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YEAR 3 REVISION > Foetal Monitoring > Flashcards

Foetal Monitoring Flashcards

1
Q

What speed should the CTG paper be set at?

A

1cm/min

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2
Q

What are some adverse effects of using cEFM?

A
  • High false positive rate
  • Increased risk of instrumental delivery/CS
  • Increased anxiety
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3
Q

What does mothers stand for?

A 
Beware of:
Meconium
Oxytocin
Temperature
Hyperstimulation/haemorrhage
Epidural
Rate of progress
Scar (VBAC)
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4
Q

What does DR C BRAVADO stand for?

A 
DR = define risk
C = contractions
BRA = baseline rate
V = variability
A = accelerations
D = decelerations
O = overall
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5
Q

How is the overall CTG categorised?

A

Normal, Suspicious, Pathological

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6
Q

How are the individual elements categorised?

A

Reassuring, Non-reassuring, Abnormal

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7
Q

What makes a CTG suspicious?

A

1 non-reassuring feature

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8
Q

What makes a CTG pathological?

A

1 abnormal or 2 non-reassuring features

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9
Q

What are the categories for baseline rate?

A 
Reassuring = 110-160
Non-reassuring = 100-109 or 161-180
Abnormal = >180 or <100
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10
Q

Give some causes of a bradycardic baseline

A
  • Maternal hypotension
  • Hypertonic uterus
  • Placental abruption
  • Cord prolapse
  • Drugs (e.g. pethidine)
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11
Q

Give some causes of a tachycardic baseline

A
  • Prematurity
  • FM
  • Hypoxia
  • Anaemia/ hypovolaemia
  • Maternal pyrexia/tachycardia
  • Maternal dehydration
  • Drugs (e.g. nicotine)
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12
Q

What causes variability?

A

Interplay between sympathetic and parasympathetic NS

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13
Q

What is cycling?

A

Periods of reduced variability, usually while the baby is sleeping - these are normal if under 30 mins

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14
Q

What are the categories for variability?

A 
Reassuring = 5-25 or <5 for <30 mins
Non-reassuring = <5 for 30-50 mins or >25 for 15-25 mins
Abnormal = <5 for >50 mins or >25 for >25 mins
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15
Q

What factors may reduce variability?

A
  • Cycling
  • Opiates (e.g. pethidine, morphine)
  • Hypoxia
  • Brain damage
  • Cardiac arrythmia
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16
Q

What kind of variability always has a pathological cause?

A

Sinusoidal (baseline 120-160 with regular sine waves)

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17
Q

What are the signs of foetal hypoxia?

A

Reduced variability + Tachycardia + Decelerations

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18
Q

What are accelerations?

A

Increase of at least 15 beats for at least 15 secs

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19
Q

What are decelerations?

A

Decrease of at least 15 beats for at least 15 secs

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20
Q

What are decelerations mediated by?

A

Baroreceptors and chemoreceptors

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21
Q

How do baroreceptors work?

A
  • Detect raised BP
  • Located in carotid artery and aortic arch
  • Cause early/variable decels
22
Q

How do chemoreceptors work?

A
  • Detect change in pH of blood
  • Located in carotid bodies, aortic arch and brain stem
  • Cause late decels
23
Q

Describe early decelerations

A
  • Very rare (2% of decels)
  • In line with contractions
  • Head compression = raised BP = baroreceptors stimulate parasympathetic NS = vagus nerve releases acetylcholine = decreased FHR
24
Q

How are late decelerations categorised?

A

> 50% for <30 mins = non-reassuring

>50% for >30 mins = abnormal

25
Q

Describe late decelerations

A
  • Mid to late contraction (finish after contraction)
  • Nadir >20 secs after peak
  • Chemoreceptor stimulation due to decreased pH
  • Usually caused by placental insufficiency or hypoxia
26
Q

How are variable decelerations categorised?

A

<50% for >30 mins or >50% for <30 mins = non-reassuring

>50% for >30 mins = abnormal

27
Q

Describe variable decelerations

A
  • Vary in size and shape
  • Dependent on concerning characteristics
  • Controlled by both chemoreceptors and baroreceptors
  • Usually caused by cord compression
28
Q

What are the concerning characteristics?

A
  • > 60 secs
  • reduced variability
  • failure to return to baseline
  • no shouldering
29
Q

What is the management for a suspicious or pathological CTG?

A
  • Correct underlying cause
  • Observations
  • Conservative measures
  • Review by obstetrician
  • Document and discuss
30
Q

What are the conservative measures?

A
  • Fluids
  • Reduce/stop synto
  • Change position
  • Offer tocolytic drugs if appropriate
31
Q

What is the most common tocolytic drug?

A

Terbutaline

32
Q

What is shouldering?

A

Increase in heart rate before a deceleration, caused by cord compression

33
Q

What is the first step of shouldering?

A
  • Contraction occludes vein
  • Decreased blood flow to foetus
  • Blood flow to placenta unchanged
  • Hypovolaemia in baby
  • Decrease BP, Increase HR
34
Q

What is the second step of shouldering?

A
  • Contraction occludes arteries
  • Blood flow equalises so BP increases
  • HR decreases to prevent haemorrhagic stroke
35
Q

What is the third step of shouldering?

A
  • Arteries spring open
  • Blood flow to placenta higher than to baby
  • BP decreases, HR increases
36
Q

What are the signs of respiratory acidosis?

A

Low pH, normal BE

37
Q

What are the signs of metabolic acidosis?

A

Low pH, high BE

38
Q

What is hypoxaemia?

A

Low oxygen tension in blood

39
Q

What is hypoxia?

A

Low oxygen tension in blood and tissues

40
Q

What is acidaemia?

A

Low pH in blood

41
Q

What is acidosis?

A

Low pH in blood and tissues

42
Q

What is the difference between base excess and base deficit?

A

They measure the same thing but base excess is -ve and base deficit is +ve

43
Q

What is respiratory acidosis?

A

Decrease in pH due to the accumulation of carbon dioxide during anaerobic metabolism

44
Q

What is metabolic acidosis?

A

Decrease in pH due to lactic acid produced during anaerobic metabolism

45
Q

What is the difference between the vein and arteries?

A

Arteries have a lower pH, lower PO2 and higher PCO2 than the vein

46
Q

When is continuous EFM required?

A
  • Meconium
  • RFM
  • Medical comorbidities
  • SGA/LGA
47
Q

What is a bradycardia?

A

Deceleration >3 mins

48
Q

How can the placental lakes change?

A
  • Small baby = smaller placental lakes = less gas exchange between foetus and mother
  • GDM = normal size villi but small placental lakes
49
Q

What is the indication for foetal blood sampling?

A

Pathological CTG with no response to foetal scalp stimulation

50
Q

What are the contraindications for FBS?

A
  • Prolonged bradycardia
  • 2nd stage
  • Maternal pyrexia or sepsis
  • Prematurity

YEAR 3 REVISION (49 decks)

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