Finding FHT early in pregnancy

[Littlewonder]

Now, working in an LDRP where we never get anyone before they are twenty weeks along, I have a hard time with this! Every once in a while we are called down to ER to find FHT on girls between 12 and 20 weeks. I don't have any problems with sixteen weeks and up, but does anyone have any tips on finding FHT with a doppler below sixteen weeks? I would appriciate any tips possible! Thanks...

[SmilingBluEyes]

First Make SURE you reassure the patient it may take a few minutes to find her baby, so she does not right-off, think something is wrong!

Then, using plenty of conducive jelly, start right at the pubis, sweeping from side to side and change the angle of the doppler from up to down and back and forth.

Make sure you do a complete sweep, from down to up, and across the entire pelvis, up to the umbilicus, changing the angle of the doppler slowly as you go. Doing this, you will find the FHT's at some point, if all is ok and they are not earlier than about 6-7 weeks.

GOOD LUCK. It just takes practice.

[babyktchr, BSN, RN]

I also find if you lay these patients completely flat, it helps finding those wee little beans.

[Aneroo, LPN]

Agreed. First thing I do is tell them "We may not be able to hear it. It might be too early", and explain to them sometimes the HB can't be heard that early. I don't want someone freakin' out because we can't hear a HB. I have to do this a lot when docs want tones on a girl who's 10 weeks or so- I'll tell the patient flat out- "I doubt we'll hear anything right now"- esp if she's overweight.

Lots of lube. I start at the hairline (or where it should be :) ) and work my way across. I make sure to tell them when it's their own HB they're hearing. In the beginning of this pregnancy, I got so excited when I heard that, then my MIL explained it was my own (no wonder it was so slow!). I work up, try changing the position of my doppler.