Monitoring Maternal and Fetal Wellbeing Flashcards
how often should observations be carried out in the 1st stage of labour?
freq of contractions: 30 mins
maternal pulse: hourly
temperature and BP: 4 hours
VE: offered 4 hourly
how often should observations be carried out in the 2nd stage of labour?
freq of contractions: 30 mins BP: hourly temperature: 4 hours VE: offered every hour woman's position and behaviour etc should also be assessed
why is it important that women urinate regularly during labour?
if bladder is not emptied fully…
fetal descent may be delayed
efficiency of contractions are reduced
pain caused
(urine should also be observed)
nutritional advice from NICE during labour:
recommend light diet and isotonic drinks
(uterine contractions demand glucose)
except for general anaesthetic
important aspects of emotional support during labour:
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
pyrexia:
high body temperature
could indicate infection
tachycardia may indicate…
infection
high pulse
hypotension may indicate…
shock
effects of epidural
(low BP)
fetal movements during labour:
should be present
however:
sometimes babies like to preserve energy
mothers may also not notice due to distraction from contractions
intermittent auscultation can be carried out via:
pinard or handheld doppler (sonicaid)
when carrying out intermittent auscultation, FHR should be measured for…
a full minute
a single rate should be recorded after contractions
during the 1st stage of labour, the FHR should be recorded…
every 15 mins
CTG:
cardiotocograph
carries out continuous monitoring of FHR and uterine activity
telemetry CTG:
wireless machine
needed for pool births
what are the four features of a CTG?
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
what would be a reassuring BL for a CTG?
110-160bpm
what would be a non-reassuring BL for a CTG?
100-109 or 161-180bpm
what would be an abnormal BL for a CTG?
below 100 or above 180
what would we class as normal variability on a CTG?
5 to 25bpm
what would we class as non-reassuring variability on a CTG?
less than 5bpm for 30 mins
or
more than 25bpm for 30 mins
what would we class as abnormal variability on a CTG?
less than 5bpm for more than 50 mins
or
more than 25 for more than 30 mins
to classify a CTG as suspicious, it would have…
1 non-reassuring feature and 2 reassuring features
to classify a CTG as pathological, it would have…
1 abnormal feature
OR
2 non-reassuring feature
a CTG would suggest a need for urgent intervention if…
it presented acute bradycardia
OR
a single prolonged decerleration for 3 minutes or more
the difference between thin and thick meconium in liquor:
thin: light green or yellow
thick: dark green, black, lumps
meconium aspiration syndrome:
when a baby gasps and inhales meconium into lungs
rare but severe
if thick meconium is recorded during a home birth…
transfer into obstetric unit would be highly recommended
deviation from norm