Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: June 2026.
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
Aansh Hospital & IVF Center is a growing chain of fertility and women's health centers across Vidarbha and northern Telangana, with its headquarters and in-house embryology lab in Chandrapur, led by Senior Clinical Embryologist Aayush Agarwal, Ph.D. Fetal monitoring is led by Dr. Shweta Agarwal (MBBS, DGO). Because antenatal care, high-risk pregnancy management, and fetal surveillance are all provided by the same clinical team who may have already overseen your IVF or fertility treatment, your history is fully integrated from the start. You can verify our government ART registration on the National ART & Surrogacy Registry.
What is fetal monitoring and why is it done throughout pregnancy?
Fetal monitoring is not a single test — it is a structured programme of assessments, each designed to answer a specific clinical question at a specific point in gestation. The purpose of every component is the same: to confirm that the baby is growing at the expected rate, that fetal anatomy is developing normally, that the placenta is functioning adequately, and that the baby's pattern of movement and heart rate indicates wellbeing. Monitoring also detects conditions — intrauterine growth restriction (IUGR), placental dysfunction, low amniotic fluid — early enough to allow timely clinical action that reduces risk. In a straightforward pregnancy, most monitoring will be reassuring; in a pregnancy with risk factors (including an IVF conception, multiple pregnancy, or maternal medical conditions), the schedule is intensified. Monitoring is an evidence-based tool for proactive care — not a source of alarm in itself.
Under the PCPNDT Act, 1994, all ultrasound and Doppler investigations performed at registered facilities in India are governed by strict legal requirements. At Aansh, every scan is conducted for the clinical purpose documented above — anatomy, growth, and wellbeing — and the sex of the baby is never determined, disclosed, or recorded as a disclosure in any form, by any member of the team, under any circumstances. This is not a policy preference; it is the law, and it is observed without exception.
What happens at the dating scan and first-trimester ultrasound?
The first ultrasound in pregnancy — the dating scan — is typically performed in the first trimester, ideally between 10 and 13+6 weeks of gestation (per FOGSI guidelines). Its purpose is to confirm the pregnancy is intrauterine (in the correct location), to measure the fetal crown-rump length (CRL) and thereby establish an accurate expected date of delivery (EDD), and to confirm the number of fetuses and whether twins share a placenta (chorionicity — important for monitoring planning). The dating scan does not assess sex. It is an anatomical and gestational-age assessment.
Women who are aware of first-trimester combined screening may also have heard of the nuchal translucency (NT) scan, which is performed as part of first-trimester chromosomal risk screening. The NT scan measures the thickness of a fluid-filled space at the back of the fetal neck between approximately 11 and 13+6 weeks of gestation, and is offered as part of first-trimester combined screening alongside maternal serum markers (PAPP-A and free beta-hCG) to assess chromosomal risk (per FOGSI guidelines). Combined with maternal blood markers (PAPP-A and beta-hCG), NT measurement provides a statistical estimate of the risk of chromosomal conditions such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13). It is a risk screening test — not a diagnostic test and not a determination of any outcome. An elevated risk on screening prompts discussion of further diagnostic options (such as chorionic villus sampling or amniocentesis); a low-risk result is reassuring but does not guarantee a normal chromosome complement. The NT scan is a structural and chromosomal risk assessment — sex is neither measured nor disclosed.
What does the anomaly scan (mid-pregnancy anatomy scan) check?
The anomaly scan — also called the mid-trimester anatomy scan or structural survey — is a detailed ultrasound assessment of fetal anatomy, typically performed at approximately 18–22 weeks of gestation (per FOGSI guidelines). It is the most detailed structural assessment of the pregnancy and evaluates:
- Fetal brain and skull — ventricular size, cerebellum, posterior fossa
- Face and spine — lip, palate profile, and spinal vertebral alignment
- Heart — four-chamber view, outflow tracts, cardiac position and rhythm
- Abdominal organs — stomach, kidneys, bladder, abdominal wall integrity
- Limbs — femur and humerus length, gross limb structure
- Placenta — location, appearance, and relationship to the cervical os
- Amniotic fluid — volume assessment (amniotic fluid index or single deepest pocket)
- Umbilical cord — insertion, vessel count
The anomaly scan is an anatomy and structural development assessment. Its purpose is to evaluate organ formation and identify any structural variation that may benefit from further investigation or specialist planning. It does not assess sex, it is not a sex-determination scan, and the sex of the baby is never communicated from this or any other investigation. Many findings that are mentioned at an anomaly scan are soft markers with no clinical significance; any finding that does require follow-up will be explained clearly by Dr. Shweta Agarwal at the time, with a plan for what happens next.
