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what are maternal indications for recommending continuous CTG monitoring?
- 1. previous CS
- 2. PET
- 3. DM
- 4. APH
- 5. other maternal medical disease
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what are fettle indications for recommending continuous CTG monitoring?
- 1. IUGR
- 2. prematurity
- 3. oligohydramnios
- 4. abnormal doppler artery studies
- 5. multiple pregnancy
- 6. breech presentation
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what are intrapartum indications for recommending continuous CTG monitoring?
- 1. meconium stained liquor
- 2. vaginal bleeding in labour
- 3. use of oxytocin
- 4. epidural analgesia
- 5. maternal pyrexia
- 6. post term pregnancy
- 7. prolonged ROM > 24 hours
- 8. induced labour
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what should the normal baseline FHR be?
110-160 bpm
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how is the baseline of a preterm different to term baby?
higher
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what is fetal tachycardia associated with?
- fever
- fetal infection
- fettle hypoxia - if in conjunction with other abnormalities
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what does a steep sustained deterioration in FHR suggest?
acute fettle distress
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what is normal variability in FHR?
> 5 bpm
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what are exceptions to variability and how long do they last?
- fettle sleep
- less than 45 minutes
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what does prolonged reduced variability, particularly with other abnormal features suggest?
hypoxia
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what constitutes as an acceleration of FHR and what does it show with contractions show?
- increase in FHR from baseline by >15bpm and lasting 15s or more
- reassuring
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what is a deceleration defined as?
- drop in FHR by > 15bpm from baseline
- lasting > 15 seconds
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what is an early deceleration ? what does it it indicate?
- synchronous with a contraction as a normal response to head compression
- so usually benign
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what is an late deceleration ? what does it it indicate?
- FHR begins to fall during the contraction and its trough is > 20seconds after the peak of the contraction, returns to baseline after the contraction
- suggests fettle hypoxia
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what is a variable deceleration?
when the timing of the slowing of the FHR in relation to the contraction VARIES and can occur in isolation
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what does variable deceleration classically reflect?
- cord compression
- which can ultimately cause hypoxia
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if you suspect hypoxia eg due to late decelerations, what should be done to confirm it?
fettle blood sample: scalp pH
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what is a sinusoidal pattern on CTG?
- regular OSCILLATION of the baseline,
- with ABSENT variability
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how long does sinusoidal pattern last?
- at least 10 minutes
- amplitude: 5-15bpm above and below the baseline
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what is a normal CTG?
- baseline normal
- variability are normal
- there are accelerations
- no decelerations
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what is a SUSPICIOUS CTG?
- one feature is non-reassuring, the others are reassuring
- eg baseline to high or low
- variability too little or for too little time
- decals present: early or variable (not late as that is abnormal)
- no accels
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what is a PATHOLOGICAL CTG?
- 2 or more features are non-reassuring
- or more than one is abnormal
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what is the mean principle of monitoring during labour?
detect fettle hypoxia, so prevent acidosis and cell damage
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what are causes of acute fettle hypoxia - 4
- 1. uterine HYPERSTIMULATION
- 2. placental ABRUPTION
- 3. cord COMPRESSION
- 4. sudden maternal HYPOTENSION eg insertion of regional anaesthesia
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what thing during pregnancy is a risk factor for hypoxia during labour?
chronic uteroplacental insufficiency eg due to PET
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apart from FHR, what is CTG useful for?
FREQUENCY of maternal uterine contractions
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why is strength and length of each contraction not checked by CTG?
- depends on positioning of monitor on maternal abdomen
- thickness of maternal abdominal wall
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what effect can epidural analgesia have on fetes?
fettle bradycardia due to maternal hypotension and less blood flow to uterus
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if CTG is found to be pathological, what should the next Ix be?
fettle blood sampling
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if FBS is abnormal, what is main aim?
to delivery
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name 3 contraindicaitons to FBS
- 1. maternal HIV, Hep B, Herpes simplex
- 2. fetal bleeding disorder: haemophilia or thrombocytopenia
- 3. prematurity < 34 weeks
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