CTG

Question 1

pathological CTG initial management

Answer 1

obtain review by obstetrician and senior MW
exclude acute events
correct underlying causes
start >1 conservative measures
talk to woman and birth partner

Question 2

if FBS cannot be obtained and no scalp stimulation

Answer 2

expedite birth

Question 3

abnormal: baseline

Answer 3

<100 or >180

Question 4

late decelerations in >50% contractions for <30minutes, with no risk factors

Answer 4

non-reassuring

Question 5

reassuring: baseline

Answer 5

110-160

Question 6

variable decelerations with any concerning characteristics in >50% contractions <30mins

Answer 6

non-reassuring

Question 7

overall normal CTG

Answer 7

all features reassuring

Question 8

if CTG still pathological after fetal scalp stimulation

Answer 8

consider FBS
consider expediting birth
take woman’s preferences into account

Question 9

acute bradycardia or decelerations >3min

Answer 9

abnormal

Question 10

if FBS borderline and no accelerations to scalp stimulation

Answer 10

2nd FBS no more than 30 minutes later if still indicated by CTG

Question 11

FBS abnormal

Answer 11

<7.20

>4.9

Question 12

abnormal: variability

Answer 12

<5 x >50min
or
>25 for >25min
or sinusoidal

Question 13

reassuring: decelerations

Answer 13

none or early

variable with no concerning characteristics for <90min

Question 14

if CTG still pathological after conservative measures:

Answer 14

obtain further review

offer digital scalp stimulation

Question 15

variability <5 x>50min

Answer 15

abnormal

Question 16

overall suspicious CTG

Answer 16

1 non-reassuring and 2 reassuring

Question 17

absence of accelerations

Answer 17

does not indicate fetal acidosis

Question 18

if FBS cannot be obtained but scalp stimulation present

Answer 18

consider continuing or expediting birth

Question 19

variable decelerations with any concerning characteristics in >50% of contractions for 30 minutes (or less if risk factors)

Answer 19

abnormal

Question 20

concerning characteristics decelerations

Answer 20

lasting more than 60s
reduced variability within deceleration
failure to return to baseline
biphasic shape
no shouldering

Question 21

variability >25 x >25min

Answer 21

abnormal

Question 22

non-reassuring: baseline

Answer 22

100-109 or 161-180

Question 23

FBS borderline

Answer 23

7. 21-7.24

4. 2-4.8

Question 24

early decelerations

Answer 24

if no non-reassuring or abnormal features should not prompt further action

Question 25

variable decelerations with no concerning characteristics for >90min

Answer 25

non-reassuring

Question 26

non-reassuring: variability

Answer 26

<5 x 30-50min
or
>25 x 15-25min

Question 27

overall pathological CTG

Answer 27

1 abnormal feature
or
2 non-reassuring features

Question 28

sinusoidal

Answer 28

abnormal

Question 29

FBS normal pH/lactate

Answer 29

> 7.25

<4.1

Question 30

variable decelerations with any concerning characteristics in up to 50% contractions for>30min

Answer 30

non-reassuring

Question 31

if FBS normal and no accelerations to scalp stimulation

Answer 31

2nd FBS no more than 1hr later if still indicated

Question 32

suspicious CTG management

Answer 32

correct underlying causes
perform set of obs
start >1 conservative measure
inform senior
document plan for reviewing
talk to woman and birth partner

Question 33

late decelerations for 30 minutes

Answer 33

abnormal

Question 34

reassuring: variability

Answer 34

5-25