Midwives Training 2019 Hola

 Screening tool  predict fetal hypoxia  Analyse FHR changes during labour  Timely intervention  prevent HIE

 HIGH FALSE POSITIVE RATES ~ 60%  HIGH LITIGATION  INCREASE C/SECTION & AVD  NO EVIDENCE TO IMPROVE CP (CP UNRElATED TO INTRAPARTUM EVENTS)  Some evidence  reduction intrapartum death

AVOID ADVERSE FETAL OUTCOME RELATED TO HYPOXIA BUT EQUALLY IMPORTANT NOT TO INCREASE UNNECESARY OBSTETRIC INTERVENTIONS.

 DO NOT MAKE DECISIONS BASED ON CTG ALONE  INTERPRETATION  INDIVIDUALIZE EACH FETUS & ANALYZE CTG + CASE SCENARIO  NO CTG IN LOW RISK

 Intermittent vs continous monitoring  1 st stage  2 nd stage

 REGULAR UTERINE CONTRACTIONS  EPISODES OF TRANSIENT INTERRUPTION OF FETAL OXYGENATION  FHR changes  reflects cardiac & CNS responses  BP, BLD gases, acid/base status

HEALTHY  MATERNAL  FETAL  PLACENTAL UNIT

 ANS  SYMPATHETIC & PARASYMPATHETIC  INFLUENCED  GESTATIONAL AGE  HIGH  PRETERM

 DR  C  BRA  V  A  D  O

 ANTENATALLY  POINT IN TIME  ANTICIPATE INTRAPARTUM PROBLEMS

 bpm

 Postterm  Maternal hypothermia  Sympathetic drugs  Acute hypoxia  myocardium

 Maternal tachycardic  pyrexia/dehydration  Recent VE  Fetal arrhythmia  Chronic hypoxia

 Bandwidth variation baseline  MAINTAIN BALANCE SYM & PARA  Gives info  WELL OXYGENATED ANS (BRAIN)  NOMAL  UNLIKELY ASSOCIATED WITH CP  RELIABLY PREDICTS ABSENCE OF HYPOXIA

 FETAL SLEEP CYCLE  CONGENITAL ANOMALIES  ARRYTHMIA  MEDICATIONS  EXTREME PREMATURITY  HYPOXIA /ACIDOSIS

 15BPM > 15SEC  RESPONSE TO FETAL MOVEMENTS  SOMATIC NERVES  PRESENT  PREDICT ABSENT OF HYPOXIA  ABSENT  POOR PREDICTOR OF HYPOXIA

 15BPM * 15SEC  REFLEX RESPONSE TO HYPOXIA  TYPES  EARLY  LATE  VARIABLE  PROLONG

 HEAD COMPRESSION  AUTONOMIC RESPONSSE TO INTRACRANIAL PRESSURES/ CEREBRAL BLOOD FLOW  VAGAL STIMULATION

 RESPONSE TRANSIENT HYPOXIA  Degree of hypoxia  Reassuring features  NR features  prompt attention

 Uterine contractions  compress maternal vessles  red perfusion intervillous space of placenta  red oxygenated bld to IS  red diffusion of 02 into fetal capillary bld in chorionic villi  red fetal P02( 15-25mmhg UA)  CHEMORECEPTORS  sympathetic (peripheral vasoconstrition)  bld to brain/heart/adrenals  high BP (BARORECEPTORS)  Parasym  slows HR/red CO & return BP normal  After contraction  fetal oxygenation restored, autonomic reflexes subsides, FHR normal

 Cord compression  Compression vessle (vein)  hypovolemia/hypotentio  inc FHR  further compress artery  abrupt high BP (baroreceptors)  parasym(vagal)  red FHR  cord decompress  sequence reversed  Look out  non reassuring pattern

 > 15bpm  > 2min but less 10min  > 10min  change in baseline  Look  non reassuring features

FIGO CLASSIFICATION OF CTG

 FHR  bpm  Moderate FHR variability (6 to 25 bpm)  Absence of late or variable FHR decelerations  Early decelerations may or may not present  Accelerations may or may not present

 Absent variability with recurrent late decel  Absent variability with recurrent variable decel  Absent variability with brady  sinusoidal pattern

 Nonreactive FHR and absent variability  preexisting fetal neuological injury  Studies suggest damage to medulla oblongata/ midbrain

Improve oxygenation/perfusion  inutero resuscitation  Maternal reposition  Iv hydration  Oxygen  Reduce frequency uterine contractions  Scalp stimulation  Amnioinfusion

 Confirm correct monitor– FHR /toco  Classify  Catergory 1  low risk  routine surveillance  Catergory 2  intrauterine resuscitation  Catergory 3  prompt delivery