Obs - Fetal Bradycardia and Cord Prolapse

Question 1

28/F G1P0 lady in spontaneous labour, 4cm dilated with membranes ruptured after PV 20 mins ago, now
presented with this CTG. Describe this CTG.

Answer 1

This is a CTG of MUM from TIME to TIME. 1 cm/min
Uterine contraction is X per 10 minutes
Basal fetal heartrate is X bpm, normal variability
No acceleration
Prolonged deceleration from x to y bpm since time to time, did not return spontaneously

The CTG is abnormal

Question 2

How to manage prolonged deceleration from 140 bpm to 70 bpm for over 5 mins?

Answer 2

This is a case of fetal bradycardia

Reversible causes
Uterine hyperstimulation: off oxytocin
Hypotension: check BP/pulse, left lateral

Irreversible causes: abd exam for placental abruption and uterine rupture; PV for cord prolapse

Delivery ASAP

Question 3

PV done and loop of cord found. Management?

Answer 3

This is cord prolapse

Call for help as this is an obstetric emergency

Check vitals and resus

Prevent cord compression by
Head down, knee to chest
PV for dilatation/station and elevate presenting part
Documentation

Question 4

Cervix is fully dilated, LOT, S+2. describe what you will do.

Answer 4

I will perform a vacuum extraction.

1. Get consent for vacuum, episiotomy and emergency CA.
2. Catheterise bladder
3. LA
4. Choose OA cup and connect to the machine.
5. Apply cup at flexion point 3 cm anterior to posterior fontanelle over the sagittal fissure.
6. Make sure no maternal tissue trapped
7. Suction force to 60cmHg
8. Make sure no maternal tissue trapped
9. Traction with uterine contraction and maternal effort (Maximum 5 pull/ 15 minutes from the start of the procedure, foetal head should descend with each pull and crown in 3 pulls)
10. +/- episiotomy when crowning
11. Give the baby to neonatologist

Cord blood sampling, documentation, debrief mother