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Y5 OG Procedures and Other Stuff > Fetal procedures > Flashcards

Fetal procedures Flashcards

1
Q

What is cardiotocography?

A

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

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2
Q

What is a growth scan?

A

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

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3
Q

What is a foetal doppler?

A

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

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4
Q

What is foetal blood sampling?

A

blood withdrawn from umbilical vein to determine if severe anaemia caused by Rh sensitisation

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5
Q

What are the complications of foetal blood sampling?

A

Bleeding from site

Changes in FH

Infection

Leaking of amniotic fluid

Death of foetus (1%)

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6
Q

What do you look for on USS?

A

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

Liquor volume

Placental location

Fibroids or other growths

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7
Q

What are the indications in labour of cardiotocography?

A

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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8
Q

What mnemonic do you use to interpret cardiotocography?

A

DR C BRAVADO

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9
Q

What are the parts of DRCBRAVADO?

A

Define Risk

Contractions

BRA (Baseline Rate)

Variability

Acceleration

Decelerations

Overall impression

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10
Q

How do you define risk?

A

Why are they on a CTG monitor? Previous CTGs?

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11
Q

What is a normal number of contractions at labour?

A

5 contractions in 10 minutes

Look at each peak (5 contractions in 1 large block

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12
Q

What is normal baseline rate?

A

110-160 bpm

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13
Q

What is normal variability?

A

5-25 bpm

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

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14
Q

What is normal acceleration?

A

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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15
Q

What is normal decelerations?

A

None

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

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16
Q

What is the overall impression?

A

Overall interpretation

17
Q

What defines baseline bradycardia and tachycardia?

A

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

HR >160bpm
Maternal pyrexia
Chorioamnionitis
Hypoxia
Pre-maturity

18
Q

What is loss of baseline variability?

A

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

19
Q

What is early decelerations?

A

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

Head compression (innocuous)

Not of concern generally

20
Q

What is late decelerations?

A

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

Reduced uteroplacental flow

21
Q

What is variable deceleration?

A

Independent of contractions

Cord compression

22
Q

What are indications for emergency C section in cardiotocography?

A

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

23
Q

What is the classification of CTG traces?

A

Normal

Non reassuring

Pathological

24
Q

What is normal antenatal/ intrapartum CTG?

A

‘met criteria’

§ FHR: 110-160 bpm

BV: 5-25 bpm

§ Decelerations: absent or early

Accelerations: 2 within 20 mins

25
Q

What is non reassuring CTG?

A

§ 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

26
Q

What is pathological CTG?

A

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)

27
Q

What do you do if the CTG is borderline?

A

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

28
Q

What is uterine hyperstimulation?

A

§ Single contraction >2 mins duration

§ 5 or more contractions in 10 mins

29
Q

How do you do an overall interpretation?

A

§ Normal -> all features are reassuring

§ Suspicious -> 1 non-reassuring AND 2 reassuring features

§ Pathological -> 1 abnormal OR 2 non-reassuring features

30
Q

What are the types of decelerations?

A

Uniform

Early

Late

Variable

Combined

31
Q

What is uniform decelerations?

A

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

32
Q

What is early decelerations?

A

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

33
Q

What is late decelerations?

A

PATHOLOGICAL -> do foetal blood sampling:

§ If foetal pH >7.2 -> normal -> continue monitoring

§ If foetal pH <7.2 -> foetal acidosis -> urgent delivery

34
Q

What is variable decelerations?

A

cord prolapse, cord compression (of any kind)

§ “Shoulders of deceleration” = accelerations before and after variable deceleration = not yet hypoxic

35
Q

What is combined decelerations?

A

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

36
Q

How do you manage a non reassuring CTG?

A

§ (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

37
Q

How do you manage a pathological CTG?

A

§ (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

§ (4) Foetal blood sampling (if not possible, expedite birth)

§ (5) EMCS

38
Q

What is this:

A

Variable decelerations

Y5 OG Procedures and Other Stuff (26 decks)

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