Intrapartum Fetal Surveillance for IUGR at 38 Weeks
Continuous fetal monitoring (Option D) is the recommended intrapartum surveillance method for this patient undergoing induction of labor for IUGR at 38 weeks.
Rationale for Continuous Electronic Fetal Monitoring
Multiple international guidelines consistently recommend continuous cardiotocography (CTG) during labor for pregnancies complicated by fetal growth restriction:
The UK, New Zealand, and French guidelines explicitly state that induction of labor with continuous CTG is recommended when umbilical artery end-diastolic flow is present in IUGR cases 1
The Society for Maternal-Fetal Medicine emphasizes that routine cesarean delivery for FGR is not recommended, but continuous fetal monitoring in labor is essential 1
Labor represents a particularly high-risk period for IUGR fetuses, as uterine contractions reduce uteroplacental perfusion by up to 60%, and these compromised fetuses can quickly decompensate once contractions begin 2, 3
Why Not Intermittent Auscultation?
While intermittent auscultation is appropriate for low-risk pregnancies 4, IUGR specifically qualifies as a high-risk condition requiring continuous electronic fetal monitoring 4. The Canadian guidelines state that continuous intrapartum electronic fetal monitoring is recommended "for pregnancies where there is an increased risk of perinatal death, cerebral palsy, or neonatal encephalopathy" - all of which apply to IUGR 4.
Clinical Context at 38 Weeks
At 38 weeks with IUGR and normal Doppler studies (implied by proceeding with induction rather than earlier delivery):
Delivery timing aligns with guideline recommendations of 37-39 weeks for IUGR with normal umbilical artery Doppler 1
The fetus remains at increased risk during labor despite reaching term gestation, necessitating heightened surveillance 2, 3
Important Caveats
Continuous monitoring should be paired with appropriate interpretation and response protocols, as electronic fetal monitoring requires proper training and understanding of fetal physiology at different gestational ages 5
If non-reassuring patterns develop during continuous monitoring, escalation to fetal scalp blood sampling or expedited delivery should be considered 4
While maternal vital signs monitoring (Option C) is standard obstetric care, it does not constitute adequate fetal surveillance for this high-risk scenario 4