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Scientific Basis of Midwifery > Foetal Monitoring > Flashcards

Foetal Monitoring Flashcards

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1
Q

Give 5 factors that may make women high-risk in labour

A
  1. Maternal/ medical history
  2. Obstetric history
  3. History of pregnancy/ foetal history
  4. Presenting factor
  5. Features of labour
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2
Q

Describe intermittent auscultation

A
  • Low-risk women
  • Do not require admission CTG
  • 1st stage = auscultate every 15 mins after most recent contraction for min. 60s
  • 2nd stage = auscultate every 5 mins after most recent contraction for min. 60s
  • If abnormalities are noted, commence continuous monitoring
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3
Q

What do NICE guidelines say regarding intermittent auscultation?

A
  • Do not offer CTG to women at low risk of complications
  • Use Pinard or Doppler ultrasound
  • Record accelerations and decelerations
  • Palpate maternal pulse if foetal HR is abnormal to differentiate between HRs
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4
Q

Give some pregnancy indications that continuous electronic foetal monitoring (cEFM) is required

A
  • Previous CS
  • Pre-eclampsia
  • Pregnancy >42 wks
  • Induced labour
  • Diabetes
  • Prematurity
  • Oligohydramnios
  • Multiple pregnancy
  • Breech
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5
Q

What is oligohydramnios?

A

Deficiency of amniotic fluid

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6
Q

Give some labour indications that cEFM is required

A
  • Pulse >120bpm
  • BP >160/ or >/110
  • BP 2x >140/ or >/90 in 30 mins (or 2+ protein in urine and >140/90)
  • Oxytocin use
  • Significant meconium
  • Vaginal bleeding
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7
Q

What is a tocograph?

A

A pressure monitor that records uterine activity continuously

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8
Q

What is an ultrasound transducer?

A

Records the foetal heart by transmitting ultrasound waves which are then bounced off a moving object (the valves of the heart)

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9
Q

Name a method of internal foetal monitoring

A

Foetal scalp electrode

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10
Q

What does monitoring help prevent?

A
  • Hypoxic Ischaemic Encephalopathy (brain injury caused by oxygen deprivation)
  • Neonatal seizures
  • Cerebral palsy
  • Intrapartum death
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11
Q

How should monitoring be prepared?

A
  • Paper speed 1cm/min
  • Date and time correct
  • FHR displays 50-210 used
  • Tocograph basline set
  • Date, time and woman’s name and number written on trace
  • Maternal pulse palpated simultaneously with auscultation and recorded
  • Palpate, measure, pinard
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12
Q

Give some limitations and adverse effects of foetal monitoring

A
  • No evidence to support it
  • High false positive rate (40-60%)
  • Expensive
  • Increases risk of intervention and operative delivery
  • Parental anxiety
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13
Q

What are the 3 groups of babies that can be classified by foetal monitoring?

A
  1. OK - coping well with stress of labour
  2. Showing stress response but coping
  3. Not coping with stress response
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14
Q

What does the anagram MOTHERS refer to?

A 
M - meconium
O - oxytocin
T - temperature
H - hyperstimulation/ haemorrhage
E - epidural
R - rate of progress
S - scar (previous CS)
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15
Q

What is significant meconium?

A

Green = sign of foetal distress

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16
Q

What does the anagram DR C BRAVADO refer to?

A

DR - define risk (high/low)
C - contractions (present, frequency, strength)
Bra - baseline rate (normal, bradycardia, tachycardia)
V - variability (>5bpm)
A - accelerations
D - decelerations (early, variable, late, prolonged)
O - overall (normal, suspicious, pathological) and plan

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17
Q

What are the 4 features that should be documented from a CTG?

A
  1. Baseline FHR
  2. Baseline variability
  3. Presence/absence of decelerations
  4. Presence of accelerations
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18
Q

What happens if the CTG cannot be interpreted?

A

Senior obstetric input is required

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19
Q

What is the baseline rate?

A
  • Mean level of FHR over 10-15 minutes without accelerations/decelerations
  • Balance between SNS and PNS
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20
Q

What are the 3 categories of baseline rate defined by the NICE?

A
  1. Reassuring = 110-160bpm
  2. Non-reassuring = 100-109 or 161-180bpm
  3. Abnormal = >180 or <100bpm
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21
Q

Give some factors that may cause an abnormal bradycardia baseline

A
  • Maternal hypotension (low BP)
  • Hypertonic uterus (too many contractions
  • Placental abruption
  • Rapid progress
  • Hypoxia
  • Cord prolapse
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22
Q

Give some factors that may cause an abnormal tachycardia baseline

A
  • Prematurity
  • Foetal movements
  • Hypoxia
  • Foetal anaemia or hypovolaemia
  • Maternal pyrexia/ tachycardia
  • Drugs = Ritodrine, Ventolin, Nicotine
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23
Q

What is baseline variability?

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A

The degree that the baseline varies in a particular band width, excluding accelerations and decelerations (5-25bpm)

  • Determined between contractions
  • Normal for foetus to have periods of reduced variability
24
Q

What are the 3 classifications of baseline variability defined by the NICE?

