MoonDragon's Pregnancy Information
ASSESSMENT OF FETAL WELL-BEING
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ASSESSMENT OF FETAL MOVEMENT
Assessment of fetal movement is a non-invasive method of monitoring the well-being of the fetus. It has been observed that when something is wrong with the fetus (i.e., placental insufficiency, infection, certain malformations, etc.) the amount of fetal movement will significantly decrease. This is because the baby is conserving needed energy for vital functions in a weakened state.
Each baby has their own patterns of movement. Some women notice their baby's movements more than others. The amount of amniotic fluid as well as the mother's activity level can effect her awareness. It is therefore important to get a good idea of the regular pattern of fetal movement throughout prenatal care by asking the mother how the baby is moving at each visit. This will also stimulate her to become more aware of how and when the baby is moving. If, for any reason, there is a question about the well-being of the baby the mother can make it a point to count movements of the fetus on a daily basis. When compared with Estriol tests, this technique proved more accurate as an indication of fetal health.
If the baby is doing poorly, the movements will diminish over a period of 3 to 4 days and some time after that they will stop altogether. It has been demonstrated that an effective number of movements is 10 in a 12 hour period. If fewer than 10 movements are noted in that time, the baby may still be fine, as 2.5 percent fall below that count and are still well. However, it indicates that the baby should be born immediately in the majority of cases. If labor is stimulated then, the woman may be able to birth vaginally. Fetal heart tones should be carefully monitored. If movement has been very slow or absent, the fetal heart may stop within 12 to 48 hours; a Cesarean delivery may be necessary to save the baby. Remember that the fetal motion often slows or ceases prior to the onset of normal labor.
Movement may be recorded by the mother on a chart at home. Included here are a copy of the fetal assessment chart, example with instructions explaining the procedure and monitoring of the movements by the mother. This sheet should be evaluated weekly at the prenatal visit. For any mother who is monitoring her baby this way, she should probably be seen weekly so that fetal heart tones may be carefully checked, as well as fetal growth, etc. Times when this procedure may be used include: when a mother is overdue (always recheck dates), the baby seems small for dates (SGA), the mother has had a previous stillbirth, if hypertension is present, diet has been poor prior to the onset of your care, the possibility of infection exists or any other time you have a question about fetal well-being.
ASSESSMENT OF FETAL HEART TONES (FHTs) WITH FETAL MOTION
This test goes hand-in-hand with assessment of fetal motion. It has been found that a healthy baby will respond to activity by raising its' heart rate, and lowering it when at rest. (Just as an adult heart will speed up and slow down with activity and rest.)
The test is often used in hospitals before the much more stressful Oxytocin Challenge test. In the hospital, the mother is hooked up to a monitor and asked to indicate when she feels the fetal motion. The heart rate is expected to vary anywhere from 10 to 25 heartbeats per minute and accelerate with movement in a normal, healthy fetus. Lack of such variability has been correlated with high incidence of fetal mortality when observed prenatally. This pattern, when observed during labor, has not been clearly associated with infant outcome, although variability should still be present (but not necessarily associated with movement).
This test can be duplicated at home by simply monitoring the baby with a standard fetascope and being sensitive to when the baby moves. If the baby is not moving (it could be asleep!) palpate until you get a response and continue to listen for heart rate fluctuations. In order to easily assess variability, count the fetal heart rate for consecutive 5 second intervals. Comparing the several numbers that you will come up with will give you a good idea of how the baby is doing and what the range of heart rate is. Multiply each 5 second count by 12 to arrive at the per minute equivalent.
The fetal heart rate is expected to vary at least 15 beats per minute for 15 to 30 seconds twice or more in a 10 minute period or five times or more in a 20 minute period. This frequency reflects fetal health.
This information obtained from Understanding Lab Work in the Childbearing Year by Anne Frye
PREGNANCY RELATED LINKS
MoonDragon's Pregnancy Information: Pregnancy & Birth Concerns
MoonDragon's Pregnancy Information: Fetal Assessment Chart
MoonDragon's Midwifery Birthing Guidelines: Vaginal Bleeding & Miscarriage
MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
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