Cardiotocography SL

What is cardiotocography (CTG)?

CTG is a continuous electronic record of the fetal heart and uterine activity.

What are the Greek roots of the term 'cardiotocography'?

Kardia (heart), Tokos (childbirth/labor), Graph (to write or record).

What is the nurse's primary role in interpreting CTG?

The nurse or midwife is the primary 'interpreter' of the CTG.

What is a key patient education point regarding CTG?

Explain that the monitor records 'snapshots' of the baby's health and that 'normal' doesn't mean no movement.

What should nurses do to address parental anxiety during CTG monitoring?

Adjust the volume of the monitor and explain that temporary dips in heart rate can be normal.

What is the historical context of fetal monitoring before the 1960s?

Nurses used a Pinard horn or Fetoscope for intermittent auscultation.

Who is considered the 'Father' of CTG?

Edward Hon, who published research on fetal heart rate patterns in 1958.

What was the original goal of CTG?

To detect fetal hypoxia early enough to prevent cerebral palsy and stillbirth.

What does the fetal heart rate (FHR) reflect?

The FHR is a 'mirror' of the fetal brain's oxygenation.

What are the two methods of monitoring in CTG?

External (non-invasive) and Internal (invasive) methods.

What is the mechanism of the Ultrasound Transducer in external monitoring?

It uses the Doppler effect to emit high-frequency sound waves that bounce off the fetal heart valves.

How is the fetal heart rate regulated?

By the sympathetic (increases rate) and parasympathetic (decreases rate) nervous systems.

What happens to blood flow to the placenta during a contraction?

Blood flow is temporarily restricted, which a healthy fetus can handle.

What is the purpose of the Tocodynamometer?

It detects the tightening of the abdominal wall during a contraction.

What is the standard paper speed for CTG monitoring?

3 cm per minute, with each small square representing 10 seconds.

What should nurses do if the external trace is poor?

Consider internal monitoring for more accurate data.

What is the purpose of the Fetal Scalp Electrode (FSE)?

To record the actual R-R interval of the fetal ECG.

What are the contraindications for using internal monitoring?

Maternal infections (HIV, Hepatitis, active Herpes) or fetal bleeding disorders.

What does the mnemonic 'DR C BRAVADO' stand for?

Determine Risk, Contractions, and other assessment parameters for fetal monitoring.

What does 'C: Contractions' refer to in CTG monitoring?

Assessing uterine activity over a 10-minute window.

What is the advantage of using an Intrauterine Pressure Catheter (IUPC)?

It measures actual pressure in mmHg, allowing for the calculation of Montevideo Units (MVUs).

What is the significance of monitoring fetal heart rate patterns?

It helps in assessing fetal distress and overall well-being during labor.

What should be checked if the heart rate suddenly drops significantly?

Check the maternal pulse to differentiate between fetal and maternal signals.

What is the role of the nurse in troubleshooting CTG signals?

Follow a checklist to ensure proper placement and function of monitoring equipment.

What is the importance of clinical correlation in CTG interpretation?

Understanding the limitations of CTG helps in making informed clinical decisions.

What should be done if the conductive gel for internal monitoring has dried out?

Re-apply the conductive gel to ensure accurate readings.

What is the significance of assessing uterine activity in CTG?

It helps determine if labor is progressing adequately.

What are contraindications for intrauterine pressure catheter (IUPC) use?

Maternal infections (HIV, Hepatitis, active Herpes) or fetal bleeding disorders.

What conditions classify a pregnancy as high risk for IUPC?

Gestational diabetes, IUGR (Intrauterine Growth Restriction), post-term pregnancy, or thick meconium.

What conditions classify a pregnancy as low risk for IUPC?

Healthy, term pregnancy with no comorbidities.

What does IUPC measure?

Actual pressure in millimeters of mercury (mmHg) to assess uterine contractions.

What is the normal frequency of contractions in a 10-minute window?

3-5 contractions.

What is tachysystole?

More than 5 contractions in 10 minutes, which can prevent the placenta from re-oxygenating.

What is the baseline rate (BRA) in fetal monitoring?

The average heart rate observed over a 10-minute period, excluding accelerations or decelerations.

What are early decelerations in fetal heart rate monitoring?

Decelerations that mirror contractions, indicating fetal head compression; considered benign.

What is fetal tachycardia and its common causes?

A heart rate >160 bpm, often caused by maternal fever/infection, fetal hypoxia, or certain medications.

What is fetal bradycardia and its potential causes?

A heart rate <110 bpm, which can be caused by cord prolapse, maternal hypotension, or rapid fetal descent.

What does variability in fetal heart rate indicate?

