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Obstetrics and Gynaecology > CTG Monitoring > Flashcards

CTG Monitoring Flashcards

1
Q

What do the following abbreviations stand for in CTG monitoring?

DR
C
BRa
V
A
D
O
A 
Define Risk
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
Overall impression
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2
Q

What is define risk?

A

Defining whether a pregnancy is high or low risk. It gives you context to the CTG and may change your threshold for intervention

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3
Q

What do you need to record about contractions?

A

Number in a 10 minute period (seen as peaks of uterine activity on CTG)

Strength and duration

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4
Q

What is a normal fetal heart rate?

A

110-160

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5
Q

How is a baseline fetal heart rate calculated?

A

Average in 10 minute window

Ignore accelerations and decelerations

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6
Q

How is prolonged severe bradycardia in a fetus defined?

A

<80bpm for >3 mins

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7
Q

What conditions are associated with fetal tachycardia?

A

Fetal hypoxia
Chorioamnionitis
Maternal or fetal anaemia
Hyperthyroidism

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8
Q

What conditions are associated with fetal bradycardia?

A

Prolonged gestation
Transverse or posterior occiput presentation

(100-120 bpm)

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9
Q

What conditions are associated with prolonged severe fetal bradycardia?

A

Prolonged cord compression
Cord prolapse
Epidural
Rapid fetal descent

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10
Q

What does baseline variability on a CTG tell you? What is a normal variability?

A

How a fetus’ HR varies from one beat to the next

Indicate fetus is adapting to environment due to input from nervous system, baroreceptors and chemoreceptors

Normal is 5-25

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11
Q

What could cause reduced fetal variability?

A 
Fetus sleeping
Fetal acidosis - hypoxia
Fetal tachycardia
Congenital heart defect
Prematurity
Maternal medication - opiates, benzo, methyldopa, magnesium sulphate
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12
Q

What is a fetal acceleration?

A

Abrupt increase in baseline fetal HR

> 15bpm for >15s

They are reassuring

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13
Q

What is a fetal deceleration?

A

Abrupt decrease in baseline fetal HR of >15bpm for >15s

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14
Q

Why do foetuses reduce their heart rate?

A

In response to hypoxia to reduce myocardial demand and preserve myocardial oxygenation and perfusion

Fetus can’t change respiratory depth or rate

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15
Q

What is an early deceleration?

A

Start when uterus contract and recover when contraction stop

Due to fetal RICP and increasing vagal tone

Physiological deceleration

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16
Q

What is a variable deceleration?

A

Rapid fall in heart rate with variable recovery phase

May not have any relationship to contractions

Seen in labour and with oligohydramnios patients

17
Q

What are “shoulders of decelerations”?

A

Accelerations occur before and after deceleration

Indicate fetus still able to adapt and not yet hypoxic

18
Q

What causes the acceleration, deceleration, acceleration in shoulders of decelerations?

A

Umbilical vein occluded - acceleration

Umbilical artery occluded - deceleration

Pressure off cord - acceleration

19
Q

What is a late deceleration?

A

Begin at peak of contraction and recover after it has ended

Indicate lack of blood supply to uterus and placenta - hypoxia and acidosis

20
Q

What causes late decelerations?

A

Maternal hypotension
Pre-eclampsia
Uterine hyperstimulation

21
Q

What must you do if you see a late deceleration?

A

Fetal blood sampling for pH

22
Q

What is a prolonged deceleration?

A

Deceleration lasting >3mins

Fetal blood sampling or emergency C section needs to be arranged

23
Q

What is a sinusoidal pattern on a CTG?

A

Smooth regular wave like pattern with no beat to beat variability

24
Q

What can cause a sinusoidal CTG pattern?

A

Severe fetal hypoxia
Severe fetal anaemia
Haemorrhage

Very concerning and associated with high levels of morbidity and mortality

25
Q

What would be seen on a reassuring CTG?

A

110-160bpm
5-25 variability
No or early decelerations
Variable decelerations with no concerning characteristics <90 mins

26
Q

What characteristics of variable decelerations are concerning?

A 
>60s
Reduced baseline variability within deceleration
Fail to return to baseline
Biphasic (W) shape
No Shouldering
27
Q

What features of a CTG would be considered non-reassuring?

A

100-109bpm OR 160-181bpm
Variability <5 for 30-50mins or >25 for 15-25mins
Variable decelerations with no concerns >90mins
Variable decelerations with concerns in <50% of contractions >30mins
Variable decelerations with concerns in >50% of contractions <30mins
Late in >50% of contractions for <30 mins with no clinical risk factors (bleeding or meconium)

28
Q

What features of a CTG would be considered abnormal?

A

<100 or >180 bpm
Variability <5 for >50 mins OR >25 for >25mins OR sinusoidal pattern
Variable decelerations with concerns >50% of contractions for >30 mins
Late decelerations >30mins
Acute bradycardia
Single prolonged deceleration >3mins

29
Q

What is a normal CTG and what is the management?

A

All features reassuring

Continue CTG and usual care

30
Q

What is a suspicious CTG and how is it managed?

A

1 non-reassuring AND 2 reassuring features

Seek advice from obstetrician or senior midwife, correct underlying causes, full set of maternal obs

31
Q

What is a pathological CTG?

A

1 abnormal feature OR 2 non reassuring features

32
Q

How is a pathological CTG managed?

A

Seek advice - obstetrician or senior midwife
Correct underlying cause
Exclude acute events - cord prolapse, placental abruption, uterine rupture
Offer digital fetal scalp stimulation

If still pathological after scalp stimulation, consider fetal blood sample and expediting birth

33
Q

What CTG requires urgent intervention?

A

Acute bradycardia

Single prolonged deceleration >3mins

34
Q

What is done if a CTG requires urgent intervention

A 
Urgently seek obstetrician help
Correct underlying causes
Expedite birth if acute event
Prepare for urgent birth
Expedite birth if bradycardia >9mins
Discuss expedited birth if bradycardia recover
35
Q

What are the CI’s for fetal blood sampling?

A

Risk of maternal-fatal infection

Fetal bleeding disorders

36
Q

What results are in a normal fetal blood sample? What is the next step?

A

Lactate <=4.1mmol/L
pH >= 7.25

Repeat in an hour

37
Q

What results are in a Borderline fetal blood sample? What is the next step?

A

Lactate 4.2-4.8mmol/L
pH 7.21-7.24

Repeat in 30 mins

38
Q

What results are in a Abnormal fetal blood sample? What is the next step?

A

Lactate >=4.9 mmol/L
pH <=7.20

Expedite birth

Obstetrics and Gynaecology (21 decks)

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