What is fetal surveillance
Germany is one of the countries with the lowest infant and maternal mortality rates in the world. Nevertheless, there are a number of risks during childbirth such as bleeding, umbilical cord complications, etc.
When admitted to the delivery room and then at regular intervals, the woman giving birth is physically examined. This also includes a vaginal examination to check the progress of the birth. The doctor or midwife examines how far the cervix has opened and how deep the child's head lies in the pelvis. After that, blood pressure, pulse and temperature are checked about every two hours.
In most clinics, the pregnant woman is given venous access - usually on the back of the hand - through which medication can be administered quickly in an emergency.
Monitoring by the CTG
The CTG offers a possibility to monitor the heart rate of the child and the contractions.
It is usually used routinely in all clinics during childbirth. The Standard Commission on Cardiotocography of the German Society for Perinatal Medicine generally recommends CTG monitoring for all births.
When admitted to the delivery room, a CTG is recorded for 30 minutes. If this CTG was normal, the recording is repeated about every two hours. In between, the pregnant woman can walk around and take the most comfortable position for her to deal with the labor.
If the child's heart rate is difficult to display via the external lead on the mother's abdominal wall, a probe is sometimes placed directly on the child's head. When done correctly, this is not painful or dangerous to the child. Continuous CTG monitoring is carried out during the expulsion phase, even if this was previously normal.
Other monitoring options
The O2 probe was developed to provide more information about the child's condition during periods of doubtful CTG recordings.
The probe can be placed on the child's cheek or temple if the amniotic sac is cracked. It measures the oxygen content of the child's blood. However, the system is very prone to failure and has not yet proven itself sufficiently.
Fetal blood analysis
If the CTG shows indications that the child is at risk, a fetal blood analysis may be carried out. Blood is taken from the child's scalp through the cervix and its oxygen content and acidity are analyzed.
This test correlates well with the child's actual well-being. The child's blood test often shows normal values, although the CTG showed evidence of an oxygen deficiency. Fetal blood analysis can often prevent the pregnancy from being terminated by surgery.
Monitoring during the postpartum phase
During the afterbirth, the birth of the placenta, the woman must be monitored particularly carefully. The blood loss should not be more than 500 milliliters. With close monitoring by the midwife, uterine atony can be detected in good time and treated with medication that stimulates labor.
Care of the mother after the birth
When the greatest effort is over and the joy about the baby is great, the mother often does not feel completely exhausted at first, despite the hardships of the birth.
After the birth of the placenta, it is important to check for possible birth injuries such as a perineal tear or tear in the cervix. These injuries or the specifically created perineal incision are usually sewn immediately under local anesthesia.
Another two to four hours in the delivery room are used for monitoring. With the transfer to the maternity ward and discharge home, the actual birth ends and the so-called puerperium begins.
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