Intrapartum Monitoring

DR C BRaVADO

DR - Define Risk = Low/High

C - Contractions = Frequency (NR 4-5 every 10 mins)

BRa - Baseline Rate = Tachy/Bradycardia (NR 110-160 bpm)

• Tachycardia can be caused by Maternal pyrexia or stress, Drugs (atropine, tocolytics), Infection, Dehydration, Prematurity, Hypoxia

• Bradycardia can be caused by foetal hypoxia (cord compression, placental abruption), Drugs (benzos), Congenital heart disease, Foetal heart block

  • Bradycardia + Decreased variability = Complete Heart block

V - Variability = Degree to which baseline varies (NR 10-25 bpm)

• It represents the integrity of the Autonomic NS

• Reduced variability can be due to a

A - Accelerations = Rise in baseline by >15, lasting over 15 secs

• Normally a good sign

• Associated with foetal movements or stimulation

D - Decelerations = Drop in baseline by >15, lasting over 15 secs - It's important to ascertain if they're periodic (With contractions – Early/Late/Variable) or episodic (Anytime).

• Early deceleration - Head compression

• Late deceleration - Uterine contraction, Uteroplacental insufficiency (usually pathological and due to hypoxia)

• Variable deceleration - Cord compression → Gradually developing hypoxia

  • Vein constricted → Foetal hypotension + Tachycardia

  • Artery constricted → Foetal hypertension + Bradycardia

O - Overall impression = Is the CTG Reassuring, Non-reassuring or Abnormal?