Fetal monitoring
Fetal monitoring in nagpur is the process of tracking and monitoring that the fetus properly develops during pregnancy, labor, and delivery. Fetal monitoring aims to measure the fetal health if there are some complications or issues with the fetus.
Electronic fetal monitoring is a procedure in which devices are placed on the abdomen to continuously record both the heartbeat of the fetus and the contractions of the uterus of the woman during the labor process. Depending on the policy of your ob-gyn or hospital, risk of problems, and how your labor is progressing will determine which technique you will use.
Types of fetal monitoring include the following:
1. Ultrasound: generates images of the fetus using high frequency sound waves
2. Fetal heart rate monitoring: measure the heart rate and rhythm of the fetus
3. Non-stress test (NST): the heart rate of the fetus is measured in response to movement
4. Contraction stress test (CST): measures the heart rate of the fetus in response to uterine contractions
5. Biophysical profile (BPP): combines ultrasound and NST in the assessment of fetal well-being
6. Doppler studies: sound wave method to determine the flow in the umbilical cord
7. Fetal movement counting: count the number of fetal movements within a designated period
Fetal monitoring is used for:
Detection of fetal distress or complications
Evaluation of fetal growth and development
Identification of possible birth defects or anomalies
Guidance on antenatal care and delivery
Enhancement of the safety or wellbeing of the fetus
Fetal monitoring is a tool that is essential in prenatal care where the health care provider will be able to monitor a fetus close enough in order to make informed decisions regarding how best to keep a pregnancy healthy and have excellent outcomes at birth.
What Is a Fetal monitoring?
Monitoring of fetal status during pregnancy, labor, or delivery through fetal monitoring is the process of tracking and assessing. Many techniques and devices are used for observing the following in a fetus:
1. Heartbeat and its rhythm.
2. Movement and activity.
3. Growth and development.
4. Oxygen levels.
5. Response to uterine contractions.
The primary purpose of fetal monitoring is ensuring that the fetus has sufficient oxygen and other nutrient resources for normal functioning.
2. Determine any complications or the risk of complications, such as fetal distress
3. Guide decisions about antenatal care and delivery
4. Enhance protection and well-being of the fetus
Some tools that may be utilized by a professional, for example, an obstetrician or a certified nurse midwife, in checking the status of the fetus are:
1. Ultrasound
2. Electronic fetal monitoring (EFM)
3. Fetal heart rate monitoring
4. Non-stress test (NST)
5. Contraction stress test (CST)
6. Biophysical profile (BPP)
This enables the health care provider to monitor the fetus closely to determine potential problems that are about to arise and then take appropriate measures for a successful pregnancy and delivery outcome.
Types of Fetal Monitoring
- Intermittent Auscultation:
- This involves periodically checking the baby’s heart rate using a handheld device like a Doppler ultrasound or a fetoscope.
- This method is commonly used in low-risk pregnancies and labor situations, where there are no complications.
- It allows mothers more freedom to move during labor since continuous monitoring isn’t required.
- Electronic Fetal Monitoring (EFM):
- EFM is more commonly used in hospitals, particularly for high-risk pregnancies and when complications are anticipated.
- It involves continuously recording the fetal heart rate and uterine contractions.
- EFM can be performed either externally or internally.
a. External Fetal Monitoring:
- Two sensors are placed on a mother’s abdomen:
- One measures the fetal heart rate, typically using ultrasound.
- The other measures the mother’s uterine contractions using a tocometer.
- The heart rate and contraction patterns are displayed on a monitor, allowing healthcare providers to observe the fetus’s condition and detect any signs of distress, such as abnormal heart rate patterns.
b. Internal Fetal Monitoring:
- Used when more precise or continuous data is needed, especially in situations where external monitoring is insufficient (e.g., during labor if the mother’s movement interferes with external readings).
- Involves inserting the thin electrode through the cervix and attaching it directly to a baby’s scalp to record the heart rate.
- A catheter can also be used to measure the strength of uterine contractions.
- Internal monitoring is typically done after the amniotic sac has ruptured and the cervix is partially dilated.
Indications for Fetal Monitoring
Fetal monitoring is often used in specific situations or high-risk pregnancies where the baby’s health needs closer observation. Common indications include:
- High-risk pregnancies, such as:
- Gestational diabetes.
- Preeclampsia (high blood pressure during pregnancy).
- Intrauterine growth restriction (IUGR).
