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97 Cards in this Set
- Front
- Back
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What does FBS stand for? |
Fetal Blood Sampling |
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What is a normal FBS result? |
pH 7.25 or above |
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What is a borderline FBS result? |
pH 7.21-7.24 |
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What is an abnormal FBS result? |
pH 7.20 or less |
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What is needed to classify a CTG as normal? |
All 4 features to be reassuring |
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What is needed for a CTG to be classified as suspicious? |
1 non-reassuring feature |
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What is needed for a CTG to be classified as abnormal? |
2 or more non-reassuring features or 1 or more abnormal feature |
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Is a baseline rate of 110-160bpm reassuring, non-reassuring or abnormal? |
Reassuring |
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What does DR in DR C BRAVADO stand for? |
Determine risk |
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What does C in DR C BRAVADO stand for? |
Contractions |
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What does BRA in DR C BRAVADO stand for? |
Baseline Rate |
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What does V in DR C BRAVADO stand for? |
Variability |
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What does A in DR C BRAVADO stand for? |
Accelerations |
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What does D in DR C BRAVADO stand for? |
Decelerations |
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What does O in DR C BRAVADO stand for? |
Overall Impression |
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What must you do once you have decided if your CTG is normal/ non-reassuring/ abnormal? |
Make a plan e.g. left lateral, increase fluids, call midwife co-ordinator, obstetric review. |
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What is the definition of baseline rate? |
The level of FHR when it is stable, excluding accelerations and decelerations, determined over a period of time of 5-10mins, expressed as bpm |
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What is a reassuring baseline rate? |
110-160bpm |
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What is a non-reassuring baseline rate? |
100-109bpm or 161-180bpm |
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What is an abnormal baseline rate? |
<100bpm or >180bpm |
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Is a rise in baseline of 15bpm or more reassuring, non-reassuring or abnormal? |
Non-reassuring |
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State what is included in the CTG checklist (12) |
Reason for CTG, Date, Time, Gestation, Mother's name, DOB and hospital number, Maternal obs inc maternal pulse FH auscultated prior to CTG ?Date set correctly on CTG ?Time set correctly on CTG ?Paper speed set to 1cm/min |
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State what you would document at the end of the CTG trace (4) |
Mode of birth DOB Time of birth Signature |
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Are accelerations reassuring. non-reassuring, abnormal? |
Reassuring |
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Typical variable decelerations with >50% contractions and for > 90 mins. Is this reassuring. non-reassuring, abnormal? |
Non-reassuring |
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Baseline rate of 161-180bpm Is this reassuring. non-reassuring, abnormal? |
Non-reassuring |
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A single prolonged deceleration lasting >3mins Is this reassuring. non-reassuring, abnormal? |
Abnormal |
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A sinusoidal pattern lasting 10mins or more Is this reassuring. non-reassuring, abnormal? |
Abnormal |
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Baseline rate >180bpm Is this reassuring. non-reassuring, abnormal? |
Abnormal |
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Variability <5bpm for >90mins Is this reassuring. non-reassuring, abnormal? |
Abnormal |
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Atypical variable decelerations with >50% contractions for <30mins Is this reassuring. non-reassuring, abnormal? |
Non-reassuring |
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A baseline rate <100bpm Is this reassuring. non-reassuring, abnormal? |
Abnormal |
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No decelerations Is this reassuring. non-reassuring, abnormal? |
Reassuring |
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Baseline rate change of 15bpm or more Is this reassuring. non-reassuring, abnormal? |
Non-reassuring |
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A single prolonged decelerations lasting <3mins Is this reassuring. non-reassuring, abnormal? |
Non-reassuring |
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Late decelerations for >30mins Is this reassuring. non-reassuring, abnormal? |
Abnormal |
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Late decelerations for <30mins Is this reassuring. non-reassuring, abnormal? |
Non-reassuring |
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Variability <5bpm for <40mins Is this reassuring. non-reassuring, abnormal? |
Reassuriing |
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Variability >5bpm Is this reassuring. non-reassuring, abnormal? |
Reassuring |
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Typical variable decelerations with <50% of contractions Is this reassuring. non-reassuring, abnormal? |
Reassuring |
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Variability <5bpm for 40-90mins Is this reassuring. non-reassuring, abnormal? |
Non-reassuring |
