CTGs

Question 1

what is the role of fetal monitoring in labour

Answer 1

assesses fetal wellbeing and allows for the early detection of fetal distress - hypoxia

Question 2

fetal monitoring in low risk labours

Answer 2

intermittent auscultation

Question 3

fetal monitoring in high risk labours

Answer 3

cardiotocography (CTG)

Question 4

methods of intermittent auscultation

Answer 4

doppler US

Question 5

timings for intermittent auscultation

Answer 5

for 1 min after a contraction every:

• 15 mins in 1st stage
• 5mins in 2nd stage
• any abnormalities or intrapartum complications - do CTG

Question 6

what does the CTG represent

Answer 6

autonomic and CNS activity

Question 7

what are the 2 parts of CTG

Answer 7

fetal heart rate sensor

contraction monitor sensor

Question 8

indications for CTG monitoring

Answer 8

induction of labour
post maturity (>42wks) or prematurity (<37wks)
multiple pregnancy
underlying maternal health conditions
antepartum/intrapartum haemorrhage
pyrexia
abnormal lie, small for gestational age, oligohydramnios
epidural
abnormalities noted on intermittent auscultation

Question 9

interpretation of CTG mnemonic

Answer 9

DR C BRAVADO

Question 10

what do the letters of DR C BRAVADO stand for

Answer 10

Determine Risk
Contractions
Baseline RAte
Variability
Accelerations
Decelerations
Overall

Question 11

what do the letters of DR C BRAVADO stand for

Answer 11

Determine Risk
Contractions
Baseline RAte
Variability
Accelerations
Decelerations
Overall

Question 12

DR C BRAVADO - determine risk

Answer 12

why is the woman having external fetal monitoring

Question 13

DR C BRAVADO - Contractions

Answer 13

how many in 10 mins

- how many occur in 20 boxes (bottom strip)

Question 14

DR C BRAVADO - baseline rate

Answer 14

avg fetal HR when accelerations and decelerations have been excluded

Question 15

DR C BRAVADO - baseline rate, baseline bradycardia

• HR
• causes

Answer 15

HR <100bpm

increased fetal vagal tone
maternal beta blocker use

Question 16

DR C BRAVADO - baseline rate, baseline tachycardia

• HR
• causes

Answer 16

> 160bpm

maternal pyrexia
chorioamnionitis
hypoxia
prematurity

Question 17

DR C BRAVADO - variability

Answer 17

variability of baseline rate

loss of baseline variability - <5bpm
- prematurity, hypoxia

Question 17

DR C BRAVADO - variability

Answer 17

variability of baseline rate

loss of baseline variability - <5bpm
- prematurity, hypoxia

Question 18

DR C BRAVADO - accelerations

Answer 18

upwards spike of >15bpm for >15s

these are reassuring and occur when fetus moves

Question 19

DR C BRAVADO - decelerations

Answer 19

downwards spike of >15bpm for >15s

may be a normal feature of labour

Question 20

what are early decelerations

Answer 20

decelerations of HR at onset of contractions

usually caused by head compression, often seen in breech presentation

Question 21

what are late decelerations

Answer 21

deceleration of the HR which lags the onset of contractions and doesn’t return to normal until after 30s following the end of the contraction

indicates fetal distress e.g. asphyxia, placental insufficiency

Question 22

what are variable decelerations

Answer 22

independent of contractions

may indicate cord compression

Question 23

DR C BRAVADO - overall

Answer 23

is this CTG normal, non-reassuring or abnormal

Question 24

what is the role of fetal blood sampling

Answer 24

to confirm CTG signs of fetal hypoxia

Question 25

responses to different fetal blood sampling pH

Answer 25

> 7.25 - repeat in 1hr if CTG remains abnormal
7.21-24 - repeat in 30 mins if CTG remains abnormal
<7.2 - immediate delivery, indicates hypoxia

Question 26

what % of cerebral palsy cases are due to fetal hypoxia

Answer 26

10%