Cardiotocography (CTG) is a technical method for recording the fetal heartbeat and uterine contractions during pregnancy using ultrasound and tocodynamometry. CTG involves using an electronic fetal monitor, commonly known as a cardiotocograph, to obtain a record of the fetal heart rate and uterine contractions. It was invented in the 1960s and refined to be more accurate. CTG is typically used in late pregnancy or labor to evaluate fetal well-being and identify any signs of hypoxia.

1. CARDIOTOCOGRAPHY
Kanchan Mehra
M.Sc Nursing 1st year
PCNMS
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2. INTRODUCTION
Cardiotocography (CTG) is a technical method for recording (graphy)
the foetal heartbeat using ultrasound (cardio) and the uterine
contractions (toco) during pregnancy, typically in the third trimester.
Fetal monitoring was invented by Doctors Alan
Bradfield, and Edward Hon. A refine version (cardiotocograph) was
later developed for Hewlett Packard by Konrad Hammacher
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3. DEFINITION
Cardiotocography (CTG) is a technical means of recording the fetal
heartbeat and the uterine contractions during pregnancy. The machine
used to perform the monitoring is called a cardiotocograph, more
commonly known as an electronic fetal monitor(EFM).
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4. TIMING OF CTG
Antepartum and on admission to the labor room (admission
CTG) the usual (minimum) duration of recording is 30
minutes. Particularly in the third trimester of pregnancy the
CTG should be obtained with the mother placed in a left lateral
position to prevent vena cava syndrome.
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5. PURPOSE OF CTG
The purpose of CTG recordings is to identify when there is
concern about fetal well-being to allow interventions to be
carried out before the fetus is harmed. The focus is on
identifying fetal heart rate (FHR) patterns associated with
inadequate oxygen supply to the fetus.
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6. INDICATION OF CTG
• Alterations in fetal HR present during auscultation.
• If FHR is less than 110bpm
• High-risk delivery like Polyhyramnios, pre- echlampsia,
echlampsia
• Induced labor.
• If there is decrease fetal monitoring
• If there is a twin pregnancy.
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7. CONTRAINDICATION
• Uterine hemorrhage of unknown cause
• Placenta previa, It may also be associated with a small risk of
fetal injury
• Placental hemorrhage
• Uterine perforation
• Vaginal Infection
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8. ARTICLE NEEDED FOR
CARDOTOCOGRAPHY
• Electronic fetal monitoring
• Ultrasound transducer
• Tocotransducer
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9. • Monitor strip
• Ultrasound gel
• Belt to hold the transducers in place
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10. METHOD
• EXTERNAL CARDIOTOCOGRAPHY:- It is for continuous or
intermittent monitoring. The fetal heart rate and activity of
the uterine muscle are detected by two transducers placed on
the mother’s abdomen(one above the fetal heart and other at
the fundus). Doppler ultrasound provides the information
which is recorded on a paper strip known as
Cardiotocograph(CTG).
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11. • INTERNAL CARDIOTOCOGRAPHY:- This method can be useful
if membrane has ruptured either spontaneously or artificially.
Uses an electronic transducer connected directly to the fetal
scalp through the cervical opening and is connected to the
monitor. This type of electrode is sometimes called a spiral or
scalp electrode. Internal monitoring provides a more accurate
and consistence transmission of the fetal heart rate than
external monitoring because factor such as movement do not
affect it. Internal monitoring may be used when external
monitoring of the fetal heart rate is inadequate, or closer
surveillance is needed.
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13. INTERPRETATION
• Baseline fetal heart rate :- It is the fetal heart rate between
uterine contraction. A rate more than 160bpm is termed
baseline tachycardia. A rate slower than 120bpm is called
baseline bradycardia. Either may be indicative of fetal hypoxia.
A constant baseline rate between 110 and 120 bpm may
indicate cord compression as in cord prolapsed.
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14. • Baseline Variability:- When feto placental function is normal,
the fetal heart rate has term variability greater than 7bpm at
least 4 acceleration of more than 15bpm in 20minutes internal
spontaneously or in response to Braxton Hicks Contractions or
fetal movements.
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15. • Response of the fetal heart to uterine contractions:- The
fetal heart rate will normally remain steady or accelerate
during contraction. Decelerations of fetal heart rate, if
recorded must be assessed for their relationship to uterine
contractions.
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16. • Early decelerate:- Begins at or after the onset of a contraction
and returns of the baseline rate by the contractions has
finished. An early deceleration is commonly associated with
compression of fetal head.
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17. • Late deceleration:- Begins during or after a contraction,
reaches its lowest point after the peak of the contraction and
has not recovered by the time that contraction has ended.
Sometimes the deceleration has barely recovered by the onset
of the next contraction. The time lag between the peak of the
contraction and the lowest point of the deceleration is more
significant of severity than the drop in the fetal heart rate. This
always indicates fetal hypoxia and the physician must be
informed.
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18. COMPLICATION
• Premature rupture of membranes.
• Preterm labor.
• Nerve injuries.
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19. CARE AFTER PROCEDURE
• Clean the gel that is used during procedure.
• Make the client in comfortable position.
• Replace all article to the utility room.
• Wash hands
• Record the date and time of CTG
• Document the recording
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20. ROLES AND RESPONSIBILITY
OF MIDWIFERY
• Explain the procedure to the patient.
• Provide privacy.
• Maintain a safe, comfortable position for the client.
• Gather all the article needed for CTG
• The woman must empty her bladder.
• Patient should be lie in semi fowler’s or left lateral position.
• FHR is then maintained for approximate 20-30 min.
• It is important that fetus not be in sleep state during entire procedure.
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21. SUMMARY
Cardiotocography (CTG) is a technical means of recording
the fetal heartbeat and the uterine
contractions during pregnancy. The machine used to perform
the monitoring is called a cardiotocograph, more commonly
known as an electronic fetal monitor(EFM). Cardiotocography
(CTG) is a technical method for recording (graphy) the foetal
heartbeat using ultrasound (cardio) and the uterine
contractions (toco) during pregnancy, typically in the third
trimester. Fetal monitoring was invented by Doctors Alan
Bradfield, Orvan Hess and Edward Hon. A refine version
(cardiotocograph) was later developed for Hewlett
Packard by Konrad Hammacher.
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22. BIBLIOGRAPHY
• https://www.uptodate.com/contents/decreased-fetal-movement-
diagnosis-evaluation-and-management/abstract/51
• https://www.cochrane.org/CD006066/PREG_continuous-
cardiotocography-ctg-form-electronic-fetal-monitoring-efm-
fetal-assessment-during-labour
• Beischer NA, Markay EV, Coldits PB, Obstetric and the
Newborn An Illustrated Textbook.3rd edition, W.B.Saunders
company Ltd, Page No-125- 127
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