CTG, Monitoring, and Partogram

Question 1

Baseline bradycardia

Answer 1

<100/min
increased fetal vagal tone
maternal b-blocker use

Question 2

Baseline tachycardia

Answer 2

>160
Maternal pyrexia
choriomamonitis
hypoxia
prematurity

Question 3

Loss of baseline variablity

Answer 3

<5beats min
Prem.
hypoxia

Question 4

Early decel

Answer 4

Decel w/commences w/onset of contraction and returns on completion
Usually innocuous indicated head compression

Question 5

Late decel

Answer 5

Lags onset of contraction and doesnt resolve until 30s after contraction
indicates distress e.g. asphyxia or placental insuf.

Question 6

Variable decels

Answer 6

Independent of contractions

?cord compression

Question 7

Interpreting CTGs

Answer 7

DR (define risk)
- why on CTG?
C (Contractions)
- up to 5/10
BRA (baseline rate)
- 110-160
V (baseline variability)
- 5-25
A (accelerations)
- rise of >15 bpm for >15s, 2 every 15min (usually with C)
- Should be in response to foetal movement
D (Decelerations):
- dec. >15bpm >15s, ?late
O: Overall impression
- beware: terminal BC (<100bpm for 10min), terminal decel FHR drop and doesnt recover for 3min (both indicate emergency c-sec)

Question 8

Maternal pulse on CTG

Answer 8

possible to accidentally get mothers pulse

would be x2 e.g. 70 = 140bpm

Question 9

Normal AN/IP CTG

Answer 9

HR: 110-160
BV: 2-25
Decel: absent or early
Accel: 2/15min
CTG with each of these = met criteria

Question 10

Non-reassuring CTG

Answer 10

100-100 or 161-180
BV: <5 for 30min or >25 for 15min
VDs w/no other concerning fx for >90m
VDs w/<50% of contractions for >30m
VDs w/>50% contraction for <30min
LDs in >50% of contractions for <30min

Question 11

Abnormal CTG

Answer 11

<100 or >180bpm
BV: <5 for >50, >25 for >23mins
VDs w/any concerning characteristics in >50% contraction for <30min
Late decels for 30 mins
Acute bradycardia or prolonged decel >3mins

Question 12

If borderline CTG

Answer 12

fetal blood sampling to check for acidosis (LATE marker of O2 delivery

Question 13

Uniform decels

Answer 13

squeezing on head causes baro-receptor reflex decel
Early dec: comon second stage, recover by end of contr
Late: maybe my myocardial ischaemia

Question 14

Combined decel

Answer 14

Decel within decel bc overactive uterus
?bleed, infection, syntocinon
1 min needed between decels for recovery

Question 15

Preterm CTG

Answer 15

baseline rate higher
variability lower
decel less helpful

Question 16

Pathological trace Mx

Answer 16

R/v obstetrician
change position
consider red. syntocinon
exclude acute event

Question 17

Monitoring during labour

Answer 17

FHR every 15m or continuous if CTG
Contractions every 30m
Maternal pulse every 1hr
Maternal BP and temp 4hrly
PV exam every 4hr
Urine for ketones and protein every 4hrs

Question 18

Partogram for whom?

Answer 18

All women i n active labour
All women on syntocinon
Threatened prem. labour w/atosiban

Question 19

Components of Partogra

Answer 19

Mat HR - 30m
BP + Temp - 4hr
Contractions 30m
Liqour 30m
Cervicography 4hrl
abdo descent

Question 20

Cervical dilatation

Answer 20

nulip 0.5cm/hr
parous up to 1cm/hr
ALERT line on partogram at 0.5cm/hr
ACTION line 4hrs right of alert and prompts urgent obstetric r/v

Question 21

Slow progress in labour

Answer 21

?malposition
Epidural
Mx: ARM, VE 2hrs later, syntocinon
Instruments in women you dont want to push (HTN)
- Ventouse: same diameter as mum but can be distressing for baby
- forceps increases diameter of baby’s head but not distressing