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Shinelkimo
Joined: 25 Apr 2007
Posts: 55
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 Posted: Tue Jun 24, 2008 6:16 pm Post subject: Obstetric |
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A 34 year old primigravida presents in spontaneous labour at 39 weeks gestation. The cervix is 4cm dilated with thin meconium stained liquor. The CTG over 25 minutes shows a base-line fetal heart rate of 135bpm with variability of 3-4bpm, no accelerations and variable decelerations. There are 3-4 uterine contractions every 10 minutes. Fetal blood sampling/ No additional intervention at this stage ? (one q two answers)
I will go with fetal blood sampling, anybody with different answer? |
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himanshu
Joined: 28 Jan 2008
Posts: 11
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| Posted: Tue Jun 24, 2008 9:20 pm Post subject: |
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Definition of normal, suspicious and pathological FHR traces
Category Definition
Normal - All four features are classified as reassuring
Suspicious- One feature classified as non-reassuring and the remaining features classified as reassuring
Pathological -- Two or more features classified as non-reassuring or one or more classified as abnormal
according to new NICE guidelines
varialbility of <5 for 40-90 min is non reassuring feature and more than 90 min is a pathological feature
variable decelerations are now divided into two groups typical and atypical [ for thier diffrences plz refer to NICE- intrapartum care]
typical variable deceleration upto 90 min is a nonreassuring feature and atypical variable decelerations upto 30 min is a pathological feature
so in either case when ur trace is only for 25 min, its difficlut to answer
so i will contimue trace for 5 more min and review
if atypical variables present then u need FBS or delivery
if typical variables present then u will need to continue trace for another 60 min unless something more interesting happens
as NICE does not say a word about management of a suspicious trace
hope this helps |
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Xerxes I
Century Club
Joined: 01 Mar 2007
Posts: 227
Location: Winchester
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| Posted: Tue Aug 12, 2008 6:44 pm Post subject: |
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| I agree, I would go for no additional intervention, although I would have liked it to say, reassess in 20 minuted or something. |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1838
Location: Nottingham
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| Posted: Wed Aug 13, 2008 8:07 am Post subject: Re: Obstetric |
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| Shinelkimo wrote: | | A 34 year old primigravida presents in spontaneous labour at 39 weeks gestation. The cervix is 4cm dilated with thin meconium stained liquor. The CTG over 25 minutes shows a base-line fetal heart rate of 135bpm with variability of 3-4bpm, no accelerations and variable decelerations. There are 3-4 uterine contractions every 10 minutes. Fetal blood sampling/ No additional intervention at this stage ? (one q two answers) |
I agree with the guys here. 25 minutes is the key word / phrase.
There are two non-reassuring feature - the variability and the variables - but you have not given us enough information to make a decision here. The new NICE Guidelines clearly state these features need to be present for either 90 minutes if the variables are typical or 40 minutes if they are atypical. In the absence of the nature of the variables we cannot answer this question.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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