What is the best surveillance method for a primigravida (first-time pregnant woman) at 39 weeks of gestation with controlled hypertension and a fetus at the 8th percentile?

Best Surveillance for Primigravida at 39 Weeks with Controlled Hypertension and Fetal Growth Restriction

Continuous electrical fetal monitoring (Option C) is the best surveillance method for this high-risk patient, combined with continuous maternal blood pressure monitoring. 1

Rationale for Continuous Monitoring

This patient has two critical high-risk factors that mandate intensive intrapartum surveillance:

Maternal Hypertension Risk

• Controlled hypertension on medication places this patient at significant risk for superimposed preeclampsia, placental insufficiency, and acute hypertensive crises during labor. 1
• At least 25% of gestational hypertension cases progress to preeclampsia, and this progression can occur rapidly during labor. 1
• Blood pressure alone is not a reliable indicator of disease severity—serious organ dysfunction can develop at relatively mild hypertension levels. 1, 2

Fetal Growth Restriction

• A fetus at the 8th percentile indicates uteroplacental insufficiency and substantially increased risk of intrapartum hypoxia and fetal compromise. 1
• Fetal growth restriction is a key risk of chronic essential hypertension and requires enhanced fetal surveillance. 3
• The combination of maternal hypertension and fetal growth restriction creates compounded risk for acute fetal decompensation during labor. 1

Comprehensive Surveillance Protocol

Continuous Fetal Monitoring

• Electronic fetal heart rate monitoring should be continuous throughout labor to detect early signs of fetal compromise. 1, 2
• Intermittent monitoring (Option B) is inadequate for this high-risk scenario where rapid deterioration can occur. 1

Maternal Monitoring Components

• Continuous blood pressure monitoring is essential for detecting severe hypertension (≥160/110 mmHg) that requires urgent treatment within minutes to prevent maternal stroke. 1, 2
• Target blood pressure should be maintained at 110-140/85 mmHg. 3
• Clinical assessment for signs of preeclampsia progression including proteinuria, neurological symptoms, and end-organ damage. 3

Critical Management Points

Severe Hypertension Protocol

• If blood pressure reaches ≥160/110 mmHg, urgent treatment is required using oral nifedipine or intravenous labetalol/hydralazine. 3, 1, 2
• Magnesium sulfate for seizure prophylaxis should be administered if severe hypertension develops or any neurological signs/symptoms appear. 1, 2

Laboratory Surveillance

• Monitor complete blood count (hemoglobin, platelet count), liver transaminases, uric acid, and creatinine at minimum. 3
• Urinalysis at each assessment for developing preeclampsia. 3

Common Pitfalls to Avoid

• Do not rely on intermittent monitoring in this high-risk scenario—the combination of hypertension and growth restriction requires continuous surveillance to detect rapid deterioration. 1
• Do not assume controlled blood pressure equals low risk—preeclampsia can develop rapidly even with previously controlled hypertension. 1
• Maternal vital signs monitoring alone (Option A) is insufficient without continuous fetal assessment given the growth restriction. 1
• Delivery at 39 weeks is appropriate timing for gestational hypertension without severe features, provided fetal monitoring remains reassuring. 3