Partogram, Caesarean and Monitoring Flashcards
What are the 4 Caesarean section categories?
1) Immediate threat to life of mother or baby
2) Problems affecting health of mother/baby but not life threatening
3) Baby has to be born early but no real threat
4) Elective
Why would a general anaesthetic be given for performing a c-section?
If there is a threat to the mum or the foetus and so a regional anaesthetic is contraindicated.
Give 2 disadvantages of using a general anaesthetic for a c-section.
- Risk of aspiration.
- Given IV and so the baby is anaesthetised too.
Give 3 advantages of using local anaesthetic when performing a c-section.
Safer.
You can see the baby immediately.
Partner present.
Give 3 disadvantages of using local anaesthetic when performing a c-section.
It can cause hypotension.
It can cause headaches.
The patient may experience discomfort from pressure sensations.
When might a LLP be detected?
On the 20w anomaly scan. The placenta must be >25mm from the cervical os.
Would a woman with a LLP complain of pain?
No LLP is usually painless
How should a LLP be managed?
1) Advise mum on the symptoms to look out for.
2) Seek early advice.
3) If recurrent bleeds, admit until delivery.
4) Elective c-section at 38 weeks.
Give 2 methods used for monitoring the foetal heart rate.
1) Intermittent auscultation using a pinard stethoscope or a hand held doppler.
2) Continuous monitoring: cardiotocography (CTG).
What are the disadvantages of intermittent auscultation?
Variability is not detected.
Long term monitoring is not possible.
Quality of FHR can be affected by the maternal HR.
What are the advantages of intermittent auscultation?
Cheap.
Easy to do.
Non invasive.
Can be done at home.
What are the advantages of continuous monitoring?
Gives lots of information e.g. variability, accelerations, decelerations etc.
Continuous.
Monitors FHR and uterine contractions.
What are disadvantages of continuous monitoring?
Not very mobile - the mum’s abdomen is strapped.
2. Expensive.
What are disadvantages of continuous monitoring?
- Not very mobile - the mum’s abdomen is strapped.
- Expensive.
CTG: what is a normal baseline HR?
110-160bpm
CTG: what is a non-reassuring baseline HR?
100-109bpm
CTG: what is an abnormal baseline HR?
<100 bpm.
>180 bpm
CTG: What are the different degrees of variability?
1) Normal: > 5
2) Non-Reassuring: <5 for 40-90 minutes.
(Reduced variability could be due to foetal sleeping)
3) Abnormal: <5 for >90 minutes.
CTG: What is an acceleration and are they concerning?
Acceleration: Increase in baseline HR by 10-15bpm
Concern: Nope! Presence is reassuring
CTG: are decelerations reassuring or non-reassuring?
Decelerations are non-reassuring.
CTG: what are early decelerations?
Early decelerations are seen just before a uterine contraction. They may be due to foetal head compression.
CTG: what are late decelerations?
Late decelerations are seen just after uterine contraction. They may be due to placental insufficiency and are often more sinister.
CTG: how would you determine if a CTG was overall normal, suspicious or abnormal?
Normal: everything is normal and accelerations are present.
Suspicious: one non-reassuring feature.
Abnormal: >2 non-reassuring features and/or >1 abnormal feature.
CTG: what are variable decelerations?
When there is a mixture of early and late decelerations.
CTG: how would you determine if a CTG was overall normal, suspicious or abnormal?
Normal: everything is normal and accelerations are present.
Suspicious: one non-reassuring feature.
Abnormal: >2 non-reassuring features and/or >1 abnormal feature.
How do you define a normal CTG? (BraVAD)
Baseline HR - 110-160 bpm.
Variability >5.
Accelerations present.
No decelerations.
What are the parameters used in determining whether a CTG is normal or abnormal?
Baseline HR.
Variability.
Accelerations.
Decelerations.
What is the gold standard method for direct FHR monitoring?
Scalp ECG.
Give a disadvantage of a scalp ECG for monitoring the FHR.
Invasive.
Membranes need to be broken and so cervix must be >2cm.
Risk of scalp injury and infection risk.
