Fetal procedures Flashcards by Can I get Uhhhh?

What is cardiotocography?

continuous monitoring of the foetal heart and uterine activity -> used in labour

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What is a growth scan?

booking scan at 12 (8-14) weeks, anomaly scan at 20 (18-21) weeks -> monitor pregnancy

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What is a foetal doppler?

– used to monitor FHR and should be placed over the anterior shoulder of foetus -> monitor pregnancy

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What is foetal blood sampling?

blood withdrawn from umbilical vein to determine if severe anaemia caused by Rh sensitisation

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What are the complications of foetal blood sampling?

Bleeding from site

Changes in FH

Infection

Leaking of amniotic fluid

Death of foetus (1%)

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What do you look for on USS?

Lie and presentation (i.e. if breech, what type of breech)

Liquor volume

Placental location

Fibroids or other growths

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What are the indications in labour of cardiotocography?

o Intrapartum care of normal labour

o Suspected chorioamnionitis or sepsis, or a temperature >38C

o Severe hypertension (> 160/110)

o Oxytocin use

o Presence of significant meconium

o Fresh vaginal bleeding that develops in labour

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What mnemonic do you use to interpret cardiotocography?

DR C BRAVADO

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What are the parts of DRCBRAVADO?

Define Risk

Contractions

BRA (Baseline Rate)

Variability

Acceleration

Decelerations

Overall impression

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How do you define risk?

Why are they on a CTG monitor? Previous CTGs?

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What is a normal number of contractions at labour?

5 contractions in 10 minutes

Look at each peak (5 contractions in 1 large block

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What is normal baseline rate?

110-160 bpm

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What is normal variability?

5-25 bpm

Most commonly <5 (≤40 minutes) due to sleeping

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What is normal acceleration?

At least 2 every 15 minutes

Acceleration = rise in FHR of ≥15 bpm lasting ≥15s Occur in response to foetal movements

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What is normal decelerations?

None

Deceleration = drop in FHR of ≥15 bpm lasting ≥15s Late decelerations are much worse than early decelerations

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What is the overall impression?

Overall interpretation

What defines baseline bradycardia and tachycardia?

HR <110bpm
Increased foetal vagal tone
Maternal beta-blocker use

HR >160bpm
Maternal pyrexia
Chorioamnionitis
Hypoxia
Pre-maturity

What is loss of baseline variability?

<5bpm [5-25 is normal]
Hypoxia
Pre-maturity

What is early decelerations?

Commences with onset of contraction and returns to normal with completion of contraction

Head compression (innocuous)

Not of concern generally

What is late decelerations?

Lags the onset of a contraction and does not return to normal until after 30s following end of contraction

Reduced uteroplacental flow

What is variable deceleration?

Independent of contractions

Cord compression

What are indications for emergency C section in cardiotocography?

o Terminal Bradycardia: FHR < 100 bpm for more than 10 mins

o Terminal Deceleration: FHR drops and does not recover for more than 3 mins

What is the classification of CTG traces?

Normal

Non reassuring

Pathological

What is normal antenatal/ intrapartum CTG?

‘met criteria’

§ FHR: 110-160 bpm

BV: 5-25 bpm

§ Decelerations: absent or early

Accelerations: 2 within 20 mins

What is non reassuring CTG?

§ 100-110 bpm or 161-180 bpm § BV: \<5 for 30-50 mins or \>25 for 15 mins § Variable decelerations with: · no other concerning characteristics, for \>90 mins · \<50% of contractions for \>30 mins · \>50% of contractions for \<30 mins § Late decelerations in \>50% of contractions for \<30 min

What is pathological CTG?

athological CTG: § Sinusoidal rhythm -\> IMMEDIATE CAT 1 EMCS · Severe foetal anaemia or hypoxia · Foetal or maternal haemorrhage § \<100 bpm or \>180 bpm § Late decelerations \>30 mins = maternal hypotension, pre-eclampsia, uterine hyperstimulation § BV: \<5 for \>50 mins, \>25 for \>25 mins, sinusoidal § Variable decelerations with any concerning characteristics in \>50% contractions for \<30 mins § Acute bradycardia or a single prolonged deceleration lasting \>3 mins (terminal bradycardia)

What do you do if the CTG is borderline?

If the CTG is borderline, you could do foetal blood sampling to check for acidosis (pH \<7.2) § Acidosis is a LATE marker of reduced oxygen delivery

What is uterine hyperstimulation?

§ Single contraction \>2 mins duration § 5 or more contractions in 10 mins

How do you do an overall interpretation?

§ Normal -\> all features are reassuring § Suspicious -\> 1 non-reassuring AND 2 reassuring features § Pathological -\> 1 abnormal OR 2 non-reassuring features

What are the types of decelerations?

Uniform Early Late Variable Combined

What is uniform decelerations?

squeezing the baby’s head causes a baroreceptor reflex leading to a uniform deceleration

What is early decelerations?

common in the 2nd stage, and should recover by the end of the contraction

What is late decelerations?

PATHOLOGICAL -\> do foetal blood sampling: § If foetal pH \>7.2 -\> normal -\> continue monitoring § If foetal pH \<7.2 -\> foetal acidosis -\> urgent delivery

What is variable decelerations?

cord prolapse, cord compression (of any kind) § “Shoulders of deceleration” = accelerations before and after variable deceleration = not yet hypoxic

What is combined decelerations?

when you get a deceleration within a deceleration due to an overactive uterus § This may be caused by bleeding, infection or overzealous use of syntocinon § There should be at least 1 minute between contractions to allow the baby to recover

How do you manage a non reassuring CTG?

§ (1) Left lateral position § (2) Stop oxytocin / consider tocolysis · Exclude acute event (e.g. cord prolapse, uterine rupture) · Correct underlying causes · Give fluids (IV or oral) § (3) Digital foetal scalp stimulation (accelerates the heartbeat

How do you manage a pathological CTG?

What is this:

Variable decelerations