We are back with a case about management in the delivery room, FHRb, pushing, and suspected fetal distress. Do you want to participate?

The pregnancy ended with a spontaneous vaginal delivery at 03:53h.

Perinatal outcome: APGAR 5/9. pHa 6.90, pHv: 7.12.

SUMMARY comment:

-First, we discussed what CTG we should imagine, considering the clinical information, and then we applied the checklist to the beginning of the CTG analysis. We talked about the characteristics of the CTG in the second stage of labor.

–CTG Section 1: The “Double mountain peak sign” stands out, in which we see increases that coincide with the contractions. This should make us suspect that it is maternal heartbeat.

Why? –> The mother may be experiencing pain, and this can already increase her HR. On the other hand, there is a physiological phenomenon whereby Valsalva is generated with contractions, which increases intrathoracic pressure, decreases venous return, and increases HR. And on the other hand, with the contraction, the vascular bed of the placenta is compressed, and blood in circulation increases, which tends to increase HR.

Erroneous monitoring of the mother’s heartbeat occurs because the transducer captures the Doppler signal from the mother’s iliac vessels, which is more intense and superficial, instead of the fetal ventricular heartbeat signal, which is deep in the cavity. This occurs more easily in obese patients and as we lower the transducer due to fetal descent.

Signs that the mother is being monitored:

-Sudden improvement of the CTG

-Abrupt change in the FHRb

-Increases >15lpm and >15”

-Double mountain peak sign

In the following sections, we see that the FHRb is increased, and the variability is progressively reduced and altered. Absence of cycling. All of this points us towards progressive decompensated hypoxia.

Finally, we talked about the perinatal results (before knowing them) and assumed that the pH would be below 7.0.

The complete video is posted on the icarectg_official Instagram feed.