CTG in simple methods in fetal assessment according to RCOG guidelines. easy and concise feel free to download by OSAMA AKL MRCOG instructor contact me on WhatsApp 00201008067383

1. CTG
OSAMA AKL
MRCOG INSTRUCTOR
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2. How to auscultate fetal heart ?
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Doppler pinard CTG

3. IA
• Auscultate the fetal heart rate for a
minimum of 1 minute immediately after a
contraction. Palpate the woman's pulse to
differentiate between the heartbeats of the
woman and the baby.
• Offer CTG if IA indicates possible fetal heart
rate abnormalities. If the trace is normal
after 20 minutes, return to IA unless the
woman asks to stay on continuous CTG12/08/2018 OSAMA AKL 2018 3

4. Indications of Transfer the woman to obstetric-led care &
continuous CTG
1. Pulse over 120 beats/minute on 2 occasions 30 minutes apart
2. Systolic ≥ 160 or diastolic ≥ 110
3. or systolic ≥ 140 or Diastolic ≥ 90 mmhg on 2 consecutive readings 30 minutes apart.
4. 2+ of proteinurea and a single reading of either raised diastolic (90 mmhg or more) or raised
systolic (140 mmhg or more)
5. Temperature ≥ 38°c once , or ≥ 37.5°C twice 1 hour apart
6. Any vaginal blood loss other than a show
7. PROM 24 h.
8. Significant meconium
9. Pain differs from the pain normally associated with contractions
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5. 10.Any abnormal presentation, including cord presentation
11.High (4/5–5/5 palpable) or free-floating head in a nulliparous
woman
12.Suspected fetal growth restriction or macrosomia
13.Suspected anhydramnios or polyhydramnios
14.Fetal HR below 110 or above 160 beats/minute
15.A deceleration in fetal heart rate heard on IA.
16.Reduced fetal movements in the last 24 hours
17.Woman requests
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Indications of CTG

7. FHR
• IA to low risk women (Pinard or Doppler).
• immediately after a contraction for at least 1 minute,
• at least every 15 minutes.
• Palpate the maternal pulse hourly to compare.
If abnormal FHR:
• IA more frequently, for example after 3 consecutive contractions initially
• position and hydration, the strength and frequency of contractions and maternal
observations
if confirmed abnormal :
• continuous CTG
• obstetric-led care,
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13. Second stage
• second and subsequent labours last on average 5 hours and are
unlikely to last over 12 hours
• Passive : full dilatation of the cervix and before involuntary expulsive
contractions.
• Active : the baby is visible, expulsive contractions or active maternal
effort
 If the CTG trace is pathological, offer digital fetal scalp stimulation. If
this leads to an acceleration in fetal heart rate, only continue with FBS
if the CTG trace is still pathological.
• If digital fetal scalp stimulation leads to an acceleration , this as a sign
that the baby is healthy.
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Second stage
of labor
Suspect
delay after
30 Min

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CTG

16. Baseline (beats/
minute)
Baseline
variability
(beats/ minute)
Decelerations
Reass
uring 110 to 160 5 to 25
None or early or Variable decelerations with no concerning
characteristics* for less than 90 M.
Nonreassuring
100 to 109 OR
161 to 180
 Less than 5 for 30-
50 M.
 More than 25 for
15 - 25 M.
• Variable decelerations with no concerning characteristics ≥90 M
• Variable decelerations with any concerning characteristics* in up
to 50% of contractions for ≥ 30 minutes.
• Variable decelerations with any concerning characteristics* in over
50% of contractions for less than 30 minutes
• Late decelerations in over 50% of contractions for less than 30
minutes, with no maternal or fetal clinical risk factors such as
vaginal bleeding or significant m.
Abnormal
Below 100 OR
Above 180
Less than 5 for more
than 50 M. OR More
than 25 for more
than 25 M. OR
Sinusoidal
Variable decelerations with any concerning characteristics* in over
50% of contractions for 30 minutes (or less if any maternal or fetal
clinical risk factors
Late decelerations for 30 minutes (or less if any maternal or fetal
clinical risk factors) OR Acute bradycardia, or a single prolonged
deceleration lasting 3 minutes or more12/08/2018 OSAMA AKL 2018 16

17. Baseline fetal heart rate
• Reassuring: 110 to 160 beats/minute
• Non-reassuring: 100 to 109 beats/minute
161 to 180 beats/minute
• Abnormal: below 100 beats/minute above 180 beats/minute.
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18. concerning characteristics of variable
decelerations
1. Lasting more than 60 seconds
2. Reduced baseline variability within the deceleration
3. Failure to return to baseline
4. Biphasic (W) shape
5. No shouldering
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19. Category Definition Management
Normal All features are
reassuring
Continue CTG (unless it was started because of concerns
arising from IA and there are no ongoing risk factors.
Suspicious 1 non-reassuring
feature
conservative measures
Pathological  1 abnormal
feature
 2 non-
reassuring
features
 Exclude (cord prolapse, suspected placental abruption or
uterine rupture)
 Correct any underlying causes, such as hypotension or
uterine hyperstimulation
 conservative measures
 counseling
 obtain a further review by an obstetrician and a senior
midwife
 offer digital fetal scalp stimulation and document the
outcome
 FBS
 expediting the birth12/08/2018 OSAMA AKL 2018 19

20. Needforurgentintervention Acute
bradycardia
, or a single
prolonged
deceleratio
n for 3
minutes or
more
 Seek Obstetric Help
 Correct Any Underlying Causes, Such As Hypotension Or
Uterine Hyperstimulation
 Conservative Measures
 Expedite The Birth If The Acute Bradycardia Persists For 9
Minutes If The Fetal Heart Rate Recovers At Any Time Up
To 9 Minutes, Reassess.
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21. Conservative measures
1. alternative position (avoid supine)
2. IV fluids if the woman is hypotensive
3. reduce contraction frequency by: reducing or
stopping oxytocin and/or offering a tocolytic drug
subcutaneous terbutaline 0.25 mg
4. Antipyretic if feverish
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22. Response to fetal scalp stimulation
 If a sample cannot be obtained or FBS is
contraindicated, a response to fetal scalp
stimulation during vaginal examination can be used
to elicit information about fetal wellbeing
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34. FBS interpretation
 interpretation Abnormal borderline normal
 pH ≤7.20 ≥7.25
 s. lactate <4.8 >4.2
 Action
 Category I CS
 OVD
Repeat after 30 M. If
CTG remains the
same
Repeat after 60 M.
If CTG remains
the same
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35. Paired cord samples
•Paired cord samples should on all births in which there has been
concern regarding fetal wellbeing or admission to neonatal unit is
expected
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