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Scientific Basis of Midwifery > Foetal Monitoring > Flashcards

Foetal Monitoring Flashcards

1
Q

Give 5 factors that may make women high-risk in labour

A
  1. Maternal/ medical history
  2. Obstetric history
  3. History of pregnancy/ foetal history
  4. Presenting factor
  5. Features of labour
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2
Q

Describe intermittent auscultation

A
  • Low-risk women
  • Do not require admission CTG
  • 1st stage = auscultate every 15 mins after most recent contraction for min. 60s
  • 2nd stage = auscultate every 5 mins after most recent contraction for min. 60s
  • If abnormalities are noted, commence continuous monitoring
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3
Q

What do NICE guidelines say regarding intermittent auscultation?

A
  • Do not offer CTG to women at low risk of complications
  • Use Pinard or Doppler ultrasound
  • Record accelerations and decelerations
  • Palpate maternal pulse if foetal HR is abnormal to differentiate between HRs
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4
Q

Give some pregnancy indications that continuous electronic foetal monitoring (cEFM) is required

A
  • Previous CS
  • Pre-eclampsia
  • Pregnancy >42 wks
  • Induced labour
  • Diabetes
  • Prematurity
  • Oligohydramnios
  • Multiple pregnancy
  • Breech
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5
Q

What is oligohydramnios?

A

Deficiency of amniotic fluid

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6
Q

Give some labour indications that cEFM is required

A
  • Pulse >120bpm
  • BP >160/ or >/110
  • BP 2x >140/ or >/90 in 30 mins (or 2+ protein in urine and >140/90)
  • Oxytocin use
  • Significant meconium
  • Vaginal bleeding
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7
Q

What is a tocograph?

A

A pressure monitor that records uterine activity continuously

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8
Q

What is an ultrasound transducer?

A

Records the foetal heart by transmitting ultrasound waves which are then bounced off a moving object (the valves of the heart)

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9
Q

Name a method of internal foetal monitoring

A

Foetal scalp electrode

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10
Q

What does monitoring help prevent?

A
  • Hypoxic Ischaemic Encephalopathy (brain injury caused by oxygen deprivation)
  • Neonatal seizures
  • Cerebral palsy
  • Intrapartum death
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11
Q

How should monitoring be prepared?

A
  • Paper speed 1cm/min
  • Date and time correct
  • FHR displays 50-210 used
  • Tocograph basline set
  • Date, time and woman’s name and number written on trace
  • Maternal pulse palpated simultaneously with auscultation and recorded
  • Palpate, measure, pinard
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12
Q

Give some limitations and adverse effects of foetal monitoring

A
  • No evidence to support it
  • High false positive rate (40-60%)
  • Expensive
  • Increases risk of intervention and operative delivery
  • Parental anxiety
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13
Q

What are the 3 groups of babies that can be classified by foetal monitoring?

A
  1. OK - coping well with stress of labour
  2. Showing stress response but coping
  3. Not coping with stress response
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14
Q

What does the anagram MOTHERS refer to?

A 
M - meconium
O - oxytocin
T - temperature
H - hyperstimulation/ haemorrhage
E - epidural
R - rate of progress
S - scar (previous CS)
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15
Q

What is significant meconium?

A

Green = sign of foetal distress

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16
Q

What does the anagram DR C BRAVADO refer to?

A

DR - define risk (high/low)
C - contractions (present, frequency, strength)
Bra - baseline rate (normal, bradycardia, tachycardia)
V - variability (>5bpm)
A - accelerations
D - decelerations (early, variable, late, prolonged)
O - overall (normal, suspicious, pathological) and plan

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17
Q

What are the 4 features that should be documented from a CTG?

A
  1. Baseline FHR
  2. Baseline variability
  3. Presence/absence of decelerations
  4. Presence of accelerations
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18
Q

What happens if the CTG cannot be interpreted?

A

Senior obstetric input is required

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19
Q

What is the baseline rate?

