Patient’s Profile: A 22-year old woman in her 2nd pregnancy has arrived in the labour ward at 38 weeks 3 days. She had a normal delivery 18 months ago. This pregnancy has been complicated by...

Patient’s Profile:

A 22-year old woman in her 2nd pregnancy has arrived in the labour ward at 38 weeks 3 days. She  had a normal delivery 18 months ago. This pregnancy has been complicated by persistent vomiting  until 20 weeks and more recently by anemia. She reports contractions commencing approximately  4 hours ago. She took paracetamol at home and tried to relieve the pain with a bath, but now she  feels she cannot cope with the pain.

She had a show 2 days ago but has had no bleeding since then and has not noticed any vaginal  leak. She has felt the baby moving normally all day.

Physical Examination:

BP is 110/58 mmhg, heart rate is 98/min. The presentation is cephalic with 2/5 palpable  abdominally. Uterine contractions are palpable and the uterus is non-irritable. On vaginal  examination, the cervix is 5 cm dilated and the head is 1 cm above the ischial spines. The fetus is  right occipitotransverse with mild caput and molding. The membranes are intact but rupture  spontaneously during examination with clear liquour draining.

The woman requests for epidural for pain relief and is therefore on continuous cardiocotograph  (CTG) monitoring. After 20 minutes you are asked to review the situation.

The CTG as you walk in has the following interpretation:

The initial 15 minutes of CTG shows a baseline of 145 min with normal variability (12/min) and  no visible acceleration or decelerations. Following this, there is a
drop in fetal heart rate
of  70/min for 7 minutes before gradual recovery to 125/min. Contractions are 2 in 10 until the  tocograph becomes unreadable.

Questions:

1. How do you explain the CTG interpretation?


2. What are the possible causes of this interpretation of CTG?


3. What nursing/medical/surgical management would be appropriate now? Expound?