FETAL HEART TONE

MONITORING

PREPARED BY:
DANMAR C. YEPEZ,RM,BSM
CP101 - INSTRUCTOR
OBJECTIVES:
1. To be able to define fetal heart monitoring.
2. To be able to enumerate the two method of FHT
monitoring.
3. To be able to present the equipments in internal and
external FHT monitoring
4. To be able to discuss the FHT monitoring procedures.
5. To be able to evaluate the importance of expertise as
health care professional in understanding the purpose of
this monitoring.
WHAT IS FETAL HEART
MONITORING?
According to JOHNS HOPKINS MEDICINE OF 2020 that
Fetal heart rate monitoring measures the heart rate and
rhythm of the baby (fetus) and the healthcare provider
see how the baby is doing.
The healthcare provider may do fetal heart monitoring
during late pregnancy and labor. The average fetal heart
rate is between 110 and 160 beats per minute. It can vary
by 5 to 25 beats per minute. The fetal heart rate may
change as the baby responds to conditions in your uterus.
An abnormal fetal heart rate may mean that the baby is
not getting enough oxygen or that there are other
problems.
Fetal heart rate monitoring is also the process of checking
the condition of your fetus during labor and delivery by
monitoring your fetus's heart rate with special equipment.

Fetal monitoring is an important diagnostic tool to monitor

fetal health.  Improving intrapartum monitoring is a key to
reducing intrapartum  stillbirths. Fetal monitoring can occur
in a variety of ways, but the cost of  most devices is still
prohibitively expensive for low-resource settings.
WHY IS FETAL HEART MONITORING
DONE DURING LABOR AND DELIVERY?
According to American College of Obstetrician and
Gynecologist s , 2022 that;
Fetal heart rate monitoring may help detect changes in the
normal heart rate pattern during labor. If certain changes are
detected, steps can be taken to help treat the underlying
problem. Fetal heart rate monitoring also can help prevent
treatments that are not needed. A normal fetal heart rate can
reassure both you and your obstetrician–gynecologist (ob-
gyn) or other health care professional that it is safe to
continue labor if no other problems are present.
WHAT ARE THE TYPES OF
MONITORING?
The two methods of fetal heart rate monitoring in labor are;
AUSCULTATION is a method of periodically listening to
the fetal heartbeat. 
ELECTRONIC FETAL MONITORING is a procedure
in which instruments are used to continuously record the
heartbeat of the fetus and the contractions of the woman's
uterus during labor. The method that is used depends on the
policy of your ob-gyn or hospital, your risk of problems,
and how your labor is going. If you do not have any
complications or risk factors for problems during labor,
either method is acceptable.
HOW IS AUSCULTATION PERFORMED?

Auscultation is done with either a special stethoscope or a

device called a Doppler transducer. When the transducer is
pressed against the abdomen, it can be hear the fetus's
heartbeat.
When auscultation is used, the ob-gyn or other health care
professional will check the heart rate of the fetus at set times
during labor. If there have risk factors for problems during
labor or if problems appear during labor, the fetal heart rate
will be checked and recorded more frequently.
There are some several methods in FHT monitoring;

Intermittent auscultation - which is a method of

sampling and  counting the fetal heart rate at specified
intervals with the human ear.
This is a method of monitoring the fetal heart rate
periodically through  either a fetoscope or a Doppler
transducer.
DOPPLER TRANSDUCER
The Doppler transducer, which
uses ultrasound, can detect the
fetal  heart rate around 10 to 12
weeks of pregnancy and is the
most  common method of
intermittent auscultation in high-
resource  settings. However, all
fetal Doppler transducers require
the  purchase of accessories, such
as transducer gel or batteries,
which  can increase the cost.
FETOSCOPE
Fetoscope is the lowest cost
technology  available for fetal heart
rate monitoring and is the only
method that  does not require
consumables or spare parts. In
general, it is  possible to detect a
fetal heart rate using a fetoscope
beginning  around 18 to 20 weeks
of pregnancy, but it can be difficult
to  pinpoint the fetal heart rate
using a fetoscope if the mother has
an  anterior placenta.
 HOW IS ELECTRONIC FETAL
MONITORING PERFORMED
Electronic fetal monitoring uses special equipment
to measure the response of the fetus’s heart rate to
contractions of the uterus. It provides an ongoing
record that can be read. The ob-gyn or other health
care professional will review the electronic
recording of the fetus’s heartbeat (called the fetal
heart rate tracing) at set times. The tracing may be
reviewed more frequently if problems arise.
 Cardiotocography
(CTG) OR ELECTRONIC
FETAL MONITORING

