Indications for direct measurement of fetal heart rate (FHR) include:
Inability to obtain adequate fetal heart tracing, could be secondary to maternal habitus (obesity) or frequent maternal movement
Confirmation of non-reassuring FHR tracing to allow for timely interventions
Requirements for the procedure include:
Rupture of membranes (spontaneous or artificial)
Engaged vertex or breech presenting part
Cervical dilatation of at least 1-2cm
Patient's ability to cooperate with sterile vaginal exam (SVE)
Contraindications to placement include:
Maternal infections: chorioamnionitis, HIV, Hepatitis B, C, D or E, active genital Herpes Simplex
Maternal or fetal clotting disorders
Gestational age less than 32 weeks