Sonicaid Labour CTG guidelines

Labour CTG guidelines Using the CTG

Assess risk Maternal problems • Hypertension • Diabetes • Collagen disease • Renal disease

Fetal problems

Labour abnormalities

• Pre / post-maturity • IUGR / placental insufficiency • Twins / triplets • Breech presentation • Rhesus disease

• Induced/augmented/

Suspected fetal distress in labour

prolonged labour • Prolonged membrane rupture • Previous Caesarean section • Epidural

• Meconium staining • Suspicious FHR on auscultation or admission CTG • Vaginal bleeding • Intrauterine infection

Low risk

Intermittent auscultation or external ultrasound monitoring only

High risk

Continuous monitoring - use fetal scalp electrode only if good trace not possible with ultrasound

FM800Encore Fetal Monitor

• Check monitor : undamaged, sufficient paper, date/time correct? • Correct and sufficient gel used with ultrasound transducer • Palpate - position U/S transducer over fetal left scapula • Adjust position for clear fetal heart sounds - slapping valve sounds not swishing cord / placental sounds

• Re-assess regularly - risk level may change at any time. • Abnormal CTGs may reflect maternal problems, not fetal (eg. maternal pyrexia) • FETAL MONITORING HAS HIGH -VE PREDICTIVE VALUE BUT LOW +VE PREDICTIVE VALUE If trace normal reactive, chance of acidosis very low1. If trace abnormal, fetus not necessarily compromised.

Check maternal rate is different from rate displayed by monitor - can be confirmed with intermittent auscultation - check & document regularly

ACCELERATIONS ARE AN INDICATOR OF FETAL WELLBEING

Normal

Early deceleration

• FIGO guidelines for normal labour CTG2 • Baseline rate at term: 110-150bpm (120-160 in early 3rd trimester) • Variability : ±5 to ±25bpm • Presence of accelerations: ↑15+bpm lasting 15s+ • Absence of decelerations: See below (↓20bpm lasting 30s+)

• Deceleration coincident with contraction • Normal autonomic response to head compression in most cases • If baseline and variability normal with rapid return to baseline - fetus probably coping well with stress 5% incidence of acidaemia1

Continue routine management - < 2% risk of acidaemia with normal trace1

Variable deceleration

Late deceleration

• Cord compression • Shallow variable decelerations with reduced variability pathological - may be associated with hyperstimulation (oxytocin) • If baseline and variability normal with rapid return to baseline - less ominous

• • • •

Deceleration delayed relative to contraction Non-autonomic biochemical response to transient hypoxia Fetus may have limited reserves (?Placental insufficiency) If baseline and variability normal with rapid return to baseline - less ominous

25% incidence of acidaemia1

50% incidence of acidaemia1

DECELERATIONS INDICATE STRESS - NOT NECESSARILY PATHOLOGICAL - FETAL ABILITY TO COPE WITH STRESS INDICATED BY OTHER SIGNS (eg. time to return to baseline, baseline rate, variability & accelerations) Our thanks to Prof. D. K. James, Queen’s Medical Centre, Nottingham, UK for his assistance in preparing this

Sponsored by: sonicaid Obstetric Solutions References: 1 Steer P.J. and Daniellian P.J. ‘Fetal distress in Labor’ In: High Risk Pregnancy - Management Options (Eds: James D, Steer P, Weiner C and Gonik B) Publ: London, WB Saunders Ltd pp1077-1100 2 FIGO : Guidelines for the use of fetal monitoring. Int.J.Gynaecol.Obstet, 1987, 25 : 159-167. Disclaimer: The information contained in this poster is believed to be correct at the time of going to print based on current European guidelines. It is intended to be used as a guide only and does not cover all risk factors. It remains the responsibility of the clinician to manage each case in accordance with local guidelines and recommended clinical practice.

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