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Atypical variable decelerations with >50% contractions and for >30mins Is this reassuring. non-reassuring, abnormal? |
Abnormal |
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What is the definition of baseline variability? |
The minor fluctuations in baseline FHR (fetal heart rate), occurring at 3-5 cycles/min |
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What is normal variability? |
5bpm or more between contractions or <5bpm for up to 40mins (according to WXH guidelines) |
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What is non-reassuring variability? |
<5bpm for 40-90 mins |
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What is abnormal variability? |
<5bpm for >90mins |
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What are accelerations? |
Accelerations are an upbrupt transient increase in FHR of 15bpm or more above the baseline, lasting for 15 secs or more |
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What does the absence of accelerations signify? |
The absence of accelerations is of uncertain significance and is therefore not classed as non-reassuring/ abnormal |
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What are decelerations? |
Decelerations are a transient slowing of the FHR below the baseline of 15bpm or more, lasting for 15secs or more |
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What are the 5 features of early decelerations? |
-uniform -repetitive -slowing of the FHR -onset early in the contraction (prior to the peak of the contraction/ midpoint of contraction the lowest point of the decel will coincide with the highest point of the contraction |
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What are early decelerations usually associated with i.e. what causes early decelerations? |
Usually associated with head compression |
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When do early decelerations occur? |
Usually late in the 1st stage of labour or during 2nd stage of labour |
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Are early decelerations associated with fetal hypoxia? |
No |
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What are the features of late decelerations (6) |
-uniform -repetitive -periodic slowing of the FHR -onset mid to end of contraction -lowest point |
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What should you do if there is poor contact from the external transducer? |
Check position of transducer or Consider applying FSE |
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What does FSE stand for? |
Fetal Scalp Electrode |
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What should you do if the FSE is not working? |
Check position of electrode and confirm FH with Pinard stethoscope and/or ultrasound (US) |
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What would you do if there was maternal tachycardia? |
Check HR manually Check temperature (?sepsis) |
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What does tachycardia mean? |
An increase in the heart rate |
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What does bradycardia mean? |
A decrease in the heart rate |
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What would you do is the mother had a temperature of 37.5degrees centigrade? |
Administer paracetamol 1g Re-check temperature in 2 hours |
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What would you do if the mother had 2 temperature readings of 37.5 degrees centigrade 2 hours apart? |
Consider sepsis screen and treatment (IVAbx) (Intravenous antibiotics) |
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What would you do if the mother was dehydrated? |
Check BP and Either encourage oral intake or give 500ml IV crystalloid (NaCl, normal saline) |
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If the mother's pulse was >140bpm and receiving a tocolytic what would you do? |
Reduce the infusion rate |
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What is uterine hypercontractility/ hyperstimulation? |
It is defined as as single contractions lasting 2 minutes or more, or five or more contractions in a 10 minute period |
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What is a tocolytic? |
A medication that can inhibit labour, slow down or stop the contractions of the uterus. Tocolytic agents are widely used today to treat premature labour and permit pregnancy to proceed so the fetus can gain in size and maturity before birth. |
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Give an example of a tocolytic drug, its strength and method of administration |
0.25mg terbutaline s/c |
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What would you encourage the mother to do if you heard the FHR decelerating? |
Ask her to adopt the left lateral position |
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What would you do if you heard the FHR decelerating? |
Increase IV fluids Ask mum to adopt left lateral position Check transducer position and readjust Inform MW co-ordinator if appropriate, i.e. if not recovering/ meets the suspicious/ abnormal classification of CTG |
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If expedition of birth is being considered what action is recommended prior to intervening? |
Taking a FBS |
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What does an FBS indicate i.e. what is its purpose? |
To indicate the presence and extent of fetal hypoxia and acidosis |
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What are the contraindications of FBS? (4) |
-clear evidence of acute fetal compromise in labour which requires immediate action -maternal infection e.g. HIV, hepatitis, herpes simplex virus -fetal blood disorders e.g. haemophilia - prematurity (<34/40) |
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What position should the mother be in when undertaking FBS? |
Left lateral |
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Should FBS be undertaken if there is acute fetal compromise e.g. a prolonged deceleration lasting >3mins |
