Hearing Fetal Heartbeat With A Doppler - Clinical Skills - Dr Gill

[Music] foreign [Music] welcome back to the channel my name is Dr James Gill and you've joined me for another clinical skills session currently we are 24 weeks pregnant and we thought it would be appropriate time to do a clinical skills video on how to use the fetal doppler probe now it's very important that we highlight that this is a clinical skills video so for medical students midwives people who are learning how to use these this is not something that we would recommend that people do at home now the reason why I highlight that and I'll put a link to the study I'm talking about in a moment the bmj highlighted why people without a medical skill should not be using these at home because they can lead to false reassurance there's certainly been cases where people have been concerned about the lack of movement to the baby and have used a fetal probe but have had their own pulse and have been falsely reassured when actually the fetus was in distress and has subsequently died so even though you can buy these off Amazon don't buy these unless you are a medical health professional and are trained to use it so hopefully with that health warning in place we can show you correctly how to do this so we need to make sure that the patient is Fit and Well at the moment so we want to make sure they've not got any issues with their stomach and that they've not had any problems with urinary tract infections basically we're going to be poking and prodding we want to make sure there's no problems so the big question will be rather than your boss told you to why should we be able to use a fetal doctor probe well there's several key reasons for that first off and this is probably the most common reason why mums will ask for it to be done is to assess fetal well-being from our point of view we're going to take that one step further and say to also assess viability so from 14 weeks approximately we should be able to detect a fetal heartbeat in reality we don't go testing until 16 weeks because we might not be able to identify it at 14 weeks and obviously that can cause significant maternal distress if we're saying it's probably fine and it's probably us that's screwing up whereas if we can set for 16 weeks we're very confident we should be able to find the fetal heartbeat and we do everybody's happy in terms of checking on fetal well-being the fetal doppler will give us an idea of how the baby is reacting to the maternal environment so for example if the mother is stressed if they are anemic and let's be fair most pregnant women will end up with a degree of dilutional anemia if the mother is suffering from hypotension or perhaps has an infection herself we'd likely see that in the fetal heart rate that we're taking in the vast majority of cases we'd find that fetal heart rate was similarly elevated because the baby is also stressed however we may find that the baby has been so stressed that we've now gone all the way through and they've essentially used up their reserves and now we have a fetal bradycardia where the baby's pulse is low that's very important for us and we consider that a negative sign of fetal well-being so we definitely want to discuss with the specialists at that point so when the actual baby is on the way and the ladies heading into labor a lot of the time people just think about the monitoring that stays on the the abdomen permanently however we can still use the faithful Doppler throughout the stages of labor and it's again vitally important that we are able to assess the fetus at that point to look for signs of decelerations so the heart rate's slowing which again might indicate fetal distress and that we might need to be paying more attention to that mother maybe getting a little bit more Interventional the other reason that we want to be using a fetal probe is we can pick up things early on so for example we might pick up ectopic beats of the fetus's heart we may hear some abnormal flows that may indicate things like an enlarged atrial septal defect or enlarged ventral septal defect similarly we might also pick up very rare conditions like tetralogy a flot where the blood flow around the heart is disrupted because the heart hasn't fully formed properly and as mentioned at any point we may pick up those bradycardis which might tell us we need to look more but in the vast majority of cases and the commonest reason you're going to be doing a fetal doppler on a pregnant mum it's just for reassurance and it is wonderful when you're in clinic and you do the Doppler and you get to see the mum hear the heart rate for the first time and you know it's it's a big moment and even throughout the pregnancy every time they get to hear their baby's heart rate you know it brings a smile and again to link back to what I've said at the beginning although that sounds like a wonderful thing to have at home it is not and I would stress if you are a layperson if you are not medically trained to use a fetal doppler do not go buying these online they can actually put your infant at risk because you may be falsely reassured when there's something going wrong that you should actually be talking to at your Healthcare professional please do not buy these so when we're using the ultrasound Probe on the abdomen it's important we don't just go hey look I found it and then move forward we need to make sure we're listening for at least 60 seconds to confirm that the fetal heart rate is at the level that we think it is that there's no decelerations and there's no obvious ectopics similarly we'll want to do the same over the maternal um pulse once we find that just to make sure there's no evidence of abnormalities with regard to the flow to the placenta there although in this particular situation this is more for the false rather than anything more specific if we wanted to get more detail on the placental blood flow then we'd actually go to a a much larger probe where we could actually visualize the flow through the Doppler probe which I hear we're only just listening to it instead now whilst I love my technology and these are great for the mum being able to hear the um the fetal heart sounds sometimes these aren't available and you'll find a lot of midwives who will still use a pinard essentially a tube that they will place over the abdomen in order for them to directly listen to the fetal heartbeat in my opinion all doctors should be able to use basic medical equipment so even if you intend to be an orthopedic surgeon I think you should still be able to use an otoscope because you never know what you're going to encounter on the wards or potentially when you're dealing with a fracture in the a e Department that patient might also ask for you to look in your ear you may be a specialist but you're also a doctor for that reason I would argue that all doctors should be able to use a Doppler probe because you're going to use it on any pregnant lady whether you see see them in the GP surgery whether you see them in the a e department whether you're seeing them on the ward for a different tissue if they have access to them and the mum likes that reassurance these are very very useful tool buying you that reassurance so I don't think this is a specialist tool I think this is a medical tool that all medical students all doctors should be able to use properly and correctly so with that in mind let's get on