Normal Fetal Heart Rate and How It's Monitored

Fetal heart sounds

A normal heart rate for your fetus is an essential indicator of the well being of the fetus during pregnancy, labor, and delivery. An abnormal pattern can warn doctors and midwives a baby is under medical stress or at risk for dying.

Normal Rate and Pattern

The heart rate of the fetus has the following characteristics:

  • The baseline heart rate ranges between 110 to 160 beats per minute (BPM), according to Johns Hopkins Medicine.
  • From one beat to the next, the rate can vary by 5 to 25 BPM - referred to as the normal "beat-to-beat variability."
  • The baseline rate responds to changes in the mother, the uterus, the placenta, umbilical cord, or the fetus:
    • If the fetus is healthy, his heart rate briefly increases when he moves or when he is stimulated, for example by uterine contractions or external sound.
    • The heart rate pattern changes when the fetus is unhealthy or if he is in distress, for example from insufficient oxygen supply (hypoxia).
  • The baby's heart rate can be easily distinguished from the mother's because it is faster than hers - normal adult heart rate ranges from 60 to 100 BPM.

Monitoring Heart Rate

There are several methods doctors use to detect the fetal heartbeat and rate for routine and high-risk pregnancies.

Ultrasound Detection

The fetal heartbeat is first detectable and measurable on ultrasound at about five to six weeks from the last menstrual period. When there are complications during the first weeks of pregnancy, such as vaginal bleeding, a visible heartbeat on prenatal ultrasound at five to six weeks is the first confirmation the fetus is viable.

Hand-Held Fetal Doppler

A hand-held fetal Doppler is a battery-operated Doppler device that uses ultrasound waves to listen to the fetal heartbeat. It can measure the heart rate through the mother's abdomen from about 10 to 12 weeks.

The fetal Doppler is the method most often used during prenatal visits from the first trimester on. The fetal Doppler can also be used for intermittent monitoring during labor.

External Monitor

Fetal monitor

The external monitor is also a Doppler ultrasound device. The electronic fetal monitoring equipment is used to measure and track the heart rate during labor or during prenatal fetal surveillance testing.

An ultrasound probe (transducer) is strapped to the mother's belly and transmits the fetal heart sounds to a computer, which can provide a continuous printed tracing of the results. A separate device, also strapped to the belly, simultaneously measures uterine contractions.

Internal Fetal Scalp Electrode

An internal fetal scalp electrode is used during labor if improved or closer monitoring is needed. A thin monitoring wire (electrode) is attached to the skin of the fetal scalp by passing it through the cervix after breaking the bag of waters if it is not already broken. As with the external device, the electrode is attached to a computer that monitors and displays heart rate.

Other Devices

Other listening devices include the fetal stethoscope, or fetoscope. It is usually used during prenatal visits if a hand-held fetal Doppler is not available. An ordinary doctor's stethoscope might suffice to listen to the fetal heart when no other device is available.

Abnormal Rate and Patterns

Printing of cardiogram

During pregnancy, labor, and delivery, an abnormal heart rate that is too low, too high, or does not vary from beat to beat might indicate a fetus in trouble, or there may be a more benign cause. An American Family Physician article reviews the abnormalities doctors take into account during pregnancy and labor to decide on what to do next for mother and fetus.

Fetal Bradycardia

Bradycardia means a persistent slowing of the mean baseline fetal heart rate to less than 110 to 120 BPM. The bradycardia is more often a sign of fetal distress if it is below 100 BPM, especially if there are other abnormal heart rate patterns, such as poor beat-to-beat variability. Causes of fetal bradycardia include:

  • The position of the fetus
  • Fetal congenital heart and other abnormalities
  • Cord compression or cord prolapse that decrease oxygen supply to the fetus
  • Other fetal compromise that cause severely low oxygen - a high risk or sudden fetal death

Fetal Tachycardia

This is a persistent heart rate faster than 160 BPM. It is not always a sign of fetal distress if there is good beat to beat variability. A rate above 180 BPM is considered a sign of a fetus in distress. Causes of fetal tachycardia include:

  • Maternal anxiety and increased physical activity
  • Drugs given to the mother, such as terbutaline, used to stop preterm labor
  • Maternal illness including anemia, infection, and fever
  • Intrauterine infection affecting the fetal membranes (chorioamnionitis) and the fetus
  • Fetal anemia or abnormal fetal heart rhythms and insufficient oxygen

Poor Beat-to-Beat Variability

A flattening of the normal beat-to-beat variation of the heart rate to less than five BPM can indicate fetal distress. The causes can include:

  • A preterm fetus less than 28 weeks gestation
  • A fetus in distress from various causes including low oxygen, congenital fetal anomalies, or preterm labor
  • Steroids used to mature the fetal lung if there is preterm labor or preterm rupture of membranes
  • Magnesium sulfate used to treat preeclampsia or stop labor
  • Narcotics for pain during labor
  • Normal fetal sleep cycles

No Response to Fetal Stimulation

The heart rate responds to stimulation, such as uterine contractions or fetal movement, with an abrupt rise of 15 BPM or more lasting less than two minutes. A lack of response to such stimulation can indicate a sleeping or compromised fetus.

No accelerations for more than 80 minutes is a sign of a severely affected fetus at high risk for dying. Note that a premature fetus of less than 28 weeks gestation might not show a normal heart rate response to stimulation.

Heart Rate Decelerations

A deceleration is a decrease in the heart rate of 15 BPM or more, associated with a uterine contraction. The timing of the deceleration in relation to the onset and end of the contraction (early, late, variable, or prolonged) can indicate whether the fetus may or may not be at high risk for dying. The causes of concerning late, variable, or prolonged decelerations include:

  • Compression of the umbilical cord, including a cord wrapped around the neck of the fetus or a knot in the cord
  • Prolapse of the cord through the cervix
  • A fetus with intrauterine growth restriction (IUGR)
  • Compression of the fetal head
  • Placental abruption - a separation of the placenta from the uterine wall
  • Placental insufficiency - poor function of the placenta
  • Severe or frequent contractions of the uterus
  • Maternal factors, such as low blood pressure, preeclampsia, gestational diabetes

Fetal Heart Rate and Gender Prediction

The ability to predict a baby's gender by its heart rate during pregnancy is one of the many old wives tales that's been around for ages. Based on several studies, there is no evidence that this popular pregnancy folklore is true. One such study that disproved the long-held belief was published in 1998 study in BJOG: An International Journal of Obstetrics and Gynaecology.

Other popular gender prediction tests, such as the as wedding ring gender test, the baby gender pencil test, or the Drano pregnancy gender test, have also never been proven to be true.

Ask Your OB Providers For Details

Changes in the normal heart rate and pattern help obstetrics healthcare providers assess if a fetus is at risk for a poor outcome during pregnancy and labor. Ask your doctor or midwife to explain any concerning changes in your baby's heart rate during your prenatal visits and labor.

Normal Fetal Heart Rate and How It's Monitored