Monitoring In Labour Flashcards
If women are low risk, how should the FH be monitored?
NICE 2014, states that low risk women should not routinely be put on CTG. In first stage of labour they should be auscultated for one minute following a contraction every 15 minutes.
Maternal pulse should be palpate every hour.
If decelerations or changing baseline, auscultate more frequently, if still decels put on CTG. If fine on CTG after 20 minutes, go back to auscultation.
What are conservative measures?
Position
Hydration
IV fluids
Tocolytic
Risk factors in pregnancy where CTG is required
Suspected sepsis Suspected chorionmitis Sig mec Proteinuria Augmentation Hyperstimulation Delay
What is baseline rate (physiologically)?
Influenced by the sympathetic and parasympathetic nervous system and gestation
What is variability (physiologically)?
Controlled by sympathetic and parasympathetic nervous system influenced by sleep or hypoxia
What is an acceleration (physiologically)?
Due to somatic nervous system and fetal movement
What are decelerations (physiologically)?
- Reflex to cord, head or uterine vessel compression
2. Prolonged oxygen shortage
What is normal baseline rate, acceleration, deceleration, variability?
Baseline rate - 110-160
Variability - 5-25 beats per minute
Accelerations - >15 beats in >15 seconds
Decelerations - >15 beats in >15 seconds
What is an early deceleration?
Less common. To do with head, cord and uterine vessel compression.
What is a variable deceleration?
And
What are abnormal characteristics of variable decelerations
Variable decels with no concerning characteristics for <90 mins is normal. Above 90 minutes is non reassuring. >50% contractions for <30 mins or <50% contractions for >30 mins
Concerning characteristics of variable decels are >60 seconds, w shape, not returning to baseline.
What does normal, suspicious, pathological mean?
Normal - all features reassuring
Suspicious - 1 non reassuring,2 reassuring
Pathological - 2 non-reassuring, 1 abnormal
Plan of care for a suspicious CTG
Correct hypotension/hyperstimulation Full set of maternal observations Start conservative measures (position, hydration, IV fluids, tocolytic) Inform obstetrician or senior midwife Document and discuss with woman
Plan of care for pathological CTG
Review by obstetrician or senior midwife
Exclude acute events
Correct hypotension/hyperstimulation
Conservative measures (hydration, position, IV fluids, tocolytic)
Document and discuss with woman
If still pathological after conservative measures, r/v by obstetrician and senior midwife.
Offer fetal scalp stimulation, consider FBS, expediting birth
Plan of care for acute bradycardia >3minutes
Seek urgent obstetric help Rule out acute event Correct hypotension, hyperstimulation Conservative measures Prepare for urgent birth Expedite brith if >9minutes
What should you always write on CTG
Mothers name DOB maternal pulse Hospital number Date and time
