Your Pregnancy After 35 : Labor and Delivery (part 8) - Fetal Monitoring during Labor, Evaluating Fetal Lung Maturity

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Fetal Monitoring during Labor

In many hospitals, a baby’s heartbeat is monitored throughout labor with external fetal monitoring and/or internal fetal monitoring. Fetal monitoring enables healthcare providers to detect problems early.

External fetal monitoring can be done before your membranes rupture. A belt with a recorder is strapped to your abdomen to pick up the baby’s heartbeat. Internal fetal monitoring monitors the baby more precisely. An electrode is placed on the fetal scalp to measure the fetal heart rate.

Fetal blood sampling is another way to evaluate how well baby is tolerating the stress of labor. Before the test can be performed, your membranes must be ruptured and your cervix must be dilated at least 2cm. An instrument is passed into the vagina and through the dilated cervix to the top of the baby’s head, where it makes a small nick in the baby’s scalp. The baby’s blood is collected in a small tube, and its pH (acidity) is checked.

Knowing the baby’s pH level helps healthcare providers determine if baby is having trouble and is under stress. The test helps the healthcare provider decide whether labor can continue or if a Cesarean delivery is needed.

Evaluating Results of Fetal Monitoring

The American College of Obstetricians and Gynecologists (ACOG) recommends use of three categories to describe the results of fetal monitoring. Category 1 tracings are normal. Category II tracings are indeterminate; this means they aren’t normal, but they aren’t absolutely abnormal. They require evaluation, continued surveillance and re-evaluation. Eighty percent of all tracings fall into this category. Category III tracings are abnormal and require prompt evaluation.

Elements used to categorize results include fetal heart rate, variability, decelerations and reaction to contractions. Each case needs to be evaluated individually using fetal monitor tracings and other information regarding the pregnancy.

Evaluating Fetal Lung Maturity

The respiratory system is the last fetal system to mature. Premature infants commonly experience respiratory difficulties because their lungs are not mature. Knowing how mature baby’s lungs are helps your healthcare provider make a decision about early delivery, if that must be considered.

If there are reasons the baby needs to be delivered early, fetal-lung-maturity tests can determine whether the baby will be able to breathe without assistance. Fluid for the tests is obtained by amniocentesis. Two tests used most often to evaluate a baby’s lungs before birth are the L-S ratio and the phosphatidyl glycerol (PG) tests.

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