This document discusses intrapartum fetal assessment using cardiotocography (CTG). CTG is used to monitor the fetal heart rate and uterine contractions during labor. CTG readings are classified as reassuring, non-reassuring, or pathological based on criteria for the baseline heart rate, variability, and presence of decelerations or accelerations. Fetal blood sampling may be used when CTG readings are non-reassuring or pathological to determine the fetal blood pH level and guide management. Interpretation of fetal blood sampling results along with the CTG pattern can indicate the risk level for fetal acidosis. Potential complications of fetal blood sampling include scalp hemorrhage and infection.
This document discusses intrapartum fetal assessment using cardiotocography (CTG). CTG is used to monitor the fetal heart rate and uterine contractions during labor. CTG readings are classified as reassuring, non-reassuring, or pathological based on criteria for the baseline heart rate, variability, and presence of decelerations or accelerations. Fetal blood sampling may be used when CTG readings are non-reassuring or pathological to determine the fetal blood pH level and guide management. Interpretation of fetal blood sampling results along with the CTG pattern can indicate the risk level for fetal acidosis. Potential complications of fetal blood sampling include scalp hemorrhage and infection.
This document discusses intrapartum fetal assessment using cardiotocography (CTG). CTG is used to monitor the fetal heart rate and uterine contractions during labor. CTG readings are classified as reassuring, non-reassuring, or pathological based on criteria for the baseline heart rate, variability, and presence of decelerations or accelerations. Fetal blood sampling may be used when CTG readings are non-reassuring or pathological to determine the fetal blood pH level and guide management. Interpretation of fetal blood sampling results along with the CTG pattern can indicate the risk level for fetal acidosis. Potential complications of fetal blood sampling include scalp hemorrhage and infection.
Nur Insyirah bt Abdullah CTG Indication Mother Medical iatrogenic others Fetus IUGR Meconium Multiple pregnancy Breech presentation labour augmentation Epidural Vaginal bleeding Fever Classification Baseline heart rate Heart rate variability Deceleration acceleration Reassuring 110-160 >5 Absent present Non reassuring 100-109/161 180 <5 for 40-90 mins Early/variable/s ingle prolonged <3mins Absence in presence of other findings abnormal <100/>180/sin usoid (S- shaped) >10 minutes <5 for >90mins Late/atypical variable/single prolonged >3mins As above -a normal CTG means that all four categories are normal. -Suspicious CTGs have 1 non- reassuring feature. -pathological is anything else i.e. >1 non- reassuring/1 or >1 abnormal. 1 non reassuring feature Inadequate quality Uterine hypercontractility Maternal Tachycardia/Pyrexia Other relevant maternal adverse factor Suspicious CTG If the CTG trace is of inadequate quality: Check contact and connections of external transducer. Check contact and connections of fetal scalp electrode (FSE), if being used. Check maternal pulse and ensure not recording this in error. Consider use of FSE if not currently being used
If there is evidence of uterine hypercontractility Consider discontinuation of oxytocin, if being used. Check whether vaginal prostaglandins have been utilised. Consider use of terbutaline or other tocolytic agents.
If there is maternal tachycardia/pyrexia Consider screening investigations and empirical treatment for infection. Consider treatment for maternal dehydration. Consider the effect of tocolytics and discontinuing them if this may be causing the tachycardia. Check maternal blood pressure (BP) and consider 500 ml infusion of crystalloid if indicated.
If there are other relevant maternal adverse factors: Check maternal position and, if supine, then move into left lateral position. Consider effect of recent vaginal examination. Consider effect of recent bedpan use. Consider effect of recent vomiting or vasovagal episode. Consider effect of recent siting or topping-up of epidural analgesia infusion. Check BP and, if low, give 500 ml infusion of crystalloid if there are no contra-indications to this.
Pathological CTG If fetal blood sampling is indicated/feasible: Encourage the mother to use the left lateral position and check BP, giving 500 ml crystalloid if appropriate. Proceed to fetal blood sampling with maternal consent. Decide further course on the basis of fetal blood sampling results
If fetal blood sampling is not indicated or not feasible: Use left lateral position and BP check with crystalloid infusion as above. Expedite delivery according to anaesthetic, paediatric and experienced obstetric opinion. Speed of delivery should take into account the severity of FHR abnormalities and relevant maternal factors. The current accepted standard is that expedited delivery should occur within 30 minutes. The evidence base for this recommendation, and its real-world practicality, have been questioned. Most practitioners advocate that quick, safe delivery is more important than rapid delivery.
Fetal Blood Sampling Diagnostic test for fetal acidosis Used to measure Blood pH and base excess
indication Prolonged and persistent early decelerations Persistent late/ variable decelerations on CTG Significant meconium stained liquor (Grade 2/3) along with CTG abnormality Persistent fetal tachycardia Prolonged loss of baseline variability contraindication Fetal bleeding disorder Vertical transmission of maternal infection Severe fetal or maternal distress
Ph results following fetal FBS pH Interpretation Management >7.25 Normal No treatment 7.20-7.25 Borderline Repeat in 30-60 minutes if not delivery <7.25 Abnormal Deliver by forceps,ventouse or ceasarian section as appropriate Base Excess Interpretation <-6mEq/L Normal -6.1 to -7.9 mEq/L Borderline >-7.9 mEq/L Metabolic acidosis Interpretation of results CTG (4 features) pH Risk percentage Normal <7.2 2% 1-2 abnormal <7.2 20% 2-4 abnormal <7.2 50% complication Fetal scalp hemorrhage infection