Monitoring in Labour Flashcards
When is the partogram started?
As soon as the woman enters the labour ward
What factors are comprised on a partogram?
Foetal heart rate
Amniotic fluid colour
Cervical dilatation
Descent
Contractions
Signs of obstruction
Maternal observations
What are the main things measured by CTG?
Which line represents each of these?
Contraction frequency - bottom line
Foetal heart rate - top line
What is the pattern for reading a CTG?
Determine risk
Contractions
Baseline rate
Variability
Accelerations
Decelerations
Overall impression
For baseline rate on CTG, what would be:
a) Normal/reassuring?
b) Non-reassuring?
c) Abnormal?
a) 110-160
b) 100-109 / 161-180
c) > 180 / < 100
For variability on CTG, what would be:
a) Normal/reassuring?
b) Non-reassuring?
c) Abnormal?
a) > 5
b) < 5 for 30-90 minutes
c) < 5 for > 90 minutes
On CTG, if there is variability > 25bpm, what is this known as?
Saltatory pattern
What is the relevance of accelerations on CTG?
Their presence is reassuring. If they are absent with no other non-reassuring features then this is of uncertain significance.
What are early decelerations on CTG?
What is the significance of early decelerations on CTG?
Start when the uterine contraction begins and recover when the contraction stops
These are physiological
What is a variable deceleration on CTG?
A rapid fall in baseline rate, with a variable recovery phase and no relationship to uterine contractions
When do late decelerations occur on CTG?
What is the significance of these?
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
The presence of late decelerations on CTG indicates the need for what investigation?
If this is abnormal, what is the management?
Foetal blood sampling
C-section
Contractions on CTG are generally described how?
How many occur in 10 minutes, e.g. ‘2 in 10’
How are contractions seen on the CTG?
Peaks on the lower line
How are duration and frequency of contractions assessed during labour?
Abdominal examination
What actually is the baseline rate of foetal heart?
The average foetal heart rate in a 10 minute period
If late decelerations are seen on CTG but there is an impending delivery, what is the management?
Wait it out if the baby will be delivered in the next 30 mins or so
Low threshold for operative vaginal delivery
When giving your overall impression of a CTG, it can be described as what?
Normal/reassuring
Non-reassuring/suspicious
Abnormal/pathological
What defines a normal CTG?
All 4 main features are normal
What defines a non-reassuring/suspicious CTG?
One non-reassuring feature, other 3 are normal
What defines an abnormal CTG?
2+ non-reassuring features or 1+ abnormal feature
In terms of decelerations, what is normal/reassuring?
None or early
