All you need to know about the track in pregnancy
The assessments to be performed during the 9 months are many, some are annoying but necessary, while others are absolutely quiet and non-invasive. It may happen that you feel agitated about having to face these tests before giving birth, but try to remain as calm as possible for the well-being of the baby you carry in your belly. You can transmit positive emotions with small gestures of love: find out which cuddles to give him by watching our video.
Cardiotocographic monitoring: definition
Technically, the tracing in pregnancy is defined as cardiotocography and it is a specific monitoring that is normally performed at the end of gestation to have a clinical picture regarding the health of the baby in the belly.
In particular, the traces are used to evaluate the goodness of the heart rate of the fetus and the contractions that can occur in the mother's uterus. They do not cause any kind of problems for either the mother or the fetus because it is a non-invasive evaluation.
Performed as a routine practice at the 40th week of pregnancy (once the estimated due date has passed), it is possible that others may be needed in the preceding weeks, usually starting at the 27th week or around the 37th week. So no traces before the third trimester of pregnancy, the most physically demanding for the expectant mother.
Monitoring is also carried out during labor: it is essential to understand whether to speed up the birth or to resort to a caesarean section.
When the baby is ready to be born and you go to the hospital you will surely be visited and "attached" to small harmless instruments that will elaborate the graph.
Read on to find out in detail what this test consists of, how it is performed and all the information concerning it.
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What is the cardiotocograph
As we have anticipated before, at the time of birth or during one of the visits in the last weeks of pregnancy, you will be monitored to know how gestation is proceeding and to assess the state of well-being of the fetus. Any information about your state of health is precious for the doctor who will report all the data in your pregnancy record.
To ensure that the test is valid, the gynecologist or obstetrician must use the support of a machine, the cardiotocograph.
This is the tool that allows you to detect both the baby's heartbeat and your possible contractions.
The cardiotocograph consists of two probes (about the size of a fist and usually with a flattened and oval shape) that must be placed on the mother's belly. They are fixed with one or two special straps and are connected with wires to a machine The first is ultrasound while the second is not.
Try to stay as relaxed as possible - this test is totally harmless! No invasive visit or needles, it is a simple assessment of the correct development of the pregnancy. If this is not the case, the specialist will immediately take all precautions to safeguard your approval.
How cardiotocographic monitoring is carried out in pregnancy
Monitoring is usually done on a couch or recliner. Depending on whether you are close to giving birth or not, you can be in the emergency room or in the hospital clinic. The midwives will support the probes correctly and the result will then be viewed by a gynecologist.
What do the two probes do?
The first carries out the task of perceiving the little heart of the unborn child and of transmitting the trend of its heartbeat and its eventual modifications. It is positioned according to the position of the child.
You will hear the classic noise you hear during the check-up ultrasound at the gynecologist.
The second probe, on the other hand, focuses on you: it determines the presence of any uterine contractions and, if present, reports their intensity. The instrument is very sensitive because it is able to perceive changes in your abdominal wall. The correct position is at the bottom of the uterus.
Once the two probes have obtained the data, they transmit the report to the cardiotocograph which prints them on paper. To inexperienced eyes it will seem to see a sheet extremely similar to that of an electrocardiogram.
In a way it resembles you because on one side you will find the baby's heart rate line and on the other line the contractions are recorded. Don't be afraid if this line is flat: it means that you did not have any contractions during the exam. On the contrary, if you notice peaks on the report it means that during the tracing some contractions were detected and in the points of maximum extension the contraction was strong; in this case you will surely have warned it too!
Because it only begins at the end of gestation
The main motivation to carry out the tracing in pregnancy not before the third trimester is because its purpose is to prepare for the birth having a complete clinical picture, and to play in advance in case of complications.
It is no coincidence that part of its task is to detect uterine contractions, which in the case of physiological gestation you will not (thankfully) feel before the last few weeks. Consider that if all goes well, the doctor will prescribe the first monitoring no earlier than the 38th week of pregnancy, together with all the other routine tests that you will have to face in view of the birth: blood count, electrocardiogram, blood pressure control ...
Virtually since every moment is good to give birth: the gynecologist could prescribe one a week, but the frequency could be even higher if you notice that there is something abnormal to be monitored more often. Don't worry about costs, the exam is free and prescribed as needed by a doctor.
Once you have reached this important milestone, your baby bump will be great, and with it the baby you carry inside. It will be possible to determine its position simply by feeling your abdomen and the obstetrician will be able more easily to position the ultrasound probe that detects its heartbeat.
Thanks to monitoring, it is possible to really analyze the changes in the fetal heartbeat and verify that everything is normal: the standard rate for the heartbeat of a baby in the belly is between 120 and 160 beats per minute.
