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Fetal Heart Rate Monitoring (FHR) is an essential method which is performed to check and find out the overall health of the growing baby. FHR helps in understanding growth of the baby in the 3 trimesters of pregnancy after weeks. This is monitored with the help of Fetal Heart Rate Monitoring Device.
Let’s Discuss in More Details About Fetal Heart Rate Monitoring (FHR):
Pregnancy is one of the best times in a woman's life. The experience of carrying a tiny embryo to a full-sized baby in those nine months cannot be compared to any other happiness. Since day 1, mom-to-be needs to prepare a place and create a perfect environment for the baby to nurture. But there are other things that need to be kept in mind to ensure the proper growth of a baby. The fetal heart rate is an important parameter to monitor as it can reveal a lot about the developing baby's health. The regular baby's thump heartbeat is not only rewarding but reassures parts of ultrasound, as it is a proof of good pregnancy. But if the fetal heartbeat is slower than the expected one, then it is a reason to worry. (1) (2) (3)
The normal fetal heart rate ranges between 120 and 160 beats per minute with a variation of 5 to 25 beats per minute. You can start observing the fetal heart rate in an ultrasound after 36 days of pregnancy, but doctors usually suggest monitoring in the 6th week. The absence of fetal heart rate initially doesn't imply miscarriage, as it may be because the embryo still measures between 2 to 4 mm – which is hard for the machine to detect. Following is its significance during the crucial three trimesters of pregnancy. (4) (5)
First Trimester of Pregnancy
The fetal heart activity confirms the signs of pregnancy. The fetal heart rate can be seen via transvaginal sonogram after 22 days of fertilization/ ovulation or after 5 weeks and 1 day of the menstrual period. In the 6th Week of pregnancy, the fetus heartbeat starts and can be seen through transvaginal ultrasound. (6) (7) (8)
If ultrasound is performed prior to 6th week, you can see around the circle in the womb with a small nub on one side. During a transvaginal ultrasound, you can see the fetus's heart and hear the beat. In the 7th week, the fetus grows from 1/17 of an inch to 1/3 of an inch – almost the size of a blueberry. Many crucial organs start developing. 7-week fetus on ultrasound looks like a yolk sac. In the 8th week, the fetus grows to 3/4 of an inch. During the ultrasound, you will notice a fluttering on the screen and can listen to the heartbeat. The uterus is about the size of an orange this week.
If the heart rate of fetal is lower in 6 to 8 weeks then there are high chances of miscarriages. Below 70 beats per minute usually means miscarriage.
During the last four weeks of the first trimester, the cartilage starts forming and bones begin to grow. The baby starts forming the skeleton and eye structure starts progressing. The tongue begins to develop while toes and fingers lengthen but are webbed. The fetus now weighs about one gram.
By the 10th week, growth reaches the crucial point and in ultrasound, the fetal movements can be seen. To ensure everything is working properly the baby needs to move. It means from week 10 till the end of 40 weeks of gestation, the baby won't be still. In some circumstances, to hear the heartbeat a fetal monitor is used.
The baby is now officially called as Fetus with the onset of the 11th week as the crucial development phases are completed. Growth will be fast now and by the end of 11th week, the fetus will grow in size by 1 inch. By the end of the week, the baby will weigh a half-ounce and will be around 2 inches in length.
With a 12th week, the speed of growth accelerates and the formed organ starts practicing to function. As the genitals start forming in the 12th week but are not visible in the ultrasound until the 16th week of pregnancy.
Second Trimester of Pregnancy
The 13th week signifies the beginning of the second trimester. You will notice the alien look of a fetus will disappear on ultrasound. The eyes will come closer and ears will shift to their place. Intestines developed within the umbilical cord moves to the baby's body. Other organs such as pancreas and liver begin to function. (9) (10)
In the 14th week, you can see the movement in the chest area on ultrasound. This movement is basically breathing practice. The fetus can measure up to 3 ½ inches in length while 2 ounces in weight. All the nutrients, calories and vitamins fetus gets from a placenta. Ultrasound can also verify the heart rate if parents want to listen.
By the 15th week, fetus measures between 4 to 4 ½ inches and weighs up to 3 ½ ounces. By this week, parents get anxious to know about baby sex, which can be determined by ultrasound. It will also provide a picture of genitals.
With 4th month, the mother will experience movements in the abdomen. The bones will start hardening now and the legs will be longer than arms so the movements will be kicks not punches. The anatomic ultrasound will be scheduled for the 20th week. During the 17th week, the fetus grows than ever before and is long as 6 inches and weighs up to 7 ounces. The heart pumps vigorously and pumps more than 25 quarts of blood. (11)
With 18th week, the baby looks like a human and weighs 8 ounces. The bowel development continues and meconium (first bowel movement) develops inside the baby. Fetal sex can be determined in ultrasound along with the arms, legs, and head and abdomen measurements.
Vernix Caseosa (it is a thin white covering which protects the skin of the baby from the fluid environment of the amniotic sac) develops during the 19th week. Physicians choose to perform ultrasound after 19 weeks as most of the fetus parts can be seen clearly. At this time, the fetus will be 6 to 7 inches long and will weigh nearly 11 ounces. It is considered to be the best size of fetus measurement and photographs.
The 20th week denotes the halfway point to normal pregnancy. Baby will now weigh more and 8 or more inches longer. It is a perfect week to check the fetal anomalies. Anatomic ultrasound can last up to 1 hour.
