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Gwen - Reproductive Medicine (Obs, Gyn, Breast) > CTG > Flashcards

CTG Flashcards

1
Q

What is cardiotocography?

A

Continuous foetal heart rate monitoring (also known as electronic foetal monitoring)

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3
Q

What are maternal antenatal risk factors that should prompt recommendation of EFM in labour?

A
  • Previous CS
  • Cardiac Problems
  • Pre-eclampsia
  • Prolonged pregnancy > 42 weeks
  • Prelabour rupture of membranes
  • Induction of labour
  • Diabetes
  • Antepartum haemorrhage
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4
Q

What are foetal antenatal risk factors that should prompt recommendation of EFM?

A
  • IUGR
  • Prematurity
  • Oligohydramnios
  • Abnormal doppler velocimetry
  • Multiple pregnancy
  • Meconium stained liquor
  • Breech presentation
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5
Q

What are intrapartum risks which require CTG?

A
  • Oxytocin augmentation
  • Epidural analgesia
  • Intrapartum vaginal bleeding
  • Pyrexia >37.5oC
  • Fresh meconium staining of liquor
  • Abnormal FHR on intermittent auscultation
  • Prolonged labour
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6
Q

What does the term baseline rate mean when decribing features of CTG?

A

Mean level of the FHR when this is stable and after exclusion of accelerations and decelerations

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7
Q

What does the term baseline variability mean when refering to CTG reading/

A

Degree to which the baseline varies:

  • 0-5 beats/min = reduced
  • 5-25 beats/min = normal
  • >25 beats/min = saltatory
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8
Q

What is meant by acceleration when referring to CTG readings?

A

Transient rise in FHR by at least 15 beats over the baseline lasting for >/= 15 secoonds

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9
Q

What is meant by the term deceleration when referring to CTG readings?

A

A reduction in the baseline of 15 beats or more for more than 15s

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10
Q

What is a bradycardia defined as on CTG?

A

FHR <110 bpm

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11
Q

What are causes of decreased baseline variability on CTG?

A
  • Foetal hypoxia
  • Foetal sleep cyce
  • Foetal malformation
  • Drug administration
  • Severe prematurity
  • Foetal heart block
  • Foetal abnormalities
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12
Q

What is regarded as tachycardia on CTG?

A

>160 bpm

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13
Q

What are maternal factors which can contribute to an abnormal CTG?

A
  • Woman’s position
  • Hypotension
  • Vaginal examination
  • Emptying bladder or bowels
  • Vomiting
  • Vasovagal episodes
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14
Q

What approach could you use for assessing a CTG?

A

DR C BRAVADO

  • Define Risk
  • Contrations
  • Baseline RAte
  • Variability
  • Accelerations
  • Decelerations
  • Overall impression
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15
Q

How would you define risk in someone with CTG?

A
  • Maternal medical issues - hypertension, diabetes, asthma
  • Obstetric complications - Multiple, Post-term delivery, Previous CS, IUGR, premature membrane rupture, oxytocin induction, pre-eclampsia
  • Other - Absence or prenatal care, smoking, drug abuse
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16
Q

How would you assess contrations as part of the DR C BRAVADO mnemonic?

A
  • Number of contractions in 10 minutes - within 10 big squares on CTG
  • Record the following:
    • Duration
    • Intensity
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17
Q

How would you assess baseline rate of CTG as part of you DR C BRAVADO mnemonic?

A
  • Average heart rate of the fetus within a 10-minute window.
  • Ignore any accelerations or decelerations.
  • A normal fetal heart rate is between 110-150 bpm
18
Q

What are causes of foetal tachycardia?

A
  • Foetal hypoxia
  • Chorioamnionitis
  • Hyperthyroidism
  • Foetal/maternal anaemia
  • Foetal tachyarrhythmias
19
Q

What are causes of mild foetal bradycardia?

A
  • Postdate gestation
  • OP/ROT/LOT presentation
20
Q

What are causes of prolonged severe foetal bradycardia?

A

Severe hypoxia:

  • Prolonged cord compression
  • Cord collapse
  • EPidural/spinal anaesthesia
  • Maternal seizures
  • Rapid foteral descent
21
Q

Why does baseline variability occur?

A

Variability occurs as a result of the interaction between the nervous system, chemoreceptors, baroreceptors and cardiac responsiveness.

22
Q

What is regarded as non-reassuring variability?

A
  • Less than 5bpm for between 30-50 minutes
  • More than 25bpm for 15-25 minutes
23
Q

What is regarded as abnormal variability?

A
  • Less than 5bpm for more than 50 minutes
  • More than 25bpm for more than 25 minutes
  • Sinusoidal
24
Q

How are accelerations in FHR on CTG interpreted?

A

Presence of accelerations is reassuring - presence alongside uterine contractions is a sign of a healthy foetus

25
Q

What is early deceleration indicative of?

A

Normal physiological response - due to increased foetal ICP due to uterine contractions; ends when contraction ends

26
Q

What are variable decelerations caused by?

A

Umbilical cord compression

27
Q

What can cause late deceleration on heart rate variability?

A

Reduced uteroplacental flow

  • Maternal hypotension
  • Pre-eclampsia
  • Uterine hyperstimulation
28
Q

What should be performed if late decelerations are present on CTG?

A

Foetal blood sampling - if acidotic indicates significant foetal hypoxia and need for emergency C-section

29
Q

What would prolonged decelerations in variability indicate?

A

Lasting longer than 2 minutes

Action must be taken quickly - FBS and emergency C-section

30
Q

What does a sinusoidal pattern on CTG indicate?

A

Very concerning. It indicates the following:

  • Severe foetal hypoxia
  • Severe foetal anaemia
  • Foetal/maternal haemorrhage

Immediate C-section is required - outcome is usually poor

31
Q

What are the 3 main descriptions used to give an overall impression of a CTG?

A
  • Reassuring
  • Non-reassuring
  • Abnormal
32
Q

What are reassuring features on CTG?

A
  • Baseline heart rate - 110 to 160 bpm
  • Baseline variability - 5 to 25 bpm
  • Decelerations
    • None or early
    • Variable decelerations with no concerning characteristics* for less than 90 minutes
33
Q

What are features of a non-reassuring CTG?

A
  • Baseline heart rate
    • 100 to 109 bpm
    • 161 to 180 bpm
  • Baseline variability
    • Less than 5 for 30 to 50 minutes
    • More than 25 for 15 to 25 minutes
  • Decelerations
    • Variable decelerations for 90 minutes or more
    • Variable decelerations with any concerning characteristics* in up to 50% of contractions for 30 minutes or more
    • Variable decelerations with any concerning characteristics* in over 50% of contractions for less than 30 minutes
    • Late decelerations in over 50% of contractions for less than 30 minutes, with no maternal or fetal clinical risk factors such as vaginal bleeding or significant meconium
34
Q

What features would make you think there was an abnormal CTG?

A
  • Baseline heart rate
    • Below 100bpm
    • Above 180 bpm
  • Baseline variability
    • Less than 5 for more than 50 minutes
    • More than 25 for more than 25 minutes
    • Sinusoidal
  • Decelerations
    • Variable decelerations with any concerning characteristics* in over 50% of contractions for 30 minutes (or less if any maternal or fetal clinical risk factors [see above])
    • Late decelerations for 30 minutes (or less if any maternal or fetal clinical risk factors)
    • Acute bradycardia, or a single prolonged deceleration lasting 3 minutes or more

Gwen - Reproductive Medicine (Obs, Gyn, Breast) (49 decks)

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