How to read CTG

1. Cardiotocography
INTERPRETATION OF CTG TRACING
OBSTETRIC DEPARTMENT
Dr Mona Al-omayri
Dr Amal Al-zahrani
Senior Resident R5

2. What is cardiotocography?
• Cardiotocography (CTG) is used during pregnancy to
monitor the fetal heart and contractions of the uterus.
•Its purpose to early detection of fetal distress.

3. HOWTO READ A CTG ?

4. Intrapartum care: NICE guideline CG190 (December 2014).

5. Define risk ( the high risk ?)
• Obstetric complications
• Multiple gestation
• Post-date gestation
• Previous cesarean section
• Intrauterine growth restriction
• Premature rupture of membranes
• Congenital malformations
• Oxytocin induction /augmentation of
labour
• Pre-eclampsia
• Maternal medical illness
• Gestational diabetes
• Hypertension
• Asthma
• Other risk factors
• Absent of prenatal care
• Smoking
• Drug abuse

6. Contractions
Dr C Bravado  ALSO

7. Monitoring of Contractions

8. Uterine contractions (CTG)
Record the number of contractions present in a 10 minute period.
Each big square on the CTG chart is equal to one minute, so look at
how many contractions occurred within 10 big squares.

9. Abnormal contraction
• Tachysystole - > 5 contractions/ 10 min.
.

10. Baseline Rate
Reassuring
110-160bpm
Non-reassuring
Tachycardia 161-180 bpm
Bradycardia 100-109 bpm
Sinusoidal pattern

11. Normal 110-160BPM
Tachycardia>160BPM
Bradycardia<110BPM

12. SINUSOIDAL
12
A smooth, regular, wave-like pattern
Frequency of around 2-5 cycles a minute
Stable baseline rate around 120-160bpm
No beat to beat variability

13. Variability
Reassuring
≥ 5 bpm
Non-reassuring
< 5 bpm for ≥ 40 min
refers to the variation of fetal heart rate from one beat to the next

14. 14
REDUCED VARIABILITY

15. Accelerations
Transient increase in FHR of 15 bpm or more lasting 15 seconds or more

16. 15 beats
15 seconds

17. Decelerations
Transient episodes of slowing of FHR more than 15 bpm for more
than 15 seconds
Non-reassuring
Early
Variable
Late
Prolonged > 3 min

18. EARLY DECELERATIONS
18

19. Early deceleration
Head compression

20. LATE DECELERATIONS
20

21. Late deceleration
Foetal Hypoxia

22. VARIABLE DECELERATIONS
22

23. Variable
decelerations
•cord compression
•Foetal hypoxia

24. Abnormal Prolonged
Deceleration

25. OVERALL IMPRESSION

26. Normal
All 4 reassuring features
Suspicious
1 non-reassuring
3 reassuring features
Pathological
2 or more non-reassuring
or
1 or more abnormal
Categorisation of fetal heart rate traces
Category Definition
Normal All 4 reassuring
Suspicious 1 non-reassuring
Rest reassuring
Pathological 2 or more non-
reassuring
1 or more abnormal

29. ThankYou ….