How often should vital signs be taken in pregnant women during the second stage of labor?

Maternal Vital Signs Monitoring in Second Stage of Labor

During the second stage of labor, maternal vital signs should be monitored at appropriate intervals as part of routine labor management, though specific frequency recommendations are not explicitly defined in current guidelines. 1

Recommended Monitoring Approach

Maternal Vital Sign Assessment

• Blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation should be monitored during the second stage of labor as part of comprehensive maternal surveillance. 1
• The European Society of Cardiology emphasizes continuous attention to maternal hemodynamic status throughout labor, particularly during the second stage when physiological stress is greatest. 1

Practical Monitoring Frequency

While guidelines do not specify exact intervals for maternal vital signs in the second stage, the framework for fetal monitoring provides context:

• Fetal heart rate should be assessed every 5 minutes during the second stage with pushing using structured intermittent auscultation. 2
• Maternal vital signs monitoring should occur at appropriate intervals alongside fetal assessment, with increased frequency if abnormalities are detected or risk factors are present. 1
• The baby's heart rate should be monitored after every second contraction during the second stage. 3

Risk-Stratified Approach

Standard Risk Patients

• Monitor maternal vital signs regularly throughout the second stage, coordinating assessments with fetal heart rate monitoring. 1
• Assess blood pressure, pulse, and other vital signs at least hourly, or more frequently if clinical concerns arise. 1

High-Risk Patients

• Women with cardiovascular disease, hypertension, or other medical complications require more intensive monitoring with vital signs checked more frequently. 1
• Lateral decubitus positioning should be used to attenuate hemodynamic impact of contractions in high-risk patients. 1

Important Clinical Considerations

Maternal Tachycardia

• Maternal tachycardia is common during the second stage, occurring in 33.9% of patients with heart rate ≥100 bpm, 18.8% with ≥110 bpm, and 9.1% with ≥120 bpm. 4
• When maternal heart rate reaches ≥100 bpm, simultaneous maternal and fetal heart rate monitoring should be used to prevent confusion between maternal and fetal tracings. 4

Hypertensive Disorders

• Blood pressure ≥160/110 mm Hg requires urgent treatment in a monitored setting regardless of the stage of labor. 2
• Blood pressure consistently ≥140/90 mm Hg should be treated with target diastolic BP of 85 mm Hg. 2

Postpartum Monitoring

• Maternal hemodynamic monitoring should continue for at least 24 hours after delivery in women with structural heart disease or cardiovascular complications. 1