RFM & CTG Flashcards
What does RFM mean?
RFM = Fetal distress
It’s a compensation mechanism to reduce O2 consumption in response to chronic hypoxia.
What are the risks associated with RFM?
Still birth
Growth Restriction
When should a mother expect fetal movement?
Nulliparous: 18-20 weeks (Quickening)
Multiparous: 16-18 weeks
What is a normal frequency of fetal movements?
10 movements within 2 hours
Plateau of movements in week 32 onwards
What are the categories of risk factors?
- Fetal
- Maternal
- Uteroplacental
What are the fetal risk factors for RFM?
HAD a PIMP
Hypoxic or Hypotonic
Amelia
Death
Physiological (sleep)
IUGR
Macrosomia
Position (baby’s back is anterior)
What are the maternal risk factors for RFM?
High BMI
Cocaine use
Smoking
Medications (Pethidine or benzo’s causing bradycardia)
Dehydration
Polyhydramnios
What are the uteroplacental risk factors for RFM?
A PUP
Anterior position
Polyhydramnios
Uterine anomaly i.e. fibroids
Polyhydramnios
How would you investigate RFM?
- US
- Growth scan
- Doppler umbilical artery (24-28 weeks)
- If > 28 weeks - CTG 20 mins
- Investigate structural or genetic fetal abnormalities
What does a CTG do?
Measures fetal heart rate and uterine contractions
What maternal medical illness are high risk in pregnancy?
Maternal medical illness
GDM
HTN
Asthma
What obstetric complication are high risk in pregnancy?
Multiple gestation
Post-date gestation
Previous cesarean section
IUGR
PROM
Congenital malformations
Oxytocin induction/augmentation of labour
Pre-eclampsia
How would you assess contractions on CTG?
1 square = 1 minute
Quantity: Number of contractions in 10 minutes
Duration: How long does the contraction last?
Intensity: How strong (using palpation)
How would you assess baseline rate on CTG?
Average fetal HR in 10 minutes.
Count the number of beats in 10 minutes ignoring accelerations and decelerations.
Normal = 110-160bpm
What might cause fetal tachycardia?
Hypoxia
Chorioamnionitis
Hyperthyroidism
Maternal (or fetal) Anaemia
Fetal Arrhythmia
What might cause fetal bradycardia?
MACC’s
Cord compression
Cord prolapse
Anesthesia
Maternal seizures
What does variability on a CTG mean?
Baseline variability is the variation of one beat to the next.
Normal variability = 5-25 bpm
How would you assess variability on CTG?
Categorise into:
Reassuring
Non-reassuring
Abnormal
What would be abnormal variability on CTG?
<5 bpm (for >50 mins)
or
>25 bpm (for >25 mins)
Sinusoidal
What would be non-reassuring variability on CTG?
Non-reassuring:
<5 bpm for 30-50 mins
or
>25bpm for 15-25 mins
What are potential causes of reduced variability?
Sat On Cushioned Drugs:
Sleeping
Acidosis
Tachycardia
Opiates
Congenital heart abnormalities
Drugs: Benzo’s, methyldopa, Magnesium sulphate
What are accelerations on CTG?
Abrupt increase in fetal HR of >15 bpm for >15seconds.
They occur alongside uterine contractions.
They are reassuring and normal.
What are decelerations on CTG?
Decelerations are an abrupt decrease in the baseline fetal HR of >15 bpm for >15 seconds.
Can be early, variable or late
What is a late deceleration?
Late decelerations begin at the peak of the uterine contraction and recover after the contraction ends.
This type of deceleration indicates there is insufficient blood flow to the uterus and placenta. As a result, blood flow to the fetus is significantly reduced causing fetal hypoxia and acidosis.
What are potential causes of placental insuffiency?
Maternal Hypotension
Pre-Eclampsia
Uterine hyperstimulation
What is a sinusoidal pattern on CTG?
Smooth, regular wave like pattern, no variability in beats.
What does a sinusoidal pattern mean on CTG?
A sinusoidal pattern usually indicates one or more of the following:
Severe fetal hypoxia
Severe fetal anaemia
Fetal/maternal haemorrhage
How would you describe overall impression?
Reassuring, suspicious or abnormal.
Always comment on the HR, variability and decerlatios.
'’This is a reassuring CTG given the baseline HR, baseline variability and absence of decelerations’’
Treatment for Non-Reassuring CTG
Maternal position change (LLDP), reassess vitals
O2, IVF, stop oxytocin if using
Change method of monitoring
Assess cervix for dilation or prolapse
Fetal blood sampling
Tocolysis
Amnioinfusion
Acoustic or scalp stimulation
Plan immediate delivery
