Do you usually obtain fetal heart tones (FHT) daily for pregnant patients in the psychiatric ward?

Fetal Heart Tone Monitoring in Psychiatric Inpatient Settings

For pregnant patients admitted to psychiatric wards, daily fetal heart tone (FHT) auscultation is not routinely indicated unless specific obstetric risk factors are present that would warrant antepartum surveillance.

Rationale for Monitoring Approach

The decision to perform daily FHT monitoring should be based on obstetric risk stratification, not psychiatric admission alone 1. Psychiatric hospitalization does not inherently constitute a high-risk obstetric condition requiring intensive fetal surveillance 1.

When Daily FHT Monitoring Is NOT Required

• Low-risk pregnancies without obstetric complications do not benefit from routine antenatal testing, as there is no evidence that routine surveillance improves outcomes in pregnancies perceived to be low risk 1
• Antenatal fetal surveillance in low-risk women has the potential to cause iatrogenic prematurity secondary to preterm delivery for false-positive results 1
• Up to half of all stillbirths occur in patients without recognized risk factors, and routine testing does not prevent these outcomes 1

When Fetal Monitoring IS Indicated

Initiate antepartum fetal surveillance only if obstetric risk factors are present, such as 1, 2:

• Intrauterine growth restriction (IUGR)
• Maternal hypertensive disorders
• Gestational diabetes
• Decreased fetal movement
• Post-term pregnancy
• Multiple gestation with complications
• Maternal medical conditions affecting placental function

If surveillance is warranted, begin at 32-34 weeks' gestation with weekly or twice-weekly non-stress testing (NST), not daily FHT auscultation 1, 2, 3.

Practical Monitoring Protocol for Psychiatric Inpatients

For Previable Fetuses (<24 weeks)

• Simple auscultation of fetal heart tones before and after any procedure (such as medication administration requiring monitoring) is sufficient 1
• FHT can first be detected with an unamplified fetoscope at a mean gestational age of 19.4 weeks, with 81% detection at 20 weeks 4
• No continuous or daily monitoring is necessary unless obstetric complications develop 1

For Viable Fetuses (≥24 weeks) Without Risk Factors

• Routine daily FHT auscultation is not evidence-based 1
• Standard prenatal care intervals apply (typically every 2-4 weeks depending on gestational age)
• Monitor for maternal symptoms suggesting fetal compromise (decreased fetal movement, vaginal bleeding, contractions) 1

For Viable Fetuses With Obstetric Risk Factors

• Implement standard antepartum surveillance protocols with NST performed weekly or twice-weekly 2, 3
• NST sessions last 20-40 minutes and should be performed in an appropriate obstetric setting, not as brief daily checks 2
• Combine NST with ultrasound assessment of amniotic fluid volume (modified biophysical profile) for comprehensive evaluation 1, 2

Special Considerations for Psychiatric Patients

Medication-Related Monitoring

If the patient is receiving chemotherapy or medications with known fetal cardiac effects (such as during treatment for acute promyelocytic leukemia with ATRA), stringent fetal monitoring with particular emphasis on cardiac function is recommended 1. This represents a specific obstetric risk factor requiring enhanced surveillance.

Pregnancy Complicated by Cancer Treatment

For pregnant patients receiving chemotherapy in any setting (including psychiatric wards if applicable):

• Additional ultrasounds every 3-4 weeks to document adequate interval fetal growth 1
• Fetal umbilical artery Doppler exams should be added in case of growth restriction 1
• Consider measurements of peak systolic velocity of the fetal middle cerebral artery when chemotherapy is administered to evaluate for fetal anemia 1

Common Pitfalls to Avoid

• Do not implement daily FHT monitoring simply because the patient is hospitalized 1. This creates unnecessary medicalization without evidence of benefit.
• Avoid confusing intrapartum monitoring (during labor) with antepartum surveillance 3, 5. Continuous monitoring is reserved for active labor with contractions, not for general inpatient care 3, 5.
• Do not use brief daily FHT checks as a substitute for proper NST when surveillance is actually indicated 2. NST requires 20-40 minutes of continuous monitoring with specific interpretation criteria 2.
• Remember that no surveillance strategy can predict stillbirth from acute events such as placental abruption or cord accidents 1, 2. Daily monitoring provides false reassurance in these scenarios.

Recommended Approach

For the typical pregnant patient on a psychiatric ward:

1. Perform initial obstetric risk assessment upon admission
2. If low-risk: no routine daily FHT monitoring required
3. If high-risk obstetric factors present: arrange appropriate interval NST per standard protocols (weekly or twice-weekly starting at 32-34 weeks) 1, 2, 3
4. Educate patient on warning signs (decreased fetal movement, bleeding, contractions, fluid leakage) requiring immediate evaluation 1
5. Coordinate with obstetric team for standard prenatal care visits during psychiatric admission

The psychiatric admission itself does not change obstetric monitoring requirements unless psychiatric medications or conditions create specific fetal risks warranting enhanced surveillance 1.