Fetal monitoring

Question 1

What are forms of fetal monitoring?

Answer 1

CTG, growth scan, movement, HR on U/S, lichal volume (fluid around fetus)

Question 2

What are indications for a CTG in labour?

Answer 2

induction, pre or postmature, pre-eclampsia, prolonged ROM, diabetes, SGA, epidural

Question 3

What causes the CTG’s variability?

Answer 3

The variability on the CTG is caused by the immature fetus’ brains parasympathetic and symp NS firing at random

Question 4

What causes decelerations on the CTG?

Answer 4

During contractions the placenta is squashed by the uterus meaning the fetus is in temporary hypoxia – so the troph of the deceleration correlates with the peak on the contraction

Question 5

What is the acronym for CTGs?

Answer 5

Dr    = Define risk eg primigravida, smokes, multiple pregnancy 
C     = Contractions 
Bra = Baseline rate 
V     = Variability 
A     = Accelerations - normal if absent 
D     = Decelerations
O    = Overall assessment

Question 6

What is toco?

Answer 6

contractions

Question 7

Does the CTG measure contractions by strength or freq?

Answer 7

frequency

Question 8

What is the baseline rate for fetal HR?

Answer 8

110-160

Question 9

What is variability?

Answer 9

rise of 5-25bpm beats for over 5 seconds

Question 10

What is an acceleration?

Answer 10

rise of over 15 beats for 15 secs- from the baseline HR

Question 11

What is concerning in terms of decelerations?

Answer 11

worried if variable (indicates cord compression) or late (more worrying, as indicates fetal hypoxia)

Question 12

What is a late vs early deceleration?

Answer 12

Late decelerations: occurs after end of contraction whereas early decelerations occur with the contractions

Question 13

What is non-reassuring on a CTG?

Answer 13

Non – reassuring: baseline off, low variability, decelerations if over ?40 mins or late

Question 14

Are we worried if there are no accelerations on a CTG?

Answer 14

no

Question 15

What are further fetal assessments that can be done if we are concerned by CTG?

Answer 15

Can have a direct ECG attached to scalp of baby for true beat to beat info but must be ROM and 3cm dilated

If concerned about fetus ie non-reassuring can take a fetal bld sample and if pH is lower than 7.2 it shows acidosis due to deoxgenation

Question 16

What does brown stained amniotic fluid mean?

Answer 16

Means that is stained by meconium from the fetus

This is a further form of fetal monitoring as it can mean the fetus is in distress although this shouldn’t be used alone