Is it a reliable test?
To date, pregnancy monitoring is the most effective method to highlight any fetal suffering.
The tool has also proved very useful in cases of pregnancy pathologies such as maternal hypertension, fetal growth retardation or a threat of preterm birth.
Furthermore, modern technologies have improved the wellness measurement system thanks to the support of a computer: the computerized tracing has brought advantages in detecting errors during the examination, minimizing the chances of making mistakes. You are in good hands!
How do you know if the track is going well? After the report is printed, a specialized doctor will look at it and only he will be able to tell you if your baby is well. To give you a general indication, know that the fundamental thing to record is the variation of the heartbeat. Basically if your little one is well, there must be ups and downs during the minutes.
A variable heartbeat is synonymous with good health, while a constant one is not.
This is why accelerations of the fetal heart with respect to the baseline of about 10 beats per minute must be recorded during the examination.
Another thing is the line of your contractions: up to 5 per day are considered physiological and it depends on whether you are doing the tracing at the time of labor or not.
How long does the survey take on average?
A standard survey lasts about "half an hour", up to 1 hour if there are difficulties in perceiving the reference values of the child or woman.
We can define it as an exam with a variable duration.
This is why future mothers are made to lie down in a comfortable position or at least are encouraged to sit down.
One case in particular causes the time dedicated to the test to be extended up to 40-60 minutes: it is when the baby sleeps on his stomach and therefore his heart beats regularly, without acceleration.
In these cases it is necessary to wake him up during the monitoring by tapping the mother's abdomen or giving her something to eat, especially sweet foods.
It is really necessary that the baby in the womb is active because it is necessary to be able to analyze all the variations of the heartbeat and thus determine if it is well.
If you are past the expected date of birth, the risks to the baby's health increase, as the further you are in gestation, the less blood exchanges between the uterus and placenta are. The unborn child could even suffer damage from lack of oxygen.
Cardiotocography after the 41st week is extremely useful because all the child's problems increase over time, every 3-4 days. This is why you are likely to repeat this test every day, or at least every other day. At this gestational period, all controls become tighter, including that relating to the level of amniotic fluid in your body, to avoid fetal suffering due to its reduction.
Cardiotocography during labor
Cardiotocography is performed during labor, close to the natural birth. In this delicate episode the examination will help in a crucial way to establish the intensity of the contractions and to evaluate the course of the event itself. Contractions are painful episodes for almost all women, but if they turn out to be extremely strong they can cause changes in the baby's heartbeat and register pain.
You can see it as an alarm bell that is used by the midwife to decree if it is necessary to accelerate labor or even to resort to an emergency caesarean. If, on the other hand, the path is normal, labor must run its course.
During pre-birth the duration of the examination is longer and is often repeated, even at one-hour intervals, based on the patient's clinical condition. Continuous monitoring can be achieved when there are obvious difficulties or elements of risk for both subjects.
Cardiotocography is a complex examination and must be carefully evaluated to always ensure the safety of mother and child.
Doubtful outcome: tests to support monitoring during labor
Although the technology has helped a lot in minimizing the chances of error during the assessment, there are still abnormalities in the report of labor that do not correspond to fetal distress.
In support of cardiotocography with doubtful results, there are some tests to be performed, which reduce the rate of false positives:
1) fetal pulsed oximetry, non-invasive test for the fetus whose purpose is to measure the concentration of oxygen in the fetal blood. A sensor is applied to the baby's skin vaginally. Conditions for carrying out: cephalic position, broken water and dilation of at least 2 cm;
2) fetal electrocardiogram, consists in applying an electrocardiogram electrode on the baby's head via the vagina. It is used to check the electrical activity of the little heart and the statistics are compared with that released by the cardiotocograph. Conditions for carrying out: cephalic position, broken water and cervical at least partially dilated;
3) blood sampling from the fetal scalp, with this test very small amounts of blood are taken from the skin of the baby, via the vagina. It is performed to measure the pH, or the degree of blood acidity that provides information on a "possible lack of oxygen. Compared to the other two it is a little used practice because it is invasive for the child.
Monitoring pregnant with twins
In the case of twin pregnancy, there are special cardiotocograph devices that simultaneously measure the heartbeat of the two brothers. If the patient is not available, the classic one is used, alternating it between the two children (if this is your case, in these measurements the time to devote is certainly greater).
The special devices are equipped with two ultrasound probes and a single probe for the woman's uterine contractions.
The double probes are applied on the mother's abdomen at the back of the little ones and instead of having a report with two lines you will find three lines.
