Tessa Quinn
Fetal heart monitoring is a procedure that measures a baby's heart rate and rhythm in the womb. This is done to ensure the baby is doing well and getting enough oxygen. Typically, fetal heart monitoring is done during late pregnancy and labour. The average fetal heart rate is between 110 and 160 beats per minute, but this can vary by 5 to 25 beats per minute. The first time a mother can hear her baby's heartbeat is usually around the 12-week mark, although some sources say it can be as early as 5 weeks.
| Characteristics | Values |
|---|---|
| When can a fetal heartbeat be detected by ultrasound? | Between 5 and 6 weeks of pregnancy. |
| When can a fetal heartbeat be detected by Doppler? | Between 8 and 15 weeks of pregnancy. |
| When can a fetal heartbeat be heard without Doppler? | Around 12 weeks of pregnancy. |
| When is the fetal heart fully formed? | Around 10 weeks of pregnancy. |
| What is the average fetal heart rate? | Between 110 and 160 beats per minute. |
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What You'll Learn
Fetal heart rate monitoring in the hospital
Fetal heart rate monitoring is a common procedure that is carried out to ensure the health and safety of the baby and the mother. It is usually carried out during late pregnancy and labour, but can be performed at any time if the pregnancy is deemed high-risk. Doctors may also recommend a scan if the patient has had spotting, bleeding, or problems with a previous pregnancy.
Procedure
The procedure for fetal heart rate monitoring may vary depending on the condition of the patient and the practices of the healthcare provider. Typically, the patient is asked to undress from the waist down or remove all clothes and wear a hospital gown. The patient is then asked to lie on their back on an examination table. The healthcare provider then applies a clear gel to the patient's abdomen and presses a transducer against the skin. The transducer is moved around until the fetal heartbeat is found. The sound of the fetal heart rate can then be heard through a Doppler or an electronic monitor.
Frequency
During labour, the fetal heart rate may be checked at intervals or nonstop, depending on the condition of the mother and the baby. The fetal heart rate is usually checked more frequently if there are risk factors or problems during labour.
Methods
There are two main methods of fetal heart rate monitoring: external and internal. External monitoring involves listening to or electronically recording the fetal heartbeat from outside the patient's abdomen. This can be done using a Doppler ultrasound device, a fetoscope, or a fetal stethoscope. Internal monitoring involves threading a thin wire (electrode) through the cervix and attaching it to the baby's scalp. This method provides better readings as it is not affected by movement. However, it can only be performed if the amniotic sac has broken and the cervix is open.
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Ultrasound detection of fetal heartbeat
Fetal heartbeats can be detected as early as 34 days (just under 6 weeks) into gestation using a high-frequency transvaginal ultrasound. The embryo's heartbeat can be challenging to detect until around the seventh week of pregnancy. A transvaginal ultrasound is a type of internal scan where a device is inserted into the vagina to monitor the embryo's development.
During the first trimester, a transvaginal ultrasound can be used to confirm the pregnancy and determine the age of the fetus. Healthcare professionals may recommend this scan as early as six weeks if the patient has had spotting, bleeding, or problems with a previous pregnancy. The heartbeat can typically be detected once the fetus is 7 millimeters or more in length. If the heartbeat cannot be identified at this stage, the doctor may request another scan after a week.
In most cases, an ultrasound can detect the beating of cardiac tissue around weeks five to six. The heart will then fully develop within the next few weeks. By week nine or ten, the fetal heart rate will be around 170 beats per minute, slowing down to 140 beats per minute by week 20. During labor, the typical fetal heart rate is between 110 and 160 beats per minute.
Fetal heart rate monitoring can be performed in a healthcare provider's office or during a hospital stay. There are two methods of monitoring: external and internal. External monitoring involves placing an ultrasound probe (transducer) on the patient's belly to send the sounds of the fetal heartbeat to a computer. The rate and pattern are displayed on a screen and printed on paper. Internal monitoring, on the other hand, involves inserting a thin wire (electrode) through the cervix to the baby's scalp. This method provides more accurate readings as it is unaffected by factors such as movement.
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Fetal heartbeat during labour
Fetal Heart Monitoring
Fetal heart rate monitoring is a widely used method to assess the status of the fetus during pregnancy, labour, and birth. The healthcare provider may do fetal heart monitoring during late pregnancy and labour. Fetal heart rate monitoring may be used in other tests, including the non-stress test, contraction stress test, and biophysical profile (BPP).
Methods of Monitoring
There are two methods of fetal heart rate monitoring in labour: auscultation and electronic fetal monitoring. Auscultation is a method of periodically listening to the fetal heartbeat using a special stethoscope or a device called a Doppler transducer. When the transducer is pressed against the abdomen, one can hear the fetus's heartbeat. Electronic fetal monitoring uses instruments to continuously record the heartbeat of the fetus and the contractions of the woman's uterus during labour. The method chosen depends on the policy of the hospital, the risk of problems, and how labour is progressing.
