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Saltatory pattern with wide variability. The oscillations
of the fetal heart rate above and below the baseline
exceed 25 bpm
Fetal tachycardia with possible onset of decreased variability
(right) during the second stage of labor. Fetal heart rate is
170 to 180 bpm. Mild variable decelerations are present.
Fetal tachycardia that is due to fetal tachyarrhythmia associated
with congenital anomalies, in this case, ventricular septal defect.
Fetal heart rate is 180 bpm. Notice the "spike" pattern of the fetal
heart rate.
Early deceleration in a patient with an unremarkable course of
labor. Notice that the onset and the return of the deceleration
coincide with the start and the end of the contraction, giving
the characteristic mirror image.
Nonreassuring pattern of late decelerations with preserved
beat-to-beat variability. Note the onset at the peak of the
uterine contractions and the return to baseline after the
contraction has ended. The second uterine contraction is
associated with a shallow and subtle late deceleration.
Late deceleration with loss of variability. This is an ominous
pattern, and immediate delivery is indicated.
Variable deceleration with pre- and post-accelerations
("shoulders"). Fetal heart rate is 150 to 160 beats per
minute, and beat-to-beat variability is preserved
Severe variable deceleration with overshoot. However,
variability is preserved.
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Late deceleration related to bigeminal
contractions. Beat-to-beat variability is preserved.
Note the prolonged contraction pattern with
elevated uterine tone between the peaks of the
contractions, causing hyperstimulation and
uteroplacental insufficiency. Management should
include treatment of the uterine hyperstimulation.
This deceleration pattern also may be interpreted
as a variable deceleration with late return to the
baseline based on the early onset of the
deceleration in relation to the uterine contraction,
the presence of an acceleration before the
deceleration (the "shoulder") and the relatively
sharp descent of the deceleration. However, late
decelerations and variable decelerations with late
return have the same clinical significance and
represent nonreassuring patterns. This tracing
probably represents cord compression and
uteroplacental insufficiency.
Pseudosinusoidal pattern. Note the decreased
regularity and the preserved beat-to-beat variability
a true sinusoidal pattern
List 6 Causes of Severe Fetal Bradycardia
?
 Prolonged cord compression
 Cord prolapse
 Tetanic uterine contractions
 Paracervical block
 Epidural and spinal anesthesia
 Maternal seizures
 Rapid descent
 Vigorous vaginal examination
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list 6 Causes of Severe Fetal Bradycardia
?
 Prolonged cord compression
 Cord prolapse
 Tetanic uterine contractions
 Paracervical block
 Epidural and spinal anesthesia
 Maternal seizures
 Rapid descent
 Vigorous vaginal examination
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What is the Signs of Nonreassuring Variable
Decelerations that Indicate Hypoxemia ?
Increased severity of the deceleration
Late onset and gradual return phase
Loss of "shoulders" on FHR recording
A blunt acceleration or "overshoot" after
severe deceleration
Unexplained tachycardia
Saltatory variability
Late decelerations or late return to
baseline
Decreased variability
what is the Nonreassuring patterns in
the CTG?
 Fetal tachycardia
 Fetal bradycardia
 Saltatory variability
 Variable decelerations associated with a
nonreassuring pattern
 Late decelerations with preserved beat-to-beat
variability

what is the Ominous patterns of the
CTG?
 Persistent late decelerations with loss of beatto-beat variability
 Nonreassuring variable decelerations associated
with loss of beat-to-beat variability
 Prolonged severe bradycardia
 Sinusoidal pattern Confirmed loss of beat-tobeat variability not associated with fetal
quiescence
 medications or severe prematurity

Emergency Interventions for Nonreassuring Patterns
 Call for assistance
 Administer oxygen through a tight-fitting face mask
 Change maternal position (lateral or knee-chest)
 Administer fluid bolus (lactated Ringer's solution)
 Perform a vaginal examination and fetal scalp
stimulation When possible,
 determine and correct the cause of the pattern Consider
tocolysis (for uterine tetany or hyperstimulation)
 Discontinue oxytocin if used Consider amnioinfusion
(for variable decelerations)
 Determine whether operative intervention is warranted
and, if so, how urgently it is needed
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Causes of Fetal Tachycardia
Fetal hypoxia
Maternal fever
Hyperthyroidism Maternal or fetal
anemia Parasympatholytic drugs
Atropine
Hydroxyzine (Atarax)
Sympathomimetic drugs
Ritodrine (Yutopar)
Terbutaline (Bricanyl)
Chorioamnionitis
Fetal tachyarrhythmia
Prematurity
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This patient was induced with prostin E2 gel. One
hour after administration the cardiotocograph
(CTG) was recorded.