A
  • Mean level of FHR over 10-15 minutes without accelerations/decelerations
  • Balance between SNS and PNS
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20
Q

What are the 3 categories of baseline rate defined by the NICE?

A
  1. Reassuring = 110-160bpm
  2. Non-reassuring = 100-109 or 161-180bpm
  3. Abnormal = >180 or <100bpm
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21
Q

Give some factors that may cause an abnormal bradycardia baseline

A
  • Maternal hypotension (low BP)
  • Hypertonic uterus (too many contractions
  • Placental abruption
  • Rapid progress
  • Hypoxia
  • Cord prolapse
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22
Q

Give some factors that may cause an abnormal tachycardia baseline

A
  • Prematurity
  • Foetal movements
  • Hypoxia
  • Foetal anaemia or hypovolaemia
  • Maternal pyrexia/ tachycardia
  • Drugs = Ritodrine, Ventolin, Nicotine
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23
Q

What is baseline variability?

A

The degree that the baseline varies in a particular band width, excluding accelerations and decelerations (5-25bpm)

  • Determined between contractions
  • Normal for foetus to have periods of reduced variability
24
Q

What are the 3 classifications of baseline variability defined by the NICE?

A
  1. Reassuring - 5-25bpm
  2. Non-Reassuring - <5bpm for 30-50 mins or >25bpm for 15-25 mins
  3. Abnormal - <5bpm for over 50 mins or >25bpm for over 25 mins or sinusoidal (constant HR - linked with thumb sucking)
25
Q

What is the most important marker of foetal wellbeing?

A

Baseline variability >5bpm

Intact CNS

26
Q

Give some factors that may cause reduced variability

A
  • Paper speeds
  • Sleep phase
  • Prematurity
  • Tachycardia
  • Congenital malformations
  • Drugs (pethidine, sedatives, anti-hypertensives, anti-epileptics)
27
Q

Describe accelerations

A
  • Increase above baseline rate of 15bpm+ lasting 15 seconds+
  • Presence is reassuring but absence is not necessarily concerning
  • There should always be accelerations antenatally
28
Q

What are decelerations?

A

Slowing of FHR below baseline of 15bpm+ lasting 15 seconds+

- If variability is abnormal, decelerations may be significant even if drop is <15bpm/ shallow

29
Q

What are the 4 types of deceleration?

A
  1. Early - very rarely <2% benign, nadir of deceleration matches peak of contraction, late 1st + 2nd stage
  2. Late - nadir 20 seconds after peak of contraction
  3. Variable - most common (85%), variable in shape, length, depth and frequency
  4. Prolonged - 3 minutes+
30
Q

What causes early decelerations?

A

Head compression

31
Q

What causes late decelerations?

A
  • Placental insufficiency

- Hypoxia

32
Q

What causes variable decelerations?

A

Cord compression

33
Q

What causes prolonged decelerations?

A
  • Hypoxia
  • Tachysystole
  • Hypotension
  • Ruptured uterus
  • Cord prolapse
  • VE
  • Spontaneous rupture of membranes
  • FBS (foetal blood sampling)
34
Q

What are decelerations caused by?

A

High BP or acidic blood

35
Q

What are the 2 main baroreceptors?

A

Carotid sinus

Aortic arch

36
Q

How do baroreceptors react to high BP?

A
  • Head and cord compression causes increased BP
  • Baroreceptor stimulated
  • Parasympathetic NS stimulated
  • AVN slowed via vagus nerve
  • FHR slows down
37
Q

What are the 3 main chemoreceptors

A

Carotid body
Aortic arch
Brain

38
Q

How do chemoreceptors react to acidic blood?

A
  • Increase in H+ ions and carbon dioxide and low PO2
  • Parasympathetic NS stimulated
  • Decreased FHR
  • Until H+ and CO2 are rinsed from foetal circulation, FHR will remain low
39
Q

What are the 3 classifications of deceleration?

