CARDIOTOCOGRAPHY

Question 1

Contributory factors to fetal morbidity and mortality following CTG

Answer 1

1. CTG technique/equipment
2. Errors of interpretation of CTG
3. Failure to act upon suspicion of pathological CTG
4. Fetal blood sampling
5. CTG and blood sampling–other

Question 2

T/F: Staff tasked with CTG interpretation must have evidence of annual training

Answer 2

T

Question 3

T/F: Key management decisions should not be based on CTG alone

Answer 3

T

Question 4

Monitoring tool to identify hypoxia

Answer 4

`Cardiotocograph

Question 5

T/F: CTG during labour is associated with reduced rates of neonatal seizures

Answer 5

T

Question 6

T/F: increase in caesarean sections and instrumental vaginal births with CTG in labour

Answer 6

T

Question 7

T/F: with CTG there is no clear differences in cerebral palsy, infant mortality or other standard measures of neonatal wellbeing.

Answer 7

T

Question 8

CTG pattern with stress

Answer 8

1. Hypoxia begins with deceleration
2. Acceleration disappear
3. Baseline HR increases

Question 9

CTG pattern with compensated stress

Answer 9

1. Stable baseline
2. normal variability
3. deceleration deeper and wider

Question 10

CTG pattern with decompensation

Answer 10

1. Unstable Baseline
2. changes in variability

Question 11

4features of fetal heart rate

Answer 11

1. Baseline rate
2. Baseline variability
3. Presence or absence of decelerations (and concerning characteristics of variable decelerations if present)
4. Presence of accelerations

Question 12

T/F: If there is a stable baseline fetal heart rate between 110and 160beats/minute and normal variability, continue usual care as the risk of fatal acidosis is low

Answer 12

T

Question 13

T/F:The presence of fetal heart rate accelerations, even with reduced baseline variability, is generally a sign that the baby is healthy

Answer 13

T

Question 14

Normalbaseline rate is

Answer 14

110 – 160 bpm

Question 15

T/F: Baseline HR is gestation dependent

Answer 15

T

Question 16

Non reassuring baseline rate are –and –

Answer 16

baseline bradycardia and baseline tachycardia

Question 17

Baseline bradycardia is

Answer 17

100 - 109 bpm

Question 18

Baseline tachycardia is

Answer 18

160 - 179bpm

Question 19

AbnormalHR

Answer 19

<100 bpm
>180 bpm

Question 20

Acceleration is

Answer 20

Increase in FHR above baseline of at least 15bpm for at least 15seconds

Question 21

T/F: Absence of FHR acceleration is a good predictor of fetal metabolic acidemia or hypoxic injury

Answer 21

F. Poor predictor

Question 22

Single most helpful method of assessing a fetus

Answer 22

Variability

Question 23

T/F: Represents integrated activity of the autonomic nervous system

Answer 23

T

Question 24

T/F: Tends to be reduced during spells of quiet sleep

Answer 24

T

Question 25

Abnormal variability is

Answer 25

Reduced variability with decelerations low or high baseline rate

Question 26

Normal variability

Answer 26

Between 5 and 25 bpm

Question 27

Increased variability

Answer 27

> 25 bpm

Question 28

Reduced variability

Answer 28

2 - 5 bpm

Question 29

Absent variability

Answer 29

< 2 bpm

Question 30

Types of variability

Answer 30

Normal, increased, reduced and absent

Question 31

Deceleration is

Answer 31

Drop in baseline of at least 15bpm, lasting at least 15 seconds 

Question 32

Types of decelerations

Answer 32

early, late and variable

Question 33

A temporary decrease in fetal heart rate below the baseline

Answer 33

Deceleration

Question 34

T/F: Deceleration may be obvious (deep and broad) or subtle (shallow)

Answer 34

T

Question 35

Fetal autonomic response to changes in intracranial pressure and/or cerebral blood as a result head compression in labour.

Answer 35

Early deceleration

Question 36

reflex fetal response to transient hypoxemia during uterine contraction

Answer 36

Late deceleration

Question 37

fetal autonomic reflex response to mechanical compression of the umbilical cord

Answer 37

Variable deceleration

Question 38

No Concerning characteristics with variable decelerations are --, --, -- and --

Answer 38

1. lasting less than 60 seconds 2. baseline variability maintained within the deceleration 3. shouldering  4. V shape

Question 39

Concerning characteristics with variable decelerations

Answer 39

1. lasting more than 60 seconds 2. reduced baseline variability within the deceleration 3. failure to return to baseline 4. biphasic (W) shape 5. no shouldering 

Question 40

T/F: Shallow decelarations are more ominous compared to deep decelarations

Answer 40

T

Question 41

Rare and associated with fetal anaemia and hypoxia.

Answer 41

Sinusoidal pattern

Question 42

A regular oscillation of the baseline long-term variability resembling a sine wave

Answer 42

Sinusoidal pattern

Question 43

Characteristics of sinusoidal pattern

Answer 43

1. a smooth undulating pattern  2. 3-5cycles per minute 3. Amplitude 5-15bpm 4. No acceleration 5. Persist at least 20 minutes

Question 44

How long should a CTG trace be stored

Answer 44

1. 25 years 2. In cases where there is concern that the baby may experience developmental delay, photocopy CTG traces and store them indefinitely in case of possible adverse outcomes. 

Question 45

T/F: Antenatal CTG can be performed from 24 weeks

Answer 45

F. Not done prior to 26 weeks

Question 46

T/F: Computerised CTG is not appropriate for intrapartum fetal monitoring

Answer 46

T. NOT appropriate for intrapartum fetal monitoring. It is not valid if the woman is experiencing regular uterine contractions, or when she is in the latent phase of labour. It can be used prior to the administration of Propess, but not after it has been administered.

Question 47

T/F: A short-term variation (STV) value of less than 3ms is strongly linked to the development of metabolic acidemia and impending intrauterine death

Answer 47

T

Question 48

Dawes Redman Criteria DRC met =

Answer 48

Normal CTG Criteria can be met as early as 10minutes and CTG discontinued before 20minutes

Question 49

DRC not met –

Answer 49

continue CTG for full 60minutes Codes for why criteria not met

Question 50

5 maternal indications for intrapartum CTG

Answer 50

Antepartum haemorrhage Significant meconium Oxytocin use Suspected chorioamnionitis, sepsis PET ( severe HTN , proteinuria)

Question 51

5 fetal indications for intrapartum CTG

Answer 51

Cord presentation Abnormal presentation – breech, transverse Fetal growth restriction Deceleration heard on IA

Question 52

Suspicious CTG is

Answer 52

2 normal features plus one non reassuring feature

Question 53

Features of a non reassuring CTG

Answer 53

1. Baseline of 100 - 109 or 161 -180 2. Variability of <5bpm for 30 mins or >25bpm for 15 mins 3. Read up the decelerations

Question 54

Features of pathological CTG

Answer 54

1. Baseline below 100 or > 180 2. Variability of <5bpm for 50 mins or >25bpm for 25 mins 3. Read up the decelerations