Fetal monitoring during labour

1. Big picture

Fetal monitoring during labour means assessing whether the fetus is tolerating uterine contractions without developing significant hypoxia or metabolic acidosis.

The examiner wants you to think like this:

Labour contractions temporarily reduce uteroplacental blood flow
        ↓
Healthy fetus compensates between contractions
        ↓
Compromised fetus develops abnormal fetal heart rate patterns
        ↓
Persistent hypoxia → anaerobic metabolism → metabolic acidosis
        ↓
Risk of neonatal encephalopathy, stillbirth, emergency operative delivery

The goal is not to diagnose every fetal problem perfectly from the tracing. The goal is to:

1. identify fetuses at risk of hypoxia,
2. correct reversible maternal or uterine causes,
3. escalate monitoring when needed,
4. expedite birth before irreversible fetal injury occurs.

Fetal monitoring in labour is mainly by:

• intermittent auscultation in low-risk labour
• continuous cardiotocography (CTG) in high-risk labour
• additional tests such as fetal scalp stimulation or fetal blood sampling where available

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