|Intrauterine Fetal Monitoring|
Monitoring of the growing fetus in-utero is an important part of preventive medicine. Its objective is to maintain the mother in good health; to anticipate difficulties and complications of labor, and to ensure the birth of a healthy baby. Diligent monitoring will no doubt reduce both maternal and perinatal mortality in our environment.
It is important to monitor all fetuses during pregnancy. Certain fetuses are more at risk than others, and it is this risk group that emphasis is placed on. Pregnant women with pre-eclampsia, eclampsia, hemorrhage, and indeed bad obstetrics history need to be adequately hypertension, renal disease, anemia, sickle cell disease, antepartum
Three methods of monitoring commonly used are:-
- Non-Hormonal or Biophysical Method
in most private clinics, however only the general and non-hormonal methods For the general method, a pregnant woman without any are used. complication should be seen in the clinic every four weeks until the 28th week; fortnightly until the 36th week and then weekly delivery. If they have any problem as mentioned above, they are seen more regularly depending on the severity of the problem and the doctor’s opinion. In the clinic, care is taken to measure the height and weight of fetal heart rate, and fetal kick count.
Height and Weight: Women who are less than one and a half meters tall often present with cephalopelvic disproportion due to the inadequate pelvis. There is usually high operative intervention in these women Adequate care is taken to assess the pelvis at the appropriate time, The weight of a pregnant woman should be steadily increasing as pregnancy progresses. This is a function of the growing fetus. Failure to gain weight may denote intra-uterine growth retardation (IUGR) or fetal death.
Blood Pressure: A rise in blood pressure above the booking block pressure is a source of concern. When this occurs in association with proteinuria it is a bad sign which usually leads to placental insufficiency and intrauterine growth retardation.
Fundal Height: Increase in fundal height as pregnancy progresses is a good function of the fetus and it usually corresponds with the gestational age of the fetus. If the fundal height is less than the date, then there is the possibility of intrauterine growth retardation, fetal death ‘big baby as in diabetes, multiple pregnancies, polyhydramnios, or pregnancy co-existing with either fibroid or ovarian cyst is suspected.
Fetal Heart Rate: the normal ranges between 120 beats per minute and 160 beats per minute. Values higher denote fetal tachycardia and values lower denote fetal bradycardia. Hypoxia may be the cause in each case. A normal fetus has periods of inactivity especially when the uterus contract during pregnancy and thus the heart drops. There are also periods of active movement during which time the heart rate increases. Any fetus that shows none of the normal variations in heart rate may be at risk.
Fetal Kick Count: The fetus kicks regularly in the uterus. This is an indication of fetal well being If the fetus stops kicking then there is danger. The hormonal method involves the measurement of two hormones widely used to assess fetoplacental function. The hormones are Oestriol (Oestrogen) and human placental lactogen (HPL). Details of the measurement are beyond the scope of this book.
- Urinary level = 20-25 mg/24 hours
- Plasma level = 200 mg/ml.
- Human placenmtal lactogen
- Blood level =5 mg/ml
Non-hormonal or biophysical methods of fetal monitoring include the use of ultrasound scanning machines; cardiotocograph, X-ray, pelvimetry amnioscopy, and amniocentesis.