What are Doppler studies and what do they tell us about fetal wellbeing?
Doppler ultrasound studies measure blood-flow velocity and patterns in specific vessels — most commonly the umbilical artery (between the placenta and baby) and the middle cerebral artery (MCA, in the fetal brain). They are used to assess how well the placenta is functioning and whether the fetus is receiving adequate oxygen and nutrition.
- Umbilical artery Doppler: A healthy umbilical artery shows continuous forward blood flow throughout the cardiac cycle. Abnormal patterns — raised resistance, absent end-diastolic flow, or reversed end-diastolic flow — indicate increasing placental resistance, which is associated with fetal growth restriction and raises the question of timing and mode of delivery.
- Middle cerebral artery (MCA) Doppler: In a growth-restricted or compromised fetus, blood flow is preferentially redirected to the brain — a process called brain sparing. MCA Doppler detects this redistribution. Changes in the MCA pulsatility index are a marker of fetal adaptation and progressive compromise.
- Uterine artery Doppler: Performed in some higher-risk pregnancies earlier in gestation to assess placentation and identify women at elevated risk of growth restriction or pre-eclampsia.
- Ductus venosus Doppler: Used in advanced fetal compromise assessment, reflecting venous blood-flow patterns from the liver to the heart.
Doppler studies are a physiological and wellbeing assessment tool. They provide information about placental blood flow, fetal cardiovascular adaptation, and fetal oxygenation — not about the sex of the baby. At Aansh, Doppler investigations are conducted in full compliance with the PCPNDT Act: the clinical indication, assessment performed, and finding are documented; no sex-related information is ever recorded or communicated.
What are growth scans and amniotic fluid assessment?
Serial growth scans measure fetal dimensions — typically head circumference (HC), abdominal circumference (AC), femur length (FL), and estimated fetal weight (EFW) — at multiple timepoints to track the trajectory of growth over time. A single measurement in isolation is less informative than the trend across measurements; a fetus that plots small on one scan but maintains consistent growth velocity is very different clinically from one whose growth velocity is falling across sequential scans.
Growth scans are typically recommended in the third trimester, commonly between 32 and 36 weeks of gestation (per FOGSI guidelines), and earlier and more frequently in pregnancies with identified risk factors. The gestational-age-specific growth charts used are an important clinical variable and are discussed with you at your appointment.
Amniotic fluid assessment is performed alongside growth scans. Amniotic fluid is produced primarily by fetal urine output; the volume reflects fetal renal function and, indirectly, fetal wellbeing and placental perfusion. Low amniotic fluid (oligohydramnios) is associated with fetal growth restriction, placental insufficiency, and fetal renal problems, and triggers further investigation and closer monitoring. High amniotic fluid (polyhydramnios) may be associated with fetal swallowing difficulties or maternal gestational diabetes, among other causes. Both are findings that guide clinical management — they are anatomy and physiology assessments with no sex-determination component.
How do fetal movement monitoring and kick counts work?
Fetal movement — the baby's kicks, rolls, and stretches — is a direct indicator of fetal neurological and musculoskeletal activity. A healthy, well-oxygenated fetus moves regularly; a reduction in movement can be an early sign of fetal compromise. From approximately 28 weeks of gestation, pregnant women are encouraged to be aware of their baby's normal movement pattern and to report any significant reduction promptly.
There is no single universal definition of normal kick count that applies to every pregnancy, and clinical guidance emphasizes overall pattern awareness of the baby's movements rather than a strict numeric cutoff (per WHO guidelines); what matters clinically is any sustained reduction from the pattern that is normal for that individual baby. If you notice that your baby's movements have slowed or feel different from usual, contact Aansh immediately on +91 80056 85160 or via WhatsApp — do not wait until the next scheduled appointment.
