Instructions
You are a medical student on placement in the maternity assessment unit. Kirsten Mallory, 33, is 40 weeks and 5 days pregnant with her first baby and has come in because the baby has been moving less. Her CTG has run for 50 minutes.
Interpret the CTG provided
Outline to the examiner:
- Your findings
- Your most likely diagnosis
- Next steps in management
- You do not need to take a history or examine the patient
- Ms Mallory is resting in the next bay; you will speak to the examiner
- The examiner will ask you one question near the end
Midwife's note
Baby moving less since yesterday morning; only two or three small movements today, when it usually kicks a lot in the evening. No pain or tightenings felt, no bleeding, no loss of fluid. No headache, visual change or itch. Feels well. CTG started at 2.10 pm.
Antenatal record
G1 P0, due date by an 8-week scan. Booking BP 116/72; booking bloods normal; O positive, no antibodies. Normal 20-week scan; placenta posterior, not low. Glucose tolerance test normal. GBS negative. Fundal height 38 cm at 40 weeks. Non-smoker; pregnancy multivitamin only; no allergies.
CTG (today, 2.10 pm to 3.00 pm)
| Item | Value | Reference range |
|---|---|---|
| Baseline rate | 155 bpm throughout | - |
| Variability | 3 to 4 bpm, the same for the whole 50 minutes | - |
| Accelerations | None in 50 minutes | - |
| Decelerations | Nine, one after each of 9 of the 10 contractions: a smooth fall of 15 to 20 bpm that starts about 20 seconds after the contraction begins, is lowest about 30 seconds after its peak and returns to baseline about 30 seconds after it ends | - |
| Contractions | Ten in 50 minutes (about 2 in 10), irregular, each 40 to 50 seconds; Ms Mallory has not felt them | - |
Antenatal trace at 1 cm/min, labelled Kirsten Mallory, 40+5 weeks. Semi-recumbent throughout. Maternal pulse 84 at the start. Movement button not pressed.