Monitoring Maternal and Fetal Wellbeing

Question 1

how often should observations be carried out in the 1st stage of labour?

Answer 1

freq of contractions: 30 mins
maternal pulse: hourly
temperature and BP: 4 hours
VE: offered 4 hourly

Question 2

how often should observations be carried out in the 2nd stage of labour?

Answer 2

freq of contractions: 30 mins
BP: hourly
temperature: 4 hours
VE: offered every hour
woman's position and behaviour etc should also be assessed

Question 3

why is it important that women urinate regularly during labour?

Answer 3

if bladder is not emptied fully…
fetal descent may be delayed
efficiency of contractions are reduced
pain caused

(urine should also be observed)

Question 4

nutritional advice from NICE during labour:

Answer 4

recommend light diet and isotonic drinks
(uterine contractions demand glucose)

except for general anaesthetic

Question 5

important aspects of emotional support during labour:

Answer 5

reading birth plan and discussing birth plans
adapting environment to woman’s preferences
encourage support from partner
only leave woman only for short periods of time
encourage woman to inform MW if requiring pain relief

Question 6

pyrexia:

Answer 6

high body temperature

could indicate infection

Question 7

tachycardia may indicate…

Answer 7

infection

high pulse

Question 8

hypotension may indicate…

Answer 8

shock
effects of epidural
(low BP)

Question 9

fetal movements during labour:

Answer 9

should be present

however:
sometimes babies like to preserve energy
mothers may also not notice due to distraction from contractions

Question 10

intermittent auscultation can be carried out via:

Answer 10

pinard or handheld doppler (sonicaid)

Question 11

when carrying out intermittent auscultation, FHR should be measured for…

Answer 11

a full minute

a single rate should be recorded after contractions

Question 12

during the 1st stage of labour, the FHR should be recorded…

Answer 12

every 15 mins

Question 13

CTG:

Answer 13

cardiotocograph

carries out continuous monitoring of FHR and uterine activity

Question 14

telemetry CTG:

Answer 14

wireless machine

needed for pool births

Question 15

what are the four features of a CTG?

Answer 15

baseline: avg FHR in between periodic changes
variability: the difference between upper and lower limits
decelerations: decrease of at least 15bpm below BL for 15 seconds
accelerations: increase of at least 15bpm above BL for 15 seconds

Question 16

what would be a reassuring BL for a CTG?

Answer 16

110-160bpm

Question 17

what would be a non-reassuring BL for a CTG?

Answer 17

100-109 or 161-180bpm

Question 18

what would be an abnormal BL for a CTG?

Answer 18

below 100 or above 180

Question 19

what would we class as normal variability on a CTG?

Answer 19

5 to 25bpm

Question 20

what would we class as non-reassuring variability on a CTG?

Answer 20

less than 5bpm for 30 mins
or
more than 25bpm for 30 mins

Question 21

what would we class as abnormal variability on a CTG?

Answer 21

less than 5bpm for more than 50 mins
or
more than 25 for more than 30 mins

Question 22

to classify a CTG as suspicious, it would have…

Answer 22

1 non-reassuring feature and 2 reassuring features

Question 23

to classify a CTG as pathological, it would have…

Answer 23

1 abnormal feature
OR
2 non-reassuring feature

Question 24

a CTG would suggest a need for urgent intervention if…

Answer 24

it presented acute bradycardia
OR
a single prolonged decerleration for 3 minutes or more

Question 25

the difference between thin and thick meconium in liquor:

Answer 25

thin: light green or yellow
thick: dark green, black, lumps

Question 26

meconium aspiration syndrome:

Answer 26

when a baby gasps and inhales meconium into lungs

rare but severe

Question 27

if thick meconium is recorded during a home birth…

Answer 27

transfer into obstetric unit would be highly recommended

deviation from norm