While caring for a client in labor, which assessment finding best indicates fetal well-being to the nurse?

Priority concerns:

Liver function tests: The client has elevated ALT (75 U/L), AST (78 U/L), alkaline phosphatase (184 U/L), and LDH (250 U/L), which are consistent with liver involvement in preeclampsia with severe features. This suggests hepatic dysfunction and possible progression to HELLP syndrome.

Blood pressure: The client’s BP is 168/100 mmHg, which meets the criteria for severe preeclampsia (≥160/110 mmHg). Uncontrolled hypertension increases the risk of stroke, placental abruption, and progression to eclampsia.

Headache: The persistent headache could indicate severe preeclampsia with neurological involvement due to cerebral vasospasm and increased risk of stroke or seizure. A headache that does not resolve with usual measures is a warning sign, and magnesium sulfate should be considered for seizure prophylaxis.

Not a Priority Concern

Heartburn is a common symptom in pregnancy due to gastric reflux and increased progesterone levels, which relax the lower esophageal sphincter. While it can be uncomfortable, it is not immediately life-threatening.

Gestational age: The client is at 37 weeks’ gestation, which is considered early term but not preterm. While gestational age is important for delivery planning, it is not the most immediate concern compared to the client’s hypertensive crisis.

Cardiac assessment: The apical pulse is 77 bpm, regular, and lungs are clear, indicating that there is no immediate cardiac or respiratory compromise.

A. "Presence of late decelerations with each contraction during monitoring."
Late decelerations indicate uteroplacental insufficiency, which can lead to fetal hypoxia and distress. This is not a reassuring sign.

B. "Increased fetal movement between contractions."
While fetal movement is a positive sign, it is not the best indicator of fetal well-being in labor. Continuous FHR monitoring provides a better assessment.

C. "Fetal heart rate of 160 beats per minute with moderate variability."
A normal fetal heart rate (FHR) is 110–160 bpm, and moderate variability (6–25 bpm fluctuations) indicates a well-oxygenated fetus with an intact autonomic nervous system.

D. "Fetal heart rate consistently below 120 beats per minute with no accelerations."
A persistent FHR below 110 bpm (bradycardia) or minimal variability suggests possible fetal compromise.