Recommended Intrapartum Fetal Surveillance
Continuous electronic fetal monitoring (continuous CTG) is the recommended intrapartum surveillance method for this multigravida at 38 weeks undergoing induction of labor for IUGR. 1
Rationale for Continuous Monitoring
The evidence strongly supports continuous electronic fetal monitoring during labor for IUGR cases:
UK, New Zealand, and French guidelines explicitly recommend induction of labor with continuous CTG when umbilical artery end-diastolic flow is present in IUGR cases. 1
The Society for Maternal-Fetal Medicine emphasizes that continuous fetal monitoring in labor is essential for fetal growth restriction, even though routine cesarean delivery is not recommended. 1
IUGR fetuses can quickly decompensate once uterine contractions have started, making careful continuous monitoring crucial during labor. 2
Why Not Intermittent Auscultation?
Intermittent fetal auscultation is inappropriate in this clinical scenario because:
IUGR fetuses with abnormal placental function are at significantly increased risk for intrapartum fetal heart rate decelerations, emergency cesarean delivery, and metabolic acidemia. 3
The fetus should be monitored continuously during labor to minimize fetal hypoxia in growth-restricted pregnancies. 4
Vaginal delivery with continuous electronic fetal monitoring is the appropriate approach when umbilical artery end-diastolic flow remains present, according to ACOG. 5
Additional Surveillance Components
While continuous fetal monitoring is the primary surveillance method, comprehensive intrapartum care includes:
Maternal vital signs monitoring should be performed regularly to detect any maternal complications, particularly if preeclampsia develops or was present. 6
Uterine activity monitoring is inherently part of continuous CTG, which tracks both fetal heart rate and uterine contractions simultaneously. 1
Critical Clinical Pitfall
Do not attempt to use intermittent auscultation or reduce monitoring intensity based on reassuring prenatal testing. The intrapartum period represents a critical stress test for the IUGR fetus with compromised placental reserve, and continuous monitoring is essential to detect early signs of fetal decompensation that may require urgent cesarean delivery. 3, 2