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1.What CTG abnormalities do you see?

Reduced baseline variability
Late deccelerations
Excessive uterine activity (approximately 7 in 10
minutes)
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2.What is the diagnosis?

Uterine hyperstimulation leading to fetal
comprimise
3.What is your management?
Move the patient onto her left side to reduce
the risk of aortocaval compression. Facial
oxygen may improve fetal oxygenation.
Use of an intravenous tocolytic agent will
reduce the uterine activity. Suitable drugs
include salbutamol or ritodrine, both of
which are beta-2 agonists.
The resulting CTG is shown below.
Q7
32 Y OLD PG who present at 38 week gestation with
reduce fetal movement
CTG done,show
1.What abnormality are shown in the
CTG?
 2.What will be the most likely plan of
management?
 3.further CTG show persistent of this
pattern what will you advice?
 4.if she went into labour ,what must
you do?
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1.What abnormality are shown in the
CTG?
1.Fetal tachycardia with possible onset
of decreased variability
2.What will be the most likely plan of
management?
Admit into the labour word with
continuous monitoring
3.further CTG show persistent of this
pattern what will you advice?
Delivery by CS if cervix un favorable
orARM if cervix favorable,and thin start
syntocinon
4.if she went into labour ,what must
you do?
Ensure that fetus monitored
continuously and perform a fetal blood
sample if this pattern persist
Q#1
39y old G3P2 admitted in active labour after 3hr
CTG show
1.Describe the CTG finding?
 2.what is the next action you will do?
 3.on examination cervix was fully dilated
head at +2 station with caput ++ CTG
persist the same.
how you are going to manage this patient?
4.What other indication for its use?
5. What 6 condition must be fulfilled before
the application of this instrument?
6.what 4 complication may arise from use
of this instrument?
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1.Describe the CTG finding?
 Late deceleration with loss of variability. This is
an ominous pattern, and immediate delivery is
indicated
 2.what is the next action you will do?
 Put the patient in lateral side ,give oxygen ,fast
iv drip ,and examine the patient to decide about
the mode of the delivery
 3.on examination cervix was fully dilated head
at +2 station with caput ++ CTG persist the
same.
how you are going to manage this patient?
Immediate delivery is indicated ,forceps delivery
is appropriate for this pt
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2Uterine artery Doppler
Q
Q3
Q4
Q5
Q6
Q7
Q8
Q9
Q10
Q11
2.Uterine artery Doppler is a promising technique
for assessment of the level of risk of preeclampsia and IUGR. Doppler ultrasound
provides a non-invasive method of assessing
the utero-placental circulationIn normal
pregnancy , impedance to flow in the uterine
artery decreases with gestation and this
presumably reflects the trophablastic invasion
of the spiral ateries and their change into low
resistance vesselsThe uterine artery is a
branch of the internal iliac artery close to the
bifurcation of the common iliac. Colour flow
Doppler is the method of choice for accurate
screening of uterine artery waveforms.
The resistance index (RI) is the most commonly used
index to measure the uterine artery flow as it is
unlikely to have absent or reverse end
Diastolic (EDF) flow. Although the pulsatility index (PI)
can also be used
3.High resistance waveforms in the uterine artery with
early diastolic notching in the second trimester are
asssociated with the later development of preeclampsia, IUGR, placental abruption and intrauterine death.
4. notches of the uterine artery waveform with a high RI,
hold the most risk of complicated pregnancies,
although it is still to be established wether the notch
or the high RI is the best indicator of poor outcome
5. Systole (Sys) and diastole (D) are identified in green
Note that diastole is less at 20 weeks (yellow ellipse)
than at 36 weeks (red ellipse).
6. This illustrates absent diastolic flow during diastole.
When this occurs there is abnormal resistance in the
placenta which results in a marked decrease in blood
flow from the fetus to the placenta.
7. Color Doppler of umbilical cord insertion
8. Color Doppler and spectral Doppler of ovarian
artery
9. Color Doppler and spectral Doppler of umbilical
artery
10. Color Doppler of left ventricular outflow tract
11. Color Doppler of umbilical cord
12. Chromosome pattern of a person with
Down's syndrome. Arrow points to an extra
chromosome No.21
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What is the Signs of Nonreassuring Variable
Decelerations that Indicate Hypoxemia ?
