CTG

Question 1

How would you classify a suspicious CTG?

Answer 1

one non-reassuring feature, two reassuring features

Question 2

How would you classify a pathological CTG?

Answer 2

2 or more non-reassuring features on CTG or one abnormal feature

Question 3

What features of a CTG are used to classify whether it is normal, suspicious or pathological?

Answer 3

Variability, FHR, decelerations

Question 4

What is an abnormal variability on CTG?

Answer 4

<5bpm for >50mins or >25 for >25mins

Question 5

What is abnormal FHR on CTG?

Answer 5

<100 or >180

Question 6

What is abnormal decelerations on CTG?

Answer 6

Late decelerations >30mins
Single deceleration lasting more than 3minutes
Variable decelerations with concerning features with >50% of contractions for 30 mins

Question 7

How long does a single deceleration need to be for it to be classified as abnormal?

Answer 7

3 minutes

Question 8

What are the features of a reassuring CTG trace?

Answer 8

variability - 5bpm-25bpm
FHR 110-160pm
Decelerations absent

Question 9

When would a fetal heart rate be classified as non-reassuring on CTG?

Answer 9

100-109 or 161-180

Question 10

When would variability be classified as non-reassuring on CTG?

Answer 10

<5bpm 30-60 mins

>25bpm 15-25mins

Question 11

When would decelerations on CTG be classified as reassuring?

Answer 11

none or early

variable decelerations with no concerning features for <90mins

Question 12

What are the descriptions of CTG features?

Answer 12

Reassuring, non-reassuring, abnormal

Question 13

What are the categories of CTG?

Answer 13

Normal, suspicious, pathological

Question 14

How would you classify a normal CTG?

Answer 14

All features are reassuring (HR 110-160, variability 5bpm-25bpm, decelerations absent or early or variable w/o concerning features for <90mins)

Question 15

What is the normal range of variability for CTG?

Answer 15

5-25 bpm

Question 16

What is increased variability of CTG?

Answer 16

> 25 bpm

Question 17

What is decreased variability of CTG

Answer 17

<5pm

Question 18

What is considered absent variability on CTG?

Answer 18

<2pm

Question 19

What is the normal pH range of cord blood samples?

Answer 19

7.25-7.30

Question 20

How would you classify a suspicious CTG?

Answer 20

1 non-reassuring feature + 2 reassuring features

Question 21

How would you manage a suspicious CTG?

Answer 21

correct hypotension with IV fluids
Correct uterine hyperstimulation by either stopping oxytocin or adding a tocolytic (terbutaline)
maternal obs
obstetric/senior midwife review

Question 22

How would you classify a pathological CTG?

Answer 22

1 abnormal feature
or
2 non-reassuring features

Question 23

How would you manage a pathological CTG?

Answer 23

as for suspicious CTG - examine mother + get senior review + apply conservative measures for hypotension or uterine hyperstimulation
if no response - fetal scalp stimulation
if no response consider FBS or expediting delivery

Question 24

When is urgent intervention required?

Answer 24

Acute bradycardia or single prolonged deceleration for >3 mins

Question 25

What are reassuring features on CTG?

Answer 25

Baseline FHR 110-160
variability 5-25
Deceleration absent or early or variable for <90mins

Question 26

What are non-reassuring features on CTG?

Answer 26

Baseline FHR 100-109 or 161-180
variablity <5 or >5
Decelerations variable >90mins, late decelerations, variable decels + concerning signs

Question 27

What are abnormal CTG features on CTG?

Answer 27

Baseline FHR <100 >180
Variability <5 for >50 mins or >25 for >25mins or sinusoidal
acute bradycardia or decel for 3 mins
late decelerations for >30 mins
Variable decels with concerning characteristics >50% of contractions for 30 mins

Question 28

What terms are used to describe decelerations?

Answer 28

Early, variable, late

Question 29

What characteristics of variable decelerations are concerning?

Answer 29

lasting more than 60 seconds

reduced baseline variability within the deceleration

failure to return to baseline

biphasic (W) shape

no shouldering

Question 30

What is shouldering referring to in an ECG?

Answer 30

It is a reassuring sign - a deceleration surrounded by an acceleration on either side i.e. acceleration before the deceleration and after

Question 31

What does NICE recommend as a tocolytic?

Answer 31

terbutaline 0.25mg subcut - can cause maternal and fetal tachycardia

Question 32

What are accelerations a sign of?

Answer 32

fetal movement - healthy and normal

Question 33

Types of deceleration

Answer 33

Type 1 - early
Type 2 - late
Type 3 - variable

Question 34

Signs of hypoxic ischemic encephalopathy postpartum

Answer 34

abnormal tone and feeding
alterations in consciousness
seizure

Question 35

What is a sinosoidal sign suggestive of?

Answer 35

fetal distress/anaemia/chorioamnionitis