PREGNANCY (2)

FETAL MONITORING: WHY, WHEN, AND HOW?
ALL ABOUT PROLONGED PREGNANCY

Preparing for Delivery Day : Symptoms in Late Pregnancy

Dr. Claude Allouche, Gynecologist Grossesse 2 engl monito et gross prol
Ahuza Clinic, Ra’anana
058 726 02 64

FETAL MONITORING: WHY, WHEN, AND HOW?

Welcome to the fascinating world of fetal monitoring!
If you are pregnant and wondering what this examination is for, we have all the answers for you.

First and foremost, fetal monitoring is used to assess your baby's well-being and detect uterine contractions.

To perform this, two sensors are placed on your abdomen:

  • One emits ultrasounds to measure the fetal heart rate (FHR),

  • The other detects uterine contractions through changes in pressure.

  • Typically, the examination lasts at least 20 minutes but may take longer depending on the recording.

Don’t worry, even if your baby is a bit shy and hard to assess, your midwife will know how to interpret the signals and alert the doctor if any abnormalities are detected.

  • Fetal monitoring can only be performed from the third trimester of pregnancy, as it is at this stage that the fetus is sufficiently developed to provide reliable data.
    Once you’ve reached this stage, you can enjoy this test to monitor your baby and discover all their little secrets.

  • Beyond its use during active labor, fetal monitoring is also used during pregnancy to monitor conditions such as intrauterine growth restriction, poorly controlled gestational diabetes, preeclampsia, post-term pregnancy, or other issues that could endanger fetal well-being.

So, if you’re expecting and want to uncover all the secrets of your little one, don’t hesitate to ask your midwife for more details about fetal monitoring. With a bit of humor and lots of technology, you’re ready to become your baby’s secret agent!

ALL ABOUT PROLONGED PREGNANCY

Pregnancy is a wonderful period, but sometimes it can extend beyond the expected due date. In this information guide, we will explain what prolonged pregnancy is, the associated risks, and the available treatments.

WHAT IS PROLONGED PREGNANCY?

(In Hebrew, “herayon odef” היריון עודף)

A pregnancy is considered prolonged when it exceeds 41 weeks of gestation, or one week past the expected due date. It’s important to note that each pregnancy is unique, and gestation duration can vary among women.

WHAT ARE THE RISKS ASSOCIATED WITH PROLONGED PREGNANCY?

Prolonged pregnancy may pose risks to both the mother and the baby, such as:

  • Risk of fetal distress, respiratory complications, or mortality.
  • Risk of placental dysfunction and low birth weight.
  • Increased risk of maternal hypertension and preeclampsia.
  • Higher likelihood of cesarean delivery, postpartum hemorrhage, and perineal tears.

WHAT MONITORING IS REQUIRED?

If your pregnancy is prolonged, your doctor will recommend enhanced monitoring to ensure the health of both you and your baby.

In Israel, monitoring begins at 40 weeks, while in France, it starts at 41 weeks of gestation.
Typically, at your final pregnancy check-up, you will be advised to visit the hospital emergency department at 40 weeks (in Israel) to register and open your hospital file if not done earlier.

During this visit, several tests will be conducted to determine whether the pregnancy should continue or be induced:

  • Questioning: Assessing fetal movements, absence of bleeding or fluid leakage, and any signs of amniotic sac rupture.
  • Maternal vitals: Monitoring pulse, blood pressure, weight, temperature, and checking for edema or urinary abnormalities.
  • Fetal heart monitoring: Using a monitor to evaluate fetal well-being and uterine contractions.
  • Clinical examination: Estimating fetal weight by measuring uterine size manually or with measurements (fundal height).
  • Ultrasound: Evaluating fetal well-being by analyzing:
    • Fetal movements, respiratory motions, and muscle tone.
    • Amniotic fluid levels (measured via the deepest vertical pocket or Amniotic Fluid Index).
    • A biophysical score (BPS) out of 8, with 8/8 being reassuring.

A vaginal examination may also be performed if labor induction is planned or contractions occur.

NEXT STEPS BASED ON TEST RESULTS

  • If all parameters are normal, induction may not be necessary, and monitoring can continue every two days from 41 to 42 weeks of gestation.
  • After 42 weeks, due to increased risks, labor induction is strongly advised.

During each examination, the type of labor induction, if needed, will depend on cervical conditions:

  • Favorable conditions: Labor may be induced with artificial membrane rupture or oxytocin infusion (Pitocin).
  • Unfavorable conditions: Cervical preparation may be needed using:
    • Prostaglandin tablets (Cytotec in Israel).
    • Prostaglandin vaginal inserts (Propess).
    • Cervical balloon catheter.

Preparation can take hours or days, so it is often started at 41 weeks and 5 days if the cervix is not favorable.

In some cases, a cesarean section may be required based on maternal history, cervical conditions, or fetal well-being evaluation.

CONCLUSION

Prolonged pregnancy can carry risks for both mother and baby. Close monitoring is crucial if pregnancy extends beyond the expected due date.
Speak with your doctor if you have concerns or questions about prolonged pregnancy or any other aspect of your pregnancy.

Preparing for Delivery Day: Symptoms in Late Pregnancy

The end of pregnancy can feel long and tiring. Here’s an overview of signs and symptoms during this phase:

  1. Diffuse Pain

    • Ligament pain: Felt during movement, standing, or sitting for extended periods.
    • Pelvic heaviness: Discomfort from the baby's low position.
    • Painful pulling: In the pubic symphysis, pelvic bones, lower back, or kidneys.

  2. Frequent Urination: Due to uterine pressure on the bladder.

  3. Insomnia: Anxiety about delivery, active baby movements, and physical discomfort may disrupt sleep.

  4. Heavy Legs: Caused by poor blood circulation, worsened by heat.

Specific Events

  1. Mucous Plug Loss

    • Thick, brownish cervical mucus, possibly with blood streaks.
    • Its loss does not necessarily indicate imminent labor.

  2. Uterine Contractions

    • Braxton Hicks contractions may transition to more regular, painful contractions as labor approaches.

Always consult your gynecologist for any concerns.

Note: This guide provides general information. For specific concerns, consult your healthcare professional.