Increased severity of the deceleration
Late onset and gradual return phase
Loss of "shoulders" on FHR recording
A blunt acceleration or "overshoot" after
severe deceleration
Unexplained tachycardia
Saltatory variability
Late decelerations or late return to
baseline
Decreased variability
what is the Nonreassuring patterns in
the CTG?
 Fetal tachycardia
 Fetal bradycardia
 Saltatory variability
 Variable decelerations associated with a
nonreassuring pattern
 Late decelerations with preserved beat-to-beat
variability

what is the Ominous patterns of the
CTG?
 Persistent late decelerations with loss of beatto-beat variability
 Nonreassuring variable decelerations associated
with loss of beat-to-beat variability
 Prolonged severe bradycardia
 Sinusoidal pattern Confirmed loss of beat-tobeat variability not associated with fetal
quiescence
 medications or severe prematurity

Emergency Interventions for Nonreassuring Patterns
 Call for assistance
 Administer oxygen through a tight-fitting face mask
 Change maternal position (lateral or knee-chest)
 Administer fluid bolus (lactated Ringer's solution)
 Perform a vaginal examination and fetal scalp
stimulation When possible,
 determine and correct the cause of the pattern Consider
tocolysis (for uterine tetany or hyperstimulation)
 Discontinue oxytocin if used Consider amnioinfusion
(for variable decelerations)
 Determine whether operative intervention is warranted
and, if so, how urgently it is needed










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Causes of Fetal Tachycardia
Fetal hypoxia
Maternal fever
Hyperthyroidism Maternal or fetal
anemia Parasympatholytic drugs
Atropine
Hydroxyzine (Atarax)
Sympathomimetic drugs
Ritodrine (Yutopar)
Terbutaline (Bricanyl)
Chorioamnionitis
Fetal tachyarrhythmia
Prematurity
EFM- 4 Basic Features of FH
Trace
EFM- 4 Basic Features of FH
Trace
Fig 3 Early Decelerations
EFM- 4 Basic Features of FH
Trace
Fig 3 Early Decelerations
Fig 2 Sinusoidal pattern
Interpretation of the CTG
Case # 1
A 26 years old, G 3 p 3 with H/O twin delivery in the first
pregnancy,
admitted to the hospital at 31 weeksgestation with labour pains
and
preterm premature rupture of membranes for 4 weeks.
Her temperature was 39º C, the cervix cm dilated, clear liquor
draining.
The WBCs were 25 x 109
Sinus Tachycardia
Actions
High vaginal swab for bacterial culture and sensitivity test
(yes)
(yes)
Parentral antibiotics
Antipyretics and review after 2 hours
(no)
(yes)
Adjust tocodynamometer and review
Cesarean section immediately
(no)
(no)
Fetal blood sampling for PH
Course and Outcome
Labour was augmented with syntocinon, and intravenous triple
antibiotics were given. After 5 hours, the patient had normal
vaginal delivery of a baby boy weighing 1.9 kg. Apgar score was
5 at one minute and 8 at five minutes. Cord blood PH was
7.061,
PO2 11.3, PCO2 61 , base excess – 13.9, and O2 saturation
Case # 2
A 31 years old patient G 2 p 1 was admitted at 41 weeks of
gestation
in active labour. Received pethidine and Phenrgan earlier.
The cervix is 9 cm dilated and meconium stained liquor is draining.
Sinus Tachycardia With Deceleration And No Variability: Mixed Pattern
Actions
(no)
Wait and review after 30 minutes
(no)
Change the position of the patient
(yes)
Fetal scalp blood sampling
(no)
Immediate cesarean section
(yes)
Give naloxone
Explain and reassure the patient
(yes)
Course and Outcome
Cesarean section was carried out. A baby girl weighing 3898
gm
Case # 3
A 25 years old patient admitted at 36 weeks of
gestation in labour. No sedation is given yet
Rebound Tachycardia
Actions
Facial oxygen
Give sedation
(yes) Fetal scalp blood sampling for PH
(no) Augmentation of labour with syntocinon
(no)
Cesarean section
(no)
Maternal hydration
(no)
(no)
Course and Outcome
After recovery from prolonged deceleration, scalp
PH
were 7.28, 7.36 and 7.36.the patient had normal
vaginal
delivery of baby girl weighing 2070gm(small for
age).
Apgar score was 9/10 at one and five minutes.
