Monitoring in Labour

Question 1

When is the partogram started?

Answer 1

As soon as the woman enters the labour ward

Question 2

What factors are comprised on a partogram?

Answer 2

Foetal heart rate

Amniotic fluid colour

Cervical dilatation

Descent

Contractions

Signs of obstruction

Maternal observations

Question 3

What are the main things measured by CTG?

Which line represents each of these?

Answer 3

Contraction frequency - bottom line

Foetal heart rate - top line

Question 4

What is the pattern for reading a CTG?

Answer 4

Determine risk

Contractions

Baseline rate

Variability

Accelerations

Decelerations

Overall impression

Question 5

For baseline rate on CTG, what would be:

a) Normal/reassuring?
b) Non-reassuring?
c) Abnormal?

Answer 5

a) 110-160
b) 100-109 / 161-180
c) > 180 / < 100

Question 6

For variability on CTG, what would be:

a) Normal/reassuring?
b) Non-reassuring?
c) Abnormal?

Answer 6

a) > 5
b) < 5 for 30-90 minutes
c) < 5 for > 90 minutes

Question 7

On CTG, if there is variability > 25bpm, what is this known as?

Answer 7

Saltatory pattern

Question 8

What is the relevance of accelerations on CTG?

Answer 8

Their presence is reassuring. If they are absent with no other non-reassuring features then this is of uncertain significance.

Question 9

What are early decelerations on CTG?

What is the significance of early decelerations on CTG?

Answer 9

Start when the uterine contraction begins and recover when the contraction stops

These are physiological

Question 10

What is a variable deceleration on CTG?

Answer 10

A rapid fall in baseline rate, with a variable recovery phase and no relationship to uterine contractions

Question 11

When do late decelerations occur on CTG?

What is the significance of these?

Answer 11

Begin at the peak of a uterine contraction and recover after the contraction ends

Insufficient blood flow to the placenta causing foetal hypoxia and acidosis

Question 12

The presence of late decelerations on CTG indicates the need for what investigation?

If this is abnormal, what is the management?

Answer 12

Foetal blood sampling

C-section

Question 13

Contractions on CTG are generally described how?

Answer 13

How many occur in 10 minutes, e.g. ‘2 in 10’

Question 14

How are contractions seen on the CTG?

Answer 14

Peaks on the lower line

Question 15

How are duration and frequency of contractions assessed during labour?

Answer 15

Abdominal examination

Question 16

What actually is the baseline rate of foetal heart?

Answer 16

The average foetal heart rate in a 10 minute period

Question 17

If late decelerations are seen on CTG but there is an impending delivery, what is the management?

Answer 17

Wait it out if the baby will be delivered in the next 30 mins or so

Low threshold for operative vaginal delivery

Question 18

When giving your overall impression of a CTG, it can be described as what?

Answer 18

Normal/reassuring

Non-reassuring/suspicious

Abnormal/pathological

Question 19

What defines a normal CTG?

Answer 19

All 4 main features are normal

Question 20

What defines a non-reassuring/suspicious CTG?

Answer 20

One non-reassuring feature, other 3 are normal

Question 21

What defines an abnormal CTG?

Answer 21

2+ non-reassuring features or 1+ abnormal feature

Question 22

In terms of decelerations, what is normal/reassuring?

Answer 22

None or early