Fetal Well –being High risk pregnancy not only place mother at danger but also fetus requires close monitoring as well. Maternal with high risk pregnancies increases the rate of fetal morbidity and mortality. It is very crucial to monitor for fetal well-being when maternal is prone to have high risk pregnancy. For example, the gestational age is expected to be smaller for a maternal with preeclampsia. This is directly related to fetal hypoxia and malnutrition, due to maternal vasospasm and hypovolemia. In some cases it may result in premature birth (London, Ladewing, Ball, & Binder 2007). Other conditions that are considered maternal with high risk pregnancy include maternal age less than 16 or greater 35, chronic illness such as diabetes, hypertension, and heart disease etc. The purpose of fetal monitoring is early detection of a fetal at risk which may require an early intervention for maternal and fetal safety. Fetal monitoring is one way of testing fetal well-being as defined by London et al. (2007) as, “Clinicians now generally agree that vigorous fetal activity provides reassurance of fetal well-being and that marked decreased in activity or cessation of movement may indicate possible fetal compromise (or even death) requiring immediate follow up” (p.294). The purpose of fetal monitoring is to prevent injury of the fetus from impaired oxygenation. It is very important to evaluate well-being, maturation and size of the fetus for planning the timing of the birth. In pregnancies complicated by conditions such as diabetes can result in neural tube defects and a ultrasounds is done to detect abnormalities. Electronic fetal monitoring is one of the ways monitoring fetal well-being of high risk maternal, which provides information of fetal heart rate (FHR). This testing can be accomplished by external monitoring with ultrasounds, which is a non-invasive procedure. Ultrasound guided fetal monitoring display graphically FHR on the screen. However, if for some reason external electronic monitoring is not sufficient than internal fetal monitoring is completed by spinal electrode. In order to perform internal fetal monitoring there are some requirements as stated by London et al. ( 2007) “To place the spinal electrode on the fetal occiput, the amniotic membrane must be ruptured, the cervix must be dilated at least 2 cm, the presenting part must be down against the cervix, and the presenting part must be known” (p. 345). If the FHR is above the normal range (120-160 beats per minute); it may be indicative of hypoxia, maternal dehydration, amnionitis, and fetal anemia. According to London et al. (2007) “Tachycardia is considered by an ominous sign if it is accompanied by late decelerations, sever variable decelerations, or decreased variability (p.346).” On the other hand, if FHR is below normal rage is indicative of late fetal hypoxia, maternal hypotension, prolonged umbilical cord compression or fetal arrhythmia associated with complete heart block. Non stress testing (NST) is done to evaluate fetal status. This test is performed when there is adequate oxygenation and intact nerve system of the fetus; there are accelerations of the (FHR) with fetal movements. It recodes acceleration of the fetal heart rate via electronic fetal monitoring and tracing is obtained of FHR and fetal movement. During this procedure two belts are placed on the woman’s abdomen. One monitors FHR and other monitors fetal movement. As mentioned by London et al. (2007) “As the NST is done, each fetal movement is documented, so that associated or simultaneous FHR changes can be evaluated” (p.297). Woman with high risk pregnancy usually start this testing at 30-32 weeks of gestation. The test results are classified as reactive, nonreactive, and unsatisfactory tests. Reactive test results are considered fetal well-being and nonreactive test results indicate that fetal is sick or asleep. However the test is considered unsatisfactory when data cannot be interpreted. If during testing deceleration is detected immediate intervention require to help improve FHR. It depends on type of deceleration such as late vs. variable maternal may needs to be prepare for cesarean birth for surveillance of the fetus. The contraction stress testing is performed to evaluate carbon dioxide and oxygen exchange of the placenta. Under a normal condition, a fetus sustains steady heart rate during contractions; however, fetus hypoxia, decreased FHR, and depression of myocardium occur if there is inadequate reservation of placenta. There are some contradiction applies for this test as indicated by London et al. (2007) “The CST is contraindicated if there is third- trimester bleeding from placenta previa or marginal abruption placentae, previous cesarean with classical incision (vertical incision in the fundus of the uterus), premature rupture of the membranes, incompetent cervix, or multiple gestation” (p. 300). The test results are considered negative when three contractions last 40 seconds or more in test period of 10 minute without any sign of late decelerations; however the results are considered positive if there is late decelerations within a given time period. Another test that is used for fetal well-being is five biophysical variables known as biophysical profile. The five different variables are mentioned by London et al. (2007) “ fetal breathing movement, fetal movement of the body or limbs, fetal tone (extension an flexion of extremities), amniotic fluid volume (visualization as pockets of fluid around the fetus), and reactive FHR with activity” (p. 299). To complete this test, it requires assessment with ultrasound and NST. The combination of assessment finding from these two different tests helps to identify any problems and to confirm fetal well-being. A scale from 0-10 is being used to rate the fetal well-being and score of 8-10 are consider normal with normal amniotic fluid volume. It is considered abnormal findings if scores are less than eight or with abnormal amniotic fluid volume.