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Interpretation of a CTG trace during labour (13HDC01430)
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Community-based midwife ~ Obstetrician ~ Labour ~ CTG
interpretation ~ Delayed consultation ~ Right 4(1)
A woman who was pregnant with her first child went into labour
at 40+4 weeks' gestation. The woman met her LMC midwife at the
delivery unit at hospital. Upon assessment, the LMC noted that the
woman was experiencing contractions at a rate of three every ten
minutes and that, on vaginal examination, the cervical opening
could not be reached. A CTG was commenced to monitor the fetal
heart rate (FHR).
The LMC noted non-reassuring features on the CTG recording and
continued to monitor the FHR, but did not interpret the CTG as
requiring consultation with the obstetric team. A second vaginal
examination was carried out an hour later by the LMC and the cervix
was found to be 2cm dilated. The woman was then given 100mg of
pethidine and 2.5mg of Droleptan to help her sleep.
Shortly afterwards the LMC noted a prolonged deceleration of the
FHR down to 60bpm. Five minutes later she called the on-call locum
obstetric consultant as she was no longer able to detect a fetal
The consultant arrived 20 minutes later and carried out an
assessment, which confirmed the absence of a fetal heartbeat. The
consultant then made the decision to perform a Caesarean section,
on the basis that a fetal heartbeat had been present within the
previous 20 minutes. A Caesarean section was performed, and the
baby was born floppy and not breathing. Resuscitation was commenced
but, sadly, the baby was pronounced stillborn.
It was found that the CTG showed non-reassuring features which
warranted earlier consultation with the on-call obstetrician and
that by failing to interpret the CTG trace correctly and, as a
result, failing to contact the on-call obstetrician early enough,
the LMC failed to provide services with reasonable care and skill
and, accordingly, breached Right 4(1).
Adverse comment was also made about the consultant's decision to
proceed with a Caesarean section in the circumstances.