Case # 4
A 24 years old patient, G 3 p1+1, with H/O cesarean section in
the last
pregnancy due to breech presentation. Currently admitted in
active
labour at 39 weeks of pregnancy. The cervix was 6cm dilated and
the
head was at 0 station 2hours prior to this trace
“Variable” Variable Deceleration
Actions:
(yes)
(no)
(yes)
(no)
(yes)
(no)
Vaginal examination and deliver if fully
Immediate cesarean section
Fetal blood sampling for PH
Facial oxygen
Change maternal position
Review after 1 hour
Course and Outcome
Vaginal examination showed fully dilated cervix with
the
head at +1 station. Progressed to normal vaginal
delivery
of baby girl weighing 2.7kg and Apgar score 9/10 at
one
and five minutes. The position of the cord was not
Case # 5
A 19 years old primigravid patient admitted in labour at 34
weeks.
She had pyelonephritis and chorioamnionitis.
Pethidene was given 90 minutes prior to this trace.
No variability, flat line-unfavorable outcome
Actions
(yes)
(no)
(no)
(no)
Ultrasound to exclude anomalies
(yes)
Fetal vibroacuastic stimulation
(yes)
Fetal blood sampling for acid base status
Observe and review after one hours
Immediate cesarean section
Stop fetal monitoring
Course and Outcome
The mean of serial fetal blood sampling four times were
showing
nonacidotic intrapartum capillary PH of 7.2, so she was allowed
to
progress in labour.had Normal vaginal delivery of female
Case # 6
A 21 years old primigravid patient complaining of reduced fetal
movement at 42 weeks of gestation was admitted for induction
of
labour. Received prostin and started labouring. The cervix was
3cm
dilated, so amniotomy was done and liquor was clear. Syntocinon
infusion was started 30 minutes ago
Increased variability with hypertonic labour
Actions
Observe and review after 30 minutes
(no)
Vaginal examination to asses progress
(no)
Reduce syntocinon infusion rate
(yes)
(no)
Immediate cesarean section
Oxygen by facial mask
(yes)
(no)
Fetal blood sampling for PH
Course and Outcome
Syntocinon infusion was reduced and fetal heart returned to
normal.
3 hours later CTG started to show late and late variable
decelerations,
so cesarean section was performed for fetal distress. Outcome
was
baby girl weighing 3 kg with 3 tight loops of the cord around the
Case # 7
A 28 years old patient G 5 p 4+ 0 was admitted in labour at 39½
weeks’
gestation. Her blood group was O positive, without antibodies.
She received pethidine and phenrgan for sedation.
Sinusoidal Pattern
Actions
Observe and review after 1 hour
Fetal blood sampling if feasible for PH
(yes)
Fetal blood sampling if feasible for haematocrit &Hg
(no)
(yes)
Maternal Kleihaure-Betke test
(yes)
Immediate cesarean section
U/S scan for fetal hydrops and abruptio placenta
(yes)
(yes)
Course and Outcome
Cesarean section was performed due to fetal distress.
Outcome was baby girl weighing 960 gm with Apgar 1/6
at
one and five minutes with intrauterine growth
restriction.
Case # 8
Fifteen years old primigravid patient was admitted
in
labour at approximately 40 weeks gestation.
She received epidural anesthesia
Increased variability with variable deceleration
Actions
Observe and review after 30 minutes
(no)
(yes) Reduce the rate of syntocinon infusion if it is in us
Vaginal examination to determine if delivery isimminent
(yes)
Cesarean section even if delivery is imminent
(no)
(no)
Fetal blood sampling
Course and Outcome
Progressed to normal vaginal delivery of a female fetus weighing
3076 gm and Apgar score 3/9 at one and five minutes.
Meconium was present requiring tracheal suctioning, which
accounted for the initial low Apgar score. There was one nuchal
cord and 10% placental abruption. The infant followed a normal
Case # 9
A 21 years old primigravid patient admitted in labour at 40
weeks’ gestation
Marked Accelerations
Actions
Observe for the development of other types of declarations
(yes)
Change maternal position
(no)
Prepare for cesarean section
(no)
Exclude maternal hypotention especially if > 50BPM
(yes)
(no)
Fetal blood sampling for PH
Course and Action
Progressed to normal vaginal delivery of male infant weighing
3374gm
Apgar score was 7/9 at one and five minutes and one nuchal cord
was
noted. The infant followed normal newborn course.
