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The Cardiotocograph

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30 views

The Cardiotocograph

Uploaded by

Vidur
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 36

THE

CARDIOTOCOGRAPH
DR CHRISTOPHER FLETCHER
INTRODUCTION

• Screening tool
• 98% Specificty
• 50% Sensitivty
• Use in specific circumstances
ADMISSION CTG

Current evidence does not


support the use of the admission
CTG in low-risk pregnancy and
it is therefore not recommended

Grade B Recommendation

4
SELECTED HIGH-RISK INDICATIONS
FOR CONTINUOUS MONITORING OF
FETAL HEART RATE
Maternal medical illness
Gestational diabetes
Hypertension
Asthma
Obstetric complications
Multiple gestation
Post-date gestation
Previous cesarean section
Intrauterine growth restriction
Oligohydramnios
Premature rupture of the membranes
Congenital malformations
Third-trimester bleeding
Oxytocin induction/augmentation of labor
Preeclampsia
Meconium stained liquor

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SELECTED HIGH-RISK INDICATIONS
FOR CONTINUOUS MONITORING OF
FETAL HEART RATE
• A Continuous CTG should be offered and
recommended in pregnancies previously monitored
with intermittent auscultation:
• if there is evidence on auscultation of a baseline less
than 110 bpm or greater 160 bpm
• if there is evidence on auscultation of any
decelerations
• if any intrapartum risk factors develop.

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DESCRIPTION OF A CTG

1. Demographics
• Name
• Date
• Time
DESCRIPTION OF CTG

2. Baseline Foetal Heart Rate


normal between 110-160bpm
over 10minutes
DESCRIPTION OF CTG

– Normal Baseline FHR 110–160 bpm


– Moderate bradycardia 100–109 bpm

–Moderate tachycardia 161–180 bpm


– Abnormal bradycardia < 100 bpm
– Abnormal tachycardia > 180 bpm

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DEDCRIPTION OF CTG
DESCRIPTION OF CTG-FETAL BRADY
DESCRIPTION OF CTG

• 3. Variability
• It is measured by estimating the difference in beats per
minute between the highest peak and lowest trough of
fluctuation in a one-minute segment of the trace
DESCRIPTION OF CTG

• 4. Decelerations
• Early
• Late
• Variable
EARLY DECELERATIONS

• Physiological
• Head Compression
LATE DECELARATIONS

• Pathological
• Obsteric Emergency
VARIABLE DECELARATIONS

• Cord compression- entanglement, nuchal cord,


cord prolapse, true knot
• Primary CNS dysfunction
• Close observation
ATYPICAL VARIABLE DECELERATIONS

Poor variabilty
Continuation of baseline rate at lower levels
Slow return to baseline FHR after the end of the
contraction
Nadir less than 60 bpm
Certain clinical scenarios
cord prolapse
thick MSL
DESCRIPTION OF CTG

• 5 Contractions
• Frequency
• Duration
• Intervals –regular?
• Amplitude
DESCRIPTION OF CTG

• 6. Accelerations
DESCRIPTION OF CTG

• 7. Foetal Movement
MANAGEMENT OF THE ABNORMAL
CTG
1. Stop any offending agent eg oxytocin
2. Place in the left lateral position
3. Oxygen
4. IVF
5. Cbc GxM
6. Repeat V/E
1. If delivery is imminent aim for vaginal delivery
2. If delivery is remote --LSCS
CTG CASES
.

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