CTG by Dr Farizal

1. CARDIOTOCOGRAPHY
(CTG)

2. USES OF CTG
• Used for both antepartum and
intrapartum care
• Used to monitor fetal well being and
detect fetal distress
• Used during pregnancy for recording
the fetal heart beat and uterine
contractions; typically in the third
trimester
• Used to detect fetal hypoxia in labor

3. APPLICATION OF THE TRANSDUCERS
• Placement of two transducers onto
the abdomen of the pregnant
woman
• One transducer records the fetal
heart rate
• The other transducer monitors the
uterine contractions
• It does this by measuring the
tension of the maternal abdominal
wall

4. Interpretation of CTG
• Uterine contraction
• Baseline fetal heart rate
• Baseline fetal variability
• Acceleration
• Deceleration(early, variable, late)

5. Uterine contractions
*1 big square = 1 min
• record the number of
contractions present in a
10 minute period
• (the number of
contractions withing the
10 big squares)
• Each peak is seen as a
contraction

6. Baseline heart rate pattern
• Average rate of fetal
heart rate between areas
of acceleration and
deceleration
• Normally 110 to 160
beats per minute

7. Bradycardia (causes)
• Fetal hypoxia/acidosis
• Local anesthetics , epidural
• Drugs taken by mother, pethidine, propanolol, magnesium
sulphate
• Fetal heart conduction defect

8. Tachycardia (causes)
• Drugs taken by mother, ritodrine
• Maternal and fetal infection
• Maternal and fetal anemia
• Fetal distress

9. Baseline variability
• Normal irregular changes and fluctuations.
• Measure from peak to trough.
• Normal value 5-25 bpm.
• Indicate a good fetal neurological status.

10. Decreased variability
• Cause:
 sleep/inactivity
 Marked prematurity
 Mild fetal hypoxia (acidosis)
 BZDs, barbiturate, MgSo4
 Neurological abnormality

11. Sinosoidal pattern of Variability
• Alert!!
• Associated w/ high rates of fetal mobidity and mortality.
• Following characteristic:
 Smooth regular wave-like pattern
 Frequency: 2-5 cycle/min
 Stable rate
 No beat to beat variabilty
• indicate:
 Severe F hypoxia
 Severe F anaemia
 fetal/maternal hemorrhage

12. acceleration
• Reflected as 15 beats rise lasting > 15 seconds
• Seen after fetal movement.
• Occur along with uterine contraction is sign of
healthy fetus.
• Presence is reassuring.

13. Deceleration
• An abrupt decrease in baseline FHR
• <100 bpm for at least 3 minutes
• Three type:
Early deceleration
Variable deceleration
Late deceleration
• Bad sign

14. • Vagal response to head compression.
• Onset with start/soon after Uterine contraction.
• Uniform in shape .
• Duration < Uterine contraction.
• Does not fall beyond 100 bpm.
Early deceleration

15. • Occur in cord compression.
• Varies in intensity, duration, timing
• Relieve by reposition of mother.
Variable Deceleration

16. Late Deceleration
• Begin at peak, recover after contraction ends
• Due to Decreased Uteroplacental insufficiency.
• Seen in placental insufficiency, maternal
hypotension, uterine hyper-stimulation,
preeclampsia.
• Life threatening: C sec

20. FETAL SCALP PH STUDIES
• Interpretation:
pH value Action
>7.25 Observe CTG and if
abnormality persists,
repeat sample in 1 hr
7.20-7.25 If delivery imminent,
episiotomy or assisted
delivery- if CTG changes
persist repeat sample in
30 minutes and act
according to the value
and clinical situation
<7.25 Expedite delivery

21. Intrauterine
resuscitation
• Measures taken to increase
oxygen delivery to the placenta
and umbilical blood flow
• Initial left lateral positioning
• Rapid iv infusion of crystalloid
• Maternal oxygen administration
• Inhibition of uterine contractions
(subcutaneous/iv terbulatine
250mg)
• Intra amniotic infusion of warmed
crystalloid solution