Fetal heart tracings are important in preventing birth injuries. Fetal heart monitoring is a way to recognize fetal distress during labor. Care providers can react and may prevent harm.
What Are Fetal Heart Tracings?
Fetal heart tracings are measurements of a baby’s heartbeat in utero. They measure fetal heart rate and rhythm to determine if the baby is in distress. Fetal heart tracings are classified as Category I, II, and III, with Categories II and III indicating possible fetal distress. When there are warning signs, medical professionals can help the baby and may prevent birth injury.
How Fetal Heart Rate Monitoring Works
It used to be that a baby’s heart rate was measured intermittently during labor and delivery using stethoscopes. Today, continuous fetal heart monitoring is common. A Doppler transducer reads sound waves. It is painless, and the instrument can be attached to the mother’s stomach for external monitoring. The monitor is a belt.
Internal monitoring is possible too, after the water has broken. An electrode attached to the baby’s scalp, attached to a wire can provide readings.
In addition, uterine pressure can be monitored with a catheter inserted into the uterus.
There is also wireless technology that can be used at hospitals, birth centers or homes.
Identifying Signs of Fetal Distress
Categories of fetal heart tracings help care providers identify signs of distress. Category I tracings are normal, and there is no asphyxia. Category II tracings indicate possible distress. Category III tracings indicate possible severe fetal compromise.
Tachycardia
Rapid heart rate, over 160 beats per minute. A normal fetal heart rate is 110-160 beats per minute. With a high heart rate, the baby’s heart may be compensating for not having enough oxygen. If left untreated, the child may suffer heart failure.
Bradycardia
Slow heart rate, under 110 beats per minute for more than 10 minutes or under 100 bpm for at least five minutes. Bradycardia may be a sign of poor oxygen or blood levels.
Abnormal accelerations
Accelerations are short-term increases in the baby’s heart rate. Some heart rate accelerations are normal. If an increase is at least 15 beats per minute (bpm) and lasts at least 15 seconds, it’s a sign everything is normal. However, when there are no accelerations or when accelerations are abnormal, there may be something wrong.
Late deceleration
Late deceleration is when the baby’s heart rate slows after the peak or the end of a contraction. If this happens repeatedly and it doesn’t improve with intervention, an emergency C-section may be appropriate. Late deceleration may result from uteroplacental insufficiency.
Variable deceleration
Sometimes, deceleration is irregular. If it appears jagged or there are large dips in the baby’s heart rate, it’s often a sign of umbilical cord compression. In turn, this cuts off oxygen to the baby. A C-section may be appropriate. Variability should be monitored over a period of several minutes.
Note: Early decelerations are usually not signs of fetal distress. They occur at the peak of a contraction and are common when the baby passes through the birth canal.
The Role of Fetal Heart Monitoring During Labor and Delivery
Fetal heart monitoring plays an important role in preventing birth injury and death. Combined with other monitoring and knowledge of the mother’s medical history, care providers can assess risk and respond to signs of distress.
Things that may affect the child’s heart rate include:
- Prolonged labor
- Pain medication or anesthesia
- Medications to induce contractions
- Uterine contractions
- History of maternal hypotension or maternal seizures
- Uterine tachysystole (contractions that are too frequent)
- Placental abruption or other placenta problems
- Umbilical cord compression and complications
- Uterine rupture
- Post term pregnancy (42+ weeks)
Medical Standards for Fetal Heart Monitoring
The normal baseline for fetal heart monitoring is 110-160 bpm. Medical standards require that professionals identify abnormal patterns.
Fetal heart monitoring should not take the place of adequate nursing care and personal support. The hospital or birthing facility must have sufficient personnel to provide care.
Fetal heart rate should be assessed every 5-30 minutes, depending on the stage of labor. If there are signs of distress, care providers should respond appropriately.
Consequences of Inadequate Monitoring
Inadequate fetal heart monitoring may result in:
- Cerebral palsy – Brain damage resulting in muscle weakness and poor posture. Cerebral palsy impairs normal body function in multiple ways.
- Hypoxic-ischemic encephalopathy (HIE) – Brain damage caused by poor oxygen before and after birth. The child may have neurological abnormalities, developmental delays, and mental impairment. Symptoms may be delayed.
- Metabolic acidosis – An imbalance of acid in the body resulting from low oxygen levels. A child may suffer from organ failure, seizures, shock, and myocardial depression.
- Death – If signs of distress are not identified or addressed, death may occur.
Legal Standards and Remedies in South Carolina
Inadequate fetal heart tracings can be a form of medical malpractice. Providing adequate care during childbirth means:
- Recognizing the important role of fetal heart tracings in preventing birth injuries
- Implementing the appropriate monitoring given the mother’s risk factors and history
- Successfully deploying an internal monitor without causing harm, if used
- Reading fetal heart tracings at the appropriate intervals
- Knowing what readings mean
- Responding in a timely manner to signs of distress
- Having sufficient staff to provide attention
South Carolina law requires medical care professionals to provide care to prevailing medical standards. Fetal heart tracings are a commonly accepted part of the labor and delivery process. When care fails to reach adequate standards, the family may claim financial compensation. Because injury may affect a child for a lifetime, claim amounts are often significant.
How a lawyer can help
If you know your child is injured or if you suspect something went wrong during childbirth, we invite you to contact Bobby Jones Law. We can help you investigate, including a medical investigation, when the hospital or birthing center is unwilling to give you answers. We can also represent you in a claim for compensation.
Contact
Robert “Bobby” Jones of Bobby Jones Law provides aggressive legal representation for families who have been harmed by errors in fetal heart tracings during childbirth. Contact us now.
