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TOPIC: Care of Mother, Child, Adolescent, Well Clients
FETAL HEART TONE (FHT)
FETAL HEART TONE (FHT)
Also called Fetal Heart Rate (FHR) - are auscultated with a De Lee-Hillis fetoscope or Pinard stethoscope. However, in the practice, the term auscultation is often used to refer to the assessment of fetal heart sounds by means of a hand-held Doppler device or ultrasound monitor.
The ultrasonic Doppler device – is the primary tool for assessing fetal heartbeat. It may detect a fetal heartbeat at about 10 to 12 weeks gestation.
The normal range for fetal heart tones (FHT) - is 120–160 beats per minute (bpm).
An ultrasound should be completed if the nurse is unable to auscultate between 10 and 12 weeks, because there may be a discrepancy of EDD, twins, or a missed abortion. In the case of twins or obese women, it may be later before the fetal heartbeat can be detected.
Auscultation of Fetal Heart Sounds
Auscultation of Fetal Heart Sounds
Fetal heart sounds are transmitted best through the convex portion of a fetus because that is the part that lies in closest contact with the uterine wall.
This means that in a vertex or breech presentation, fetal heart sounds are usually best heard through the fetal back; in a face presentation, the back becomes concave so the sounds are best heard through the more convex thorax.
In breech presentations, fetal heart sounds are heard most clearly high in the uterus, at a woman’s umbilicus or above.
In cephalic presentations, they are heard loudest low in the abdomen.
In a ROA position, the sounds are heard best in the right lower quadrant; in an LOA position, in the left lower quadrant.
In posterior positions (LOP or ROP), heart sounds are loudest at a woman’s side. Hearing fetal heart sounds in these positions provides confirmatory information about the fetal position. Conversely, recognizing fetal position aids in locating fetal heart sounds.
To auscultate fetal heart sounds, use either a stethoscope or a fetoscope (a modified stethoscope attached to a headpiece), or obtain them with a Doppler unit, which uses dddddddddd waves that bounce off the fetal heart to produce echoes or clicking noises. Each click reflects the fetal heartbeat.
(A) Auscultation of the fetal heartbeat using a fetoscope.
(B) A Doppler ultrasound device can be used to monitor fetal heart rate intermittently in low-risk labor.
Fetal Heart Monitoring Devices
Fetal Heart Monitoring Devices
Pinard Fetoscope
Pinard Fetoscope
One of the oldest known tools used to listen to the fetal heart rate is the stethoscope, still regularly used, primarily by midwives, in many European countries and in most developing countries).
The trumpet-shaped Pinard horn formally called a fetoscope, is made of wood or metal and transmits efficiently the sound made by the fetal heart to the listener's ear. It allows intermittent assessment of the fetal heart rate and it is used mainly during labor to detect fetal bradycardia.
Doppler Device
Doppler Device
Uses sound waves to check the baby’s heartbeat. It’s a type of ultrasound that uses a handheld device to detect changes in movement that are translated as sound. Tee ultrasound probe (transducer) is fastened to the belly. It sends the sounds of the baby’s heart to a computer. The rate and pattern the baby’s heart rate are shown on a screen and may be printed on paper.
Fetoscope
Fetoscope
A fetoscope, or a fetal stethoscope, works much like a regular stethoscope except that it has a bell-shaped end that magnifies sound waves from the fetal heartbeat in order to make them audible. You can usually hear a fetal heartbeat with the stethoscope starting around 20 weeks of pregnancy.
Stethoscope
Stethoscope
The stethoscope is a common medical tool used to amplify internal noises, especially for the heart and lungs. This trusty device is also good for listening to babies in utero.
You can hear the baby's heartbeat at about 18 to 20 weeks, depending on factors like mom's weight, baby's position, and the location of the placenta.
REFERENCES/SUPPLEMENTAL MATERIALS
REFERENCES/SUPPLEMENTAL MATERIALS
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