Wk 3: Fetal surveillance and RANZCOG

Question 1

What is included in a biophysical profile (BPP), what does it include and why may it be assessed?

Answer 1

Includes;
- an u/s for monitoring fetal movements, fetal tone and fetal breathing.
- u/s to assess fetal liquor volume w/ or w/out FHR assessment

Performed in an effort to try and identify babies that may be at risk of poor pregnancy outcome, so that additional assessments of wellbeing may be performed, or labour may be induced or a caesarean section performed to expedite birth.

Question 2

What are dopplers and why/when might they be used?

Answer 2

= Doppler ultrasound uses sound waves to detect the movement of blood in vessels to show blood circulating in the baby, uterus and placenta.
- Using it in high-risk pregnancies, where there is concern about the baby’s condition, shows benefits. However, its value as a screening tool in all pregnancies needs to be assessed as there is a possibility of unnecessary interventions and adverse effects.

Question 3

What is CTG monitoring, what are the benefits and when may it be used?

Answer 3

= Cardiotocography (CTG) or electronic fetal monitoring (EFM) used for assessing fetal wellbeing in labour in the developed world.
- Purpose of fetal surveillance by CTG is to prevent adverse fetal outcomes.
- high degree of sensitivity but a low level of specificity which means that they are very good at telling us which fetuses are well but are poor at identifying which fetuses are unwell.
The differences in individual fetal responses to a decrease in oxygen (and therefore differences in heart rate changes) mean that the positive predictive value of CTG for adverse outcome is low and the negative predictive value high.
- The increased intervention rates associated with EFM can be reduced with the use of fetal blood sampling (FBS).
- use is linked to improved fetal outcomes in many areas.
- use increases risk of c/s and instrumental births.

Question 4

What are the 4 points that show a CTG with low association to a compromised fetus? aka normal parameterss?

Answer 4

Baseline: 110-160bpm
Variability: 2-25bpm
Accelerations: present (15bpm increase for 15sec)
Declarations: absent

Question 6

What are the points that show a CTG associated with a significantly compromised fetus?

Answer 6

Baseline: fetal tachy >160bpm
Reduced or reduced baseline variability: 3-5bpm
Rising baseline FHR
Complicated variable decels
Late decels
Prolonged decelerations

Question 7

What are the points that show a CTG associated with a significantly compromised fetus that needs urgent delivery?

Answer 7

• prolonged bradycardia (<100bpm or >5mins)
• Absent baseline variability (<3bpm)
• Sinusoidal pattern
• complicated variable decels with reduced or absent baseline variability
• late decels with reduced or absent variabillity