Monitoring Complex Labour Flashcards by Gabby Quarcoo

What can cause a complex labour think? MOTHERS

Meconium 
Oxytocin 
Temperature 
Hyperstimulation/Haemorrhage
Epidural 
Rate of progress
Scar

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100-109 beats as baseline is considered as…

non-reassuring (continue usual care if variability is normal and there are no variable or late decelerations)

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160-180 beats as baseline is considered as…

NO OTHER NON- REASSURING features and no maternal tachycardia or pyrexia – continue (uncomplicated tachycardia)

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<100 beats or >180 as a baseline is considered as …

abnormal

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How can the sympathetic system have an influence on the baseline rate.

Increase in heart rate through direct nerve impulses and indirectly through catecholamine release

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How can the parasympathetic system have an influence on the baseline rate.

decrease heart rate through the release of acetylcholine

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5-25 beats in variability is considered as…

normal

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5 beats for >30mins but < 50mins

non-reassuring

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5 beats for >50mins

abnormal

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25 beats

(salutatory)

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25 beats ) for >15mins but <25mins

non-reassuring

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Name 3 associated factors that could influence the variability of a CTG

Fetal sleep – cycling indicative of an intact CNS
Maternal opiates 
Fetal hypoxia
Pre-existing fetal brain damage 
Cardiac arrhythmia

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What is suspected with reduced variability in conjunction with tachycardia and decelerations?

high suspicion of fetal hypoxia

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Name the basic characteristics of sinusoidal traces

Stable baseline of 120-160bpm with regular sine-wave oscillations
Amplitude of 5-15bpm
Frequency of 2-5 cycles/minute
Reduced or absent baseline variability
No accelerations

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What can a Smooth or typical – rounded, symmetric in shape in trace indicate?

fetal thumb sucking,
some narcotics,
fetal anaemia secondary to rhesus isoimmunization

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What can a Jagged or atypical – saw-tooth trace indicate?

fetal hypoxia and acidosis, sudden loss of fetal blood volume – fetomaternal haemorrhage

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What are Accelerations?

An Increase of at least 15 beats for at least 15 seconds

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When is Accelerations more frequent?

Occurs most frequently during fetal activity
–Generally a sign the baby is healthy
–Absence in an otherwise normal CTG is not indicative of acidosis

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What are Decelerations?

Drop in the FHR of at least 15beats for at least 15 seconds

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What are the two types of deceleration?

reflex and effect of hypoxia on myocardium

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Reflex – low levels of O2 as a result of…

placental bed perfusion impairment – compression of uterine vessels
•Head compression
•Cord compression which increases stimulation of vagus nerve (parasympathetic nervous system),

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what is the effect of hypoxia on heart?

Severe or prolonged shortage of O2 may affect myocardium which ceases to contract efficiently and the FHR falls

Name 4 characteristics of early decelerations

-Uniform
–Repetitive
–Starts at beginning of contraction and returns to baseline by the end of the contraction
–Nadir of deceleration corresponds to peak of contraction
– head compression(Relatively rare – only in late 1st and 2nd stage of labour)

Name the characteristics of Variable decelerations.

-Vary in shape, form and timing
–Most common >85%
–Classified as concerning and un-concerning

Name the characteristics of un-concerning variable decelerations

last <60 sec & <60 bpm | have shoulders

Name the characteristics of concerning variable decelerations

Lasts >60 sec, decreased variability within deceleration •Failure to return to baseline, biphasic •No shouldering

What is considered as a reassuring variable decelerations ?

Variable decelerations with no concerning characteristics for <90mins

What is considered as a Non-reassuring variable decelerations ?

Variable decelerations with no concerning characteristics for >90mins Variable decelerations with concerning characteristics with <50% contractions for >30mins Variable decelerations with concerning characteristics with >50% contractions <30mins

What is considered as a Abnormal variable decelerations ?

Variable decelerations with concerning characteristics with >50% contractions for >30mins (less if maternal or fetal risk factors – vaginal bleeding or significant meconium)

Name four characteristics late decelerations

Occurs mid to late in contraction Nadir at least 20 seconds after peak of contraction Return to baseline after contraction ceased Similar shape to contraction Related to hypoxaemia, hypercarbia and acidosis Placental insufficiency

What is considered as Non-reassuring late deceleration?

With >50% contractions and <30mins (no maternal or fetal risk factors – mec or bleeding)

What is considered as Abnormal late deceleration?

With >50% contractions and >30mins

How long does a Prolonged decelerations or acute hypoxia last for?

lasts at least 3mins

Name the 4 types of ways to manage a prolonged deceleration

Exclude placental abruption, uterine rupture and cord prolapse May be secondary to uterine hyperstimulation or tonic contraction or hypotension Give IV fluids and stop oxytocin or give tocolytic

What is the Rule of 3s?

3mins – call for help 6mins – prepare for transfer to theatre 9mins – in theatre 12mins – have started LSCS

FUN FACT!!!

Always abnormal but action dependent on cause and assessment of CTG before and after incident

What is considered as a NORMAL DR C BraVADO ?

All features reassuring

What is considered as a SUSPICIOUS DR C BraVADO ?

1 feature non-reassuring and 2 features reassuring*

What is considered as a PATHOLOGICAL DR C BraVADO ?

1 feature pathological OR 2 features non- reassuring*

What are 8C’s of physiological approach to CTG interpretation?

``` Clinical picture Cumulative uterine activity Cycling of FHR Central organ oxygenation Catecholamine surge Chemo- or baroreceptor mediated decelerations Cascade Consider the next change on the CTG trace ```

What is subacute hypoxia?

Defined as when the HR spends more time decelerating than at the baseline Iatrogenic cause = uterine hyperstimulation

What are the steps to a evolving hypoxia ?

``` Normal CTG decelerations loss of accelerations catecholamines released raising baseline reduced variability baseline instability terminal bradycardia fetal demise ```

what does Acidaemia mean?

low blood pH

what does Acidosis mean?

low blood and tissue pH

What does Base Excess/Deficit mean?

measure of how much buffer has been used

What does Hypoxia?

low O2 levels in tissues

What does Hypoxaemia mean?

low O2 tension in blood (low pO2)

What does Metabolic acidosis mean?

low blood pH and high base excess due to the accumulation of CO2 and H+ ions using up buffers

What does Respiratory acideamia mean?

low blood pH due to the accumulation of CO2

What does Low pH and a normal BE cause?

respiratory acidaemia (accumulation of CO2 through impaired gas exchange)

What does Low pH and an abnormal BE cause

combined respiratory and metabolic acidaemia (accumulation of CO2 through impaired gas exchange and the build up lactate and H+ ions through anaerobic metabolism)

what does it mean If there is a large arterial – venous difference in pH?

acidaemia is likely to have occurred in the 2nd stage or if LSCS before full dilation an acute event or cord compression

what does it mean If there is a small arterial – venous difference in pH?

acidaemia is likely to be longstanding