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Intrapartum Care > NICE fetal Monitoring > Flashcards

NICE fetal Monitoring Flashcards

1
Q

How frequently should an assessment be done?

A

Hourly

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2
Q

Fetal monitoring general principles

A

Maternal reports of frequency, length, and strength of her contractions

Any antenatal and intrapartum risk factors for fetal compromise

The current wellbeing of the woman and unborn baby

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3
Q

Offer CTG for

A

VBAC / full thickness myomectomy
HTN requiring medication
PROM (if not in established labour at 24 hours)
PV bleeding other than show
Suspected chorio or maternal sepsis
T1 / T2 DM and GDM requiring medication
Anhydramnios / polyhydramnios
RFM before contractions
Meconoium

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4
Q

Contractions categories

A

White - <5/10
Orange - >5/10
Full risk assessment
Take action reduce contraction frequency
Reduced interval in between contractions with hypertonus

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5
Q

NICE CTG categories

A

White - 110-160
Orange - increase of 20 beats a minute or more from the start of labour or since the last review an hour ago, or, 100 to 109 beats a minute
Unable to determine baseline

Although 100-109 is abnormal, continue usual care if this has been stable throughout labour and there is normal variability and no variable / late decels

Red

<100 bpm or > 160 bpm

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6
Q

Heart rate categories

A

110-160 reassuring
100-109, 160-80 non reassuring
<100, > 180 abnormal

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7
Q

Variability categories

A

5-25 reassuring

<5 30-50 minutes , >25 15-25 minutes non reassuring

<5 (>50 minutes ) > 25 > 10 minutes

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8
Q

CTG decelerations

A

White -

No decels
Early decels
Variable decels that are not evolving to have concerning characteristics

Amber -

Repetitive variable decels with concerning characteristics for < 30 mins

Variable decels with concerning features for > 30 mins, or, repetitive late decels for < 30
Mins

Red

Repetitive variable decels with concerning features for > 30 minutes
Repetitive late decels for > 30 minutes
Acute bradycardia
Single prolonged decel > 3 minutes

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9
Q

Decelerations reasons

A

Early - head compression
Variable - cord compression

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10
Q

CTG concerning characteristics variable characteristics

A

> 60s
Reduced baseline variability
Failure to return to baseline
Biphasic W shape
No shouldering

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11
Q

Late decelerations categories

A

> 50% Contractions < 30 minutes

No fetomaternal risk (significant méconium, vaginal bleed)

Non reassuring

If fetomaternal risk present - abnormal

> 30 minutes - abnormal

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12
Q

Late deceleration reasons

A

Placental insufficiency
Compromised fetal distress

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13
Q

CTG features and categories

A

Features - reassuring , non reassuring, abnormal

=

Normal
Suspicious
Pathological

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14
Q

CTG categories

A

Normal - all features reassuring

Suspicious - 1 non reassuring feature, 2 reassuring features

1 amber / 2 white

Actions: correct underlying causes
Low BP, uterine hyperstimulation

Full set maternal obs
1+ conservative measures
Inform Obs / senior midwife
Document plan for reviewing whole clinical picture and CTG findings
Talk to woman and her birth companion about what is happening and take her preferences into account

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15
Q

CTG management : pathological features

A

1 abnormal or 1 non reassuring features

Obtain review by obstetrician and senior midwife
Exclude acute events (cord prolapse, suspected placental abruption, suspected uterine rupture)
Correct any underlying causes such as low BP or uterine hyper stimulation
1 or more conservative measures
Talk to woman and BP about what is happening and take preferences into account
If CTG is pathological after implementing Cx measures
Obtain further review by obstetrician and senior midwife
Offer digital fetal scalp stimulation
If CTG trace pathological after FSS consider expediting birth
Take woman’s preferences into account

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16
Q

Need for urgent intervention

A

Acute bradycardia or a single prolonged deceleration for 3 minutes or more

Urgently seek obstetric help
If there has been an acute event - cord prolapse, suspected placental abruption or uterine rupture, expedite their birth

Correct any underlying causes such as hypotension or uterine hyperstimulation

Start 1 or more conservative measure

Make preparations for an urgent birth

Talk to the woman and her birth companions about what is happening and take preferences into account

Expedite birth if acute bradycardia persists for 9 minutes

If FHR recovers at any time up to 9 minutes, reassess any decision to expedite the birth, in discussion with the woman

17
Q

FHR pattern : suspicious

A

Consider overall clinical picture, parity, current cervical dilatation and rate of progress of labour and fetal reserve
Consider hyperstimulation, pyrexia, epidural, dehydration, reposition

If CTG becomes normal : continue close monitoring

18
Q

FHR pattern : pathological

A

Consider overall clinical picture, parity, current cervical dilatation and rate of progress of labour and fetal reserve
Consider hyperstimulation, pyrexia, epidural, dehydration, reposition

If CTG worsens / continues to be pathological

consider fetal blood sample if possible

19
Q

FBS possible?

A

Yes - FBS performed

Normal ph => 7.25
Repeat FBS within 1 hour if CTG remains pathological

Borderline pH 7.21 - 7.24

Repeat FBS within 30 minutes if CTG pathological

If abnormal pH after repeat FBS, deliver. If repeat FBS stable, monitor CTG and clinical situation. Repeat FBS only if further abnormalities appear.

Abnormal pH < 7.2 _ deliver

If third FBS needed, seek consultant opinion and review overall clinical picture to consider if delivery is needed.

20
Q

If FBS not possible

A

Consider immediately delivery

21
Q

Pathological CTG management

A

1) Conservative management : left lateral, hydration

2) Fetal scalp stimulation

If no acceleration -> FBS
0+1 FBA first
+2 direct OVD

If no acceleration
FBS
<7.2
Deliver - IVS / CS

22
Q

When not to do FBS in exam

A

Fetal
Premature < 34/40
Active heroes
Known HIV / Hep B, Hep C +ve
Thrombocytopenia
Maternal - unfavourable Cx
Mobile PP
Malpresentation (face etc) uncertain
PI Praevia or APH
Sepsis

Intrapartum Care (4 decks)

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