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Scientific Basis of Midwifery > Foetal Monitoring > Flashcards

Flashcards in Foetal Monitoring Deck (56)
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What causes late decelerations?

- Placental insufficiency
- Hypoxia


What causes variable decelerations?

Cord compression


What causes prolonged decelerations?

- Hypoxia
- Tachysystole
- Hypotension
- Ruptured uterus
- Cord prolapse
- VE
- Spontaneous rupture of membranes
- FBS (foetal blood sampling)


What are decelerations caused by?

High BP or acidic blood


What are the 2 main baroreceptors?

Carotid sinus
Aortic arch


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


What are the 3 main chemoreceptors

Carotid body
Aortic arch


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


What are the 3 classifications of deceleration?

1. Reassuring
2. Non-reassuring
3. Abnormal


Describe a reassuring deceleration

-No decelerations
- Variable decelerations with no CC for <90 mins


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


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


What does CC stand for?

Concerning characteristics


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)


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


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


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


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


What should be done if CTG remains pathological after implementing conservative measures?

- Further review by obstetrician
- Offer digital foetal scalp stimulation and document outcome


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


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


Give 2 examples of underlying causes



Give 3 examples of acute events

Cord prolapse
Placental abruption
Uterine rupture


Give 4 examples of conservative measures

Reduce/stop oxytocic
Change position
Offer tocolytic drugs (e.g. terbutaline 0.25mg)


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


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