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
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]
References6ShowHide
- [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]Yeoh M, Ameratunga D, Lee J, et al. Simplifying the language of fetal monitoring Aust N Z J Obstet Gynaecol, 2019.PMID 30460717
- [3]Kulier R, Hofmeyr GJ Tocolytics for suspected intrapartum fetal distress Cochrane Database Syst Rev, 2000.PMID 10796094
- [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]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]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