Author: Dr. Tejinder Kaur

MBBS, Diploma in Hospital Administration, Diploma of National Board training, Fellowship in Reproductive Medicine

Consultant: Obstetrician & Gynaecologist at  Motherhood Hospital, Mohali

Fetal Heart Monitoring: Stages, Procedures, & Results

Introduction:

Fetal Heart Monitoring (FHM) is a crucial practice during pregnancy and childbirth, aimed at assessing the well-being of the fetus by tracking its heart rate and, sometimes, the uterine contractions of the mother. This practice becomes especially vital in a country like India where perinatal mortality rates are relatively high due to various risk factors like maternal infection and preterm birth. This article delves into the stages when FHM is performed, the procedures involved, and what the results could indicate.

Stages:

FHM is generally conducted during three primary stages:

1. Prenatal Visits: Regular monitoring of the fetal heart rate during prenatal care appointments helps in the early detection of any irregularities.
2. High-Risk Pregnancies: Pregnancies deemed high-risk due to conditions like preeclampsia or diabetes necessitate more frequent FHM.
3. Labor and Delivery: Continuous monitoring during labor and delivery helps ensure the baby’s well-being and can alert healthcare providers to potential distress.

Procedures:

FHM can be carried out through various methods, each with its set of procedures:

• External Monitoring:
  • Fetoscope: A manual method where a fetoscope, similar to a stethoscope, is used to listen to the baby’s heartbeat. Not used in clinical practice anymore. 
  • Handheld Doppler: Utilizes sound waves to measure the baby’s heart rate, displayed on a pocket handheld screen.
  • Continuous Doppler: During labor, continuous monitoring is done using an ultrasound device held in place on the abdomen, providing a continuous readout of the baby’s heart rate alongside uterine contractions.
• Internal Monitoring:
  • Conducted inside the uterus, a wire is attached to the baby’s head for continuous heart rate tracking, especially utilized when external monitoring results are unreliable or more precise monitoring is required.

Risks:

While generally safe, continuous electronic monitoring can restrict movement and potentially increase the chances of a cesarean section or delivery using vacuum devices or forceps. Internal monitoring carries risks like injury to the baby’s scalp, maternal infection, or transmission of infections like HIV from mother to baby.

Results & Follow-Up:

Results from FHM are usually shared by healthcare providers promptly. An abnormal heart rate or rhythm doesn’t always signify danger; however, persistent changes in heart rate could necessitate further monitoring, other tests, or in severe cases, an immediate cesarean section or assisted vaginal delivery.

At-Home Monitoring:

At-home fetal heart rate monitors and mobile apps are available but come with their set of drawbacks. They might not provide accurate results and could potentially lead to undue stress or a false sense of confidence. The FDA discourages the use of at-home Doppler devices due to the lack of medical necessity and the requirement of training to accurately use and interpret the devices.

Conclusion:

FHM is an invaluable tool for ensuring fetal well-being throughout pregnancy, especially during labor and delivery. While the procedures are largely safe, understanding the nuances, risks, and interpretations of FHM results is pivotal for expectant parents to ensure a healthy pregnancy and childbirth experience.

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