NICE Foetal Monitoring in Labour Flashcards
How often should a systematic review o the woman and foetus be carried out in labout?
Hourly
(more if there are concerns).
What are the risks of using CTG in labour in low risk women?
Increased risk of intervention.
In first stage of labour, how often should IA be carried out?
Immediately after a palpated contraction.
For 1 minute.
Every 15 minutes.
(no FH heard, carry out urgent USS).
How often should IA be carried out in second stage of labour?
Immediately after a palpated contraction.
Every 5 minutes.
How should FH be recorded on partogram?
(What else is recorded on partogram?)
As a single number.
(Also record accelleratins, decelerations, maternal pulse, VE findings, contraction frequency).
When should IA be switched to CTG?
If there is clinical concern, do IA after each contraction to confirm:
- FH baseline increase 20+
- Deceleration heard.
if confirmed, call for help, apply CTG and transfer to obstetric lead unit.
What pre-existing risk factors would lead you to use a CTG in labour?
-Patient preference
- Prev LSCS or full thickness uterine surgery
- Any HTN on medication
- prolonged SROM (unless established by 24 hours)
- Suspected chorio or sepsis
- Diabeties
- Non cephalic
- FGR/SGA
- Gestational age >42/40
- An or polyhydramnios
- RFM in 24 hours prior to labour
What evolving risk factors would lead you to recommend CTG in labour?
- Contractions >2 mins or >5:10
- Meconium
- PVB or blood stained liquor
- HTN>140/90
- 2+ or more protinuria
- Delay in 1st stage or starting oxytocin
- Regional anaesthetic.
How is variability calculated on CTG?
Difference between highest and lowest value in 1 minute.
What characteristics make decels concerning on a CTG?
- Lasting >60 seconds
- reduced variability within
- failure or slow to return to baseline
- Loss of shouldering
(-Overshoot).
When is reduced variability a concerning feature?
Amber:
- <5 for 30-50 mins
- >25 for 10 mins
Red:
- <5 for >50 mins
- >25 for >10 mins
Sinusoidal.
What conservative measures can be taken for a non reassuring CTG?
- Change maternal position.
- Correct hypotension.
- Correct number of contractions.
- Apply FSE if any doubt.
Should maternal O2 be given for concerning or pathological CTG?
Not unless mum is hypoxic.
O2 is harmful to the foetus.
What is the dose and route of Turbutaline?
250 micrograms (0.25mg)
SC
2 doses if required.
In second stage of labour, how frequently should maternal and foetal pulse be differentiated?
Every 5 minutes.
Consider FSE if any concern.
