and professional responsibility of the perinatal nurse to maintain accurate documentation and provide supportive, informed care to the labouring patient and their family.