Monitoring or cardiotocography

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Catherine Le Nevez
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Monitoring

Il monitoring (or tracing or cardiotocography) is a type of examination that is carried out during pregnancy and can be particularly useful in its final phase because it allows you to monitor the health of the fetus especially near the expected date of delivery. Usually the first monitoring is performed no earlier than the 38th week gestation together with the other tests that are routinely performed in view of delivery (blood count, electrocardiogram, blood pressure control, etc.).





It is carried out by the gynecologist or a midwife in the obstetrics and gynecology division of the hospital where the expectant mother is followed or hospitalized. It is a completely technique risk-free for both the mother and the child, it generally lasts from 30 minutes to 1 hour during which the expectant mother is lying on a cot or sitting on an armchair, in any case in a comfortable position, and the father of the baby.
From a technical point of view it is an examination based on the measurement of two parameters: the fetal heart rate, which is the number of heartbeats of the fetus per minute, and uterine contractions.

Monitoring is still the most effective measurement system to highlight any fetal suffering, in fact the relationship between the heart rate of the fetus and the contractions of the uterus allow the gynecologist or midwife to carry out the examination to obtain important information about the health of the child, for example the detection of constant heart beat can signal a problem with the fetus. The instrument used for this exam is called cardiotocograph, similar in size and shape to a small box to which two detectors (or transducers) are connected which are applied to the mother's abdomen, through two elastic bands. 

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The first is connected to the ultrasound sensor of the heartbeat and is placed in the point of the abdomen where there is an optimal perception of the fetus's heartbeat; the second is connected to a mechanical meter which detects uterine contractions and is positioned near the bottom of the uterus.

The fetal heart rate is displayed on a screen and these readings, together with those relating to uterine contractions, are recorded moment by moment on graph paper, similar to that used for the electrocardiogram. The strip of paper comes out directly from the device and shows at the top the tracing relating to the heartbeat and, further down, the one concerning the contractile activity of the uterus. While the mother is being monitored can feel the pulsations "live" of the little one's heart, thanks to an amplifier inside the device, and this often causes a great emotion in the mother or in both parents who feel the long-awaited moment in which they will know their little one ever closer. 



Thanks to monitoring it is possible to check the variability of the baby's heartbeat and check if the pulsations are normal, in this way situations where the baby's health is at risk can also be highlighted. The frequency considered normal of the pulsations oscillates on average between 120 and 160 beats per minute but can vary according to the different needs of the fetus' organism; the pulsations remain constant when the baby sleep, in this case, in order to accurately evaluate the pulse frequency, the exam can be prolonged and last even 40-60 minutes because you have to wait for the child to wake up.
Modern monitoring techniques also include the use of a computer that processes the data detected by the transducer and provides the tracing of the heartbeat, also highlighting any anomalies that could signal a problem in the child. Computerized monitoring also has the advantage of being able to report any "errors" in the execution of the exam. In any case, the official interpretation of the test results must in any case be entrusted to a doctor or competent staff, who read the tracings, interpret them and write the report accordingly.

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In addition to close to the expected date of delivery (DPP), this examination is used in the last weeks of pregnancy in the presence of a health problem of the future mother or of the baby. In this case, monitoring is useful if there is the suspicion of delayed fetal growth or if the mother suffers from particular ailments that could harm the baby. Another case in which the gynecologist may decide to subject the expectant mother to a series of monitoring is when the pregnancy continues. beyond the 40th week of gestation: in such a circumstance, cardiotocography is aimed at ascertaining that the placenta is still functioning correctly and that the baby continues to grow well. In this case, the mother may need to go to the hospital every other day to keep the situation under control.

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