Case # 10
A 23 years old primigravid patient was admitted in labour at 40
weeks’ gestation. The cervix was 4 cm dilated. Amniotomy was
done and excessive clear liquor drained.
Baseline obscured by acceleration with variable decelerations
Actions
(yes)
(no)
(no)
(no)
(no)
Adjust tocodynamometer
Give sedation to the mother
Start syntocinon
Fetal blood sampling for PH
Immediate cesarean section
Course and Outcome
Progressed to the second stage of labour and had normal vaginal
delivery. The outcome was female weighing 3218 gm. Apgar
score
was 9/9 at one and five minutes.
The infant followed an uncomplicated newborn outcome.
Case # 11
A 27 years old G 4 p 3 + 0 was admitted in labour at 41 ½
weeks’
gestation. 15 minutes prior to this recording the cervix was
4cm
dilated with the head at –1 station. Artificial rupture of
membranes
was performed and clear liquor drained.
Early decelerations
Actions
Oxygen by facial mask
(no)
(no)
Change maternal position
(no)
Cesarean section
Observe for the development of other types of declarations
(yes)
(no)
Vaginal examination for progress assessment
(no)
Fetal blood sampling
Course and outcome
Progressed to normal vaginal delivery of female
infant
weighing 3969 gm. Apgar score was 8/9 at one and
five
Case # 12
A 21 years old primigravid admitted in labour at 40 weeks‘
gestation.The vertex was in occipitoanterior position and
liquor
was meconium stained.
Progression from Early to Variable Decelerations
Actions
(no)
Cesarean section
(no)
Syntocinon infusion
Observe for the development of other types of declarations
(yes)
Fetal blood sampling for PH
(no)
Oxygen by facial mask
(no)
Course and Outcome
No other types of declarations developed. Progressed to normal
vaginal delivery of male infant weighing 3374 gm. Apgar score
was 7/9 at one and five minutes. The infant followed a normal
newborn course.
Case # 13
A 35 years old patient G 7 p 6 admitted at 42 weeks’ gestation
in
labour. The cervix was 6 cm dilated with the head at - 2
station,
liquor was stained with meconium.
Late decelerations
Actions
(no)
Observe and review after1 hour
Cesarean section unless the fetus is about to be delivered
(yes)
(yes)
Correct maternal hypotention if present
(no)
Fetal scalp blood for PH
Maternal Kleihaure-Betke test
(yes)
Course and Outcome
Cesarean section was done. The outcome was male baby
weighing
3100 gm. Apgar score was 2/8 at one and five minutes.
The infant had meconium aspiration.
Case # 14
A 21 years old primigravid patient complaining of reduced
fetal
movement at 42 weeks of gestation was admitted for
induction of
labour. Received prostin and started labouring. The cervix
was
3cm dilated, so amniotomy was done and liquor was clear.
Syntocinon infusion was started 30 minutes ago.
Classic Variable Deceleration
Actions
(yes)
(no)
Observe for development of other abnormal forms
(no)
Cesarean section
Fetal blood sampling for PH
Oxygen by facial mask
(no)
Amnioinfusion
(no)
Course and Outcome
Syntocinon infusion was reduced and fetal heart returned to
normal.
3 hours later CTG started to show late and late variable
decelerations,
so cesarean section was performed for fetal distress.
Outcome was baby girl weighing 3 kg with 3 tight loops of the
cord
around the neck. Apgar score was 9/10 at one and five minutes.
Case # 15
A 29 years old G 4 p 2 + 1 patient admitted at 40 weeks’
gestation
in labour. The head of the fetus was in occipitoposterior
position.
Sinus bradycardia with deceleration: mixed pattern
Actions
(yes)
(no)
(yes)
Check maternal pulse
(yes)
Change maternal position
Cesarean section
Fetal blood sampling for PH
Oxygen by facial mask
(no)
Reduce syntocinon infusion rate if it is in use
(yes)
Course and outcome
Progressed to normal vaginal delivery of male baby weighing
2665 gm. Apgar score was 9/9 at one and five minutes.
The infant followed normal course.
Case # 16
A 30 years old G 4 p 3 patient was admitted in labour at 36
weeks’
gestation. She had H/O cesarean section in her second
delivery.
One hour prior to this trace, the cervix was 8cm dilated and
clear
liquor was draining
Prolonged Deceleration
Actions
(yes)
(yes)
(no)
(yes)
Vaginal examination
Check maternal vital signs
Fetal blood sampling for PH
Cesarean section
Oxygen by facial mask
(no)
Course and outcome
Rupture uterus was suspected and laparatomy was performed.
