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GOSH > Foetal monitoring > Flashcards

Foetal monitoring Flashcards

1
Q

How would you monitor the foetus of a low risk mother?

A

Intermittent auscultation (sonicaid/doppler)

monitor baby’s heart rate after every contraction (if mother is low risk)

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2
Q

How would you monitor the foetus of a high-risk mother in labour?

A

Continuous monitoring eg. CTG cardiotocograph

Bottom probe picks up heart rate (top trace)

Top probe picks up contractions (bottom trace)

Every time a woman feel foetal movement, presses a button

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3
Q

What are some examples of high-risk situations in which you might use CTG cartiotocography?

A

Any pregnancy which is not low risk eg.

Oxytocin infusion

Meconium stained liquor

Multiple pregnancy

Intra-uterine growth restriction (IUGR)

Abnormality on intermittent auscultation

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4
Q

When might you use a foetal scalp electrode over an abdominal transducer?

A

Poor contact with abdo transducer

High BMI

Twins (can’t decipher between babies)

Baby is too active

Abdo scarring (sound waves don’t go through very well)

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5
Q

What is the baseline foetal heart rate?

A

100-160 bpm

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6
Q

What is an acceleration - is that a good or a bad thing?

A

Rise of >15bpm for 15 seconds

good - indicates movement

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7
Q

What is a deceleration - is this a good or a bad thing?

A

drop of >15bpm for 15 seconds

bad (if late). Not concerning if early

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8
Q

What are the benefits of CTG?

A

reduced rate of neonatal seizures

increases intervention rate

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9
Q

What are the limits/drawbacks of CTG?

A

No clear benefit of cerebral palsy and perinatal death

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10
Q

What should you do if you are worried about a CTG?

A

Change maternal position (to left lateral)

Give fluids - ?dehydrated (less perfusion to baby)

Fetal scalp stimulation

Foetal blood sample (if concerned and delivery is not imminent)

Deliver

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11
Q

How many centimetres dilated must someone be before foetal blood sample can be taken?

A

3cm

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12
Q

Why are foetal blood samples useful?

A

Immediate and accurate result re. baby’s welfare

Measures foetal pH (indicative of hypoxaemia)

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13
Q

What doe foetal blood samples measure?

A

Foetal pH (indicative of hypoxaemia)

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14
Q

What does a foetal pH of >7.25 indicate?

A

normal - baby is not hypoxaemic

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15
Q

What does a foetal pH of 7.20-7.25 indicate?

A

borderline ?hypxoaemic

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16
Q

What does a foetal pH <7.20 indicate that you should do?

A

DELIVER

17
Q

What is the mnemonic for interpreting CTGs?

A

DR C BRAVADO

DR: determine risk - why is woman on CTG?

C: contractions

BR: baseline rate

A: accelerations

VA: variability

D: decelerations

O: Overall impression eg. normal/reassuring, non-reassuring/abnormal

18
Q

What should happen to the baby’s heart rate when it moves in the womb?

A

HR should increase (acceleration)

19
Q

How are contractions classified?

A

per 10 minutes

20
Q

How do contractions present on CTG?

A

Peaks

21
Q

What is the desired rate of contractions on a CTG during labour?

A

4-5:10

22
Q

How do you measure the intensity of contractions?

A

Mother will tell you

palpate

23
Q

Why is a flat trace a concern in a CTG?

A

shows no variability (therefore shows damage to PONS and lack of sympathetic/parasympathetic competition)

24
Q

What is the ideal variability on a CTG?

A

> 5bpm or more

25
Q

What do accelerations show?

A

Foetal movement

26
Q

What is a deceleration on a CTG?

A

> 15 beats for >15 seconds

27
Q

What can decelerations indicate?

A

placental insufficiency

28
Q

When do LATE decelerations occur?

A

have to occur after contraction

BUT

HAVE TO ALL BE EXACTLY THE SAME TIME AFTERWARDS TO BE CLASSED AS LATE

29
Q

What is a typical variable deceleration?

A

deceleration of <60 beats for <60 seconds

30
Q

What is an atypical variable deceleration?

A

deceleration of >60 beats for >60 seconds (profound and broad drops)

31
Q

What is the problem with the false-positive rate in CTG?

A

can mean that some interventions occur unnecessarily and can cause distress for a mother that was otherwise not needed

32
Q

Why is Left lateral position the best position for a mother?

A

takes pressure of IVC, therefore allows better blood supply to baby

33
Q

What is a more accurate test of baby’s hypoxia level than a CTG?

A

Foetal blood sample

34
Q

What can cause an increase in heart rate in a baby? (other than foetal movements)

A

foetal distress
infection
maternal dehydration (less blood volume going to baby)

35
Q

How can an epidural effect foetal heart rate?

What should you do about this?

A

tachycardia/bradycardia - any changes to CTG

because:
Maternal BP drops
Less blood to baby
baby becomes distressed

First thing to do: Left lateral position
1L of fluids STAT.

36
Q

What foetal heart rate is needed to maintain cerebral perfusion?

A

100 for 50% of time

GOSH (33 decks)

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