Your SlideShare is downloading. ×
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Cardiotocography (CTG)
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Cardiotocography (CTG)

29,844

Published on

SALSO Series

SALSO Series

Published in: Health & Medicine
3 Comments
48 Likes
Statistics
Notes
No Downloads
Views
Total Views
29,844
On Slideshare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
0
Comments
3
Likes
48
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. BASIC CTG TEACHING SALSO Sarawak General Hospital
  • 2. BASELINE HEART RATE
    • mean level of FHR when stable, acceleration and deceleration being absent
    • Normal = 110 – 160 bpm
  • 3. ACCELERATION
    • A transient increase in FHR of 15 bpm or more and lasting for 15 seconds or more
  • 4. DECELERATION
    • A transient episode of slowing of FHR below the baseline level more than 15 bpm and lasting 15 seconds or more
  • 5. VARIABILITY
    • Degree to which the baseline varies within a particular band width excluding acceleration and deceleration (5-15 bpm)
    • Represent interaction of nervous system which determine the cardiac output and heart rate, in response to venous return and metabolic demands of fetus
  • 6. REACTIVE TRACE
    • Normal baseline heart rate, variability, presence of acceleration (2 in 20 minutes trace) and absence of deceleration
  • 7.  
  • 8. BRADYCARDIA
    • A baseline FHR persistently low than 110 bpm
    • Causes :
      • Gestational age > 40 w
      • Cord compression/prolapsed
      • Congenital heart malformation
      • Drugs
      • Late fetal hypoxia
      • unknown
  • 9.  
  • 10. TACHYCARDIA
    • Persistantly baseline > 160 bpm
    • Causes :
      • Maternal pyrexia
      • Fetal infection
      • Chronic hypoxia
      • Hyperthyroidism or maternal stress
      • Fetal hormones in response to stress
      • Gestational age < 32 w
      • Drugs
      • Excessive fetal movements
  • 11.  
  • 12. DECREASE VARIABILITY
    • Variability < 5 bpm or absent
    • Causes :
      • Severe hypoxia
      • Fetal sleeping pattern
      • Maternal sedation
      • Gestational age < 28 – 30w
      • Congenital malformation
  • 13.  
  • 14. SINUSOIDAL
    • A smooth, wave like baseline, absent beat to beat variability
    • Causes :
      • Severe hypoxia
      • Anaemic fetus
      • idiopathic
  • 15.  
  • 16. EARLY DECELERATION
    • Onset of deceleration is at the onset of contraction
    • Causes :
      • Fetal head compression
  • 17.  
  • 18. LATE DECELERATION
    • Deceleration occur more than 15 seconds after the peak of contraction
    • Causes :
      • Reduction in placental blood flow (abruptio, hyperstimulation)
      • Maternal related disease (PIH)
      • Fetal compromised (IUGR, premature)
      • Supine hypotension
  • 19.  
  • 20. VARIABLE DECELERATION
    • Deceleration that inconsistent in shape and in timing with uterine contraction
    • Causes :
      • Umbilical cord entanglement
      • Cord round neck
      • True knot
      • Cord prolapsed
  • 21. PROLONGED DECELERATION
    • A consistent drop in fetal heart rate > 30 bpm, lasting 2 minutes
    • Causes :
      • Total umbilical cord occlusion
      • Uterine hypertonic
      • Maternal hypotension
      • Cord compression
  • 22.  
  • 23. SUSPICIOUS/EQUIVOCAL CTG
    • Absence of acceleration for > 40 min
    • BHR 160-170 bpm or 100-110 bpm
    • Absent BV for >40 min with normal baseline and no deceleration
    • Variable deceleration <60 bpm for 60 sec
    • Transient bradycardia <100 bpm more than 2 min
  • 24. PATHOLOGICAL/OMINOUS
    • BHR >160bpm with absent variability and/or repetitive late or variable deceleration
    • Absent BV >90min
    • Complicated variable deceleration (>60 bpm lasting >60 sec)
    • Repetitive late decelerations
    • Prolonged bradycardia
    • Sinusoidal pattern
  • 25. APPROACH TO CTG (DR C BRAVADO)
    • D efine r isk : low/risk
    • C ontraction : freq/duration
    • B aseline r ate : brady/tachy/normal
    • V ariability : 5 – 10 bpm
    • A cceleration : present/absent
    • D eceleration : early/variable/late
    • O verall : comment & management
  • 26. CLINICAL SCENARIO
  • 27. CASE 1
    • 16 y old, G2P0 at 40w came with contraction pain. A/N uncomplicated
    • Os 5cm, ARM clear liquor
  • 28.  
  • 29. CASE 2
    • 25 y, G1P0 at 40w + 11 days presented with contraction pain.
    • At this time, os 2cm well effaced
  • 30.  
  • 31. Case 3
    • 23 y old, G3P1 at 37 weeks came with contraction pain. She also PIH on treatment.
    • Os 4cm, ARM minimal liquor
  • 32.  
  • 33. CASE 4
    • 26, G2P1 at 41w
    • Os already 7cm, clear liquor
    • Good labour progress
    • Os become full then CTG show :
  • 34.  
  • 35. Case 5
    • 25, G1P0 at 40w admitted with contraction
    • Os 3cm, clear liquor and given pethidine as pt restless
  • 36.  
  • 37. Case 6
    • 25, G1P0 at 40 w had contraction pain
    • At that time os 7cm, clear liquor.
    • 2 hours later progress to os 8 cm
  • 38.  
  • 39. UTERINE HYPERSTIMULATION
    • Contraction lasting longer than 90 sec
    • Relaxation between contractions less than 30 sec
    • Contractions more frequent than every 2 minutes (>5 in 10 min)
    • Peak pressure of contraction above 80 mmhg
  • 40. INTERVENTIONS
    • Continuous CTG monitoring
    • Discontinue/reduce oxytocin infusion
    • Increase rate of IVF
    • Change maternal position
    • Oxygen
    • FBS to assess fetal wellbeing
    • Tocolytic drug

×