What should a 9-month pregnant woman do if she experiences decreased fetal movement and her baby's position feels abnormal, with only one finger able to fit between the presenting part and her pelvis?

Immediate Assessment and Management at 9 Months Pregnancy with Cervical Changes

You need immediate evaluation at your hospital's labor and delivery unit to assess fetal well-being and determine if delivery is indicated. At 9 months (term pregnancy), cervical dilation of 1 finger (approximately 1-2 cm) with possible decreased fetal movement requires urgent assessment to rule out fetal compromise and determine labor status. 1

Why Immediate Evaluation is Critical

Decreased fetal movement at term is a warning sign that requires prompt fetal heart rate monitoring. The combination of cervical changes and altered fetal activity patterns necessitates:

• Continuous electronic fetal monitoring (EFM) to assess fetal heart rate baseline, variability, and presence of decelerations that could indicate fetal hypoxia or acidemia 1
• Assessment of contraction patterns to determine if you are in active labor 1
• Evaluation of cervical dilation and effacement to determine labor stage and progress 1

What to Expect at the Hospital

Initial Monitoring

• Fetal heart rate assessment will categorize the tracing as Category I (normal), II (indeterminate), or III (abnormal) 1
• Normal findings include moderate baseline variability (110-160 bpm) with accelerations present, which predict absence of fetal acidemia 1
• Concerning findings include absent variability, late decelerations, or bradycardia, which may indicate fetal compromise requiring expedited delivery 1, 2

If Fetal Monitoring Shows Abnormalities

General measures will be implemented immediately: 1

• Maternal position change (left lateral position) to optimize placental blood flow
• Oxygen administration at 6-10 L per minute
• Intravenous fluid bolus if not already established
• Vaginal examination to check for cord prolapse or rapid descent
• Discontinuation of oxytocin if being administered

Delivery Decision-Making

If Category III abnormalities are present (absent variability with recurrent decelerations or bradycardia), expedited delivery via operative vaginal delivery or cesarean section is required 1, 2

If Category II abnormalities persist despite interventions, consider expedited delivery to prevent progression to fetal acidemia 1, 2

If monitoring is reassuring (Category I), you may continue expectant management with ongoing monitoring 1

Critical Pitfalls to Avoid

• Do not wait at home if you are experiencing decreased fetal movement at term - this requires immediate assessment 1
• Do not assume cervical changes alone indicate imminent delivery without proper assessment of labor progress and fetal well-being 1
• Avoid supine positioning during evaluation, as this can cause aortocaval compression and decrease placental perfusion after 20 weeks gestation 1

What "1 Finger Loose" Means Clinically

Cervical dilation of approximately 1-2 cm at term may indicate:

• Early labor if accompanied by regular contractions 1
• Cervical ripening in preparation for labor without active labor yet 1
• This finding alone does not determine delivery timing - fetal well-being assessment is the priority 1

Transport Considerations

Go to the hospital immediately rather than waiting for scheduled appointments. At term with cervical changes and decreased fetal movement, same-day evaluation is medically indicated to ensure fetal safety. 1