What symptom would indicate that a patient in labor may need further evaluation after receiving epidural anesthesia?

When a patient in labor receives epidural anesthesia, monitoring the fetal heart rate is crucial, as changes can indicate potential complications. A decreased fetal heart rate may signal issues such as fetal distress, which could arise due to a variety of reasons, including uteroplacental insufficiency or an adverse reaction to the anesthesia. This requires immediate evaluation and intervention by the healthcare team to ensure the safety of both the mother and the fetus.

While a severe headache could be a symptom of a post-dural puncture headache from the epidural procedure, it does not directly indicate fetal distress. Increased contractions might occur as the labor progresses or as a reaction to the anesthesia, and while they should be monitored, they are not as critical as the fetal heart rate. Sleepiness during labor can be influenced by the anesthesia and may not warrant immediate evaluation unless it is extreme or associated with other concerning symptoms. Thus, a decrease in fetal heart rate is the most pressing symptom in this context, necessitating further evaluation.