The 21st week marks the bit slow growth process as the focus shifts to internal organs development rather than weight gain. At this time, male fetuses start dropping the testes. There is no ultrasound test required in this week as most of them are already done. In a 22nd week, the fetal brain continuously grows along with the development of hearing, smell, taste, sight, and touch. During this week, the physician performing ultrasound can determine baby sex.
By the starting of 23rd week, the fetus develops remarkably so, if the early birth is detected the fetus can survive. There are high chances of impaired neonatal health while survival is very low. In the 24th week, the fetus is considered 'viable', implying the reasonable chances of survival if born prematurely. The baby keeps gaining weight.
The spine continues to strengthen in the 25th week and comprises 1000 ligaments, 33 rings, and 150 joints once it is completed. The closed nostrils will start to open a bit. With a 26th week, the fetus grows rapidly and weighs around 2 pounds and is 9 inches in measurement. The lungs' air sacs begin to develop and secretes the surfactant (important for normal lung function) to air sacs line. The brain works hard as hearing and vision senses develop. (12)
In the last week of second trimester, the baby's brain develops quickly and lungs continue to breathe air. Eyelids open and retinas start to develop. The physician may suggest ultrasound appointments this week.
Third Trimester of Pregnancy
With the beginning of the 28th week, the fetus grows in leaps and bounds with 90% chances of survival. The lungs functions and body fat increases to 2-3% in this week. Ultrasound is important this week, a fetus will have a face like a human.
By the 29th week, the fetus looks like a baby and its head and body are proportionate. Gaining weight is quite rapid and the eyes are fully developed. Baby can now see, hear and smell. In the 30th week, the baby weighs either 3 pounds or more and keeps gaining weight. Bones are now developed and bone marrow starts functioning i.e. producing red blood cells. Hearing develops and recognizes certain voices. (13) (14) (15)
The 31st week marks the slow growth as space tightens. Other body functions are perfect and now the focus is on lung development and weight gain. The 32nd week marks the complete development of senses. Hair continues to grow and gaining weight slows down. In a 33rd week, amniotic fluid levels are high and will remain the same until the baby is born. Skin starts to red but eventually changes to pink due to fat distribution.
By the 34th week, there is the rapid development of the brain and head size starts growing to hold new brain tissues. In the 35th week, the fetus weighs more than 5 ½ pounds. The mother can see the movement through the abdomen skin that includes punching, rolling and kicking. The 36th week marks the four weeks of the due date and for the next few weeks, the baby weight will shift towards down leaving the breath shortness for pregnant woman and little space for storage in a bladder.
37th and 38th week are considered the early term. The baby weighs around 6 ½ pounds and practices breathing. The parents get confused with the fetal breathing movements in the ultrasound, as a baby isn't breathing, as there is no air in the uterus. In the 38th week, if the baby measures too large in ultrasound then the doctor may select to induce labor for protecting the mother’s and baby’s health. Meconium develops in the fetus bowel. And once the water bag breaks, it gets clear.
The wait is worthy with the 39th week. But if you are scheduled for cesarean section for any reason then there are chances that it will be performed in 39th or 40th week. With 40 weeks of pregnancy, women start to feel the time to have a baby. Till 42nd week, pregnancy is considered overdue. With the onset of 41st week, the woman is prepared to give birth and starts noticing pain, swelling, fatigue and abdominal weight until the beginning of labor pain. Baby is fine until the placenta is working properly and good amniotic fluid level. In this week, if an ultrasound depicts any distress on fetus then the doctor might suggest medical induction or C-section.
In most of the pregnancies, the baby will be borne by the 42nd week. The chances of vaginal birth diminish with every passing day. C-section is the best option if a baby has moved to the birth canal.
Hope this article gave you an idea about the fetal heart rate and why ultrasounds need to be done in each stage of the pregnancy. Follow OVO Fertility blog to get regular updates on fertility health and treatments.
SOURCES AND REFERENCES:
- ^ Fetal Heart Rate Monitoring During Labor | ACOG M.acog.org, 13 July 2019
- ^ Fetal Monitoring | Stanford Childrens Health Stanfordchildrens.org, 13 July 2019
- ^ What Fetal Heart Rate Monitoring Can? Utswmed.org, 13 July 2019
- ^ Fetal monitoring | Pregnancy Birth and Baby Pregnancybirthbaby.org.au, 13 July 2019
- ^ Fetal Monitoring during Pregnancy | Missouri Baptist Medical Center Mobapbaby.org, 13 July 2019
- ^ First Trimester of Pregnancy: What to Expect, Baby Development | WebMD Webmd.com, 13 July 2019
- ^ Health and Pregnancy: First Trimester | WebMD Webmd.com, 13 July 2019
- ^ The First Trimester of Pregnancy | Healthline Healthline.com, 13 July 2019
- ^ Second Trimester: Weeks 13 to 28 | Tommys Tommys.org, 13 July 2019
- ^ The Second Trimester of Pregnancy | Healthline Healthline.com, 13 July 2019
- ^ Changes in Your Body During Pregnancy: Second Trimester Familydoctor.org, 13 July 2019
- ^ Second Trimester Pregnancy: What to Expect | Mayo Clinic Mayoclinic.org, 13 July 2019
- ^ The Third Trimester of Pregnancy | Healthline Healthline.com, 13 July 2019
- ^ Health and Pregnancy: Third Trimester | WebMD Webmd.com, 13 July 2019
- ^ Fetal development: The 3rd trimester | Mayo Clinic Mayoclinic.org, 13 July 2019
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