- Multiple pregnancies (twins or more).
- Preterm labor or post-term pregnancy.
- Maternal conditions:
- Chronic conditions like hypertension, kidney disease, or autoimmune disorders.
- Complications during labor:
- Abnormal fetal heart rate patterns and signs of fetal distress.
- Prolonged labor or issues with uterine contractions.
- Induced labor.
- Use of epidural anesthesia: This may slow down labor or affect contractions, requiring closer monitoring of the fetus.
- Vaginal birth after cesarean (VBAC): Fetal monitoring is often recommended to reduce risks of uterine rupture during labor.
- High-risk pregnancies, such as:
Fetal Heart Rate Patterns
Fetal monitoring focuses on assessing the baby’s heart rate and how it responds to uterine contractions. Key indicators include:
- Baseline Fetal Heart Rate:
- Normal range: 110–160 beats per minute (bpm).
- Abnormal heart rate patterns, such as tachycardia (heart rate over 160 bpm) or bradycardia (heart rate under 110 bpm), may indicate fetal distress or other complications.
- Variability:
- Variability refers to fluctuations in the fetal heart rate, which indicate how well the baby is adapting to changes in the uterine environment.
- Moderate variability is a sign of the healthy, well-oxygenated fetus.
- Reduced variability may suggest issues such as fetal hypoxia and central nervous system depression.
- Accelerations:
- Temporary increases in the fetal heart rate are generally a reassuring sign of fetal well-being.
- Accelerations often occur during fetal movements or contractions and indicate a healthy, responsive fetus.
- Decelerations:
- These are decreases in the fetal heart rate or can be the classified into three types:
- Early Decelerations: These are normal or usually occur during contractions due to head compression.
- Late Decelerations: These are more concerning and may indicate placental insufficiency, where the baby is not getting enough oxygen.
- Variable Decelerations: Often associated with umbilical cord compression and may require closer monitoring.
- These are decreases in the fetal heart rate or can be the classified into three types:
Benefits of Fetal Monitoring
- Detection of Fetal Distress: Fetal monitoring can help detect signs of distress, such as abnormal heart rate patterns or oxygen deprivation, allowing for timely intervention (e.g., changing the mother’s position, administering oxygen, or performing a cesarean section).
- Assessment of Labor Progress: Monitoring contractions helps assess the progress of labor and whether contractions are strong enough to promote delivery.
- Support for Informed Decisions: Continuous fetal monitoring provides real-time data that can inform decisions about labor management and delivery.
Limitations and Risks
- False Positives: Fetal monitoring may sometimes indicate issues that are not serious, leading to unnecessary interventions (such as an unplanned cesarean section).
- Restricted Movement: Continuous external monitoring may limit the mother’s ability to move around during labor, which can impact comfort and the progression of labor.
- Increased Cesarean Risk: Some studies suggest that continuous EFM is associated with a higher rate of cesarean deliveries and instrumental births, though it can be life-saving in cases of true fetal distress.
- Invasive Nature of Internal Monitoring: Internal fetal monitoring can increase the risk of infection and may cause some discomfort.
What procedures Fetal monitoring?
Fetal monitoring involves the following procedures:
Ultrasound: this makes use of increased frequency sound waves that bring out images of the fetus.
Electronic Fetal Monitoring (EFM): this uses sensors to monitor fetal heart rate and uterine contractions.
Fetal Heart Rate Monitoring: it monitors and documents the baby’s heart rhythm and rate.
Non-Stress Test (NST): this test measures the reaction of the fetus to movement as it affects heart rate.
Contraction Stress Test (CST): this also measures the reaction of the fetus to uterine contractions.
6. Biophysical Profile (BPP): It combines Ultrasound and NST for checking the well-being of the fetus.
7. Doppler Studies: using sound waves to evaluate the blood flow within the umbilical cord.
8. Fetal Movement Counting : counts the number of movements over a period
9. Fetal Tone Monitoring : measures the tone of the fetus muscles
10. Amniotic Fluid Index (AFI) : measures the amniotic fluid surrounding the fetus.
11. Umbilical Artery Doppler (UAD): It measures blood flow in the umbilical artery.
12. Fetal Echocardiography: uses ultrasound views to study the heart anatomy of the fetus, and its function
These services enable the care provider to monitor fetal well-being, identifies areas of potential concern, and guides decisions regarding prenatal treatment and delivery.
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