CTG report basics

Cardiotopography (CTG) reporting - basics

CTG: to record fetal heart rate during contractions
When reviewing the CTG trace, assess and document contractions and all 4 features of fetal heart rate: baseline rate; baseline variability; presence or absence of decelerations (and concerning characteristics of variable decelerations* if present); presence of accelerations.

1. check baseline rate

• normal rate: 110bpm to 160bpm
• continue usual care as the risk of fetal acidosis is low

2. Baseline Variability

• normal: 5bpm - 10bpm
• increased: >25bpm

3. Acceleration

• to be cautious and take necessary actions when
• >15bpm
• >15s
• The presence of fetal heart rate accelerations (if it is constant with contraction and within range), even with reduced baseline variability, is generally a sign that the baby is healthy.

4. Deceleration

• to be cautious and take actions when 
• >15bpm
• >15s-40s
• uniform and repetitive
• If it occurs with contraction < 20s, it is called early deceleration
• need constant monitor and stand by for Mx

5. To monitor frequency of contraction

• is it present or absent?

Notes:

1. If CTG is normal, can reexamine again in 7 days time. it varies and depends on situation 

2. If it is difficult to categorise or interpret a CTG trace, obtain a review by a senior midwife or a senior obstetrician

Tips:

1. Document the condition of the woman and unborn baby (including cardiotocography [CTG] findings)systematically every hour, or more frequently if needed. 

2. CTG findings alone could not determine what is the next action that is needed for the mother.

3. Take into account the mother's condition, any antenatal and intrapartum risk factors, the current wellbeing of her and unborn baby and the progress of labour. 

4. Ensure that the focus of care remains on the woman rather than the CTG trace.

5. Remain with the woman in order to continue providing one-to-one support.

6. Talk to the woman and her birth companion(s) about what is happening and take her preferences into account.

More explanation on the different types of situation click here.

References:
1. https://www.nice.org.uk/guidance/cg190/resources/interpretation-of-cardiotocograph-traces-pdf-248732173
2. Video: https://www.youtube.com/watch?v=N9hNCjaL_dE 

Depression and suicide risk

This post mainly focus on how medical students should do when they are asking for the patient's history, especially those suspected with depression. 

It is important to know if the depression that they are facing will lead to serious issues like harming themselves. 

In normal hospital setting, you can see that it is quite often that physicians tie this two together, so we can access their situation in one session. 

Try not to ask their history multiple times as it could affect the way they answer the question. 

History taking always starts with 

Remember to always be caring and a helpful listener.

1. Introduction

• Name, age, occupation, marital status

2. Ask for chief complain.

• complain + duration
• Depression duration: >2 weeks >1 symptoms

3. Present History 

• ask symptoms that could help you differentiate depression from other diagnosis
• they are helpful to differentiate the other diseases related. 
• you can refer to the notes in this link 

4. How to diagnose depression?

•  Remember : SIG CAPES
• If they have >1 symptoms 
• Check if they have
• Sadness
• Insomnia
• Guilty feeling
• Observe 
• Concentration
• Agitation
• Psycho-motor system
• Energy
• Suicidal idea
• Check if there are any manic involve. it is important to use it to differentiate between bipolar or depression
• Depression : 
• no manic
• not under medication or drug usage (cannabis)

5. Check for their suicidal risk

• Any signs of them trying to harm themselves? if yes check the below

• Suicide assessment (5 points)

	Details	For example:
Ideation	Idea of trying to harm themselves	e.g. to jump off the plane,  etc.
Plan	Any realistic plan to harm themselves?	Booked a flight ticket
Means	Do you have the materials?	Already have a knife at home.
Intent	Do you intent to, when?	By next month
History	Past history	Prior suicide attempts, abort attempts, self-harm

• SAD PERSONS scale is needed to further evaluate their risk.
• Then you should check with the SAD PERSONS scale to figure out their score if they need further treatment or not.
• score  >7 : 
• Admit them immediately and get consent from them or their family members 
• Bio-psycho social therapy : relaxation technique, CBT, systemic desensitizing, BZD, SSRI, 
• Family support

Overall Management

Reference: http://www.smj.org.sg/article/managing-depression-primary-care

Major Depressive Disorder (MDD) Management

Reference: https://www.researchgate.net/figure/Treatment-algorithm-for-MDD_fig1_283155381

Reference: 

1. https://www.porticonetwork.ca/documents/366159/1073220/Suicide+Assessment+Five-Step+Evaluation+and+Triage+%28SAFE-T%29%20Booklet/00b209ca-3078-45db-a175-6983c6962166

2. https://www.healthline.com/health/suicidal-ideation

Pocket notes - Post Traumatic Stress Disorder & OCD

Post Traumatic Stress Disorder (PTSD)

&

Obsessive Compulsive Disorder (OCD)

Another list of mnemonics I found useful 

Pocket notes - Psychiatry and related diseases

This post is mainly explaining the differences between 

Dementia

Bipolar disorder

Schizophrenia

Depression

& also

some things to take note of when we are asking for patient's history.

I remember them through mnemonics, hope you find it useful too!

Chronic Obstructive Pulmonary Disease (COPD)

Pocket notes Series:

COPD : Chronic Obstructive Pulmonary Disease

 

COPD Assessment

COPD: chronic obstructive pulmonary disease; 

GOLD: Global Initiative for Chronic Obstructive Lung Disease; 

mMRC: modified Medical Research Council dyspnea scale; 

CAT: COPD Assessment Test; 

FEV1: forced expiratory volume in one second; 

FVC: forced vital capacity.

Reference:

1. https://www.ncbi.nlm.nih.gov/pubmed/30286833

2. https://goldcopd.org/

3. https://goldcopd.org/gold-reports/
4. UptoDate