There was complete scar dehiscence and the infant was in the
peritoneal cavity. It was male 3.1 00 gmand fresh stillbirth.
The uterus was repaired.
Case # 17
A 29 years G 3 p 1 + 1 was admitted at her first antenatal care
visit at
38 weeks’ gestation for blood sugar control, as blood sugar was
found high. Polyhydraminous and big baby were diagnosed.
She started to complain of labour pains
Absent Long Term, Present Short Term Variability
Actions
(yes)
(yes)
(no)
(yes)
Vaginal examination
Vibroa-acouastic stimulation
(no)
Oxygen by facial mask
(no)
Maternal blood sugar
Immediate cesarean section
Wait for another 10 minutes
Course and Outcome
Fetal heart returned to normal with good variability and
accelerations.
Cesarean section was done as planned.
The outcome was baby boy weighing 4100gm. Apgar score was
Case # 18
A 23 years old primigravid patient, twin pregnancy was admitted
in
labour at 40 weeks’ gestation. The first twin was in cephalic
presentation and second twin was in breech presentation. The
cervix
was 3 cm dilated with intact membranes one hour earlier
Dual channel monitoring:
twins single scale
Actions
(yes)
(no)
(no)
Continue observation as for uncomplicated twin
Amniotomy and fetal scalp electrode
(no)
Cesarean section
Oxygen by facial mask
(no)
Change maternal position
Course and Outcome
Cesarean section was done for arrest of cervical dilatation at 6 cm
and
failure to descent of fetal head. First twin was male with deflexed
head
weighing 3000 gm. Apgar score was 5/8 at one and five minutes.
Second twin was breech, male weighing 2150 gm. Apgar score 6/8
at
one and five minutes. There was one placenta. Both twins had
Case # 19
A 25 years old primigravid patient, diabetic on diet control with
mild pregnancy induced hypertension.Labour was induced at 38
weeks gestation with vaginal prostin. She had spontaneous
rupture of membranes 24 hours before this trace and clear
liquor drained.
Late Deceleration and Severe Variable Deceleration
Actions
(yes)
(no)
(no)
(no)
Change maternal position
Fetal blood sampling
Immediate cesarean section
Exclude cord prolapse
(yes)
Wait and review as normal patient
Administration of tocolytics if the pattern continues
(yes)
Course and outcome
Cesarean section was performed for failed induction of labour.
Outcome was female infant weighing 3200 gm. Apgar score
was
9/10 at one and five minutes.
The infant followed normal newborn outcome.
Case # 20
A 35 years old G 3p 1 + 1 had induction of labour at 39 weeks
for
premature rupture of membranes. She had received pethidine 90
minutes prior to this segment. The fetus was in vertex
presentation in occipetoanteror position at that time.
Absent short term, present long term variability
Actions
Review previous segments of the trace to compare
(yes)
(yes)
Fetal blood sampling for PH
(no)
Change maternal position
(no)
Immediate cesarean section
(yes)
Observe and review vaginally after 30 minutes
Course and outcome
The tracing improved and the patient had normal vaginal delivery
of
female baby weighing 3600 gm. Apgar score was 8/9 at one and
five
minutes. The infant had normal newborn course.
Case # 21
A19 years old G 2 p1 patient was admitted in active labour at
30weeks gestation
Decreased uterine activity produced by tocodynamometer
placement: artifact
Actions
Adjust tocodynamometer belt
(yes)
(yes) Observe for development of other forms of decelerations
(no)
Administration of tocolytics
Start augmentation with syntocinon
(no)
(no)
Immediate cesarean section
Course and outcome
Uterine contractions were properly recorded after adjustment of
the
tocodynamometer belt. The patient had normal vaginal delivery
of a
Male baby weighing 1304 gm. Apgar score was 7/7 at one and
five
minutes. The cord was wrapped around the arm of the baby
Case # 22
A 25 years old primigravida admitted in labour at 40 weeks
gestation.The fetus was in occipitoanterior position
W –shaped Variable deceleration with maternal straining
Actions:
(no)
(no)
Observe and allow labour to progress
(yes)
Cesarean section
Syntocinon infusion for augmentation of labour
Adjust tocodynamometer belt
(no)
Oxygen by facial mask
(no)
Course and outcome
Progressed and had normal vaginal delivery of a female weighing
3445 gm. Apgar score was 9/9 at one and five minutes.
The infant followed a normal newborn course.