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ALSO > Assessing fetal welfare > Flashcards

Assessing fetal welfare Flashcards

1
Q

Frequency of auscultation

A

Low risk - Active phase every 15-30 minutes
- Second stage every 5 minutes (or after every contraction)

High risk - Active phase every 15 minutes
- Second stage every 5 minutes (or after contraction)

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2
Q

What other moments in labour do you need to do intermittent ausculatation?

A

After VE
After SROM/ARM
After administration of meds
Abnormal uterus activity

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3
Q

Where is fetal heart best heard

A

anterior shoulder

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4
Q

How to do IA

A

Listen for long time when first done

When listening in listen for 1 minute

Get maternal pulse at same time

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5
Q

When should IA in low risk women be converted to CEFM

A

thick mec (consider for thin)
abnormality of IA
Bleeding
Synto
Womens reuest
Pyrexia

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6
Q

Maternal indications for continuous CTG

A

Maternal morbidity: diabetes/pre-eclampsia/HTN/hypothyroidism/anaemia
High BMI
Previous CS
APH

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7
Q

Fetal indications for CEFM

A

Multiple pregnancy
IUGR/SGA
Oligohydramnios
Polyhydramnios
Rh isoimmunisation
Abnormal dopplers
Gestation >42 weeks
Prematurity <37 weeks
Breech

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8
Q

Labour indications for CEFM

A

Pyrexia - 2x measurements >37.5 or one >38.0
Thick mec (consider for thin)
Abnormal uterine contractions
Blood stained liquour
Syntocinon
Epidural
Abnormal IA
Induced/augmented labour
PROM >24h
Prolonged labour

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9
Q

What is tachysystole

A

> 5 contractions in 10 minutes

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10
Q

What is hypertonus

A

contracteions >2 min or <60 seconds between

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11
Q

How do you assess a change in baseline fetal heart rate

A

needs to be 10 minutes or more

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12
Q

What is mild bradycardia associated with

A

post-dates and OP babies

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13
Q

What does persistent fetal tachy >180 suggest

A

chorio

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14
Q

What about a transient tachycardia after an acute hypoxic episode

A

Physiological response due to catecholamine release

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15
Q

What effect can steroids have on the CTG

A

Reduced variability for 24h

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16
Q

What is the significance of shouldering

A

may indicate partial cord compression. Reassuring sign in comparison to is they disppear.

17
Q

Why is there decellerations in second stage

A

head compression causing vagal stimulation –> parasympathetic.

18
Q

What if there are accelerations in second stage

A

MAKE SURE NOT MATERNAL

19
Q

What are early decellerations

A

Occur with head compression usually during SLEEP cycle.

Mirror and finish by the time contraction is over

They are benign if all other features of CTG are normal.

Only occur when woman is 4-8cm dilated as beyond this the head compression is more significant

Seldom go below 100bpm. Do not decrease more than 60 from baseline

20
Q

Factors that make variables complicated

A

rising baseline
smooth over shoot after decel
slow to get back to baseline
rop >60 bpm
reduced variability
loss of shouldering

21
Q

Define late decelleration

A

Begins after the onset of contraction. Madir is at least 20 seconds after peak of contraction and ends after the end of contraction

22
Q

Pathophysiology of late decellerations

A

In healthy babies that are centrally oxygenated a contraction will limit the gas exchange within the intervillous space - but the babies have been able to spare the important organs so heart rate can go back up no problem. They have some back up O2 because the placenta is giving them loads of O2 in between contractions.

In inhealthy babies that are already hypoxic, the HR drops after the contraction has started because the baby has no O2. This is because there is utero-placental insufficiency. It is only when the contraction stops that the baby can get some more O2 and gradually raise the heartrate.

23
Q
A
24
Q

Contraindications to FBS

A

Maternal infection - chorio/HIV/hepB
Fetal compromise significant on CTG
Face presentation
<34 weeks
Fetal bleeding disorders

25
Q

Where must be avoided in FBS

A

caput because there is venous stasis

26
Q

What to do if FBA taken and trace remains abnormal

A

repeat in 30-60 minutes

27
Q

What are the ‘normal’ ‘borderline’ ‘abnormal’ PH values

A

Normal >7.25
Borderline 7.2-7.25
Abnormal <7.2
<7.15 - IMMEDICATE BIRTH

28
Q

What are the ‘normal’ ‘borderline’ ‘abnormal’ lactate values

A

Normal < 4.1
bornderline 4.1-4.8
abnormal >4.8
IMMEDIATE BIRTH >5.7

29
Q

What is the most important cord blood and why

A

arterial because most reflective of fetal status as going from baby to mum.

ALSO (8 decks)

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