Cardiotocograph

Question 1

Aside from CTG, how else can you monitor baby?

Answer 1

pinard stethoscope

Question 2

List two complications of fetal hypoxia?

Answer 2

perinatal death
hypoxic ischaemic encephalopathy
cerebral palsy

Question 3

List three maternal factors associated with fetal hypoxia

Answer 3

hypotension
epidural or spinal
respiratory disease
cardiac disease
diabetes
smoking
infection
drugs alcohol
thyroid disease

Question 4

List two placental factors associated with fetal hypoxia

Answer 4

placental abruption
cord accidents
infection
chorioamnionitis 
pre-eclampsia

Question 5

List three fetal causes of hypoxia

Answer 5

instrumental delivery
cord prolapse
malpresentations
infection
anaemia
prematuryity
haemorrhage
congenital anomalies

Question 6

What are the four features of fetal heart rate?

Answer 6

baseline rate
baseline variability
presence/absence of accelerations
presence/absence of decelerations

Question 7

What are reassuring baseline rates for CTG?

Answer 7

110-160 bpm

Question 8

What are abnormal/worrying baseline HR?

Answer 8

<100

>180

Question 9

What is normal baseline variability?

Answer 9

5 to 25 bpm

Question 10

What is abnormal baseline variability?

Answer 10

<5 bpm for >50 mins

>25 bpm for >25 mins

Question 11

Are accelerations reassuring or not?

Answer 11

reassuring! the absence of them is abnormal.

15 bpm for 15 sec or more

Question 12

When is variable deceleration concerning?

Answer 12

lasting more than 60 sec
failure to return to baseline
biphasic W shape

Question 13

What is a normal/non concerning cause of variable deceleration?

Answer 13

cord compression

Question 14

Which type of deceleration is most indicative of fetal hypoxia?

Answer 14

late deceleration

Question 15

List two causes of decreased variability

Answer 15

sleep
fetal hypoxia
drugs

Question 16

List one drug that can cause decreased varability

Answer 16

opiates

magnesium sulphate

Question 17

List one cause of fetal tachy?

Answer 17

fetal hypoxia

chorioamnionitis

Question 18

List two factors associated with high risk pregnancy?

Answer 18

meconium stained liquor
fever
intrauterine growth restriction

Question 19

Explain the compensating mechanisms for hypoxia

Answer 19

reduced myocardial workload + reduced movement to conserve energy. No accelerations. Release of catecholamines which increase HR, promote peripheral vasoconstriction (to divert blood to vital organs), and promote glycogenolysis to increase energy supply.

Question 20

What are the signs of decompensation on CTG?

Answer 20

loss of baseline variability (reduced oxygen to brain)

myocardia hypoxia and acidosis- unstable baseline

Question 21

What is a pneumonic to remember the patterns of CTG changes in response to hypoxia?

Answer 21

ABCDE
Accelerations disappear
Baseline FHR increases
Compensated stress (stable basline FHR and normal variability)
Decompensation (unstable baseline and changes in varaibility)
End stage (Step ladder pattern due to myocardial failure)

Question 22

Are early decelerations normal?

Answer 22

physiological- head compression, resolves when contraction ends

Question 23

What is shouldering?

Answer 23

umbilical cord compression- fetus not hypoxic, compensating well. Variable deceleration

Question 24

What are concerning features of variable decelerations?

Answer 24

> 60 sec
biphasic shape
no shouldering
reduced baseline variability

Question 25

What do late decelerations indicate?

Answer 25

utero-placental insufficiency

Question 26

List two causes of late decelerations?

Answer 26

maternal hypotension
pre-eclampsia
uterine hyperstimulation