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Fetal Well-being Tests

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When you're pregnant, you worry about your baby's health—that's perfectly normal and natural. Fortunately, we have tests nowadays that provide information and reassurance for you during this thrilling, but sometimes frightening, time of your life.

Below you'll find basic facts on some common fetal well-being tests:
what the tests measure, where they're given, who is usually tested, when the tests are performed, and how they are conducted. Learning a little about each test can help you feel more comfortable. Your prenatal health care provider can give you even more information on these procedures and answer any questions you may have. Keep in mind that not all women need these tests, nor do all women get them. Some tests are only used when there are specific risk factors in a pregnancy, so don't be concerned if you haven't been offered one of the tests.

Fetal Movement Counting

Nonstress Test

Biophysical Profile

Doppler Ultrasound of Umbilical Blood Flow

Fetal Movement Counting

What, where, who. Counting the movements your little one makes is a reliable marker for how well your baby is doing. There's an old saying that "A moving baby is a healthy baby," and this test helps you to be more aware of those kicks and flutters by having you count them for a period of time each day. This simple, low-tech procedure, performed at home, can and should be used by all women. Most women enjoy the counting process, as it makes them feel closer to their baby!

When. This test is important to perform during months 7, 8, and 9. Your provider may ask you to do this test daily during the third trimester. For best results, count at a time of day when your baby is usually moving. Not all babies move the same amount or at the same time of day, so it is important for you to become aware of your baby's pattern of movement.

How. Lie down in a quiet place for one hour. Mark down on paper each time the baby moves during that time. You should count the first 10 movements your baby makes during that hour. If your baby does not move at least three times during the hour, then keep counting for another hour. If you don't count four movements in those two hours, call your doctor or your midwife. Tell him or her that your baby isn't moving much (tell about the counting you've done), and that you want to be seen right away. Don't take "No" for an answer!

Why some babies stop moving. There are many reasons for lack of movement. Sometimes the placenta (afterbirth) is losing its vitality and isn't nourishing the baby well. The baby reacts by moving less. Sometimes the amniotic fluid level in the uterus decreases, and the baby stops moving as much. Lack of movement can indicate a serious problem, so don't wait longer than two hours to call your doctor or midwife. If your baby isn't moving much, you need to be seen, further tests need to be done, and there's no time to waste.

Nonstress Test

What, where, who. This test is designed to find out how your baby is doing when there is no "stress" of uterine contractions. Some experts also believe that this test will predict how your baby will do in labor. It must be conducted at your doctor's office or the hospital. Not all pregnant women receive this test. Your doctor or midwife would be likely to order this test if you have a risk factor such as diabetes or preeclampsia, or if you have passed your due date and have not yet gone into labor. The test would also be ordered if the baby doesn't seem to be growing well.

When. The test is usually ordered during the third trimester, sometimes after your due date.

How. You'll probably recline in an easy chair with a fetal monitor attached to your abdomen for about 30 minutes. The monitor will record any uterine contractions and will also record your baby's heartbeat. You will be asked to push a button—making a mark on the monitor strip—each time you feel the baby move. The nurse or doctor will examine the interaction between the baby's heartbeat, your uterine contractions, and the baby's movements. If the heartbeat remains stable or increases when the baby moves, then the test will be finished and you can go home. If there is any question about the baby's condition, the doctor or nurse will continue the test a bit longer, and perhaps order another type of test called a biophysical profile or a Doppler ultrasound, described below.

Biophysical Profile

What, where, who. The biophysical profile test was developed to look at several different areas of fetal well-being, as described below. It can only be done by qualified providers, and is not offered at all hospitals. Usually a biophysical profile is ordered if your doctor or midwife is concerned about whether the baby is well enough to stay in the uterus much longer.

When. The test is most frequently given in the third trimester.

How.This painless test is like an ultrasound except that the machine is much more sensitive, and the doctor can see more and record more. You will lie on your back on a stretcher or a bed. The nurse or doctor will pass a small instrument, called a transducer, across your abdomen, and look at the pictures on a monitor screen. The provider will look at the following five parameters of fetal well-being:

  • the movement of the baby
  • breathing movements of the baby
  • the baby's muscle tone
  • how much amniotic fluid is around the baby
  • how well the baby's heart rate reacts to movement

    Each one of these factors receives a score, and 2 points are the maximum for each factor. A score of 10 is "perfect." This score is not infallible, and should be used in combination with other considerations—such as the doctor's or midwife's experience and skill—in making a decision about when the baby needs to be born. If the baby's amniotic fluid is really low and the baby is not moving well, the doctor might make a decision to deliver the baby right away.

    Doppler Ultrasound of Umbilical Blood Flow

    What, where, who. This is a special type of ultrasound that shows the flow of blood through an artery contained in the umbilical cord. The test is offered in only some fetal testing centers and hospitals and is recommended when there is concern about the placenta or about the growth or health of the fetus. The umbilical cord carries the blood from the placenta to the fetus and back again. When this test is done, the doctor can see the blood flow through the umbilical artery and can measure how strong the blood flow is, and therefore how healthy the fetus and placenta are.

    When. The test is usually ordered at the end of pregnancy, during the third trimester.

    How. This painless test is very much like an ultrasound, using special equipment to view the blood flow through the artery.

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