Prepared by Helen Cooke

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Intrapartum Fetal Heart Rate Monitoring Workshop
Prepared by Helen Cooke Warwick GilesFONT
Project Officer February 2008
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Case 1 - Sandie

• 34 yr old multip in spontaneous labour at term
• Normal antenatal period and no identified risk
  factors
• Has been in established labour since 4am
• The FHR has been auscultated throughout labour
  and has been reassuring
• At 7.45am FHR auscultated at 170 bpm

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Sandie
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Case 2 - Amy

• 21 yr old primip, smoker 39 2 days gestation
• History of ruptured membranes for the past 3 days
• GBS negative
• Irregular uterine activity
• Cx closed
• Admitted at 5.10 am

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Amy
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Amy cont 2

• The FHR pattern continued to be non-reassuring
  no reactivity.
• Reviewed by a medical officer at 6.30 am
  continue to monitor and wait and see
• Amys temp 36.6 C
• Medical review again at 09.30 IV Antibiotics
  commenced
• Labour failed to establish and induction with
  Syntocinon commenced at 11am, Cx still closed.
• Syntocinon increased over the next 6 hrs

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Amy cont 2

• VE 4cm dilated
• Syntocinon stopped
• No FBS attended
• CTG continues medical officer called again at
  1830

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Amy cont 3

• Syntocinon stopped
• No FBS attended

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Case 3 - Kate

• 28 yr old primip, 41 weeks gestation
• Presents to your birthing unit having been
  contracting for the past 5 hrs and has just
  ruptured her membranes
• No relevant antenatal history
• On VE Kate Cx is 4cm dilated, 50 effaced with a
  Vx presentation at 2
• FHR on auscultation is 136 140 bpm following
  each contraction

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Case 4 - Beth

• 31 yr old multip, 40 4 weeks gestation,
  cephalic presentation, no antenatal risk factors
• Has been contracting since 1.30am
• Admitted at 0500 and VE then 4cm dilated Vx 2
• 10am VE 7cm dilated Vx well applied at spines

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Case 5 Rhania

• 39 yr old multip at 403 wks gestation
• Contracting regularly for the past three hrs
• Previous history of 2 normal births
• Membranes ruptured 30 mins ago draining mec
  stained liquor

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Case 6 Mia

• Primip at 403 wks gestation, draining copious
  amounts of moderate mec stained liquor
• VE 2cm dilated 1 cm thick Vx Stn 2
• Contracting irregularly
• For IOL, Syntocinon started

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Case 6 Mia Cont

• FHR pattern improved
• Synto remained turned off until 11am when it was
  restarted.
• This is now the FHR pattern

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Case 7 - Jacqueline

• 36 yr old primip
• 404 days gestation
• IOL (Syntocinon) for gestational hypertension
• Draining clear liquor
• BP 130/82, pulse 86, temp 36.7 C
• Has been in labour for past 6 hrs
• VE Cx 6cm dilated 75 effaced Vx St - 2

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Case 8 Morgana

• Primip at term
• SROM 24 hrs ago
• IOL (with Syntocinon) for prolonged ROM
• Uneventful pregnancy
• Ve Cx 5 cm dilated Vx St 0 some caput
• Draining clear liquor

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Morgana cont

• VE at 12mn Cx 7-8 cm dilated thick
• Epidural inserted

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Case 9 Karina

• Primip at 404 wks gestation.
• GBS positive
• SROM 12 hrs ago
• IOL (Syntocinon) commenced
• VE Cx 2cm dilated Vx Stn -2

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Karina cont

• Synto halved due to uterine hyperstimulation
• VE at 14.20 3 cm dilated
• Epidural inserted
• Now 14.30

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