It is the gold standard indicator of fetal well-being, reflecting the balance between sympathetic and parasympathetic systems.

What are variable decelerations and their significance?

Decelerations that vary in shape and depth; moderate (5-25 bpm) indicates good oxygenation, while absent is a clinical emergency.

What are accelerations in fetal heart rate?

An abrupt increase of at least 15 bpm above baseline lasting at least 15 seconds, indicating a reactive, healthy fetus.

What are late decelerations and their clinical significance?

Decelerations that begin after the peak of contractions, indicating uteroplacental insufficiency; considered pathological.

What is the nursing action for prolonged decelerations?

Immediate intrauterine resuscitation and notification of the obstetrician.

What does the acronym VEAL CHOP represent?

A summary for nurses to assess fetal heart rate patterns and their causes.

What is the nursing action for a flat fetal heart rate trace?

Try waking the baby by having the mother drink cold juice, changing her position, or using vibroacoustic stimulation.

What is the definition of prolonged decelerations?

A drop in FHR of >15 bpm lasting more than 2 minutes but less than 10 minutes.

What should be done if a patient is on a Pitocin drip and prolonged decelerations occur?

Stop the Pitocin immediately to allow the uterus to relax and restore blood flow.

What is the significance of absent variability in fetal heart rate?

It may indicate fetal distress and requires immediate evaluation.

What are the clinical implications of a flat fetal heart rate trace?

It may indicate fetal sleep cycles; however, if persistent, it requires further assessment.

What is the role of IV fluids during fetal distress?

Administering a rapid bolus increases maternal blood volume and helps correct hypotension.

What is the significance of a pulsating loop of cord felt during a vaginal exam?

It indicates cord prolapse, which is an emergency situation.

What is the clinical significance of fetal heart rate monitoring during labor?

It is often an obstetric emergency requiring immediate delivery if the heart rate does not recover.

What does the VEAL CHOP acronym stand for?

It is a summary table for nurses to assess fetal heart rate patterns.

What should be done if cord prolapse is detected?

It is an emergency; feeling a pulsating loop of cord requires immediate action.

What does the 'O' in VEAL CHOP represent?

Oxygen: Administer 8-10 L/min via a non-rebreather mask.

What is the purpose of notifying the provider during fetal monitoring?

To communicate clearly using SBAR (Situation, Background, Assessment, Recommendation).

What indicates uterine tachysystole?

More than 5 contractions in 10 minutes, indicating the fetus isn't getting enough rest.

What medication may be administered to manage uterine tachysystole?

Terbutaline, a tocolytic, may be ordered to stop the uterus and allow the baby to recover.

What is the goal of scalp stimulation during labor?

To reverse fetal hypoxia and buy time for the fetus while preparing for potential delivery.

What does the 'POISON' protocol help nurses remember?

The sequence of nursing actions during fetal monitoring.

What does a positive result in the POISON protocol indicate?

An acceleration in response to stimulation suggests the fetus is not acidotic.

What should be done if there is no response during fetal scalp stimulation?

It may indicate the fetus is already in a state of metabolic exhaustion.

What is the first step in initiating external cardiotocography?

Preparation and consent for the procedure.

Where should the Toco transducer be placed?

On the uterine fundus, the firmest part of the uterus during a contraction.

What should be done before placing the sensors for fetal monitoring?

Perform a quick palpation of the abdomen to identify the fundus and locate the fetal back.

What is the importance of verifying the patient's identity before monitoring?

To confirm the patient using two identifiers (Name and Date of Birth).

What position should the patient be in to avoid Supine Hypotension Syndrome?

A semi-fowler's position or slight lateral tilt.

What should be done if there is signal loss during monitoring?

Re-palpate and reposition the ultrasound transducer.

What is the purpose of zeroing the Toco?

To set the baseline pressure to a reference point when the uterus is relaxed.

What should the nurse document during fetal monitoring?

Mark the exact time of every intervention on the CTG trace or digital record.

What is the 'Three-Minute Rule' in fetal monitoring?

If a deceleration lasts more than 3 minutes, the crash team should be alerted.

What should be done if contractions aren't registering on the Toco?

Ensure the Toco is at the fundus and the belt is tight enough to maintain contact.

What is the recommended action if the fetal heart rate matches the maternal pulse?

Reposition the ultrasound transducer toward the fetal heart.

What is the purpose of drawing the curtains during the monitoring procedure?

To ensure privacy and comfort for the patient.

What should be done to ensure the CTG machine is functioning properly?

Check that it is plugged in, turned on, and that the paper is loaded correctly.

What is the significance of labeling the trace during monitoring?

To enter the patient's name and relevant details for accurate record-keeping.