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BASIC CTG TEACHING SALSO Sarawak General Hospital
BASELINE HEART RATE <ul><li>mean level of FHR when stable, acceleration and deceleration being absent </li></ul><ul><li>No...
ACCELERATION <ul><li>A transient increase in FHR of 15 bpm or more and lasting for 15 seconds or more </li></ul>
DECELERATION <ul><li>A transient episode of slowing of FHR below the baseline level more than 15 bpm and lasting 15 second...
VARIABILITY <ul><li>Degree to which the baseline varies within a particular band width excluding acceleration and decelera...
REACTIVE TRACE <ul><li>Normal baseline heart rate, variability, presence of acceleration (2 in 20 minutes trace) and absen...
 
BRADYCARDIA <ul><li>A baseline FHR persistently low than 110 bpm </li></ul><ul><li>Causes : </li></ul><ul><ul><li>Gestatio...
 
TACHYCARDIA <ul><li>Persistantly baseline > 160 bpm </li></ul><ul><li>Causes : </li></ul><ul><ul><li>Maternal pyrexia </li...
 
DECREASE VARIABILITY <ul><li>Variability < 5 bpm or absent </li></ul><ul><li>Causes : </li></ul><ul><ul><li>Severe hypoxia...
 
SINUSOIDAL <ul><li>A smooth, wave like baseline, absent beat to beat variability </li></ul><ul><li>Causes : </li></ul><ul>...
 
EARLY DECELERATION <ul><li>Onset of deceleration is at the onset of contraction </li></ul><ul><li>Causes : </li></ul><ul><...
 
LATE DECELERATION <ul><li>Deceleration occur more than 15 seconds after the peak of contraction </li></ul><ul><li>Causes :...
 
VARIABLE DECELERATION <ul><li>Deceleration that inconsistent in shape and in timing with uterine contraction </li></ul><ul...
PROLONGED DECELERATION <ul><li>A consistent drop in fetal heart rate > 30 bpm, lasting 2 minutes </li></ul><ul><li>Causes ...
 
SUSPICIOUS/EQUIVOCAL CTG <ul><li>Absence of acceleration for > 40 min </li></ul><ul><li>BHR 160-170 bpm or 100-110 bpm </l...
PATHOLOGICAL/OMINOUS <ul><li>BHR >160bpm with absent variability and/or repetitive late or variable deceleration </li></ul...
APPROACH TO CTG (DR C BRAVADO) <ul><li>D efine  r isk : low/risk </li></ul><ul><li>C ontraction : freq/duration </li></ul>...
CLINICAL SCENARIO
CASE 1 <ul><li>16 y old, G2P0 at 40w came with contraction pain. A/N uncomplicated </li></ul><ul><li>Os 5cm, ARM clear liq...
 
CASE 2 <ul><li>25 y, G1P0 at 40w + 11 days presented with contraction pain. </li></ul><ul><li>At this time, os 2cm well ef...
 
Case 3 <ul><li>23 y old, G3P1 at 37 weeks came with contraction pain. She also PIH on treatment. </li></ul><ul><li>Os 4cm,...
 
CASE 4 <ul><li>26, G2P1 at 41w </li></ul><ul><li>Os already 7cm, clear liquor </li></ul><ul><li>Good labour progress  </li...
 
Case 5 <ul><li>25, G1P0 at 40w admitted with contraction </li></ul><ul><li>Os 3cm, clear liquor and given pethidine as pt ...
 
Case 6 <ul><li>25, G1P0 at 40 w had contraction pain </li></ul><ul><li>At that time os 7cm, clear liquor. </li></ul><ul><l...
 
UTERINE HYPERSTIMULATION <ul><li>Contraction lasting longer than 90 sec </li></ul><ul><li>Relaxation between contractions ...
INTERVENTIONS <ul><li>Continuous CTG monitoring </li></ul><ul><li>Discontinue/reduce oxytocin infusion </li></ul><ul><li>I...
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Cardiotocography (CTG)

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Cardiotocography (CTG)

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

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