What are the recommendations for managing early labor and monitoring fetal movement?

Managing Early Labor and Monitoring Fetal Movement

Women in early/latent labor with reassuring fetal status should be managed expectantly at home with clear instructions to monitor fetal movements daily and return for regular, painful contractions (every 3-5 minutes, lasting 45-60 seconds for 1-2 hours) or any decrease in fetal movement. 1

Understanding Latent vs. Active Labor

The critical distinction is the pattern of progressive cervical change over time, not a specific centimeter threshold. 1 Contraction patterns alone are unreliable for determining labor phase, as contractions do not consistently increase in intensity, frequency, or duration during the transition from latent to active phase. 1

Oxytocin is contraindicated in latent phase labor and should only be used for slow progress in confirmed active labor—premature intervention increases cesarean delivery risk without improving outcomes. 1

Fetal Movement Monitoring Recommendations

During Late Pregnancy (Last 8-10 Weeks)

• Mothers should be taught to monitor fetal movements daily during the last 8-10 weeks of pregnancy. 2
• Women must report immediately any reduction in the perception of fetal movements. 2
• A sudden decrease or cessation of fetal movements can precede fetal death by at least 12 hours while fetal heart beats remain audible—this "movements alarm signal" indicates severely compromised fetal status requiring immediate evaluation. 3

Evidence on Monitoring Methods

Women who use a daily structured approach to fetal movement awareness (such as formal counting methods) have lower rates of neonatal nursery transfer compared to those using non-structured daily observation. 4 However, data are insufficient to determine the optimal method of intensive fetal monitoring in women with gestational diabetes who maintain good glycemic control. 2

Safe Discharge Criteria from Early Labor Assessment

Women may be safely discharged home when: 1, 5

• Fetal status is reassuring with normal monitoring (Category I fetal heart tracing)
• High presenting part with no signs of imminent delivery
• Intact membranes confirmed
• Maternal condition stable with no complications
• No regular contraction pattern establishing active labor

Return Precautions - When to Come Back

Women should return immediately for: 1, 5

Labor-Related Signs

• Regular, painful contractions occurring every 3-5 minutes, lasting 45-60 seconds, for at least 1-2 hours 1
• Urge to push or sensation of imminent delivery 6

Fetal Movement Concerns

• Decreased fetal movement or absence of usual fetal activity 1, 5
• Any sudden change in movement patterns 2

Other Warning Signs

• Vaginal bleeding 1, 5
• Gush of clear fluid, continuous leakage, or visible pooling (suggesting rupture of membranes) 5
• Severe headache or visual disturbances 6
• Fever or foul-smelling discharge 5
• Severe abdominal pain 1

Intrapartum Fetal Monitoring Once in Active Labor

For Low-Risk Patients

Structured intermittent auscultation is equivalent to continuous electronic fetal monitoring for screening fetal compromise in low-risk patients, requiring a 1:1 nurse-to-patient ratio. 2, 7

The protocol requires: 2

• Counting FHR between contractions for ≥60 seconds to determine baseline
• Counting FHR after contractions for 60 seconds to identify fetal response
• Assessment every 15 minutes in active first stage
• Assessment every 5 minutes during second stage 6

For High-Risk Patients or Abnormal Findings

Continuous electronic fetal monitoring is recommended when: 2, 7

• Increased risk of perinatal death, cerebral palsy, or neonatal encephalopathy exists
• Oxytocin is used for labor induction or augmentation
• Abnormal fetal heart rate characteristics are detected by intermittent auscultation

Continuous monitoring requires inspection and documentation every 15 minutes in active labor and at least every 5 minutes in second stage. 7

Common Pitfalls to Avoid

• Do not admit patients during latent phase without objective findings—this increases healthcare costs and anxiety without improving outcomes. 5
• Do not use routine admission tracings in low-risk pregnancy, as they increase intervention without improved neonatal outcomes. 2
• Do not initiate oxytocin in latent labor—active phase must be confirmed first. 1
• Do not ignore maternal reports of decreased fetal movement—this may be the only warning sign before fetal compromise. 2, 3