Other Important Topics Flashcards
What is a bradycardia?
Deceleration (drop in the baseline >15 for >15 seconds) that goes on longer than 3 minutes
Causes of fetal bradycardia
drop in blood pressure, change in position
Management of fetal bradycardia
Change position (usually try left lateral)
Examine
If does not recover, immediate delivery by quickest / safest route
Is a CTG invasive?
No, it is a non-invasive method of monitoring foetal heart rate and uterine contractions during pregnancy and labour.
Mnemonic for interpretation of a CTG
DR C BRAVADO
Define Risk
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
Overall Impression
When defining risk on a CTG, what pre-existing features suggest a high risk?
Gestational diabetes
Hypertension
Asthma
Multiple gestation
Post-term pregnancy
Previous C-section
IUGR
PPROM
Congenital malformations
Pre-eclampsia
When assessing contractions on a CTG, what should you do?
Record number of contractions over a 10 minute period
1 big square = 1 minute
Assess duration and intensity of contractions
When assessing contractions on a CTG, how long should you do it for?
10 mins
What does 1 big square on a CTG equal?
1 minute
When assessing baseline rate on a CTG, what is the normal range?
Normal Range: 110-160 bpm
What is a bradycardia on CTG?
<100 beats per min
What is a tachycardia on CTG?
> 160 beats per min
Causes of fetal tachycardia
Foetal hypoxia
Hyperthyroidism
Anaemia
Infection
Causes of foetal bradycardia
Cord prolapse
Cord compression
Anaesthesia
Maternal seizures
What is the normal baseline variability on a CTG?
5-25BPM
Causes of abnormal baseline variability
Foetal sleep
Hypoxia
Infection
Drugs (e.g. opioids, magnesium)
Prematurity
Congenital heart defects
What are accelerations defined as?
Definition: Increase in baseline heart rate of > 15 bpm for > 15 seconds
What do the presence of accelerations on a CTG suggest?
The presence of accelerations during contractions is reassuring and suggestive of a healthy foetus
What are decelerations defined as?
Definition: Decrease in baseline heart rate of > 15 bpm for > 15 seconds
Types of deceleration
Early
Late
Variable
Prolonged
Sinusoidal
What are early decelerations?
Begins with the onset of a contraction and recovers once the contractions ends
This is physiological and caused by increased vagal tone and intracranial pressure during a contraction
What are early decelerations caused by?
physiological and caused by increased vagal tone and intracranial pressure during a contraction
What are late decelerations?
Begins at the peak of a contraction and recovers after the contraction ends
Caused by reduced uteroplacental blood flow which results in foetal hypoxia and acidosis
Causes include maternal hypotension, pre-eclampsia and uterine hyperstimulation
What are late decelerations caused by?
Caused by reduced uteroplacental blood flow which results in foetal hypoxia and acidosis
Causes include maternal hypotension, pre-eclampsia and uterine hyperstimulation
What are variable deeclerations?
There appears to be no relationship between the decelerations and uterine contractions
Caused by compression of the umbilical cord
What are variable deceleraitons caused by?
Caused by compression of the umbilical cord
What are prolonged decelerations?
If lasting 2-3 minutes it is considered non-reassuring, and if it is > 3 mins it is considered abnormal
When are decelerations classed as non-reassuring?
If lasting 2-3 minutes it is considered non-reassuring,
When are decelerations classed as abnormal?
> 3 mins it is considered abnormal
What is a sinusoidal pattern of decelerations?
Extremely concerning sign that is associated with severe foetal anaemia or hypoxia
What are a sinusoidal pattern of decelerations associated with?
severe foetal anaemia or hypoxia
How can an overall CTG be described?
as reassuring, non-reassuring or abnormal
What post-partum mental health conditions are there?
Baby Blues
Postnatal Depression: persistent low mood, low energy and/or lack of enjoyment of usual activities that begins around the time of birth and lasts for longer than 2 weeks
Puerperal Psychosis: development of delusions and hallucinations in the peripartum period
What is postnatal depression?
persistent low mood, low energy and/or lack of enjoyment of usual activities that begins around the time of birth and lasts for longer than 2 weeks
What is puerperal psychosis?
development of delusions and hallucinations in the peripartum period
Presentation of the baby blues
Features: Low mood, irritability and emotional lability
Management of the baby blues
Management: Resolves spontaneously relatively soon after childbirth
Features of postnatal depression
Features: Persistent low mood, low energy and/or lack of enjoyment of usual activities. Patients may complain of feelings of worthlessness, inadequacy and difficulties bonding with the baby.
PACES: What is important to screen patients with postnatal depression for?
thoughts about harming themselves or harming their baby
PACES: What screening tools can be used for postnatal depression?
Edinburgh Postnatal Depression Scale
Whooley Questions
Management of postnatal depression?
Important to avoid separating mother and baby where possible
CBT
SSRIs
Sertraline and paroxetine are generally considered safe options in pregnancy and breastfeeding
Which SSRIs are safe to use in pregnancy and breastfeeding?
Sertraline and paroxetine are generally considered safe options in pregnancy and breastfeeding
Features of puerperal psychosis
Features: Delusions and hallucinations usually relating to the baby. May also demonstrate unusual behaviour, disinhibition and irritability. Usually presents within the first 6 weeks of childbirth.
Management of puerperal psychosis
If the patient is thought to pose a risk to themselves or their baby, they need to be admitted to a mother and baby unit
They are likely to be started on antipsychotic medications
Electroconvulsive therapy may be considered
Talking therapies
If the mother is thought to pose a risk to themselves or their baby, where should they be admitted?
mother & baby unit
What medication are patients with puerperal psychosis likely to be started on?
Antipsychotic medications
What is post partum thyroiditis?
Abnormal thyroid function arising in the first year after childbirth.
Stages of post partum thyroiditis
Hyperthyroid (usually for the first 3 months)
Hypothyroid (occurs once the stores of thyroid hormone are depleted and the follicular cells are too damaged to generate more thyroid hormone)
Euthyroid (usually occurs within 1 year)
How does post partum thyroiditis present?
Features of hyperthyroidism or hypothyroidism
Investigations for post partum thyroiditis
Bloods
TFTs
Anti-TPO Antibodies
Anti-Thyroglobulin Antibodies
Imaging & Other
Thyroid Uptake Scan
Management of post partum thyroiditis
Hyperthyroid Phase
Symptomatic management usually with propranolol
Carbimazole may be considered in some cases
Hypothyroid Phase
Thyroxine replacement
Risks associated with smoking in pregnancy
Miscarriage
Preterm Birth
Stillbirth
Intrauterine Growth Restriction
Sudden Infant Death Syndrome
Risks associated with alcohol in pregnancy
Foetal Alcohol Syndrome
Presentation of foetal alcohol syndrome
Smooth or absent philtrum
Learning difficulties
Microcephaly
Growth retardation
Cardiac malformation
