Fetal Heart Rate Monitoring: Definition, Types, Benefits, Risk & Procedure.

01/06/2023

What is the Fetal Monitoring? 

Fetal monitoring is a critical process used to assess the health and well-being of a fetus during the pregnancy and labor. The primary objective of this monitoring is performed to ensure the well-being and health of both the mother and the developing baby. It involves using various methods to measure and monitor the fetus's vital signs, such as heart rate, breathing patterns, and uterine contractions. The goal is to ascertain that the fetus is receiving sufficient oxygen and nutrients, while also ensuring that it is not experiencing any distress.

Types of Fetal Monitoring During Pregnancy:

During pregnancy, various types of fetal monitoring system are used to ensure the well-being of both the mother and the developing baby. These monitoring techniques play a crucial role in tracking key indicators of fetal health. Let's explore the different types:

External Fetal Monitoring:

External fetal monitoring is a non-invasive method used to assess the well-being of the fetus during pregnancy and labor. This monitoring technique involves placing sensors on the mother's abdomen to track and record the baby's vital signs, including the fetal heart rate and uterine contractions. It's also known as antepartum fetal monitoring. There are various components of external fetal heart monitoring are:

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  1. Continuous Doppler Ultrasound: An ultrasound transducer is placed on the mother's abdomen with the help of elastic bands. The transducer of the fetal monitor uses the doppler phenomenon to detect the fetal heart movements and transmits these signals to the monitor, which records the rate, rhythm, and pattern of the heartbeat. Intrauterine pressure is also detected using this method. The heart rate primarily indicates the oxygen status of the fetus. Despite this, if the individual is obese or if there is excessive fetal movement, continuous external fetal monitoring becomes difficult using external means. This is also known as continuous fetal monitoring. 


  2. Fetoscope: Fetoscope or fetal stethoscope is a device that increases the volume of fetal heart beat so that the heart beat is loud enough and clearly heard. This device is similar to a stethoscope except for the fact that the fetoscope has a conical diaphragm. It is mainly used to detect fetal movement monitoring because the heart sounds are louder when fetoscope is placed directly on the fetal heart.
  3. Fetal Doppler: These fetal dopplers use the same principle as mentioned in the continuous doppler ultrasound. However, these can be used at home for frequent monitoring of fetal heartbeat. Before using the device, it is important that you apply aloe vera gel or any gel recommended by your doctor to increase the conductance of the waves through the skin. You must remember that at home devices are not as sensitive as the devices used by your healthcare provider, they fail to catch the feeble heart signals.

Internal Fetal Monitoring:

Internal fetal scalp monitoring is a medical procedure used to assess the well-being of a fetus during labor. Unlike external monitoring methods, which involve placing sensors on the mother's abdomen, internal monitoring requires the placement of a small electrode directly on the baby's scalp. This electrode is typically attached during a vaginal examination. It provides more accurate and direct measurements of the fetal heart rate, which is crucial for assessing the baby's response to contractions and ensuring they receive sufficient oxygen. In this method, the transducer is the monitor. The monitor records and prints the heart rate and rhythm.

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Difference Between External and Internal Fetal Monitoring

BasisExternal Fetal Heart Rate MonitoringInternal Fetal Monitoring
Placement of SensorUltrasound transducer placed on the mother's abdomenA thin, flexible catheter with a pressure-sensitive tip is inserted into the uterus, near the fetus's head
Monitored ParametersFetal heart rate, uterine contractionsFetal heart rate, uterine contractions, intrauterine pressure
AccuracyMay be influenced by factors like maternal obesity or fetal position.Generally more accurate as it directly measures fetal signals.
Method of MeasurementMonitors fetal heart rate using Doppler ultrasound.Directly measures fetal heart rate from the scalp.
Comfort of MotherNon-invasive and generally more comfortable.It involves a minor procedure, may cause discomfort or require local anesthesia.
RiskExternal monitoring has no risk.Internal monitoring has risk such as Infection, uterine rupture, fetal injury, maternal hemorrhage
Mobility of MotherAllows greater freedom of movement for the mother.Limits the mother's movement due to internal placement.

This table provides a clear overview of the distinctions between external and internal fetal monitoring, helping to understand their respective advantages and considerations in pregnancy care.

Benefits of Fetal Monitoring:

  1. Early Detection of Issues: Fetal heart rate monitoring allows healthcare providers to detect signs of fetal distress, such as abnormal heart rate patterns, decreased variability, and loss of accelerations, early on. This enables timely intervention to prevent adverse outcomes.
  2. Optimizing Time of Delivery: Fetal monitoring during labor helps determine the optimal time for delivery, avoiding prolonged labor that can increase the risk of complications. It can aid in identifying conditions like uterine hyperstimulation or fetal hypoxia, prompting cesarean delivery if necessary.
  3. Management of High-Risk Pregnancies: In high-risk pregnancies, such as those with maternal medical conditions, multiple pregnancies, or fetal abnormalities, fetal monitoring is crucial. It allows healthcare providers to closely monitor the fetal well-being throughout labor and make informed decisions to ensure a safe delivery.
  4. Facilitates Decision-Making During Labor: Fetal monitoring provides valuable information to healthcare providers, helping them make informed decisions about the progress of labor, interventions needed, and any necessary changes in the delivery plan.
  5. Identification of Abnormal Patterns: Fetal heart rate monitoring can identify abnormal patterns that may indicate fetal distress, such as late decelerations, variable decelerations, or bradycardia. These patterns require prompt attention and action to ensure fetal well-being.
  6. Enhanced Oxygenation for the Baby: Monitoring uterine contractions helps in assessing the oxygen supply to the baby. This information is crucial for ensuring the fetus receives an adequate oxygen and nutrient supply, vital for its growth and development.

