40. Detection of fetal distress during labor

Question 1

how is auscultation of the FHR performed?

Answer 1

by listening from the beginning of one contraction to the beginning of the next contraction.
Repeat q30 min’ in the first stage of labor, q15 min’ in the second stage of labor, and up to q5 min’ in high-risk pregnancies.

Question 2

what is a cardiotocography (CTG)?

Answer 2

Continuous electronic fetal heart rate monitoring
Fetal heart rate is analyzed against a uterine contraction recording.
Used to monitor fetal well-being during labor.

Question 3

what is the frequency of doing a CTG during labor?

Answer 3

q30 min’ in the first stage of labor, q15 min’ in the second stage of labor, q5 min’ or continuous monitoring in high-risk pregnancies.

Question 4

how is direct monitoring (invasive, internal) carried out?

Answer 4

by placing an electrode onto the fetal scalp to monitor heart rate, and inserting a transcervical catheter to monitor uterine contractions

Question 5

how is indirect monitoring (non- invasive, external) carried out?

Answer 5

out by placing two transducers on the external surface of the abdomen, one is placed at the fundus, the other is placed closer to the pelvis

Question 6

how are normal values on a CTG described?

Answer 6

Reactive NST

Question 7

Steps of CTG

Answer 7

1. baseline assessment- determination of the rate and variability ,FHR 110-160 BPM
2. oscillations (variability)
   3.Normal accelerations
3. No decelerations- other than DIP-0 or DIP-I.

Question 8

Reasons for fetal tachycardia on CTG

Answer 8

FHR > 160 for > 10 min’
chorioamnionitis, maternal dehydration, hyperthyroidism

Question 9

Reasons for fetal bradycardia on CTG

Answer 9

FHR < 110 for > 3 min’
fetal hypoxia, umbilical cord traction, placental abruption

Question 10

when can reduced variability (silent CTG pattern) may be seen?

Answer 10

fetal sleep state, hypoxia (acidosis), fetal tachycardia, maternal sedation (drugs), prematurity.

Question 11

what is the frequencies of normal oscillations (variability)?

Answer 11

frequency > 5 per 1 min’, amplitude 5-25 BPM.

Question 12

what are normal accelerations (transient frequency increase?

Answer 12

represents fetal movements. FHR increases in response to uterine contractions (normal response). > 2 accelerations in 20 min’, increase by at least 15 BPM and lasts 15 sec’ (15 x 15 rule).

Question 13

what does DIP-0 indicate?

Answer 13

Episodic contraction independent deceleration.
Due to momentarily umbilical cord traction.

Question 14

is DIP-0 (spike type) a normal finding?

Answer 14

yes, artefacts from umbilical cord compression .
may be a sign of fetal danger if > 1 deceleration during 20 min’ recording

Question 15

what causes DIP-I Early deceleration?

Answer 15

head compression → Vagus ↑
Deceleration on the same time of contraction
NORMAL FINDING

Question 16

what causes DIP-II late deceleration?

Answer 16

(uteroplacental insufficiency). Deceleration onset, maximal fall, and recovery that is shifted to the right in relation to the contraction.
Asynchronous

Question 17

what does DIP-II indicate?

Answer 17

Fetal danger sign.

FHR drop 15-45 BPM → moderate
FHR drop > 45 BPM → severe

Question 18

what does DIP-III indicate?

Answer 18

Fetal danger sign.

 Duration of deceleration 30-60 s' → moderate
  Duration of deceleration > 60 s' → severe

Question 19

what is DIP-III?

Answer 19

Variable deceleration (severe cord compression).
Some decelerations are in the same time of the contraction. Some are not.

Question 20

what is the management in case of an abnormal (non-reassuring) CTG during delivery?

Answer 20

1. Search for the underlying cause and address appropriately when possible.
2. In-utero resuscitation → initial interventions, aimed at improving uteroplacental perfusion and maternal/fetal oxygenation
3. Administer 100% O2 by face mask.
4. Rule-out cord prolapse.
5. Consider terbutaline (tocolytic).
6. Consider fetal scalp blood pH testing (pH < 7.21 implies fetal asphyxia).
7. Procced with immediate delivery if persistent decelerations or fetal pH < 7.2.

Question 21

In-utero resuscitation interventions in case of an abnormal CTG during delivery

Answer 21

1. Reposition: change the woman’s position to the left lateral recumbent position, or if she is already on her side, switch positions to the other side.
2. Discontinue or reduce infusion of uterotonic agents (oxytocin) to improve uteroplacental blood flow.
3. Increase intravenous fluids by infusing 500-1000 mL of normal saline with 5% dextrose or Ringer lactate solution; ensure adequate intravascular volume and substrate for the fetus and placenta.

Question 22

Absent baseline variability or Prolonged bradycardia in category III FHR is suggestive of?

Answer 22

severe metabolic dysregulation

Question 23

Recurrent late decelerations in category III FHR is suggestive of?

Answer 23

↓ uteroplacental blood flow

Question 24

Recurrent variable decelerations in category III FHR is suggestive of??

Answer 24

umbilical cord compression or decreased amniotic fluid volume

Question 25

Sinusoidal pattern in category III FHR is suggestive of?

Answer 25

on admission → suggests severe fetal anemia; during labor → suggests fetal bleed

Question 26

what criteria is predictive of abnormal fetal acid-base status in category III FHR?

Answer 26

1. absent baseline variability
2. recurrent late decelerations
   3.recurrent variable decelerations
3. prolonged bradycardia
4. sinusoidal pattern

Question 27

what is the approach in cases of category FHR tracing?

Answer 27

delivery within 30 minutes