Cardiotocography

Question 1

IMPORTANT FEATURES:

1. Baseline bradycardia
2. Baseline tachycardia
3. Loss of baseline variability
4. Early deceleration
5. Late deceleration

Answer 1

1. Baseline bradycardia:
   - <100/min
   - Increased fetal vagal tone, maternal beta-blocker urse
2. Baseline tachycardia:
   - >160/min
   - Maternal pyrexia, chorioamnionitis, hypoxia, prematurity
3. Loss of baseline variabilit
   - <5 beats/min
   - Prematurity, hypoxia
4. Early deceleration:
   - deceleration which commences with onset of a contraction and returns to normal on completion of the contraction.
   - usually harmless and indicates head compression.
5. Late deceleration:
   - Deceleration of heart rate which lags onset of contraction and does not return to normal until >30s following end of contraction
   - fetal distress eg asphyxia/placental insuffciency
6. Variable decelerations
   - Independent of contractions
   - May indicate cord compression.

Question 2

Dr C BraVADO

Answer 2

Dr: Define risk
C: Contractions per 10 mins
- Hyperstimulation: >5 in 10 mins
Bra: Baseline rate
- 100-160 beats/min
V: Variability
- should be >5 beats/min
- reduced variability can indicated fetal sleep if <45 mins.
A: Accelerations 
D: Decelerations
- Early decelerations
- Variable decelerations
- Late decelerations

Question 3

NICE CLASSIFICATION OF CTG ABNORMALITIES:

1. Normal/reassuring
2. Non-reassuring
3. Abnormal

Answer 3

1. a) Baseline: 100-160 beats/min
   b) Baseline variability: ≥5 beats/min
   c) Decelerations absent
2. a) Baseline: 161-180 beats/min
   b) Baseline variability: <5 for 30-90 mins
   c) i) Variable decelerations:
   - drop from baseline by ≤60 beats/minute and takes ≤60s to recover
   - present for >90 mins
   - occurs with >50% contractions OR
   ii) Variable decelerations:
   - drop from baseline by >60 beats/min or takes >60s to recover
   - present for up to 30 mins
   - occurs with >50% contractions OR
   iii) Late decelerations:
   - present for up to 30 mins
   - occurs with >50% contractions
3. a) Baseline: >180 or <100 beats/min.
   b) Baseline variability: <5 for >90 mins.
   c) i) Non-reassuring variable decelerations:
   - still observed 30 mins after starting conservative measures.
   - occurs >50% contractions. OR
   ii) Late decelerations
   - present for >30 mins
   - X improve with conservative measures
   - occurs with >50% contractions OR
   iii) Bradycardia/single prolonged deceleration lasting ≥3 mins

Question 4

MANAGEMENT:

1. CTG normal/reassuring:
2. CTG non-reassuring and warrants need for conservative measures
3. CTG is abnormal and indicates need for conservative measures AND further testing
4. CTG abnormal and indicates need for urgent intervention

Answer 4

1. a) All 3 features are normal/reassuring
   b) Continue CTG and normal care
   c) If CTG started due to concerns from intermittent auscltation, remove after 20 mins if no non-reassuring/abnormal features and no ongoing risk factors.
2. a) 1 non-reassuring features AND 2 normal/reassuring features
   b) If fetal HR >160 beats.min, check maternal temperature and pulse. Offer fluids and paracetamol if either are raised.
   c) Start ≥1 conservative measures:
   - encourage to mobilise, adopt left-lateral position and avoid being supine.
   - Oral/IV fluids
   - Stop oxytocin if being used and offer tocolysis(0.25 mg terbutaline)
   d) Inform coordinating midwife ad obstetrician.
3. a) 1 abnormal feature OR 2 non-reassuring features
   b) If fetal HR >180 beats/min, check maternal T and pulse. Offer fluids and paracetamol if either raised.
   c) Start ≥1 conservative measures
   d) Offer to take FBS after conservative measures or expedite birth if FBS cannot be obtained or no accelerations seen with scalp stimulation.
   e) Action ≤30 mins if late decelerations with tachycardia and/or reduced baseline variability
   f) Discuss with consultant obstetrician if FBS cannot be obtained or 3rd FBS thought to be needed.
4. a) Bradycardia or single prolonged deceleration with baseline <100/min persisting for ≥3 mins
   b) Start ≥1 conservative measures
   c) Inform coordinating midwife
   d) Urgently seek obstetric help
   e) Make preparations for urgent birth
   f) Expedite birth if persists for 9 mins
   g) If heart rate recovers before 9 mins, reassess decision to expedite birth in discussion with woman.

Question 5

FBS:

1. ≥7.25
2. 7.21-7.24
3. ≤7.20

Answer 5

1. ≥7.25
   - Repeat FBS if FHR abnormality persists.
2. 7.21-7.24
   - Repeat FBS ≤30 mins or consider delivery if rapid fall since last sample
3. Delivery

Question 6

INDICATIONS FOR CONTINUOUS FETAL MONITORING:

Answer 6

1. Maternal and/or Fetal problems
2. Intrapartum risk factors
3. Abnormal fetal heart rate on auscultation:
   - Baseline ≤110 bpm or ≥160 bpm
   - Any decelerations