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Phase 3a Obstetrics > Fetal monitoring > Flashcards

Fetal monitoring Flashcards

1
Q

why is it important to monitor babies?

A

To reduce the rate of stillbirths in pregnancy

To detect hypoxia to prevent hypoxic ischaemic encephalopathy during labour

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2
Q

When is fetal monitoring carried out broadly?

A

During pregnancy and labour

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3
Q

How has the prevalence of stillbirth changed over the last century?

A

Dramatically declined, but is now stable at 5/1000

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4
Q

How are low risk women cared for during pregnancy?

A

community midwife and sometimes GP input

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5
Q

How are high risk women cared for during pregnancy?

A

Hospital and community

High risk patients come to antenatal clinic

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6
Q

All patients attend antenatal clinic. T or F?

A

False

Only high risk women attend antenatal clinic

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7
Q

What are the categories of reasons why a patient may be considered high risk?

A 
Maternal disease
Maternal situation
Fetal conditions 
Complications in previous pregnancy 
Complications in current pregnancy
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8
Q

What are the types of maternal disease that will put a pt at high risk?

A 
Almost anything 
Diabetes 
Hypertension 
Epilepsy 
RA 
Asthma 
ITP (can be a chronic condition in adults, autoimmune reaction against platelets, causing thrombocytopenia)
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9
Q

What are the effects of diabetes in pregnancy

A

Baby in 1st trimester
- miscarriage

Baby in 2nd trimester

  • miscarriage
  • stillbirth
  • congenital malformation - heart defects, syringomyelia, neural tube defects (spinabifida and anencephaly)

Baby in 3rd trimester

  • stillbirth
  • pre-term labour and delivery
  • macrosomia
  • polyhydramnios
  • IUGR if placental insufficiency

Effects on mother

  • postpartum haemorrhage
  • perineal trauma
  • hyperemesis gravidarum and ketoacidosis
  • UTI
  • hypoglycaemia
  • progression of retinopathy
  • preeclampsia
  • type 1 - higher dose of insulin needed

Labour

  • shoulder dystocia
  • stillbirth
  • postpar

Neonatal

  • brachial plexus injury - Erb’s palsy
  • hypoxic ischaemic encephalopathy
  • respiratory distress syndrome
  • cerebral palsy
  • death
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10
Q

What are the effects of hypertension in pregnancy

A

Fetal

  • IUGR
  • IUD - intrauterine death

Maternal

  • worsening hypertension
  • preeclapsia and eclampsia
  • placental abruption
  • stroke
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11
Q

What are the effects of epilepsy in pregnancy

A

Fetus
- Sodium valproate can cause spina bifida (as well as cleft lip and palate, delayed developmental milestones)

Mother
- Recurrent or worsening fits - can get injured or die
Status epilepticus is more common in pregnancy
- constant dose adjustment due to haemodilution

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12
Q

What are the effects of rheumatoid arthritis in pregnancy

A

Fetal

  • pre-term birth
  • SGA - small for gestational age
  • Methotrexate should be stopped AT LEAST 3 MONTHS before pregnancy - reduced folate causes neural tube defects, also can cause miscarriage, facial and skull defects, heart, ribs, spine, digits defects

Maternal
- RA can get worse in pregnancy or better

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13
Q

What are the effects of asthma in pregnancy

A

Fetus

  • IUGR due to inadequate placental perfusion
  • premature delivery - may need to reduce pressure on mother’s lungs

Mother
- exacerbation in 3rd trimester

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14
Q

What are the effects of ITP in pregnancy

A

Fetal

  • baby may also have low platelets after delivery - need platelet count after birth
  • avoid instrumental delivery
  • avoid fetal sampling from head

Mother
- haemorrhage, can be spontaneous, can be cerebral haemorrhage

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15
Q

What are the complications of previous pregnancy that may put the mother at high risk?

A 
Previous Caesarean section 
3rd or 4th degree tear
previous traumatic delivery
previous Pre-eclampsia
previous PPH
Previous small baby or preterm birth
previous stillbirth
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16
Q

What are the different degrees of tear?

A

1st degree - perineal tear
2nd degree - vaginal muscle tear
3rd degree - anal sphincter tear
4th degree - rectal tear

These are cummulative, so 4th degree tear contains all of the other tears too

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17
Q

What are the different degrees of tear?

A

1st degree - perineal tear
2nd degree - vaginal muscle tear
3rd degree - anal sphincter tear
4th degree - rectal tear

These are cumulative, so 4th degree tear contains all of the other tears too

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18
Q

What are the complications in the current pregnancy that can make a woman high risk?

A 
pre eclapmpsia 
breech presentation 
gestational diabetes 
multiple pregnancy 
placental previa -
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19
Q

What are the different types of fetal monitoring?

A

USS

Intermittent auscultation - hand held doppler or Pinard stethoscope

CTG

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20
Q

What does an USS assess in pregnancy?

A

Everyone gets a:

  • dating scan - between 11 weeks and 13+6
  • anomaly scan - 20 weeks

If high risk only or if something happens eg reduced symphysis fundal height or reduced fetal movements:
1. Growth
- head circumference (HC)
- femur diaphysis length (FL)
- abdominal circumference (AC)
- these estimates are used to estimate fetal weight (EFW)
2. Liqour volume (amniotic fluid index)
3. Umbilical artery dopplers - assess the placenta
4. fetal heart pulsations
Abnormal parameters suggest placental insufficiency or foetal problems

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21
Q

When is a dating scan?

A

between 11 weeks and 13+6 from LMP

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22
Q

When is the anomaly (anatomy) scan?

