Monitoring

Question 1

What are the key components monitored in ultrasound during pregnancy?

Answer 1

1. Foetal heart,
2. Foetal movements,
3. Presentation,
4. Amniotic fluid volume,
5. Placental location,
6. Umbilical artery Doppler,
7. Biometry

Amniotic fluid volume can be assessed using AFI (8-20) or DVP (2-8).
Biometry includes measurements like head circumference, abdominal circumference, femur length, and crown-rump length.

Question 2

What is the normal range for Amniotic Fluid Index (AFI)?

Answer 2

8-20

AFI is used to assess the volume of amniotic fluid.

Question 3

What does an increased S/D ratio in umbilical artery Doppler indicate?

Answer 3

Increased resistance in the umbilical artery

This can suggest placental insufficiency.

Question 4

What are the indications for monitoring foetal health?

Answer 4

IUGR,
Oligohydramnios,
Abnormal Doppler,
Preterm labour,
Multiple pregnancy,
Breech presentation,
Rhesus isoimmunisation

IUGR stands for Intrauterine Growth Restriction.

Question 5

What maternal conditions warrant increased monitoring during pregnancy?

Answer 5

• Previous CS,
• Pre-eclampsia,
• GA >42/40,
• Prolonged ROM >24h,
• Diabetes,
• Antepartum haemorrhage,
• Significant medical condition

CS refers to Cesarean Section.

Question 6

What is the baseline heart rate range considered normal for foetal heart rate monitoring?

Answer 6

110-160 bpm

bpm stands for beats per minute.

Question 7

What does the acronym DR C BRAVADO represent in reading CTGs?

Answer 7

Determine Risk, Contraction pattern, Baseline Rate, Variability, Accelerations, Decelerations, Overall Assessment and Action Plan

It is a mnemonic to help remember the steps in assessing CTGs.

Question 8

What are the characteristics of a reassuring CTG trace?

Answer 8

All 4 features are ‘reassuring’

Reassuring features typically include normal baseline rate, variability, and absence of decelerations.

Question 9

What defines a non-reassuring CTG trace?

Answer 9

≥2 features are ‘non-reassuring’ or ≥1 feature is abnormal

Non-reassuring traces may require further intervention.

Question 10

What management steps should be taken for a non-reassuring CTG?

Answer 10

1. Maternal position change,
2. oxygen and IV fluid,
3. change method of monitoring,
4. reassess maternal vital signs,
5. assess cervix for dilation or prolapse,
6. stop oxytocin if in use,
7. foetal blood sampling,
8. tocolysis,
9. amnioinfusion,
10. acoustic or scalp stimulation,
11. plan immediate delivery

These interventions aim to improve foetal condition and assess the necessity of delivery.

Question 11

Fill in the blank: The normal variability in foetal heart rate is _______.

Answer 11

5-15 bpm

Variability is an important indicator of foetal well-being.

Question 12

What is the significance of accelerations in foetal heart rate monitoring?

Answer 12

15 bpm increase for at least 15 seconds

Two accelerations in 20 minutes are typically needed for a reassuring assessment.

Question 13

True or False: Late decelerations in CTG are usually caused by head compression.

Answer 13

False

Late decelerations are indicative of foetal hypoxia.

Question 14

What does a pathological CTG category indicate?

Answer 14

≥2 features are ‘non-reassuring’ or ≥1 feature is abnormal

This category indicates a need for urgent assessment and possible intervention.

Question 15

What is the purpose of foetal blood sampling during monitoring?

Answer 15

To assess the acid-base status of the foetus

This helps determine the need for immediate delivery or further management.