Intrapartum and Maternal and Fetal Monitoring Flashcards
(21 cards)
Monitoring in labour?
- Fetal heart rate (FHR) - every 15 minutes (or continuously with a CTG).
- Contractions -every 30 minutes.
- Maternal - checked hourly.
- BP and temperature - checked 4 hourly.
- Vaginal examination should be offered every 4 hrs. when in active phase and every 6 hrs. when in latent phase of labor.
- Maternal urine is tested 4 hourly or when passed for ketones and protein.
Function of a Pinar stethoscope?
performing intermittent auscultation
When to do intermittent auscultation?
IA should be offered and recommended in labour in low risk pregnancies using either a doppler ultrasound or Pinard stethoscope to monitor fetal wellbeing.
How often do we do intermittent auscultation in labor ward?
- In first stage of labour IA should occur at least every 15 minutes, after a contraction, and for a minimum of 60 seconds.
- In second stage of labour IA should occur every 5 minutes, after a contraction, and for a minimum of 60 seconds
What to do when you detect a fetal heart anomaly with a pinard stethoscope?
If a fetal heart rate abnormality is suspected, maternal pulse should be palpated simultaneously with the fetal heart to differentiate between the two heart rates.
Advantages of pinard stethoscope?
- Easy to use
- Cheap
- Non invasive
- Allows mother to ambulate
Disadvantages of pinard stethoscope?
- Cannot give FHR pattern over time when medically indicated.
- Requires a midwife to be physically present to listen to FHR.
Advantages of Moyo FHR monitor?
- Easy to use and can detect FHR within a few seconds.
- Portable and lightweight, and allows the woman to ambulate
- Prolonged monitoring of FHR
- Affordable compared to CTG and can be used in low-resource settings.
- Can measure maternal heart rate for easy comparison
- Gives a visible and audible alarm for the health worker and/or mother whenfetal heart rateis abnormal.
Disadvantages of Moyo FHR monitor?
requires electricity
What is cardiotochography?
The measurement of fetal heartbeat (including baseline heart rate, accelerations, and decelerations) and uterine contractions (including frequency, intensity, and duration) with a cardiotocograph
When to do CTG?
Continuous CTG monitoring should be considered in all situations where there is a high risk of fetal hypoxia/acidosis.
Position of mother in CTG?
Maternal lateral recumbent, half sitting and upright positions are favorable for CTG acquisition as maternal supine recumbent position results in aortocaval compression by the pregnant uterus causing placental hypoperfusion and inadequate fetal oxygenation.
Maternal risk factors that prompt electronic fetal monitoring?
Previous CS.
Cardiac problems
Pre-eclampsia
Diabetes
Post-term pregnancy (>42 weeks).
Prolonged rupture of membranes (>24hours).
Induction of labour
Antepartum haemorrhage.
Other significant maternal medical conditions.
Fetal risk factors that prompt electronic fetal monitoring?
IUGR
Prematurity.
Oligohydramnios
Abnormal doppler velocimetry
Multiple pregnancy.
Meconium stained liquor
Breech presentation
Intrapartum risks requiring EFM?
Oxytocin augmentation
Prolonged labour
Abnormal FHR on IA.
Fresh meconium staining of liquor.
Pyrexia >37.5oC.
Intrapartum vaginal bleeding
Epidural analgesia.
Analysing CTG?
DR C BRAVADO
DR - Define risk
C - Contractions
BRA - Baseline Rate
V - Variability
A - Accelerations
D - Decelerations
O - Overall
CTG classification can be categorised as?
- Normal
- Suspicious
- Pathological
Normal CTG?
baseline - 110-160 bpm
variability - 5-25 bpm
decelerations - no repetitive decelerations
interpretation - no hypoxia/acidosis
Suspicious CTG?
lacking at least one of the normal characteristics but with no pathological features
interpretation - low probability of hypoxia/acidosis
Pathological CTG?
baseline < 100 bpm
variability - reduced/increased variability, sinusoidal pattern
decelerations - repetitive late prolonged decelerations for >30 min, one deceleration >5min