When is Fetal Monitoring Necessary?

Fetal heart rate monitoring is more likely to be used by the doctor in high-risk pregnancies. Some situations when fetal heart rate monitoring may be necessary include:

  • If the mother has diabetes, which can increase the risk of complications for both the mother and the baby.
  • If the mother is taking medication for preterm labor, as this can affect the baby's heart rate.
  • If the baby isn’t growing or developing normally.
  • If severe fetal hypoxia due to umbilical cord compression
  • To check the baby's heart rate during certain procedures, such as amniocentesis or chorionic villus sampling (CVS).
  • To evaluate the effectiveness of treatment for certain conditions, such as fetal anemia.

Risk of Fetal Heart Monitoring During Pregnancy:

External Fetal Monitoring Risk

  • External monitoring is generally safe and does not pose significant risks.
  • In rare cases, the use of a fetal monitoring belt might cause mild discomfort or require the mother to remain in bed during labor.

Internal Fetal Monitoring Risk

  • Slight discomfort: The insertion of the monitor might cause temporary discomfort or pain.
  • Infection: There is a small risk of infection at the insertion site. 
  • Bruising or scratching of the baby's scalp: The monitor might cause minor bruising or scratching of the baby's scalp. 
  • Risk of HIV transmission: For HIV-positive mothers, internal fetal heart rate monitoring is generally not recommended due to the potential risk of passing the infection to the baby.

Fetal Monitoring Procedure:

Fetal heart rate monitoring can be conducted in medical facilities setting. The specific procedure will vary depending on the type of monitoring being performed.

External Fetal Heart Rate Monitoring Procedure

  • Preparation: You'll be requested to undress and lie down on an exam table and medical bed.
  • Gel Application: A clear gel will be spread over your abdomen to improve the result.
  • Transducer Placement: A medical professional will utilize a device called a Doppler transducer to gently press and move it around your abdomen.
  • Heartbeat Detection: As the transducer moves, you'll be able to hear the rhythmic sound of your baby's heartbeat.
  • Continuous Monitoring: In case continuous tracking of the heartbeat is required, a wide belt will be wrapped around your abdomen to keep the transducer securely in place.
  • Recording and Display: The fetal heart rate will be recorded and displayed on a computer screen, allowing you and the medical team to observe the real-time data.

Internal Fetal Heart Rate Monitoring Procedure

  • Your Doctor will ask you to undress and lie down.
  • Position yourself with your feet and legs in supports, akin to a standard vaginal exam.
  • Your doctor will assess the dilation of your cervix.
  • If your water hasn't broken, the doctor might perform an intervention to break it.
  • The doctor will feel for your baby’s head.
  • A slender tube (catheter) equipped with a small wire at its end will be gently inserted into your vagina.
  • The doctor will carefully place the wire on your baby's scalp, removing the catheter afterward.
  • Once connected to a cable, this wire will diligently record your baby's heartbeat until either a doctor removes it or your baby is born.

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Conclusion:

In conclusion, fetal heart rate monitoring is a vital tool in ensuring the well-being of both the mother and the baby during labor. It provides valuable information about the baby's condition and can help to identify any potential problems early on. While there are some risks associated with fetal monitoring, such as infection or vaginal lacerations, these are generally outweighed by the benefits. With proper technique and interpretation, fetal heart rate monitoring can significantly improve the chances of a successful and safe delivery. Therefore, it is essential for healthcare providers to be proficient in fetal movement monitoring and to use this tool judiciously to optimize maternal and fetal outcomes.

Frequently asked questions:

What is the normal range when monitoring fetal heart rate?

The normal fetal heart rate ranges between 110-160 beats per minute. A difference of 5-25 beats is considered normal.

What is fetal distress?

Fetal distress is a sign of fetal hypoxia. When the fetal heart is unable to meet the needs, it causes fetal distress. It is majorly seen when there is cardiovascular dysfunction.

Which week can monitor the fetal heart?

During pregnancy, two primary ultrasounds are typically scheduled: one before or around 12 weeks to confirm the pregnancy and detect a fetal heartbeat, and another around week 20, known as the fetal Doppler test, to check the baby's heart rate and overall well-being. Additional ultrasounds may be ordered if complications arise or if further assessment is deemed necessary.

What does it mean when the fetal heart rate is 170?

When fetal heart rate is above 170 it indicates fetal tachycardia.

What are the 2 methods of monitoring fetal heart rate?

Two methods of monitoring fetal heart rate include:

  1. Auscultation with the stethoscope.
  2. Electronic fetal heart rate monitoring.
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