A

20 weeks

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23
Q

What do you measure in a dating scan?

A

fetal heart pulsation
crown-rump length
weeks gestation measurement
placenta - any bleeding or normal

24
Q

What do you measure in the anatomy (anomaly) scan?

A

fetal heart pulsations
placental localisation
liqour volume

Anatomy of: 
- intracranium
- heart 
- stomach 
- bowel 
- kidneys 
- bladder - make sure ureters are not visible 
- MSK - spine: longitudinal, saggital, transverse; 2 upper and lower limbs hand and feet, femur, tibia, fibula angle of foot, club foot
face, cleft lip
profile of baby (side of face)
25
Q

What parameters does a customised growth chart take into account and what does it plot?

A

maternal: age, ethnicity, height, weight, parity
Previous foetal weight

Plots the symphyseal-fundal height, should stay roughly within the same centile throughout - any deviation, organise a scan

26
Q

What monitoring will low risk patients get intrapartum (during labour)?

A

intermittent monitoring - doppler or Pinard

Listen for 1 minute after a contraction and repeat after 15 mins

27
Q

What monitoring will high risk patients get intrapartum (during labour)?

A

Continuous monitoring with CTG

28
Q

What is the normal HR of a baby

A

110-150bpm
More premature = higher HR
More mature = lower HR

29
Q

What does a CTG measure?

A

Heart rate

Uterine contractions

30
Q

What is the disadv of using doppler to measure HR instead of the Pinard stethoscope?

A

The doppler may pick up the mum’s HR and

31
Q

What is the disadv of using doppler to measure HR instead of the Pinard stethoscope?

A

The doppler may pick up the mum’s HR and double it or can double the fetal HR

32
Q

What are the advantages of using a Pinard stethoscope over CTG?

A

inexpensive
non-invasive
midwife can use it at home

33
Q

What are the disadvantages of using a Pinard stethoscope over CTG?

A

variability and decelerations cannot be detected
long-term monitoring not possible
if the mother moves, you can’t hear very well with the Pinard

34
Q

What are the advantages of CTG?

A

provides info about foetal HR AND contractions
long-term monitoring is possible
can determine variability

35
Q

What are the disadvantages of CTG?

A

no improved outcome for low risk pregnancies - so just use it for high risk
fetal exposure to US (left handedness)
No morphological assessment of heart
ambulatory monitoring may not be possible

36
Q

When do we use CTG?

A

Only in high risk women

Used antenatally and intrapartum

37
Q

What is the normal variability?

A

5-25 bpm - remember that the foetal HR should vary and not stay constant
The squiggles should be crossing over the height of 1 small box

38
Q

What are the aspects of assessment when using a CTG?

A

Dr C Bravado

Dr = Define risk
- hypertension, multiple pregnancy, diabetes, pre-eclampsia, ruptured membranes, previous stillbirth etc

C = Contractions
3-4 per 10 minutes

Bra = Baseline rate
Should be between 110-150 bpm

V = Variability
Should be 5-25 bpm

A = Accelerations
Should be at least 2 accelerations in 30 mins

D = Decelerations
No decelerations are the norm

  o Early decelerations 

  o Variable decelerations 

  o Late decelerations

O = Overall assessment

  • normal
  • suspicious
  • pathological
39
Q

What are early decelerations, what do they mean and what would you do about them?

A
  • not concerning
  • Peak of contraction corresponds with trough of deceleration
  • due to compression of the head during a uterine contraction, starts and recovers at the same time as the uterine contractions, shape is the same as the contraction - just monitor the woman
40
Q

What are variable decelerations, what do they mean and what would you do about them?

A
  • not normal
  • vary in shape and timing
  • due to cord compression, timing varies from the time of the contraction and the shape is different from that of the contraction, also just needs monitoring
41
Q

What are late decelerations, what do they mean and what would you do about them?

A
  • not normal,
  • deceleration after contraction
  • placental problem - suggests hypoxia, even after the contraction the baby’s HR has not recovered, the late deceleration, continues after the contraction has finished, identify the cause, would take fetal blood sampling if persisting, if very acidotic would deliver - so is a worrying sign
42
Q

What are the normal amount of contractions and their length?

A

3-4 per 10 minutes

40-60 seconds

43
Q

What is the normal baseline heart rate?

A

110-150 bpm

44
Q

What is normal variability?

A

5-25 bpm

45
Q

What is the normal amount of accelerations?

A

Should be at least 2 accelerations in 30 mins

46
Q

How many decelerations is normal?

A

None, though can have early declerations in labour, but need to monitor

47
Q

What does a umbilical artery doppler do?

A

Measures the resistance in the fetal circulation

48
Q

What does an abnormal umbilical artery doppler mean?

A

Placental insufficiency and likely acidosis
Which means high resistance to blood flow
Which may lead to IUGR or IUD

49
Q

What does an abnormal CTG mean?

A

Hypoxia

50
Q

What are the main 4 features measured in the CTG?

A

Baseline rate
Variability
Accelerations
Decelerations

51
Q

What is a normal CTG

A

All 4 features normal

52
Q

What is a suspicious CTG

A

1 non-reassuring CTG sign

53
Q

What is a pathological CTG

A

2 or more non-reassuring features

or

1 or more abnormal features

54
Q

How would you classify the findings of a CTG?

A

Reassuring
Non-reassuring
Abnormal

55
Q

How would you classify your overall assessment of a CTG?

A

Normal
Suspicious
Pathological

Phase 3a Obstetrics (11 decks)

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