Obstetrics: Monitoring of fetal wellbeing

Dr. Najma | Lecture 15

2012

Monitoring of fetal wellbeing

Examination should be made for risk factors:
There are many conditions like DM, hypertension, intrauterine growth
restriction, pervious poor outcome, bleeding during pregnancy,..etc
Examination may reveal risk factors; in particular, breech presentation,
small for date, large baby, twin pregnancy, etc
In many hospitals, CTG will be recommended. When history, examination,
and admission CTG are found to be reassuring, then the mother can be
mobilized for the next few hours. In this time, intermittent auscultation of
the fetal heart rate is undertaken with a fetal stethoscope. This can be
done in an interval of 15-30 minutes, should any abnormality is heard then
further electronic monitoring is undertaken.
The appearance of meconium staining of amniotic fluid is an important
sign. In most cases, this is an older meconium passed physiologically
because of the maturity of the fetus. In other occasions, it indicates that
the fetus is compromised.
The appearance of meconium is an indication for electronic fetal
monitoring; the confirmation of fetal condition comes from clinical and
electronic assessment.
The healthy fetus is able to withstand the distress of labour, head
compression, umbilical cord compression, and reduced placental blood
flow. He will respond to stress but occasionally there will be distress; in
normal response to distress, the fetal heart rate is increased.
The use of electronic fetal monitoring was introduced in 1970. Education
and training is crucial for proper use of these instruments. They can be
used with adjuvant tests such as fetal scalp pH measurement.
There is little doubt that babies lives is safe with the use of electronic
devices since they have been linked with increased rate of C/S. The fetus is
assessed in labour for any evidence of growth restriction. The color,
The SPIKINGS | Page | 1

Obstetrics: Monitoring of fetal wellbeing

Dr. Najma | Lecture 15

2012

consistence, and amount of amniotic fluid are also used to assess the
fetus. These are the most important as sometimes artificial rupture of the
membranes is recommended.
All high risk factors are monitored electronically using external monitoring.
Intrapartum risk factors include: Oligohydramnios, meconium staining,
labour more than 8 hours, the use of epidural anesthesia, and oxytocininduced labour.
CTG is recorded on a paper strip that is carried out by either an external
abdominal transducer or fetal scalp attachment that is inserted through the
vagina. Uterine contractions are also recorded on the same paper strip
using either external or internal monitors. CTG interpretation requires
training.
Normally when there are uterine contractions, there is acceleration of the
fetal heart rate. But if there is deceleration, it indicates fetal distress.
There are four components for interpreting CTG:
1. Baseline rate: This is the average fetal heart rate between
acceleration and deceleration. Normal value is 110 150 bpm
2. Baseline variability: This is the variation in the baseline rate over 1
minute excluding acceleration and deceleration. Normal value is 10
25 bpm.
3. Acceleration (activity): The presence or absence of acceleration. This
is increased fetal heart rate from the baseline. Acceleration must
have amplitude of 15 bpm for at least 15 seconds. The normal value
is at least 2 accelerations for 15 minutes
4. Deceleration: This is slowing of the fetal heart rate from the baseline.
This is significant when there are at least 15 bpm for at least 15
seconds. Each deceleration should be described in terms of
amplitude.
A. Amplitude is the difference between the baseline heat rate and the
lowest fetal heart rate in bpm
B. Duration of deceleration is the length of deceleration in seconds.
C. The shape of deceleration whether it is V shaped or U shaped. The
prognosis in V shape is better than in U shape
The SPIKINGS | Page | 2

Obstetrics: Monitoring of fetal wellbeing

Dr. Najma | Lecture 15

2012

D. Lag time of deceleration in relation to the peak of uterine

contractions.
If deceleration occurs at the beginning of the contraction, this is called
early deceleration. If it occurs at the end, it is called late deceleration. It it
occurs without relation to contractions, it is called variable deceleration.
The most significant are the late and variable deceleration. The late one
indicates placental insufficiency while the variable one indicates cord
compression (The cord is around the head; during contraction, the cord is
compressed between the head and the chest wall. In this case we see
variable deceleration in CTG). Deceleration appears with contraction and
with short lag time, early deceleration and V shape are less significant and
occasionally indicate full progress

You can find the lectures with the PowerPoint slides at Students FOR Humanity
Website:
Fourth.www.students4h.net Facebook.com/students4h

THE SPIKINGS: MLJ Ali Safaa ASA Muhammad Hikmat MH

Ali Maher AM Ali Abduljasim ABJ

The SPIKINGS | Page | 3