In most cases, the results of monitoring will assure you and your doctor all is going well. However, sometimes the results may signal that the baby is having a problem. If so, the baby may need additional tests or may need to be delivered sooner than expected.

Who Should Be Monitored?

The need for tests and the type of tests depend on the stage of your pregnancy, any risk factors, and the results of routine tests. Some conditions that may signal a need for more frequent testing include:

• High blood pressure
• Diabetes
• Kidney or heart disease
• Multiple pregnancy, if there are complications
• Pregnancy that has gone past the due date
• Fetal growth problems
• Too much or too little amniotic fluid

The tests used to monitor fetal health include fetal movement counts, ultrasound, nonstress test, biophysical profile, and contraction stress test. In most cases, they are done in the last trimester of pregnancy, although some can be done earlier. These tests may be done to confirm other test results or provide more information.

Fetal Movement Counts

You may be asked to keep track of your baby's movements. Fetal movement counting is a test that you can do at home to help check on your baby's health. Sometimes it is called kick counts.

If you have been asked to note your baby's kick counts, your doctor will tell you how often to do it and when to call him or her. One method is to write down how long it takes the fetus to make 10 movements each day. To do this, choose a time when the fetus usually is active. Often, a good time is after a meal. Each baby has its own level of activity, and most have a sleep cycle of 20–40 minutes. Alert your doctor if there is a change from the normal pattern or number of movements.

Obstetric Ultrasound

Ultrasound is a way to examine the fetus using sound waves. With this exam, pictures of the baby appear on a screen similar to a television. An ultrasound exam may be done in a doctor’s office or in a hospital. It may be performed by a doctor or a specially trained technician. An ultrasound exam can provide useful information about the baby’s health, including:

• Age of the fetus
• Rate of growth
• Location of the placenta
• Position and heart rate of the fetus
• Amount of amniotic fluid in the uterus
• Number of fetuses
• Some birth defects

Nonstress Test

The nonstress test measures the heart rate of the fetus in response to its own movements. Usually the baby's heart beats faster when he or she moves. Such changes in the fetal heart rate are believed to be a sign of good health. For this test, a special device is placed on your abdomen and the fetal heart rate is measured. This test may be done in the doctor's office or in a hospital. It usually takes between 10 and 40 minutes. If your baby does not move for a while during the nonstress test, he or she may just be asleep. Your doctor may suggest you have something to eat or drink to make the baby active. A buzzer-like device also may be used to wake the baby and cause movement.

Biophysical Profile

In some cases, a combination of the nonstress test and an ultrasound exam may be done. This test is called a biophysical profile. It checks fetal well-being in these five areas:

1. Variation of fetal heart rate (the nonstress test)
2. Breathing movements (movements of the baby's chest)
3. Body movements (any significant movements of the baby)
4. Muscle tone (quick, jerky movements of hands or feet)
5. Amount of amniotic fluid (too little or too much may signal a problem)

In measuring the amount of amniotic fluid, your doctor may use the term "amniotic fluid index" or AFI. For this test, ultrasound is used to measure the depth of the amniotic fluid in four different areas of your uterus. The sum of these measurements is the AFI. A normal AFI is 5–20 centimeters. Sometimes a modified biophysical profile, which includes a nonstress test and amniotic fluid assessment, is performed.

A biophysical profile does not cause any harm to the fetus. If the results are normal (a score of 8 or 10), it is most often repeated weekly. In some cases, it will be repeated more often. If the results are abnormal, this may mean that additional tests are needed or, in some cases, that the baby needs to be delivered. It can be repeated, if needed, at various times to check the well-being of the fetus. The score will help decide whether you need special care or whether your baby should be delivered sooner than planned.

Contraction Stress Test

The contraction stress test measures how the fetal heart rate reacts when the uterus contracts. For this test, the fetal heart rate and the contractions of the uterus are recorded at the same time. The contraction stress test often is used if the nonstress test is nonreactive (shows no change in the fetal heart rate when the baby moves). To make your uterus contract mildly, you may be asked to stimulate your nipples or you may be given a drug called oxytocin intravenously (through a vein). (In rare cases, a woman's uterus may contract on its own, especially if the test is done late in pregnancy.)

During a contraction, the blood flow to the placenta decreases for a brief time. Normally, contractions do not affect the fetal heart rate. If there is something wrong with the placenta or the baby is showing signs of having a problem, the contraction can decrease the oxygen flow and cause the fetal heart rate to decrease.

Finally...

Although no test is 100% accurate, testing can reassure you and your doctor that all is going well with your baby. If there is a problem, tests may help your doctor find it and treat it. Keep in mind that tests cannot always find a problem, or the results may say there is a problem when there isn't one. Results of your test may mean that your baby will need special care during pregnancy. This will help keep you and your baby as healthy as possible.

Glossary

Amniotic Fluid: The liquid in the sac surrounding the fetus in the woman's uterus.

Fetus: A baby growing in the woman's uterus.

Multiple Pregnancy: A pregnancy in which there are two or more fetuses.

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women’s health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as “superior.” To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © May 2006 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

Requests for authorization to make photocopies should be directed to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923.

To reorder Patient Education Pamphlets in packs of 50, please call 800-762-2264 or order online at sales.acog.org.

The American College of Obstetricians and Gynecologists
409 12th Street, SW
PO Box 96920
Washington, DC 20090-6920

12345/98765