A
  1. Reassuring
  2. Non-reassuring
  3. Abnormal
40
Q

Describe a reassuring deceleration

A
  • No decelerations

- Variable decelerations with no CC for <90 mins

41
Q

Describe a non-reassuring deceleration

A
  • Variable decelerations with no CC for >90mins
  • Variable decelerations with CC with <50% contractions for >30mins
  • Variable decelerations with CC with >50% contractions for <30mins
  • Late decelerations with >50% contractions and <30mins
42
Q

Describe an abnormal deceleration

A
  • Variable decelerations with CC with >50% contractions for >30mins
  • Late decelerations with >50% contractions and >30mins or <30mins with maternal/foetal risk factors
  • Prolonged decelerations >3mins
43
Q

What does CC stand for?

A

Concerning characteristics

44
Q

What are the 4 categories that are defined by foetal monitoring?

A
  1. Normal (all features reassuring)
  2. Suspicious (1 non-reassuring feature and 2 reassuring features)
  3. Pathological (1 pathological feature OR 2 non-reassuring features
  4. Need for Urgent Intervention (acute bradycardia or a single prolonged deceleration)
45
Q

What is the appropriate timeline for a foetus in need of urgent intervention?

A 
3 mins = call obstetrician
6 mins = obstetrician present, thinking about theatre
9 mins = in theatre
12 mins = knife to skin
15 mins = baby born
46
Q

Describe the management for the ‘normal’ category

A
  • Continue CTG if high risk
  • Discontinue if CTG commenced due to concerns arising from intermittent auscultation
  • Discuss progress with woman
47
Q

Describe the management for the ‘suspicious’ category

A
  • Correct underlying cause
  • Maternal obs
  • Start conservative measures
  • Inform senior midwife/ obstetrician
  • Document plan for CTG review and clinical picture
  • Discuss progress with woman
48
Q

Describe the management for the ‘pathological’ category

A
  • Obtain review by senior midwife and obstetrician
  • Exclude acute events
  • Correct underlying causes
  • Start conservative measures
  • Discuss progress with woman
49
Q

What should be done if CTG remains pathological after implementing conservative measures?

A
  • Further review by obstetrician

- Offer digital foetal scalp stimulation and document outcome

50
Q

What should be done if CTG is still pathological after foetal scalp stimulation?

A
  • Consider FBS
  • Consider expediting (speeding up) birth
  • Take woman’s preferences into account
51
Q

Describe the management for the ‘need for urgent intervention’ category

A
  • Urgently seek obstetric help
  • Expedite birth if there has been acute event
  • Correct underlying causes
  • Start conservative measures
  • Prepare for urgent birth
  • Discuss progress with woman
  • Expedite birth if acute bradycardia persists for 9mins
  • If FHR recovers before 9mins, reassess decisions to expedite birth and discuss with woman
52
Q

Give 2 examples of underlying causes

A

Hypotension

Hyperstimulation

53
Q

Give 3 examples of acute events

A

Cord prolapse
Placental abruption
Uterine rupture

54
Q

Give 4 examples of conservative measures

A

Fluids
Reduce/stop oxytocic
Change position
Offer tocolytic drugs (e.g. terbutaline 0.25mg)

55
Q

What are the NICE guidelines regarding general care during foetal monitoring?

A
  • Make documented systematic assessment of condition of woman and baby every hour, or more frequently if concerned
  • Do not make decisions based on CTG alone
  • Focus care on woman, not CTG
  • Consider woman’s preferences
  • Provide one-to-one support
  • Maintain communication with woman and family
56
Q

Describe how foetal monitoring information should be stored and documented

A
  • Check date/time on EFM machine
  • Note all events
  • ‘Fresh eyes’ hourly - trace should be seen, reviewed and a plan made by 2 staff members
  • Sign trace and record date, time and mode of birth
  • Store records securely

Scientific Basis of Midwifery (22 decks)

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