Fetal Monitoring in Labour NICE

Question 1

How often should there be a systematic assessment of women and baby in labour?

Answer 1

Every 1 hour

Question 2

1st stage of labour, how often should intermittent auscultation be performed?

Answer 2

After contraction for 1 min every 15 mins. Record accelerations and decelerations
Monitor material heart rate hourly

Question 3

in 2nd stage of labour how often should intermittent auscultation be performed?

Answer 3

Every 5 mins, palpate material heart rate at the same time

Question 4

If increase in FHR by 20bps or deceleration, what to do

Answer 4

Carry out IA more frequently
Carry out full review

Ask for help if ongoing concerns, advise CTG and move to obstetric led unit

Question 5

If CTG normal after how long can you return to intermittent auscultation?

Answer 5

20 mins if mother happy to

Question 6

Intrapartum reason for CTG

Answer 6

• Contractions >2 mins, >5/10
• Meconium
• Maternal pyrexia
• Suspected chorio/sepsis
• Pain out of keeping with contractions
• PVB, blood stained liquor
• Mat HR >120 30 mins
• HTN >160/110
• > 140/90 30 min apart
• 2+ urine dip
• Slow progress
• Regional analgesia/synto
• Use of oxytocin

Question 7

For contractions
What features are white and amber

Answer 7

White <5
Amber >5

Question 8

For baseline rate
What features are white, amber and red

Answer 8

White 110-160

Amber Rise in baseline >20, 100-110 or unable to determine

Red
<100 or >160

Question 9

For variability
What features are white/ amber/red

Answer 9

White 5-25

Amber
<5 for 30-50 mins
>25 for 10 mins

Red
<5 for 50 mins
>25 for 10 mins
Sinusoidal

Question 10

For decelerations:
What features are white and amber

Answer 10

White
No decelerations
Early decelerations
Variable decelerations that are not evolving to have concerning characteristics

Amber
Repetitive variable decelerations with any concerning features <30 mins
Variable decelerations with any concerning features for >30mins
Repetitive late decelerations for <30mins

Red
Repatitice variable decelerations with any concerning features >30mins
Repetitive late decelerations for 30+ mins
Acute bradycardia, prolonged decelerations >3mins

Question 11

What to consider when reviewing acceleration

Answer 11

Prescence is generally a sign baby is healthy
Absence does not indicate acidosis

Question 12

A normal trace is defined as

Answer 12

No amber or red features (all 4 features white)

Question 13

A suspicious trace is

Answer 13

Any 1 amber feature

Question 14

Pathological trace is

Answer 14

1 red feature
2 + amber features

Question 15

In active 2nd stage, a rise in baseline of 20 is considered what?

Answer 15

A red feature

Question 16

What to do if concerns with CTG in active 2nd stage

Answer 16

Obs review
Consider stopping pushing/oxytocin to allow baby to recover, unless birth is imminent

Question 17

What features of a deceleration are concerns?

Answer 17

> 60 seconds
reduced variability within
Failure or slow recovery to baseline
Loss of previous shouldering

Question 18

If CTG categorised as suspicious, what to do?

Answer 18

• Full risk assessment (mat obs etc)
• If accelerations, acidosis unlikely
• Conservative measures
• Obs review

Question 19

If CTG categorised as pathological, what to do?

Answer 19

• Urgent Obs review + senior MW
• Exclude acute events (prolapse, abruption, rupture)
• Full risk assessment (Obstetric)
• Conservative measures, if no improvement consider expediting brith
• Brady 9 mins - deliver, unless AN/intrpartum RF then deliver sooner

Question 20

What conservative measures can be offered

Answer 20

Change Mat positions
If hypotensive 2nd epidural - IV fluids and L lateral + anaesthetics
Excessive contraction → Tocolysis
Consider fetal scalp stimulation if suspicious, abscence is worrying sign

Question 21

How long are CTG traces kept?

Answer 21

25 years
If concerns to baby - store indefinitely

Question 22

What is hypertonus

Answer 22

Contraction > 2mins

Question 23

Definition early deceleration

Answer 23

Slowing of FH with onset early in the contraction and return to baseline at end of contraction

Question 24

Definition of late deceleration

Answer 24

Slowing of FH with onset mid to end of the contraction, the lowest point >20 secs after peak of the contraction, ending after the contraction

Question 25

Definition variable deceleration

Answer 25

Slowing FH with a variable time in relation to the contraction