PULLED: Utilising CTG Scanning to Help Detect Bradycardia Developing During Labour
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Independent Recommendations to Improve Healthcare Standards and Patient Safety
Labour is a dynamic, quick-changing situation, which can be stressful and uncertain when it is a patient’s first time giving birth. Routine monitoring using CTG or other methods should be utilised to make sure that the baby and mother’s heart rates are presenting as usual.
Labour Phases and CTG Monitoring
Whether or not the mother is in latent or active labour, clinicians should bear in mind that utilising CTG scanning can be useful in determining any risk to the fetus and this should not be overlooked, especially when the mother is complaining of increased pain and the fetus had originally presented with a slow heart rate.
During these presentations of increased pain, further assessments should take place to monitor the situation and to determine the strength and frequency of the contractions experienced.
This can either be made by counting the duration and frequency of the contractions and auscultating the fetal heart rate or using a CTG monitor. Practitioners should be aware that utilising CTG scanning can aid in recognising early bradycardia and can limit the risk of injury befalling the baby.
Bradycardia (sustained heart rate below that of 110 beats per minute) can indicate when the fetus is in distress and clinicians must act quickly to prevent hypoxia or loss of life. Utilising CTG monitoring throughout all stages of labour can assist in noticing the signs of intrapartum bradycardia and can help to prevent injury or death to the baby.
After Diagnosis
Once a fetal heart rate is noted to be low (as above) and bradycardia is diagnosed, clinicians should remember the Rule Of Three:
- Call for help after 3 minutes;
- Patient transferred to theatre if not deliverable in the current room at 6 minutes;
- Preparations to be made for delivery by 9 minutes, with the aim for delivery achieved at 15 minutes or less.
Clinicians should remember that there is a short window to deliver the baby when bradycardia is diagnosed and by following these above steps, the risk to the fetus can be significantly reduced.
Conclusions
Bradycardia can be severe for a fetus if not quickly acted upon and can lead to loss of life. From this article, THEMIS aims to assist in developing awareness of utilising CTG scans throughout all stages of labour to prevent bradycardia from being missed or diagnosed late, thereby reducing the risk to the fetus and mother intrapartum and facilitating a quick delivery.
By raising awareness of the above issues, THEMIS hopes to overall, improve clinical care and reduce litigation risk facing medical practitioners.
