Intermittent Monitoring is Sufficient in the Absence of Doppler Abnormalities and Contractions
For fetuses with normal umbilical artery Doppler studies and no active labor (no contractions), intermittent monitoring is appropriate and continuous fetal heart rate monitoring is not necessary. The context of your question—absence of both Doppler abnormalities and contractions—indicates you are asking about antepartum surveillance rather than intrapartum monitoring, which fundamentally changes the monitoring approach.
Antepartum Surveillance Context (No Labor/Contractions)
When Doppler studies are normal and the patient is not in labor:
Weekly or twice-weekly non-stress testing (NST) is the standard approach for high-risk pregnancies requiring antepartum surveillance, not continuous monitoring 1.
NST is performed intermittently for 20-40 minutes per session, with testing frequency based on the specific risk factors present 1.
International guidelines for fetal growth restriction with normal umbilical artery Doppler recommend surveillance every 2 weeks, not continuous monitoring 2.
Continuous fetal heart rate monitoring outside of labor is not indicated when Doppler studies are normal, as there is no evidence supporting this practice and it would lead to unnecessary interventions 1.
Key Surveillance Parameters with Normal Doppler
Umbilical artery Doppler should be repeated every 2 weeks when initially normal in at-risk pregnancies 2.
Middle cerebral artery Doppler and cerebroplacental ratio may be added every 2 weeks at ≥34 weeks gestation if growth restriction is present, even with normal umbilical artery Doppler 2.
NST should not be used as the only form of surveillance; it must be combined with Doppler assessment and growth monitoring 2.
Intrapartum Monitoring Context (Active Labor with Contractions)
If your question pertains to labor monitoring, the answer differs significantly:
For low-risk pregnancies in active labor, structured intermittent auscultation is equivalent to continuous electronic fetal monitoring and is the preferred method 3, 4.
Intermittent auscultation requires checking fetal heart rate every 15-30 minutes during active first stage and every 5 minutes during second stage with pushing 2, 3.
Continuous monitoring during labor is indicated only for high-risk conditions, not for normal Doppler findings alone 2.
When to Switch from Intermittent to Continuous Monitoring
Abnormal fetal heart rate patterns detected on auscultation warrant immediate conversion to continuous monitoring 4.
Meconium-stained amniotic fluid, maternal fever, or chorioamnionitis require continuous electronic fetal monitoring 2, 4.
Neuraxial analgesia or intrathecal catheters necessitate continuous monitoring due to increased risk of fetal bradycardia 3.
Critical Distinction: Antepartum vs Intrapartum
The absence of contractions in your question strongly suggests you are asking about antepartum surveillance, not labor monitoring:
Antepartum surveillance uses intermittent NST sessions (20-40 minutes, weekly or twice-weekly) 1.
Continuous monitoring is reserved for intrapartum care (during active labor with contractions) 2, 3.
Normal Doppler studies indicate lower risk and support less intensive monitoring approaches 2.
Common Pitfalls to Avoid
Do not confuse antepartum surveillance with intrapartum monitoring—they require completely different approaches 1, 3.
NST cannot predict acute events like placental abruption or cord accidents, so normal testing does not eliminate all risk 1.
Extending monitoring beyond 40 minutes for a single NST session is appropriate to account for fetal sleep cycles, but this is still intermittent, not continuous 1.
Avoid unnecessary continuous monitoring in low-risk situations, as it increases cesarean delivery rates (NNH = 20) and instrumental births (NNH = 33) without improving neonatal outcomes 2, 4.