Fetal wellbeing

Question 1

When assessing fetal wellbeing, what is key on history, examination and investigations?

Answer 1

History: Fetal movements
Examination: Fundal height
Investigations: Ultrasound (blood flow, amniotic fluid) and CTG

Question 2

What are some parameters looked at on U/S?

Answer 2

Fetal biometry (baby size)
  > head circumference / abdominal circumference / femur length
  > absolute and serial measurements
  > head:abdo ratio
Liquor volume 
  > amniotic fluid index
Fetal activity 
  > body movements
  > breathing movements
  > tone
Blood flow (Doppler U/S)
  > umbilical artery waveform 
  > MCA

Question 3

After what stage antenatally does CTG become useful?

Answer 3

28 wks, better interpretation from 32 wks onwards

CTG to measure fetal HR is not useful before 28 wks

Question 4

What are the features of a normal CTG?

Answer 4

“Reactive” = normal

Baseline: 110 - 160 bpm
Variability: 5-25 bpm
Accelerations: at least 2 x 15 bpm in 20 mins
Decelerations: NO ominous delerations

Question 5

When looking at a CTG, what do some of the concerning changes in variability mean?

Answer 5

Increased variability
- hypoxia

Reduced variability
(= non-reactive)
- sick, sleeping, sedated, submature

Absent
- SEVERE hypoxia

Sinusoidal pattern
- fetal anaemia

Question 6

What are some of the causes of a non-reactive CTG (reduced variability)?

Answer 6

S ick
> hypoxia

S leeping

S edated
> sedatives / anti-hyptensives / anti-convulsants

S ubmature
> prematurity

Question 7

When looking at a CTG, what are some concerning decelerations and what can they mean?

Answer 7

Early decelerations: head compression in labour

Late decelerations: fetal hypoxia (appropriate response)

Variable decelerations: cord compression

Prolonged decelerations: sustained hypoxia

Question 8

What on CTG would warrant investigation antenatally, and what investigations should be done?

Answer 8

Non-reactive
> no accelerations
> reduced variability

** Must think, is it due to hypoxia? **

Investigations:

• Fetal stimulation tests (VAST)
• Doppler US (umbilical artery waveform and MCA peak systolic velocity)
• Biophysical profile (AFI/fetal activity/CTG)

Question 9

What findings on CTG demonstrate a critical fetal condition and warrant immediate delivery via c-section?

Answer 9

• Late decelerations (fetal hypoxia)
• Absent variability (severe hypoxia)
• Sinusoidal pattern (detal anaemia)

Question 10

On CTG intrapartum, what changes would be considered critical and warrant immediate delivery (c-s, vaginal delivery)?

Answer 10

Late/prolonged/severe variable decelerations

Absent variability

Sinusoidal pattern

Question 11

What action should be undertaken if a CTG is non-reactive during intrapartum?

Answer 11

Continuous CTG monitoring

** Could there be narcotics in the mum/baby system? **