Fetal Heart Rate
The average fetal heart rate is between 110 and 160 beats per minute. It can vary by 5 to 25 beats per minute. During labour, a typical fetal heart rate can span from 110 to 160 beats per minute, although brief variations outside this range can occur. The fetal heart rate may change as the baby responds to conditions in the uterus.
Detection of Fetal Heartbeat
Cardiac tissue starts to pulse at around 5–6 weeks of pregnancy, registering as a heartbeat on an ultrasound, though the heart has not yet developed. An ultrasound can detect the beating of cardiac tissue around weeks five to six, and the heart typically forms within the next few weeks. A doctor may recommend a scan as early as 6 weeks if the patient has had spotting, bleeding, or problems with a previous pregnancy. You'll most likely hear fetal cardiac activity with a Doppler at around the 15-week mark.
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At-home fetal Dopplers
Fetal heartbeats can be detected as early as 5 to 6 weeks of pregnancy using an ultrasound. However, at-home fetal Dopplers may not be able to detect the heartbeat until much later. Most sources recommend not using at-home fetal Dopplers until the second trimester, as they may not be able to detect a heartbeat before then. Some at-home fetal Dopplers claim to work from 12 weeks onwards, while others claim to work from 8 to 10 weeks.
Safety concerns
While at-home fetal Dopplers can provide reassurance to expectant parents, they also present significant risks. The main concern is that these devices can give a false sense of security or set off needless alarms. Users may mistake their own heartbeat for the baby's, or they may not be able to detect the baby's heartbeat, causing unnecessary stress and anxiety. The United Kingdom's National Health Service (NHS) and the British Medical Journal have cautioned against using at-home fetal Dopplers, as they cannot replace a doctor's expertise. The US Food and Drug Administration (FDA) has also advised against their use since 2014, noting that they are legally marketed as "prescription devices" for use only by trained operators. Additionally, the quality of at-home fetal Dopplers may vary, and they may not be as sophisticated as the devices used by medical professionals.
Recommendations for use
If you choose to use an at-home fetal Doppler, it is important to follow certain guidelines to minimize risks:
- Consult with your doctor or midwife before use and ask for recommendations on specific devices and any factors that might make use especially risky.
- Read the instructions carefully and follow the manufacturer's guidelines on how early the device can detect a heartbeat.
- Use ultrasound gel or aloe vera gel on the skin to facilitate heartbeat detection.
- Use the device at maximum volume.
- Use the device for a limited time only (1-2 minutes) and as infrequently as possible.
- Stop using the device after the baby starts moving, as fetal movements are a more reliable way to check on the baby's health.
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Fetal heart rate abnormalities
Fetal heart rate monitoring is a standard procedure during late pregnancy and labour. The average fetal heart rate is between 110 and 160 beats per minute, with normal variations of 5 to 25 beats per minute. Typically, an ultrasound can detect cardiac tissue development around weeks five to six, and by week nine or ten, the fetal heart rate will hover around 170 beats per minute. At week 20, this will slow down to about 140 beats per minute.
An abnormal fetal heart rate could indicate a severe problem with the baby's health. For example, it can signify oxygen deprivation (neonatal asphyxia), hypoxia (a lack of oxygen in the fetus's blood), or ischemia (a lack of oxygen flow to the brain). These issues are extremely serious and can result in fetal death or severe birth injuries. Other common situations that can cause abnormal fetal heart rate patterns include fetal infection and/or inflammation, anaemia, congenital heart disease, and fetal CNS injury.
One of the most common abnormal fetal heart rates is "supraventricular tachycardia", where the fetal heartbeat is very fast and sometimes even double the normal heart rate. This condition can be fatal to the fetus but can be controlled or cured with medication. Fetal bradycardia is another problem diagnosed before birth, where a "heart block" occurs, resulting in a heart rate too slow to sustain the fetus's life. This condition can be treated with medications that reduce inflammation and increase the baby's heart rate, as well as close monitoring and early delivery when necessary.
In some cases, abnormal fetal heart rate patterns may be caused by pathophysiologic processes other than fetal acidemia. These abnormalities can be detected through continuous cardiotocography (cCTG) and may indicate potential central nervous system (CNS) injuries or cerebral palsy.
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Frequently asked questions
The heart of an embryo starts beating around week 5 of pregnancy. It may be detected at this point using a vaginal ultrasound. By week 6, the embryonic heart cells will pulse about 110 times a minute.
Most women first hear their baby's heartbeat during a routine checkup using a fetal Doppler. You'll most likely hear fetal cardiac activity with a Doppler at around the 15-week mark. Some at-home devices say not to use them before 16 weeks.
By week 4, a distinct cluster of cells has formed inside the embryo, which will develop into the heart and circulatory system. At week 5, the preliminary structures that will become the heart begin spontaneously pulsing.
A normal fetal heart rate can range from 110 to 160 beats per minute (BPM). This average rate varies depending on the stage of pregnancy.
