Global perinatal mortality has dropped steadily, yet millions of stillbirths still occur each year, with stillbirth affecting 1 in 175 pregnancies in the United States. Many of these are potentially avoidable with timely fetal surveillance and practical baby health tips that support early intervention.
As front-line obstetric clinicians, we stand at the intersection of technology and assessment, translating signals into actionable care plans. The three tips below distil the latest guidance into a quick-read refresher for immediate application.
Tip #1 – Maternal Fetal Kick Counts: Low-Tech, High-Value Surveillance
What Are Kick Counts and Why Do They Matter?
Fetal movement reflects intact neuromuscular function and adequate oxygenation. Hypoxemia typically leads to a reduction in gross body movement long before heart-rate changes appear. Daily maternal assessment of fetal activity can reduce stillbirth by facilitating earlier evaluation.
When to Start and How to Instruct Patients
Clinicians should advise patients to begin routine counting at 28 weeks’ gestation. This can be as early as 24 weeks for high-risk pregnancies involving diabetes or growth-restricted fetuses. Two common approaches include:
- “Count-to-10” Method: Record the time needed to feel ten movements. A normal result is two hours or less.
- Fixed-Time Method: Count movements for a 60-minute period. A normal result is ten or more kicks.
Providing an illustrated handout that shows comfortable positions, such as left lateral recumbent or semi-Fowler's, can significantly improve compliance.
Normal vs. Concerning Patterns
While most healthy fetuses exceed ten movements in under an hour, concerning patterns that require further evaluation include:
- Fewer than 10 movements in a two-hour period.
- A noticeable downward trend from the patient's personalised baseline.
- Complete cessation of movement for 12 hours.
Troubleshooting Low Counts
Advise patients to eat or drink something cold, change their position, and try counting again for one hour. If the criteria for normal movement are still not met, they should proceed to a same-day non-stress test (NST) or biophysical profile.
| Pro Tip: Instruct patients with low kick counts to re-count after eating/drinking something cold. If still low, they must proceed immediately for a same-day NST or biophysical profile. |
Tip #2 – Electronic / External Fetal Monitoring (EFM, NST, CTG)
By 1997, electronic fetal monitoring was utilised in 83.3% of live births in the United States, making it a ubiquitous tool in obstetrics. While a Cochrane review found continuous EFM did not significantly reduce perinatal death, it did show a significant decrease in neonatal seizures, highlighting its role in specific clinical scenarios.
Interpretation Fundamentals for Front-Line Staff
- Baseline Rate: Normal is 110–160 bpm. Rates below 110 bpm signify bradycardia, while rates above 160 bpm indicate tachycardia.
- Variability: Moderate variability (6–25 bpm) is reassuring. Absent or marked variability warrants immediate evaluation.
- Accelerations: An increase of ≥15 bpm above baseline for ≥15 seconds after 32 weeks is considered reactive and reassuring.
- Decelerations: Early decelerations are often benign. Variable decelerations may indicate cord compression, and late decelerations suggest potential utero-placental insufficiency.
Equipment Integrity: Why Cables & Sensors Matter
Signal artefact is a leading cause of unnecessary intra-partum intervention. Degraded Doppler crystals or frayed conductors can mimic late decelerations or reduce variability, leading to misinterpretation.
One audit found 12% of unscheduled cesarean deliveries for “non-reassuring FHR” were linked to hardware faults. Using reliable, compatible equipment is crucial; for instance, ensuring your unit has the right fetal monitor cables from Cables and Sensors can prevent delays during emergent traces.
Escalation Protocols for Abnormal Tracings
For abnormal tracings, immediate intrauterine resuscitation is key, including maternal repositioning and administering oxygen.
Reassess within 10 minutes; persistent late or variable decelerations after these interventions mandate an immediate obstetric review and preparation for potential operative delivery.
| Important: Don't underestimate signal issues. One study found 12% of emergency C-sections for "non-reassuring FHR" were linked to hardware faults, not actual fetal distress. Regularly audit and replace worn transducer cables. |
Tip #3 – Routine Prenatal Check-ups & Risk-Based Surveillance
Standard Visit Schedule & Core Assessments
The standard prenatal visit schedule is every four weeks until 28 weeks, then every two weeks until 36 weeks, and weekly thereafter.
Each visit should include recording vitals, weight gain, fundal height, fetal heart tones, and urinalysis. An anatomy ultrasound is standard at 18–22 weeks, with others performed as indicated.
Identifying High-Risk Scenarios
Conditions like preeclampsia, uncontrolled gestational diabetes, or multiple gestations warrant more frequent assessments.
Typical escalations include twice-weekly NSTs plus an amniotic fluid index. This may also include growth scans every 3–4 weeks and early anesthesiology consults.
Communicating the “Why” to Patients
Patient engagement improves when they understand the rationale behind surveillance. For example, explain that checking their blood pressure and the baby’s size can signal stress on the placenta. Detecting changes early gives clinicians options to protect the baby’s oxygen supply.
Integrating Lifestyle Counselling for Optimal Monitoring Accuracy
Encourage moderate exercise to improve baseline variability and adequate iron intake to reduce fetal tachycardia from anemia.
Also, promote smoking cessation to minimise chronic hypoxia. Documenting this counselling is essential for meeting quality-of-care metrics.
| Key Insight: Patient engagement is key to effective surveillance. Explaining the "why" behind each check, such as how blood pressure relates to placental health, transforms patient compliance into an active partnership. |
Putting It All Together: Baby Health Tips for Monitoring at Home
Consistent fetal well-being surveillance rests on three pillars: maternal kick counts, accurate electronic monitoring, and risk-calibrated prenatal visits.
Each pillar succeeds only when clinicians marry evidence-based interpretation with clear patient education and reliable hardware. Auditing your unit’s sensor cables and updating patient handouts are small changes that can translate into healthier newborns and calmer delivery suites.
| Author Profile: Cables and Sensors is the leading manufacturer and distributor of compatible patient monitor accessories for healthcare facilities worldwide. |