with the examination so obviously we want to gel our hands and introduce ourselves to the patient hello my name is Dr Gill I've been asked to have a look at your baby today and do the Fatal heartbeat before we go any further could you please confirm your name and date of birth yes I'm Dr Bethany Gill and my date of birth is the 15th of August 1991. super so before we go any further have you noticed any problems with the bump at the moment and have you felt the little one move today yes super and so far have there been any problems with the pregnancy for you a bit of sickness early in pregnancy but seems to settle there okay okay so if we can get you to lie back if you're comfortable then we'll have a look at what we can find so it's important that we keep the patient comfortable so we're actually putting the bed at 15 degrees as we get more advanced than the pregnancy and we get an increased size of what everything then we want to have the patient in the left lateral position so the fetus and the uterus Etc don't press down on the vena cava which could cause issues with blood supply to the mum okay so with that in mind if we can have a look at the bump if that's okay and if we can just bring things down for a little bit thank you so in terms of approaching the bump what we need to do first off is actually find how far up the fundus how far up the uterus can be felt I'm going to come over with both hands starting at the bottom and I'm just going to slowly Flex my fingers up until I run out of essentially density and I'm fine I'm dropping off and that there is telling me that I found the edge of the fundus or the uterus at this point it's at the umbilicus which is not surprising because that's where we'd expect it for 24 weeks gestation the next thing we need to do is find out where the baby's actually sitting is it sitting in a transverse line so lengthway is stretching out across all the insides or is it top to bottom which is hopefully we'll be looking at it and similarly is it head down or head up the reason for all of this is I want to find the shoulder and I'm going to use the probe directed toward the shoulder which will hopefully give us the greatest chance of picking up the sounds we're going to be listening for so in terms of what we're listening for we're going to be investing for two main noises we're going to be listening for uh the maternal flow through the placenta which should be at their heart rate so I'm going to check that before I actually put hands on the patient and then I'm going to be listening for the Gallup Rhythm of the fetal heart which will be somewhere around 110 to 165 so hopefully considerably higher than the mother so I'm just going to take the Pulse to start off with so we've got a pulse of about 70 there so I know I'm now going to be able to distinguish both the maternal and the fetal pulse so I'm going to feel up for the fundal height so using both hands I'm just flexing the at the fingertips up until we get to the end of the density so here just at the umbilicus and I can go all the way over it so I know where I've got the uterus then I'm going to fill with both hands on the left of the patient initially and then on the right the patient so that's trying to establish the LIE and here we've definitely got a longitudinal lie and as I'm doing this I'm trying to feel essentially can I feel knobbly bits with one hand versus smooth bits on the other which is telling me that we've got the arms and legs and things on one side versus the back on the other so we think that we've got a a baby head down we're going to double check that by changing my position so I'm now pressing from the bottom and then steadily moving up and I can't be certain but I think I've got more density towards the bottom and less density towards the top so I think we may have feelings of the head down here and a bottom up here in which case I'm going to be listening around about here ish hoping that I'm listening through the shoulder into the um into the womb so before we actually start getting the gel and the probe out we're going to get a little bit of paper I'm going to give the patient that to us to tuck into the top of their trousers or underwear because well we don't want to get things all messed for for the patient or the patient's doing that I'm going to get the ultrasound okay so we're going to leave it to probe off for the moment and we're going to apply the jelly to the top so more rather than less is always better then detach the probe head which is going to be vital important and then we'll switch things on we can check our battery life and also our volume so for ourselves we're going to increase the volume up so the jelly is your friend so more of it will help sound transmit through so again as I said from from what I felt on the abdomen to start off with I'm expecting to find something towards uh the right side so let's have a listen again plenty of jelly on there and I'll turn the volume up for yourselves and we're suspecting that we're going to find the shoulder down here so this is where we're going to stick a kick off with it [Music] so right away I found the fetal heartbeat sitting there at a nice 150. [Music] then we need to move around to find the maternal pulse so there's some maternal flow and it's coming up there about 77 beats per minute and we'll move back around foreign so we can hear that Gala so it's a really good Rhythm and we can see the significant difference in rate between the two don't forget they're going to be moving around inside as well whilst this is happening so it's not just about the operator they can just object and decide to go for a quick wiggle inside so we let the Almond wipe off the jelly and then we'll put that all in the bin and obviously make sure that Mum covers themselves up so we also want to make sure we're wiping off the probe at the same time so any questions with myself with that so were you happy that you could hear both yourself your own heart rate and that of the baby super do you have any other questions for me at the moment super well thank you very much your time so in terms of using the probe the best way to look at it is actually as a torch so you're shining the light around and we're trying to shine it onto the baby if we heck we'll use the ultrasound device as the main thing if I'm shining it away I'm literally not going to hear anything back from it so I need to try and position it to where I think I'm going to have found the baby and I go back to what I was saying that I'm listening through the shoulder so I think here's the shoulder the heart's going to be here so I'm positioning in that direction trying to shine the ultrasound waves in that direction and once you can grasp using this as a torch trying to illuminate what's inside it's something much easier for you to perform these procedures and I hope that's been a useful overview for yourselves on how to use the Doppler app probe we're going to be doing a few more videos like this if I can get permission to use this uh um do this demonstration um if there's any questions please put them down below and yeah thank you for putting up with this and thank you all for joining us the best part of it is although I'm clinical skills she's actually Hobbs and guinea so it really should be Beth doing the examination on me but uh well I lack certain organs for this right take care and we'll see you in the next one cheerio foreign