Study These Flashcards
A
  1. Reassuring - 5-25bpm
  2. Non-Reassuring - <5bpm for 30-50 mins or >25bpm for 15-25 mins
  3. Abnormal - <5bpm for over 50 mins or >25bpm for over 25 mins or sinusoidal (constant HR - linked with thumb sucking)
25
What is the most important marker of foetal wellbeing?
Baseline variability >5bpm | Intact CNS
26
Give some factors that may cause reduced variability
- Paper speeds - Sleep phase - Prematurity - Tachycardia - Congenital malformations - Drugs (pethidine, sedatives, anti-hypertensives, anti-epileptics)
27
Describe accelerations
- Increase above baseline rate of 15bpm+ lasting 15 seconds+ - Presence is reassuring but absence is not necessarily concerning - There should always be accelerations antenatally
28
What are decelerations?
Slowing of FHR below baseline of 15bpm+ lasting 15 seconds+ | - If variability is abnormal, decelerations may be significant even if drop is <15bpm/ shallow
29
What are the 4 types of deceleration?
1. Early - very rarely <2% benign, nadir of deceleration matches peak of contraction, late 1st + 2nd stage 2. Late - nadir 20 seconds after peak of contraction 3. Variable - most common (85%), variable in shape, length, depth and frequency 4. Prolonged - 3 minutes+
30
What causes early decelerations?
Head compression
31
What causes late decelerations?
- Placental insufficiency | - Hypoxia
32
What causes variable decelerations?
Cord compression
33
What causes prolonged decelerations?
- Hypoxia - Tachysystole - Hypotension - Ruptured uterus - Cord prolapse - VE - Spontaneous rupture of membranes - FBS (foetal blood sampling)
34
What are decelerations caused by?
High BP or acidic blood
35
What are the 2 main baroreceptors?
Carotid sinus | Aortic arch
36
How do baroreceptors react to high BP?
- Head and cord compression causes increased BP - Baroreceptor stimulated - Parasympathetic NS stimulated - AVN slowed via vagus nerve - FHR slows down
37
What are the 3 main chemoreceptors
Carotid body Aortic arch Brain
38
How do chemoreceptors react to acidic blood?
- Increase in H+ ions and carbon dioxide and low PO2 - Parasympathetic NS stimulated - Decreased FHR - Until H+ and CO2 are rinsed from foetal circulation, FHR will remain low
39
What are the 3 classifications of deceleration?
1. Reassuring 2. Non-reassuring 3. Abnormal
40
Describe a reassuring deceleration
- No decelerations | - Variable decelerations with no CC for <90 mins
41
Describe a non-reassuring deceleration
- Variable decelerations with no CC for >90mins - Variable decelerations with CC with <50% contractions for >30mins - Variable decelerations with CC with >50% contractions for <30mins - Late decelerations with >50% contractions and <30mins
42
Describe an abnormal deceleration
- Variable decelerations with CC with >50% contractions for >30mins - Late decelerations with >50% contractions and >30mins or <30mins with maternal/foetal risk factors - Prolonged decelerations >3mins
43
What does CC stand for?
Concerning characteristics
44
What are the 4 categories that are defined by foetal monitoring?
1. Normal (all features reassuring) 2. Suspicious (1 non-reassuring feature and 2 reassuring features) 3. Pathological (1 pathological feature OR 2 non-reassuring features 4. Need for Urgent Intervention (acute bradycardia or a single prolonged deceleration)
45
What is the appropriate timeline for a foetus in need of urgent intervention?
``` 3 mins = call obstetrician 6 mins = obstetrician present, thinking about theatre 9 mins = in theatre 12 mins = knife to skin 15 mins = baby born ```
46
Describe the management for the 'normal' category
- Continue CTG if high risk - Discontinue if CTG commenced due to concerns arising from intermittent auscultation - Discuss progress with woman
47
Describe the management for the 'suspicious' category
- Correct underlying cause - Maternal obs - Start conservative measures - Inform senior midwife/ obstetrician - Document plan for CTG review and clinical picture - Discuss progress with woman
48
Describe the management for the 'pathological' category
- Obtain review by senior midwife and obstetrician - Exclude acute events - Correct underlying causes - Start conservative measures - Discuss progress with woman
49
What should be done if CTG remains pathological after implementing conservative measures?
- Further review by obstetrician | - Offer digital foetal scalp stimulation and document outcome
50
What should be done if CTG is still pathological after foetal scalp stimulation?
- Consider FBS - Consider expediting (speeding up) birth - Take woman's preferences into account
51
Describe the management for the 'need for urgent intervention' category
- Urgently seek obstetric help - Expedite birth if there has been acute event - Correct underlying causes - Start conservative measures - Prepare for urgent birth - Discuss progress with woman - Expedite birth if acute bradycardia persists for 9mins - If FHR recovers before 9mins, reassess decisions to expedite birth and discuss with woman
52
Give 2 examples of underlying causes
Hypotension | Hyperstimulation
53
Give 3 examples of acute events
Cord prolapse Placental abruption Uterine rupture
54
Give 4 examples of conservative measures
Fluids Reduce/stop oxytocic Change position Offer tocolytic drugs (e.g. terbutaline 0.25mg)
55
What are the NICE guidelines regarding general care during foetal monitoring?
- Make documented systematic assessment of condition of woman and baby every hour, or more frequently if concerned - Do not make decisions based on CTG alone - Focus care on woman, not CTG - Consider woman's preferences - Provide one-to-one support - Maintain communication with woman and family
56
Describe how foetal monitoring information should be stored and documented
- Check date/time on EFM machine - Note all events - 'Fresh eyes' hourly - trace should be seen, reviewed and a plan made by 2 staff members - Sign trace and record date, time and mode of birth - Store records securely

Scientific Basis of Midwifery (22 decks)

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