Base-line heart rate of 165 beats / minute with variability > 5 beats / minute and typical variable decelerations occurring with over 50% of contractions for 45 minutes
correct answer: false
This is always a debate on labour wards about when this CTG is classified as suspicious or pathological. I read the guidelines as saying the above CTG would only become pathological when the the variable decelerations have been present for 90 minutes (making this a non-reassuring feature along with the baseline of 165) and therefore when it has only been like this for 45 minutes I think this answer should be true rather than false.
Thoughts?
Posted by Jonathan N.
This is a problem with the NICE guidelines and how you classify a CTG when the typical variable decels have been present for less than 90 minutes.
It clearly depends on the clinical circumstances.
I personally in the situation you describe above would write in the notes:
Normal CTG with typical variables for 20 minutes therefore to continue CTG monitoring for review before 90 minutes of typical variables, try conservative measures like position change, oral or IV fluids.
Or you could call it suspicious before it reaches 90 minutes, but it then remain suspicious after this anyway.
Posted by Jonathan N.
I disagree that NICE is as black and white as you say. They do say for a normal CTG all 4 features need to be reassuring (although by their own admission the absence of accelerations is of uncertain significance.
However, for a suspicious CTG their wording is : 'one feature non-reassuring and the remaining features reassuring'. A CTG with variable decels for <90 minutes with all other features reassuring has no non-reassuring features so falls between classification of a normal and suspicious CTG.
However, it probably is safer practice to call a CTG like this suspcious but as I said NICE is unclear about this I believe.
Anyway the discussion has been helpful for my learning/practice.
