CTG

Question 1

Maternal indications for CTG

Answer 1

gestational hypertension (moderate-> severe) or preeclampsia

diabetes or other medical conditions affecting fetal wellbeing

recurrent APH/ fresh vaginal bleeding develops in labour

prev CS

significany meconium

suspected chrorioamniotitis / sepsis / temp 38 degrees plus

regional analgesia

IOL/ oxytocin use

prolonged 1st/ 2nd stages of labour

Question 2

fetal indications for CTG

Answer 2

twin pregnancy

breech presentation

oligohydramnios

fetal growth restriction

preterm labor

abnormal doppler

abnormal FHR on auscultation

Question 3

intermittent auscultation

Answer 3

• fetal heart rate low risk women first stage of labour in all birth settings
• pinnard stethoscope or doppler ultrasound
• intermittent auscultation immediately after contractionfor at least 1 minute every 15 minutes in 1st stage of labour and every 5 minutes at 2nd stage of labour

record it as a single rate

record accelerations and decelerations if heard

palpate the maternal pulse if fetal heart abnormality is suspected to differentiate between 2 heart rates

Question 4

CTG differentiating features

Answer 4

baseline fetal heart rate

variability

accelerating

decelerations

uterine contractions

DRCBRAVADO- define risk, contractions, baseline rate, variability, accelerations, decelerations, overall (assesment category 1,2,3)

Question 5

what is tachycardic

Answer 5

160bpm

Question 6

what is bradycardic

Answer 6

110bpm

Question 7

what is lag time

Answer 7

contraction -> deceleration

Question 8

baseline fetal heart rate

Answer 8

reassuring 110-160bpm,
non reassuring 100-109 bpm, 161pm - 180 bpm,
abnormal: <100bpm, >180bpm

Question 9

tachycardia causes

Answer 9

increased fetal activity
fetal anemia,
fetal compromise
maternal tachycardia, pyrexia, dehydration,

Question 10

bradycardia

Answer 10

fetal heart block (SLE)
maternal hypotension,
maternal vagal stimulation,
fetal compromise

Question 11

variability

Answer 11

normal variability represents normal fetal autonomic system

reassuring 5 or more
non reassuring <5 for 30 - 50 minutes or >25 for 15 to 25 minutes
abnormal: <5 for more than 50 minutes or >25 for more than 25 minutes or sinusoidal knees

Question 12

causes of decreased variability

Answer 12

fetal sleep
prematurity <32 weeks
medication : opiates beta blockers magnesium

Question 13

accelerations

Answer 13

inc baseline FHR at least 15bpm for 15 seconds,

presence of accelerations is a sign that the unborn baby is healthy

absence of accelerations in an otherwise normal trace is of uncertain significance

Question 14

decelerations

Answer 14

decrease in baseline at least FHR for at least 15 bpm, lasting for at least 15 seconds

when describing decelerations in fetal heart rate specify,

• duration of decelerations
• timing in relation to peaks of contractions whether or not fetal heart rate returns to baseline
• how long they’ve been present for
• whether they occur with over 50% contractions

decelerations early- head compression, variable- cord compression, late- placental insufficiency,