fetalmonitoring

Fetal monitoring refers to a group of techniques used to assess fetal well-being during pregnancy and especially during labor. Its purpose is to detect signs of fetal hypoxia or distress, guide clinical decisions, and improve outcomes. Monitoring is common in high‑risk pregnancies and labor, but may be used selectively in low‑risk situations as well.

External monitoring typically involves ultrasound-based recording of the fetal heart rate and a tocodynamometer to measure uterine contractions. A transducer placed on the abdomen provides continuous or intermittent data on heart rate, while a second sensor tracks contractions. Intermittent auscultation with a handheld Doppler device or a fetal stethoscope is an alternative in some settings and may be preferred to reduce interventions.

In labor, monitoring can be continuous electronic fetal monitoring (EFM) or intermittent auscultation. Continuous EFM records fetal heart rate and contractions on a strip or monitor, offering ongoing data. Internal monitoring may be used in certain situations, employing a fetal scalp electrode for heart rate and an intrauterine pressure catheter to measure contractions, which provides more precise information.

Diagnostic tests associated with fetal monitoring include the non‑stress test (NST), which assesses fetal heart rate acceleration in response to movement; the biophysical profile (BPP), combining NST with ultrasound assessment of fetal movement, tone, and amniotic fluid; and the contraction stress test (CST), which evaluates fetal response to uterine contractions. These tests help stratify risk and inform timing of delivery.

Interpretation centers on patterns such as tachycardia, bradycardia, and decelerations (early, late, or variable). Early decelerations are often benign; late decelerations may signal placental insufficiency; variable decelerations can reflect cord compression. Management may include maternal position changes, supplemental oxygen, fluid management, stopping oxytocin, expedited delivery, or additional testing as indicated. Limitations include the potential for false positives and the need for trained interpretation within the clinical context.