Fetal Monitoring in Labour NICE Flashcards
How often should there be a systematic assessment of women and baby in labour?
Every 1 hour
1st stage of labour, how often should intermittent auscultation be performed?
After contraction for 1 min every 15 mins. Record accelerations and decelerations
Monitor material heart rate hourly
in 2nd stage of labour how often should intermittent auscultation be performed?
Every 5 mins, palpate material heart rate at the same time
If increase in FHR by 20bps or deceleration, what to do
Carry out IA more frequently
Carry out full review
Ask for help if ongoing concerns, advise CTG and move to obstetric led unit
If CTG normal after how long can you return to intermittent auscultation?
20 mins if mother happy to
Intrapartum reason for CTG
- 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
For contractions
What features are white and amber
White <5
Amber >5
For baseline rate
What features are white, amber and red
White 110-160
Amber Rise in baseline >20, 100-110 or unable to determine
Red
<100 or >160
For variability
What features are white/ amber/red
White 5-25
Amber
<5 for 30-50 mins
>25 for 10 mins
Red
<5 for 50 mins
>25 for 10 mins
Sinusoidal
For decelerations:
What features are white and amber
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
What to consider when reviewing acceleration
Prescence is generally a sign baby is healthy
Absence does not indicate acidosis
A normal trace is defined as
No amber or red features (all 4 features white)
A suspicious trace is
Any 1 amber feature
Pathological trace is
1 red feature
2 + amber features
In active 2nd stage, a rise in baseline of 20 is considered what?
A red feature
What to do if concerns with CTG in active 2nd stage
Obs review
Consider stopping pushing/oxytocin to allow baby to recover, unless birth is imminent
What features of a deceleration are concerns?
> 60 seconds
reduced variability within
Failure or slow recovery to baseline
Loss of previous shouldering
If CTG categorised as suspicious, what to do?
- Full risk assessment (mat obs etc)
- If accelerations, acidosis unlikely
- Conservative measures
- Obs review
If CTG categorised as pathological, what to do?
- 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
What conservative measures can be offered
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
How long are CTG traces kept?
25 years
If concerns to baby - store indefinitely
What is hypertonus
Contraction > 2mins
Definition early deceleration
Slowing of FH with onset early in the contraction and return to baseline at end of contraction
Definition of late deceleration
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
Definition variable deceleration
Slowing FH with a variable time in relation to the contraction
