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High-Risk Pregnancy - Fetal Monitoring

What is fetal monitoring?

During late pregnancy and during labor, your physician may want to monitor the fetal heart rate and other functions. Fetal heart rate monitoring is a method of checking the rate and rhythm of the fetal heartbeat. The average fetal heart rate is between 110 and 160 beats per minute. The fetal heart rate may change as the fetus responds to conditions in the uterus. An abnormal fetal heart rate or pattern may mean that the fetus is not getting enough oxygen or there are other problems. An abnormal pattern also may mean that an emergency or cesarean delivery is needed.

How is fetal monitoring performed?

Using a fetoscope (a type of stethoscope) to listen to the fetal heartbeat is the most basic type of fetal heart rate monitoring. Another type of monitoring is with a hand held Doppler device. This is often used during prenatal visits to count the fetal heart rate. During labor, continuous electronic fetal monitoring is often used, especially if an abnormal rhythm is heard with the fetoscope. Although the specific details of each procedure vary slightly, generally, electronic fetal monitoring follows this process:

  • Gel is applied to the mother's abdomen to act as a medium for the ultrasound transducer.
  • The ultrasound transducer is attached to the abdomen with straps and transmits the fetal heartbeat to a recorder. The fetal heart rate is displayed on a screen and printed onto special paper.
  • During contractions, an external tocodynamometer (a monitoring device that is placed over the top of the uterus with a belt) can record the patterns of contractions.
  • Sometimes, internal fetal monitoring is necessary for a more accurate reading of the fetal heart rate. Your bag of waters (amniotic fluid) must be broken and your cervix must be partially dilated to use internal monitoring. Internal fetal monitoring involves inserting an electrode through the dilated cervix and attaching the electrode to the scalp of the fetus, called a fetal scalp electrode.

What are the risks and benefits of fetal monitoring?

Risks Benefits
Fetal monitoring is widely used. There are no known risks to using the fetoscope, Doppler, or external monitoring. There may be a slight risk of infection with internal monitoring. The scalp electrode may also cause a mark or small cut on the baby's head, but this usually heals quickly. An abnormal fetal heart rate pattern does not always mean the fetus is in danger. Studies have found that the use of electronic fetal monitoring is associated with a greater chance for vacuum and forceps with vaginal deliveries, and for cesarean delivery with abnormal fetal heart rate tracings. Fetal monitoring may help with possible recognition of problems in the fetus. Other testing or delivery may be necessary.

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