Overall Assessment
- Category 1 – no risk
- Category II – intermediate risk (Most problamatic)
- Category III – HIGH RISK (rapid C/S or immediate vaginal delivery)
Category I
7 m
:Include all of the following
- Baseline rate:110–160 beats/minute-
- Baseline FHR variability: moderate
- Late or variable decelerations: absent
- Early decelerations: present or absent-
- Accelerations: present or absent -
Nonreactive and reactive is cat 1 without stimulation
Category II
FHR tracings include any of the following: Tachycardia
- Baseline FHR with Absent or minimal or marked variability
- Absence induced Accelerations after fetal stimulation
- Recurrent (late or variable) decelerations with moderate variability
After stimulation no reaction is not reassuring and is
cat 2
Category III
Category III FHR tracings include either Absent baseline FHR variability and :any of the following
- Recurrent late decelerations
- Recurrent variable decelerations
- Bradycardia
- Sinusoidal pattern
Management
CTG is Normal/Reassuring/Category 1
- Healthy fetus -
- Continue CTG and normal care ---
Non-Reassuring/Category 2
10 s Think about possible underlying causes.
If the baseline fetal heart rate is over 160 beats/minute, check the woman’s temperature and pulse. If either are raised, offer fluids and paracetamol.
Noninvasive Management
- A left-lateral position, rule out cord prolapse
- Give O2 to mother
- Offer oral or intravenous fluids
- Discontinue oxytocin until the FHR and uterine activity become normal.
- Vibroacoustic stimulation (VAS) or fetal scalp stimulation (if reduce variability and or no acceleration)
- Tocolytic agents: Beta-adrenergic agonists (e.g., terbutaline, subcutaneously can be administered to decrease uterine activity in the presence of uterine tachysystole).
- Inform coordinating midwife and obstetrician.
Invasive Management
- Amniotomy: If the FHR cannot be monitored adequately externally, an amniotomy should be performed to place internal monitors.
- Fetal scalp electrode (FSE)
- contraindicated in cases of fetal coagulopathy or maternal infections such as HIV, active herpes simplex virus, and hepatitis (B or C).Z
Fetal Scalp Blood pH
(More accurate) Determination of fetal scalp blood pH can clarify the acid-base state of the fetus
- A pH value of 7.25 or higher is normal-
- A pH range of 7.20 to 7.24 is a borderline repeat in 30 minute
- A pH of <7.20 on two measurements 5 to 10-minutes apart may indicate sufficient fetal acidosis to warrant immediate delivery
Category 3 is Abnormal Indicates Need for Urgent Intervention - delivery
Case Studies
166. A 31-year-old woman at 39 weeks of gestation presents with chorioamnionitis in active labor
167. A 21-year-old woman at 31 weeks of gestation is brought to the hospital after a motor vehicle collision
168. A 39-year-old woman at 41 weeks of gestation is completely dilated and effaced and pushing with contractions
169. A 23-year-old woman at 33 weeks of gestation presents to triage with abdominal pain, vaginal bleeding, and a positive urine toxicology screen for cocaine
abruptio placentea
170. A 19-year-old woman at 42 weeks of gestation with limited prenatal care has meconium staining of the amniotic fluid and is in active labor
171. A 27-year-old woman at 38 weeks of gestation with preeclampsia with severe features is admitted for labor induction
Non-reactive
