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Because uterine contractions may decrease the maternal blood flow to the placenta, and thereby cause a reduced supply of oxygen to the fetus, it is essential that the fetal heart rate is monitored during labour. In practice, this means that the fetal heart rate must be checked before uterine contractions to determine the fetal heart rate between contractions, then again during and after the contraction. A comment on the fetal heart rate, without knowing what happens before, during and after contractions, is of very limited value.
The fetal heart rate must be assessed before, during, and after a contraction.
The fetal heart rate assessed before, during and after a contraction is called the fetal heart rate pattern. This provides important information on the fetal condition.
Low-risk women who have had a normal pregnancy with normal observations on admission:
The following women would be regarded as high risk:
If possible, these high-risk women should have continuous electronic fetal heart rate monitoring during labour with a CTG. If this is not possible, the fetal heart rate should be observed more frequently with a fetal monitor.
When using a fetal monitor:
There are two features that should always be assessed:
The baseline fetal heart rate and the presence or absence of decelerations must always be assessed and recorded.
The baseline fetal heart rate is the fetal heart rate between uterine or just before contractions. The baseline fetal heart rate is normally between 110 and 160 beats per minute.
This is a temporary slowing down of the fetal heart rate. Decelerations are almost always related to contractions and can be detected with a fetal monitor.
An acceleration is a speeding up of the heart rate. Accelerations are normal and do not indicate fetal distress. During pregnancy they usually occur with fetal movements. During labour, accelarations usually occur during a contraction.
Usually these fetal heart rate patterns can be easily recognised with a fetal monitor. However, variable decelerations are more difficult to recognise. It is common to get a combination of patterns, e.g. a baseline bradycardia with late decelerations. It is also common to get one pattern changing to another pattern with time, e.g. early decelerations becoming late decelerations.
CTG tracings can be used to learn how to recognise different fetal heart rate patterns. This knowledge is very useful when using a fetal monitor.