What is Fetal Health Surveillance?
Fetal Health Surveillance (FHS) refers to the various techniques that health care providers use to evaluate the health of your baby. All health care providers aim to ensure that the baby remains healthy before, during, and after delivery. It is quite important for both expectant mothers and health providers to pay attention to features that tell us that a baby is not doing well.
Fetal Kick Counting
One of the earliest signs of a distressed baby is a baby that moves less than expected. Fetal kick counting is a simple, non-invasive method that all mothers can utilize during the prenatal period. Mothers are asked to count their baby’s individual movements for up to 2 hours.
It is important that you find a relaxed and quiet setting in order to truly focus on counting. It is asked that mothers get into a comfortable position, either lying on one side, or sitting. One or both hands should be placed on the abdomen, and each individual movement is counted.
Mothers should feel at least 6 movements within a 2 hour period. If you feel 5 or less movements, you should go to the hospital for evaluation. You may stop counting upon reaching 6 movements. Please note that this is a practice intended for pregnant women around 26 weeks and beyond.
It is recommended that fetal kick counting is performed once daily, particularly in those women who have other medical conditions such as high blood pressure and diabetes, or in women who carry extra weight.
Ultrasound – Biophysical Profile
An ultrasound is often requested if there are concerns about the baby. These are often done outside of the hospital, in the community. When a mother has health conditions such as diabetes, high blood pressure, or elevated body weight in pregnancy, an ultrasound is performed as a routine screen to assess the baby. Another common reason for this ultrasound is when health care providers wish to monitor a baby’s growth or if a mother is measuring smaller than expected. In every evaluation, a scoring system called a Biophysical Profile (BPP) is used to grade the baby. A healthy baby with good amniotic fluid levels will receive a grade of 8/8.
A non-stress test is a hospital-based evaluation. It involves placing a monitor on the abdomen to check the baby’s heart rate, as well as your contraction pattern. The test is run for 20-30 minutes and provides important clues about the health of the baby. The test is performed as the first evaluation in all mothers who have pregnancy-related concerns. To obtain useful tracing, mothers typically need to be more than 28 weeks pregnant. The fetal heart rate should generally be between 110 and 160 beats per minute. Occasionally, short-lived rises in the heart rate occur and these are called accelerations. Accelerations are a good sign as they help reassure the health care team that the baby is okay. Contractions can also be seen on a non-stress test, but it cannot tell the team how strong they are. This is best felt by touch. This evaluation may also be referred to as a ‘tracing’ or ‘strip’.
This is a listening technique that involves hearing the baby’s heartbeat for short term intervals using a handheld Doppler machine when a mother is in labour. This is a technique reserved and preferred for healthy mothers with completely normal pregnancies. It is highly recommended that this technique be used when a mother is eligible. Studies have shown that this technique helps avoid unnecessary medical interventions, as it helps avoid the detection of very subtle (and insignificant) abnormalities that the team may have otherwise acted on. However, if there are concerns, additional evaluation is needed.
Continuous Fetal Monitoring
This test involves the use of monitors, just like a non-stress test. However, as its name implies, it monitors the fetal heart rate and contraction pattern continuously, which usually means until the baby delivers. Like intermittent auscultation, it is performed when patients are in labour. At times, members of the team may also refer to this evaluation as a ‘tracing’ or ‘strip’.
There are many reasons why a health care provider will recommend this, although it is recommended when there are maternal health concerns, fetal health concerns, or when interventions such as induction of labour are being performed. It is also used if intermittent auscultation (see above) is abnormal.
Occasionally, continuous fetal monitoring is achieved by using a fetal scalp electrode. This is a tiny probe that clips onto the baby’s scalp. This technique is used when more accuracy is needed when monitoring the baby’s heart, or when the medical team finds it difficult to measure the baby’s heartbeat. It is safe for most laboring mothers.
Continuous fetal monitoring can be a little restrictive, given that the monitors are fastened to the tummy. It is important to know that while abnormalities in the tracing are quite common, the baby is well at birth in the majority of cases. Yet in other cases, there can be very concerning abnormalities that may force the need for a rapid emergency delivery.
Fetal Scalp pH Continuous fetal monitoring
A fetal scalp pH is a test used when there are features on continuous fetal monitoring that are difficult to interpret. It involves taking a small blood sample from the baby’s head and testing the baby’s pH. It is quite safe in the majority of cases. The scalp pH is another way to help the medical team decide if an immediate/emergency delivery is needed.