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O&G CasesIntrapartum care — fetal surveillance

O&G Cases · Intrapartum care — fetal surveillance

Acute fetal bradycardia on labour ward — emergency management station

Team-based emergency station: acute intrapartum bradycardia in a woman labouring after previous caesarean. Tests parallel intrauterine resuscitation, the differential for an acute bradycardia including scar rupture, the three-minute timetable, closed-loop team leadership, and communication under time pressure. Includes assessor key, timeline and fail criteria.

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Target exams

FRANZCOGMRCOGABOG
Prompt
A 33-year-old G3P2 at 40+1 weeks is labouring after one previous caesarean. She is 6 cm dilated, on an oxytocin infusion for slow progress, with an epidural sited 25 minutes ago. You are the registrar. The emergency buzzer goes: the fetal heart rate has fallen to 60 bpm and has not recovered. The midwife is at the bedside, the consultant is 12 minutes away, and the woman's partner is in the room.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar. A midwife is with you, an anaesthetist is available, and the consultant has been called and is 12 minutes away. The assessor runs the clock and feeds new observations. [2][1]

Candidate instruction. Lead the management of an acute intrapartum fetal bradycardia in a woman labouring after previous caesarean. Verbalise your actions, your drug orders with doses, your differential, your timings, and your communication with the woman, her partner and the team. [2][5]

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References6ShowHide
  1. [1]Ayres-de-Campos D, Spong CY, Chandraharan E FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography Int J Gynaecol Obstet, 2015.PMID 26433401
  2. [2]Yeoh M, Ameratunga D, Lee J, et al. Simplifying the language of fetal monitoring Aust N Z J Obstet Gynaecol, 2019.PMID 30460717
  3. [3]Kulier R, Hofmeyr GJ Tocolytics for suspected intrapartum fetal distress Cochrane Database Syst Rev, 2000.PMID 10796094
  4. [4]Raghuraman N, Temming LA, Doering MM, et al. Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation: A Systematic Review and Meta-analysis JAMA Pediatr, 2021.PMID 33394020
  5. [5]Clark SL, Nageotte MP, Garite TJ, et al. Intrapartum management of category II fetal heart rate tracings: towards standardization of care Am J Obstet Gynecol, 2013.PMID 23628263
  6. [6]Alfirevic Z, Devane D, Gyte GM, et al. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour Cochrane Database Syst Rev, 2017.PMID 28157275
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PreviousAcute abdomen in pregnancy after gastric bypass — emergency management stationAntenatal care — pregnancy after bariatric surgeryNextChanging the monitoring plan — communication and decision-making stationIntrapartum care — fetal surveillance