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CTGCONCEPTS AND INTERPRETATION

Techniques for fetal heart rate evaluation:

a) Phone method (auscultation)

b) Ultrasound detector (continuous Doppler)

c) Fetal ECG (Transabdominal ! Direct" throu#h: fetal scalp electrode)

C$%T&$' $F FET' E&T &TE

CNS (Dural stretchin# ! arterial chemoreceptor) * Baroreceptors

eart rate re#ulatin# center in medulla oblon#ata

+,mpathetic (&) or Paras,mpathetic (&)

C&D-$T$C$G&P.: ( CTG ) -%F$&/T-$%+

Periodic changesBaseline variability 0 1and 2idthBaseline rateccelerations

Decelerations

+ilent 3 ! 4 bpm

&educed 5 ! 63 bpm

%ormal 63 ! 74 bpm

+alutator, 8 74 bpm

663!643bpm

1+E'-%E 9&-1-'-T.

%1 fetal maturation 8 ;7

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A typical CTG output for a woman not in

labour

)A(Fetal heartbeat)B(Indicator showing movements felt by mother caused by pressing a button

)C(Fetal movement

)!("terine contractions

ACC#$#%ATI&'2-C&*#'AT&%+

ACC#$#%ATI&'

1-*"%# ACC#$#%ATI&'

hape: UniformTiming: With

contraction%ange: Moderate (20

25 bmp) ate)+eturn to baseline delas ' 20 sec(

Mana&ement: as the more ominous component

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)9n combined pattern with late component indicate fetal hpo

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CAT#G&%IATI&' &F F#TA$ .#A%T %AT#

(F.%) F#AT"%#AccelerationsDecelerationsVariability

(bpm)Baseline

(bpm)

PresentNone5110160Reassuring

Te !"sen#e o$!##e%er!t&ons'&t oter'&senor!% tr!#e &so$ n#ert!&ns&*n&$!n#e

Earl, deceleration

T,pical variable deceleration '&t o+er 50, o$#ontr!#t&ons o##rr&n* $or o+er 0 &ntes

+in#le prolon#ed deceleration up to ; min

>5

$or 400&ntes

10010

161180

Non-reassuring

'ate deceleration o+er 30 &ntes

t,pical variable deceleration '&t o+er 50, o$ #ontr!#t&onso##rr&n*$or o+er 30 &ntes

+in#le prolon#ed deceleration 8 ; minutes

>5

$or 0&ntes

>100

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1.12Complicated labour: monitoring babies in labour6

EF an! recor!-"eeping

n orer to ensre !##r!te re#or-=ee&n* re*!r&n* 9:

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Bont&nos 9 &n te resen#e o$ oto#&n:

$ te tr!#e &s nor!% oto#&n ! "e #ont&ne nt&% te 'o!n &s eer&en#&n* 4or 5 #ontr!#t&ons e+er 10 &ntes. Cto#&n so% "e re#e &$ #ontr!#t&ons o##rore $reDent% t!n 5 #ontr!#t&ons &n 10 &ntes.

$ te tr!#e &s #%!ss&$&e !s ss&os t&s so% "e re+&e'e " !n o"stetr&!n!n te oto#&n ose so% on% #ont&ne to &n#re!se to !#&e+e 4 or 5 #ontr!#t&onse+er 10 &ntes.

$ te tr!#e &s #%!ss&$&e !s !to%o*!% oto#&n so% "e stoe !n ! $%%!ssessent o$ te $et!% #on&t&on nert!=en " !n o"stetr&!n "e$ore oto#&n &s

re#oen#e.

A!uncts to t'e use o$ continuous EF inclu!ing FB*

A&*&t!% st&%!t&on o$ te $et!% s#!% " te e!%t#!re ro$ess&on!% r&n* ! +!*&n!% e!&n!t&onso% "e #ons&ere !s !n !n#t to #ont&nos 9.

$ $et!% e!t &s sse#te es&te te resen#e o$ !n !!rent% re#ore ten $et!% +&!"&%&tso% "e #on$&re '&t re!%-t&e %tr!son !ssessent.

@ so% "e !+&se &n te resen#e o$ ! !to%o*!% tr!#e n%ess tere &s #%e!r e+&en#e o$!#te #oro&se.

Eere !ss&ste "&rt &s #onte%!te "e#!se o$ !n !"nor!% !ttern &n #!ses o$ sse#te$et!% !#&os&s @ so% "e nert!=en &n te !"sen#e o$ te#n!% &$$%t&es or !n#ontr!&n!t&ons.

Eere tere &s #%e!r e+&en#e o$ !#te $et!% #oro&se ($or e!%e ro%on*e e#e%er!t&on *re!ter

t!n 3 &ntes) @ so% not "e nert!=en !n r*ent re!r!t&ons to ee&te "&rtso% "e !e.

et!% "%oo s!%es so% "e t!=en '&t te 'o!n &n te %e$t-%!ter!% os&t&on.

Te #%!ss&$!t&on o$ @ res%ts so'n &n t!"%e 7 &s re#oene.

able + 'e classi$ication o$$etal bloo! sample (FB*)results FB* result (p%)

#nterpretation

7.25Nor!% @ res%t

7.217.24@orer%&ne @ res%t

7.20"nor!% @ res%t

$ te tr!#e re!&ns n#!n*e !n te @ res%t &s st!"%e !$ter te se#on test ! t&r/$rters!%e ! "e e$erre n%ess !&t&on!% !"nor!%&t&es e+e%o on te tr!#e.

Eere ! t&r @ &s #ons&ere ne#ess!r #ons%t!nt o"stetr o&n&on so% "e so*t.

Bontr!&n!t&ons to @ &n#%e:

!tern!% &n$e#t&on ($or e!%e F e!t&t&s +&rses !n eres s&%e +&rs)$et!% "%ee&n* &sorers ($or e!%e !eo&%&!)

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