Partogram, Caesarean and Monitoring

Question 1

What are the 4 Caesarean section categories?

Answer 1

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

Question 2

Why would a general anaesthetic be given for performing a c-section?

Answer 2

If there is a threat to the mum or the foetus and so a regional anaesthetic is contraindicated.

Question 3

Give 2 disadvantages of using a general anaesthetic for a c-section.

Answer 3

1. Risk of aspiration.
2. Given IV and so the baby is anaesthetised too.

Question 4

Give 3 advantages of using local anaesthetic when performing a c-section.

Answer 4

Safer.
You can see the baby immediately.
Partner present.

Question 5

Give 3 disadvantages of using local anaesthetic when performing a c-section.

Answer 5

It can cause hypotension.
It can cause headaches.
The patient may experience discomfort from pressure sensations.

Question 6

When might a LLP be detected?

Answer 6

On the 20w anomaly scan. The placenta must be >25mm from the cervical os.

Question 7

Would a woman with a LLP complain of pain?

Answer 7

No LLP is usually painless

Question 8

How should a LLP be managed?

Answer 8

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.

Question 9

Give 2 methods used for monitoring the foetal heart rate.

Answer 9

1) Intermittent auscultation using a pinard stethoscope or a hand held doppler.
2) Continuous monitoring: cardiotocography (CTG).

Question 10

What are the disadvantages of intermittent auscultation?

Answer 10

Variability is not detected.
Long term monitoring is not possible.
Quality of FHR can be affected by the maternal HR.

Question 11

What are the advantages of intermittent auscultation?

Answer 11

Cheap.
Easy to do.
Non invasive.
Can be done at home.

Question 12

What are the advantages of continuous monitoring?

Answer 12

Gives lots of information e.g. variability, accelerations, decelerations etc.
Continuous.
Monitors FHR and uterine contractions.

Question 13

What are disadvantages of continuous monitoring?

Answer 13

Not very mobile - the mum’s abdomen is strapped.
2. Expensive.

Question 14

What are disadvantages of continuous monitoring?

Answer 14

1. Not very mobile - the mum’s abdomen is strapped.
2. Expensive.

Question 15

CTG: what is a normal baseline HR?

Answer 15

110-160bpm

Question 16

CTG: what is a non-reassuring baseline HR?

Answer 16

100-109bpm

Question 17

CTG: what is an abnormal baseline HR?

Answer 17

<100 bpm.
>180 bpm

Question 18

CTG: What are the different degrees of variability?

Answer 18

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.

Question 19

CTG: What is an acceleration and are they concerning?

Answer 19

Acceleration: Increase in baseline HR by 10-15bpm
Concern: Nope! Presence is reassuring

Question 20

CTG: are decelerations reassuring or non-reassuring?

Answer 20

Decelerations are non-reassuring.

Question 21

CTG: what are early decelerations?

Answer 21

Early decelerations are seen just before a uterine contraction. They may be due to foetal head compression.

Question 22

CTG: what are late decelerations?

Answer 22

Late decelerations are seen just after uterine contraction. They may be due to placental insufficiency and are often more sinister.

Question 23

CTG: how would you determine if a CTG was overall normal, suspicious or abnormal?

Answer 23

Normal: everything is normal and accelerations are present.
Suspicious: one non-reassuring feature.
Abnormal: >2 non-reassuring features and/or >1 abnormal feature.

Question 24

CTG: what are variable decelerations?

Answer 24

When there is a mixture of early and late decelerations.

Question 25

CTG: how would you determine if a CTG was overall normal, suspicious or abnormal?

Answer 25

Normal: everything is normal and accelerations are present.
Suspicious: one non-reassuring feature.
Abnormal: >2 non-reassuring features and/or >1 abnormal feature.

Question 26

How do you define a normal CTG? (BraVAD)

Answer 26

Baseline HR - 110-160 bpm.
Variability >5.
Accelerations present.
No decelerations.

Question 27

What are the parameters used in determining whether a CTG is normal or abnormal?

Answer 27

Baseline HR.
Variability.
Accelerations.
Decelerations.

Question 28

What is the gold standard method for direct FHR monitoring?

Answer 28

Scalp ECG.

Question 29

Give a disadvantage of a scalp ECG for monitoring the FHR.

Answer 29

Invasive.
Membranes need to be broken and so cervix must be >2cm.
Risk of scalp injury and infection risk.