Published 18 August 2009, doi:10.1136/bmj.b3220
Cite this as: BMJ 2009;339:b3220

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Caution with home fetal Doppler devices

¹ Department of Obstetrics and Gynaecology, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Wirral

A 27 year old presented to our labour ward at 8 pm, 32 weeks into her first pregnancy with reduced fetal movements. She had first noted a reduction in fetal activity two days earlier but had used her own Doppler device to listen to the fetal heartbeat and reassured herself that everything was normal. A fetal cardiotocograph was not reassuring and showed reduced variability for over an hour. Steroids were given to enhance fetal lung maturity, and the baby was delivered by caesarean section later that evening. The baby was floppy and small for gestational age with poor Apgar scores (3 at 1 minute, 6 at 5 and 10 minutes) and acidotic cord gases (pH 6.97, base excess –19.1). The placenta looked calcified and pale. The baby remained on the special care baby unit for eight weeks with hypoxic ischaemic encephalopathy and an intraventricular haemorrhage. The baby is making steady progress with her neurodevelopment.

The current guidelines from the National Institute for Health and Clinical Excellence (NICE) on detection of fetal wellbeing do not support the routine counting of fetal movements, but most obstetric units would encourage patients to attend for a cardiotocograph and possibly further ultrasound assessment of growth and fetal activity if episodes of reduced movements recur. A hand-held Doppler device assesses the presence of fetal heart pulsations only at that moment, and it is used by midwives and obstetricians to check for viability or for intermittent monitoring during labour. In untrained hands it is more likely that blood flow through the placenta or the maternal aorta or iliac vessels will be heard.

An internet search revealed that a fetal Doppler device could be hired for £10 a month or bought for £25-50 (www.ebay.co.uk). Although the companies offering sales state that the device is not intended to replace recommended antenatal care, they also make claims such as "you will be able to locate and hear the heartbeat with excellent clarity" (www.hi-baby.co.uk).

Although self monitoring provided false reassurance and a delay in seeking help in this case, it is difficult to say if this altered the outcome. We now have posters in our antenatal areas to recommend that patients do not use these devices.

Cite this as: BMJ 2009;339:b3220

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Patient consent obtained.

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