Fetal monitoring in labour

Question 1

What should be done in each hourly assessment?

Answer 1

• Contractions- length, strength and freq
• Risk factors
• FH monitoring- any concerns
• Progress of labour

Question 2

Intermittent auscultation in 1st stage

Answer 2

• IA after a palpated contraction for at least 1min
• at least once every 15min
• Record any accelerations or decels if heard
• Maternal HR every hour
• Urgent USS if no FH detected

Question 3

IA in 2nd stage

Answer 3

• IA after a palpated contraction for at least 1min
• FH once every 5min
• Check mums HR simultaneously
• Seek help if both HRs the same

Question 4

What to do if decel or inc of 20bpm in FH

Answer 4

• IA more frequently
• Full review- contractions, freq, maternal obs, progress of labour

If concerns-
Call for help
Transfer to Obs led unit
Continuous CTG

Question 5

When to change back to IA?

Answer 5

If CTG normal for 20min unless women decides to stay on CTG

Question 6

Continue CTG if

Answer 6

FH concerns ongoing
Maternal or fetal RF arise

Question 7

Reasons for cont CTG in labour

Answer 7

• Prev section
• HTN
• PROM
• APH
• Sepsis/suspected chorio
• Diabetes
• Non-cephalic lie
• FGR/SGA
• Poly/anhydraminos
• > 42weeks
• RFM

Question 8

Intrapartum risk factors

Answer 8

• Contractions lasting >2min
• 5 or more cont in 10min
• Mec
• Mat pyrexia/signs of infection
• Abnormal pain presentation
• APH
• Mat HR >120
• HTN- Raised BP or proteinuria- new onset
• Delay in 1st or2nd stage
• Epidural
• Synto

Question 9

Differentiating maternal and FH

Answer 9

• USS
• Pinnard
• Pulse ox for maternal HR
• FSE
• Palpate MH

Question 10

CTG White criteria

Answer 10

Baseline- 110-160bpm
Variability 5-25bpm
Accelerations- reassuring if present
Decels - none
- Early or variable w no concerning features

Question 11

CTG amber

Answer 11

Baseline- 100-109bpm
- Inc of 20bpm
- Undetermined baseline

Variability- <5 for 30-50min
>25 for 10min

Decels- Variable with concerning charc <30min
Late decels <30min

Question 12

CTG Red

Answer 12

Baseline <100bpm or >160bpm
Variability- <5 for >50min
>25 for >10min

Decels- Variable with concerning charc >30min
Late decels >30min
Acute brady

Question 13

What can affect variability

Answer 13

Normal sleep period- should cycle
Opioids- pethedine, morphine

Question 14

Concerning characteristics of decels

Answer 14

Decel- Drop by >15bpm, lasting 15s

Concerning if:
- Lasting >60s
- Red variability in the decel
- Slow return to baseline
- Loss of shouldering

Question 15

Conservative measures for suspicious traces

Answer 15

Change position
Review RF
Adjust synto if needed ie hyperstimulating

DO NOT- offer IV fluids unless- Mum is hypotensive/septic

Consider-
Fetal scalp stimulation
Expediting birth

FBS no longer advised

Question 16

CTG categorization

Answer 16

Normal- No amber or red features
Suspicious - any 1 amber
Pathological- 1 red or 2 amber

Question 17

Pathological mx

Answer 17

Urgent obs rv
Exclude acute events- abruption, scar rupture, cord prolapse
Risk assessment

Question 18

Acute brady

Answer 18

3min- emergency buzzer
6min- conservative measures
9min- Plan to deliver, if not recovered

Question 19

CTG storage

Answer 19

• Keep for 25yo if no concerns
• If birth concerns/possible brain injury, keep indefinitely