Synopsis – Intrapartum Surveillance Workshop
Prof Steer will help participants construct a rational approach to intrapartum surveillance, with particular emphasis on the use of continuous fetal heart rate and uterine contraction monitoring (cardiotocography, CTG). He will cover the basics that are sometimes forgotten, but also pass on the many insights he has acquired over 45 years of involvement in intrapartum care.
The introduction will explain why the rise of litigation has emphasised the role of CTG monitoring as a key component of intrapartum care. Then in a session on technology, participants will be reminded how fetal monitors work, because failure to appreciate their limitations is a common cause of errors in the interpretation of fetal heartrate recordings. The next session will review fetal pathophysiology, in particular how hypoxia, hypoxaemia, acidosis, and asphyxia are defined, and their interrelationships.
The following session will present a systematic approach to the analysis of fetal heart rate tracings, emphasising how to recognise artefact, and illustrating both the common and the more unusual abnormalities encountered. There will then be an explanation of how clinical features of concern (in particular, fetal growth restriction, meconium and pyrexia) influence CTG interpretation, and explain how changes in the fetal heartrate should be interpreted in the presence of these stressors. Recent trials such as INFANT and studies such as ‘Each Baby Counts’ have emphasised the vital importance of taking into account risk factors when interpreting fetal heart rate traces.
After lunch there will be a practical session, where participants will work in small groups to analyse CTG tracings, including case studies. This will be followed by a feedback session where we discuss reports on the traces given by participants.
The workshop will then cover the use of pH and lactate measurement, ECG ST segment analysis (STAN) and computerised CTG pattern interpretation. The workshop will finish with a presentation on the dangers of excessive oxytocin use, followed by a general discussion of management issues.
FETAL SURVEILLANCE IN LABOUR WORKSHOP 2019
Professor P Steer
|09:00||Introduction – why are we so concerned?|
|09:40||Fetal monitoring technology – FHR and IUP|
|10:15||The pathophysiology of fetal asphyxia and the role of fetal blood pH measurement|
|11:15||FHR interpretation – the systematic approach|
|12:00||Clinical features of concern – meconium, pyrexia|
|13:30||Workshop for participants|
|15:10||Other fetal monitoring techniques: Lactate, ECG waveform analysis (STAN)|
|16:00||Use of oxytocin|
|16:40||Management issues (Case studies)|
|17:00||End of workshop|