This can be monitor both the fetal

heart rate and uterine  contractions.
This method provides a paper
recording of the fetal heart  rate and
the uterine contractions, but prevents
the mother from leaving  the hospital
bed and restricts general movement.
UMBILICAL ARTERY MONITORING

It uses Doppler ultrasound to 

measure the blood flow through
the umbilical cord. This method 
measures placental insufficiency,
which is associated with intra-
uterine  growth restriction,
placental abruption, pre-
eclampsia, pre-term labor  and
delivery, and stillbirth. Little
info exists about the umbilical
artery  Doppler use in low- and
middle-income countries.
 HOW IS INTERNAL MONITORING
PERFORMED?

In this method, a wire called an electrode is used. It is

placed on the part of the fetus closest to the cervix, usually
the scalp. This device records the heart rate. Uterine
contractions also may be monitored with a special tube
called an intrauterine pressure catheter that is inserted
through the vagina into your uterus. Internal monitoring
can be used only after the membranes of the amniotic
sac have ruptured (after “your water breaks" or is broken).
 INTERNAL MONITORING FOR
ELECTRONIC FETAL MONITORING
 WHAT HAPPENS IF THE FETAL HEART RATE
PATTERN IS ABNORMAL?
Abnormal fetal heart rate patterns do not always mean
there is a problem. Other tests may be done to get a
better idea of what is going on with your fetus.
If there is an abnormal fetal heart rate pattern, your ob-
gyn or other health care professional will first try to find
the cause. Steps can be taken to help the fetus get more
oxygen, such as having you change position. If these
procedures do not work, or if further test results suggest
the fetus has a problem, the ob-gyn or other health care
professional may decide to deliver right away. In this
case, the delivery is more likely to be by cesarean
birth or with forceps or vacuum-assisted delivery.
 EXTERNAL FETAL HEART MONITORING
PROCEDURES

1. Depending on the type of procedure, you may be asked to

undress from the waist down. Or you may need to remove all of
your clothes and wear a hospital gown.
2. You will lie on your back on an exam table.
3. The healthcare provider will put a clear gel on your abdomen.
4. The provider will press the transducer against your skin. The
provider will move it around until he or she finds the fetal
heartbeat. You will be able to hear the sound of the fetal heart
rate with Doppler or an electronic monitor.
5. During labor, the provider may check the fetal heart rate at
intervals or nonstop, based on your condition and the condition
of your baby.
6. For continuous electronic monitoring, the provider will
connect the transducer to the monitor with a cable. A wide
elastic belt will be put around you to hold the transducer in
place.
7. The provider will record the fetal heart rate. With
continuous monitoring, the fetal heart pattern will be
displayed on a computer screen and printed on paper.
8. You may not be able to get out of bed with nonstop
external fetal heart rate monitoring.
9. Once the procedure is done, the provider will wipe off
the gel.
 INTERNAL FETAL HEART MONITORING
PROCEDURES
1. You will be asked to remove your clothes and put on a
hospital gown.
2. You will lie on a labor bed. Your feet and legs will be
supported as for a pelvic exam.
3. Your healthcare provider will do a vaginal exam with a
gloved hand to see how far you are dilated. This may be slightly
uncomfortable.
4. If the amniotic sac is still intact, your healthcare provider may
break open the membranes with a tool. You will feel warm fluid
coming out of your vagina.
5. Your healthcare provider will feel the part of the baby at the
cervical opening with gloved fingers. This is usually the baby’s
head.
6. The provider will put a thin tube (catheter) into your
vagina. He or she will put a small wire at the end of the
catheter on the baby’s scalp. He or she will gently turn it on
the baby’s skin.
7. The provider will remove the catheter and leave the wire
in place on the baby’s scalp.
8. The provider will connect the wire to a monitor cable. He
or she will keep it in place with a band around your thigh.
9. You may not be able to get out of bed with nonstop
internal fetal heart rate monitoring.
10. Once the baby is born, the provider will remove the
wire.