Perinatal and maternal mortality and Foetal monitoring: Flashcards
What are the top 3 causes of Stillbirths?
1) Unexplained
2) Antepartum or intrapartum haemorrhage
3) Intrauterine growth restriction
What are the top 3 causes of neonatal deaths?
1) Respiratory disorders
2) Major congenital abnormalities
3) Neurological disorders
What are the top 2 commonest direct cause of maternal deaths in the UK?
1) Sepsis
2) Pre-eclampsia and eclampsia
What is the top indirect cause of maternal death in the UK?
1) Cardiac disease
List 3 advantage and 2 disadvantages of using intermittent auscultation for foetal monitoring (with an example of the equipment used):
(hand-held doppler used): Advantages: - Inexpensive - Non-invasive - Can be used at home Disadvantages: - FHR variability and decelerations can't be categorised Long term monitoring not possible
List 3 advantages and 3 disadvantage of using continuous auscultation for foetal monitoring (plus what equipment is used for this):
(CTG - cardiotocography) Advantages: - Continuous monitoring - Ambulatory/wireless Information of FHR pattern
Disadvantages:
- Belts painful
- False positive
- Increased risk of interventions
What does CTG measure? When is it used?
Uterine contraction and foetal heart rate. Consists of Doppler USS and a pressure transducer.
It is used antenatally and intrapartum for high risk women.
What acronym is used for CTG interpretation?
DR - Define Risk C - Contraction Frequency BR - Baseline Rate A - Accelerations V- Variability D - Decelerations O - Overall assessment
List 2 maternal risks in pregnancy in each category noted below - Maternal antenatally, maternal intrapartum, foetal antenatally, foetal intrapartum, LABOUR:
Maternal antenatally -
1) Pregnancy induced hypertension Or pre-eclampsia
2) DM
Maternal Intrapartum -
1) Intrapartum/antepartum Haemorrhage (IPH/APH)
2) Infection
Foetal antenatally -
1) IUGR
2) Oligohydramnios
Foetal intrapartum -
1) Meconium
2) Abnormal fetal heart rate (FH) on intermittent auscultation (IA)
3) Breach
Labour:
1) Previous CS
2) Augmentation (inducing labour)
What is a normal Baseline foetal heart rate on a CTG trace?
100-160bpm
What do accelerations in a CTG trace indicate?
Presence are sign of foetal well being
What variation of foetal heart rate is acceptable and what is not?
Variability >5bpm is normal
Variability of <5bpm only acceptable for 30mins
List 4 types of CTG decelerations are what each one suggests:
1) Early decelerations (rare):
- Normal reflex response to pressure on foetal head
- Not associated with foetal hypoxia or acidosis
2) Late decelerations:
- Foetal response to contraction in a hypoxic environment
- Associated with hypoxia and acidosis when sustained
3) Variable decelerations:
- Defined by the no of bpm drop from the baseline and the length of time they last
- <60bpm drop and taking <60 seconds to recover can be normal
- Drop of >60bpm or taking >60s to recover is reassuring
4) Prolonged decelerations:
- lasting 3-5mins
- >5mins bradycardia
What does a CTG screen for? Why should CTG not be the only method used in assessing a mother and foetus?
Screens for foetal hypoxia.
Has a low specificity and has a very high false +ve rate.
List 3 measures which can be done in an attempt to improve a CTG trace:
- IV fluids
- Ceasing oxytocin
- Position change
List 2 advantages of a foetal ECG and 2 disadvantages:
Advantages:
- true beat-to-beat FHR is obtained
- Morphological analysis is possible
Disadvantages:
- Invasive
- Monitoring is possible only in labour
- requires membranes to be absent and cervix to be at least 2cm
(Electrode attached to foetal scalp)
List one other method of monitoring the foetal heart rate other than CTG, hand-held doppler and Foetal ECG:
Foetal magneto-cardiogram:
- Records magnetic field generated by the electrical activity of the heart
- High resolution
- Expensive
- Research tool
