Perinatal and maternal mortality and Foetal monitoring:

Question 1

What are the top 3 causes of Stillbirths?

Answer 1

1) Unexplained
2) Antepartum or intrapartum haemorrhage
3) Intrauterine growth restriction

Question 2

What are the top 3 causes of neonatal deaths?

Answer 2

1) Respiratory disorders
2) Major congenital abnormalities
3) Neurological disorders

Question 3

What are the top 2 commonest direct cause of maternal deaths in the UK?

Answer 3

1) Sepsis

2) Pre-eclampsia and eclampsia

Question 4

What is the top indirect cause of maternal death in the UK?

Answer 4

1) Cardiac disease

Question 5

List 3 advantage and 2 disadvantages of using intermittent auscultation for foetal monitoring (with an example of the equipment used):

Answer 5

(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

Question 6

List 3 advantages and 3 disadvantage of using continuous auscultation for foetal monitoring (plus what equipment is used for this):

Answer 6

(CTG - cardiotocography)
Advantages:
- Continuous monitoring
- Ambulatory/wireless
Information of FHR pattern

Disadvantages:

• Belts painful
• False positive
• Increased risk of interventions

Question 7

What does CTG measure? When is it used?

Answer 7

Uterine contraction and foetal heart rate. Consists of Doppler USS and a pressure transducer.

It is used antenatally and intrapartum for high risk women.

Question 8

What acronym is used for CTG interpretation?

Answer 8

DR - Define Risk
C - Contraction Frequency
BR - Baseline Rate
A - Accelerations
V- Variability
D - Decelerations
O - Overall assessment

Question 9

List 2 maternal risks in pregnancy in each category noted below - Maternal antenatally, maternal intrapartum, foetal antenatally, foetal intrapartum, LABOUR:

Answer 9

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)

Question 10

What is a normal Baseline foetal heart rate on a CTG trace?

Answer 10

100-160bpm

Question 11

What do accelerations in a CTG trace indicate?

Answer 11

Presence are sign of foetal well being

Question 12

What variation of foetal heart rate is acceptable and what is not?

Answer 12

Variability >5bpm is normal

Variability of <5bpm only acceptable for 30mins

Question 13

List 4 types of CTG decelerations are what each one suggests:

Answer 13

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

Question 14

What does a CTG screen for? Why should CTG not be the only method used in assessing a mother and foetus?

Answer 14

Screens for foetal hypoxia.

Has a low specificity and has a very high false +ve rate.

Question 15

List 3 measures which can be done in an attempt to improve a CTG trace:

Answer 15

• IV fluids
• Ceasing oxytocin
• Position change

Question 16

List 2 advantages of a foetal ECG and 2 disadvantages:

Answer 16

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)

Question 17

List one other method of monitoring the foetal heart rate other than CTG, hand-held doppler and Foetal ECG:

Answer 17

Foetal magneto-cardiogram:

• Records magnetic field generated by the electrical activity of the heart
• High resolution
• Expensive
• Research tool