No, the baby should be delivered urgently, ideally within 30mins depending on the severity of the situation |
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What is a side effect of terbutaline that should be considered when preparing for a category 1 birth? (emergency caesarean section) |
The possibility of uterine atony post-birth |
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If the FBS result is pH 7.20 or less, what should you do? |
Seek consultant obstetric advice Expedite birth within 30 mins |
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What should you do if the FBS result is pH 7.21-7.24? |
This is a borderline FBS result -Repeat FBS within 30mins if the FHR remains pathological or sooner if there are further abnormalities -If a third sample is indicated advice should be sought from a consultant obstetrician |
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What are the side effects of terbutaline |
Uterine atony -Maternal tachycardia -Fetal tachycardia -Raised BP -Nausea -Nervousness -Dizziness |
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When using an oxytocin infusion, you may continue to increase the infusion as per hosiptal protocol until what number of contractions are achieved? |
4 to 5 contractions in 10 mins |
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What would you do if the mother had an IV oxytocin infusion running and was contracting more often than 5 times in 10 minutes? |
Reduce the IV infusion of oxytocin until a maximum rate of 5 contractions in 10mins was achieved |
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What should you do if the CTG was pathological and the mother had an IV oxytocin infusion in progress? |
Stop the IV oxytocin infusion and request that a full assessment of the fetal condition is undertaken by an experienced obstetrician |
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Give 5 situations in which the RCOG recommends paired cord blood samples should be taken |
When: -emergency caesarean section is performed -instrumental vaginal birth is performed -shoulder dystocia has occurred -FBS has been performed in labour - the bay's condition is poor at birth with an Apgar score of 6 or less at 5 minutes |
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From how many weeks gestation may you perform a CTG in the antenatal period? |
26 weeks |
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What is a normal FHR pattern indicative of? |
A healthy fetus with a properly functioning autonomic nervous system (ANS) |
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Are decelerations normal during the antenatal period? |
No. Decelerations are only normal in labour |
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What are variable decelerations? |
-Most common form of decelerations in labour -Variable in frequency and duration -intermittent slowing of the FHR -rapid onset and recovery -time relationships with contraction cycle are variable and the occur in isolation -sometimes they resemble other types of deceleration patterns in timing and shape - often caused by umbilical cord compression -can be typical/atypical |
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What are atypical variable decelerations? |
An autonomic nervous system (ANS) response to cord compression and are indicative of the fetus coping well in labour It may not be appropriate to wait 90mins (typical variable)/ 30mins (atypical variable) to refer for obstetric review if the CTG is showing typical atypical decelerations from the beginning of the trace. |
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Atypical variable decelerations |
Variable decelerations with any of the following components: -loss of primary or secondary rise in baseline rate (shouldering) -slow return to baseline FHR after the end of the contraction -prolonged secondary rise in baseline rate -biphasic deceleration -a loss of variability during deceleration -continuation of baseline rate at lower level -if atypical decels occur with >50% of contractions >30mins this is abnormal, therefore the CTG is pathological and further action is required. |
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What is a prolonged deceleration? |
An abrupt drop in FHR of 15bpm or more below the baseline that lasts for up to 120 secs |
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What should be done if fetal bradycardia occurs for more than 3 minutes? |
Plans should be made to expedite delivery using the most appropriate method e.g. instrumental/ emergency caesarean section |
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What is a category 1 CS (caesarean section)? |
1. Immediate threat to the life of the woman or fetus |
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What is a category 2 CS? |
2. maternal or fetal compromise which is not immediately life-threatening |
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What is a category 3 CS? |
3. no maternal or fetal compromise but needs early delivery |
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What is a category 4 CS? |
4. delivery timed to suit woman or staff |
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If the FHR recovers after a prolonged deceleration lasting up to 9 minutes should the decision for immediate delivery be reconsidered? |
Yes, if reasonable and in consultation with the woman |
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What is a sinusoidal pattern? |
-A regular oscillation of the baseline long term variability -Reasonably a sine wave -Undulating pattern -Lasting at least 10 mins Relatively fixed period of 3-5 cycles/ minute and an amplitude of 5-15bpm above and below the baseline -Baseline variability is absent -A true sinusoidal pattern is ABNORMAL and is associated with increased rates of fetal morbidity and mortality |
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What are contractions? |
The tightening and shortening of the uterine muscles during labour causing effacement and dilation of the cervix and contributing to the descent of the baby. |