Fetal movement assessment is a wellbeing tool. It has no connection to sex determination.
What is cardiotocography (CTG / NST) and when is it used?
Cardiotocography (CTG) — also referred to as the non-stress test (NST) in the Indian clinical context — is a continuous recording of the fetal heart rate alongside any uterine contractions. It is performed using two transducers placed on the maternal abdomen, with a continuous tracing recorded over typically 20–40 minutes.
A reactive (normal) CTG shows a baseline fetal heart rate within the normal range, with regular accelerations (short-term increases in heart rate) in response to fetal movement. Accelerations are a positive sign of fetal wellbeing. Non-reactive or suspicious features — reduced baseline variability, absent accelerations, decelerations — prompt further assessment, which may include a biophysical profile (see below) or clinical review and decision-making about the pregnancy.
CTG is used primarily in the third trimester and in labour, and is the standard tool for assessing fetal heart rate response in real time. Indications include:
- Routine surveillance in high-risk pregnancies (including IVF conceptions, diabetes, hypertension, growth restriction, reduced fetal movements)
- Assessment of fetal wellbeing when a woman reports reduced fetal movement
- Intrapartum (in-labour) monitoring to detect fetal heart rate changes in response to contractions
The CTG recording is an assessment of fetal heart rate pattern and fetal neurological reactivity — a physiological wellbeing assessment entirely unrelated to sex.
What is the biophysical profile and when is it recommended?
The biophysical profile (BPP) is a combined ultrasound and CTG assessment that assigns a scored evaluation of fetal wellbeing across five parameters, each scored 0 or 2:
- Fetal breathing movements — the presence of sustained breathing movements on ultrasound
- Gross body movement — a defined number of body or limb movements
- Fetal tone — extension and return to flexion of a limb or the fetal hand
- Amniotic fluid volume — a single deepest pocket or amniotic fluid index within normal range
- Reactive CTG (NST) — a reactive non-stress test
A score of 8–10 is generally reassuring of fetal wellbeing. A score of 6 is considered equivocal and may prompt repeat assessment or clinical review. A score of 4 or below raises concern and typically prompts immediate clinical decision-making about the pregnancy.
The BPP is used when there is clinical concern about fetal wellbeing — for example, in the context of growth restriction with abnormal Doppler, reduced fetal movements, or suspicious CTG. It is a comprehensive, multi-parameter fetal wellbeing score. It assesses anatomy and physiology; it has no sex-determination component.
How is fetal monitoring intensified in high-risk and IVF pregnancies?
In a standard low-risk pregnancy, fetal monitoring follows a scheduled programme of scans and clinical assessments that is sufficient to detect the most common complications. In pregnancies with identified risk factors — including IVF conceptions, multiple pregnancy, pre-eclampsia, gestational diabetes, intrauterine growth restriction, previous pregnancy loss, or abnormal Doppler findings — the monitoring schedule is appropriately intensified. This means:
- More frequent growth scans — for example, fortnightly rather than every 4 weeks — to detect slowing growth velocity early.
- Serial Doppler studies — to track umbilical artery and MCA patterns over time rather than a single snapshot.
- Earlier introduction of CTG — commencing non-stress testing at an earlier gestational age and more frequently.
- Biophysical profile — triggered by any concern on CTG, Doppler, or movement assessment.
- Amniotic fluid measurement at every scan appointment, rather than only at growth scan intervals.
At Aansh, fetal surveillance in high-risk pregnancies is integrated within the same clinical team. The findings from fetal monitoring directly inform the high-risk pregnancy management plan — including decisions about timing and mode of delivery. Detailed fetal surveillance is coordinated with the prenatal care programme so that nothing is duplicated and no finding is acted on in isolation. For pre-conception planning and genetic risk discussion, prenatal counseling is available.
Most monitoring encounters, even in higher-risk pregnancies, will be reassuring. The purpose of intensified surveillance is to provide early detection when intervention is needed — the majority of scans confirm that the pregnancy is progressing well.