assessment of fetal wellbeing in labour

Assessment is very important because labor is very stressful to the fetus and intrauterine asphyxia is a major cause of morbidity and mortality.
1- Early detection of intrapartum asphyxia especially in high risk group which is about 20-30% of all cases but only 40% of them is really asphyxiated babies.
2- We shouldn t leave the low risk group without monitoring but we pay more attention to the high risk group.
One of the best methods available for detection of fetal wellbeing is the FHR because the FHR change with condition of the fetus.

Etiology of fetal distress during labor could be due to maternal, fetal, umbilical, placental, and uterine factors:
1- Maternal: maternal hyper or hypotension, severe anemia, heart diseases, epilepsy, pulmonary diseases, (asthma, COLD) àHYPOXIA.
2- Fetal factors: such as fetal anemia (in case of Rh-isoimmunization), infections, twin to twin transfusion.
3- Uterine factors: titanic uterine contractions, or excessive or misuse of oxytocic drugs.
4- Umbilical cord problems:
One artery, vasa brevia artery, short cord, haematoma in the cord, cord prolapse.
5- Placental factors:
Infarction, abruption, post mature placenta (placental aging)

* Methods of assessing FHR:

1- Auscultation.
2- Continuous electronic fetal monitoring


There is a high risk of hypoxia in the following circumstances so continuous EFM is required:
• Preterm infants (less than 37 weeks’ completed gestation).
• Fetuses that are or are suspected to be SGA (small for gestational age)
• Multiple pregnancies.
• Breech presentations.
• Women with epidural analgesia.
• Women with Syntocinon augmentation of labor.
• Women who have been induced.
• Women who are hypertensive.
• Women with major medical disorders, including diabetes.
• Women who develop meconium staining of the amniotic fluid during labor.
• Women who undergo a trial of uterine scar (previous C/S).
• If a fetal heart abnormality is recorded with the Pinard stethoscope/sonicaid.

Continuous electronic fetal heart rate monitoring
This is performed with either:
1) An external fetal heart rate monitor with Doppler ultrasound
2) An electrode attached to the fetal scalp showing the fetal heart rate derived from the fetal ECG.