project

1. OBSTETRIC &GYNAECOLOGY DEPARTMENT
CARDIOTOCOGRAPHY

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 Cardiotocography (CTG) is a test used in pregnancy to
monitor both the fetal heart pattern as well as the
uterine contractions.
 It should only used in the 3rd trimester when fetal neural
reflexes are present.
 Its purpose is to monitor fetal well-being & allows early
detection of fetal distress antenatal or intra-partum.
 An abnormal CTG indicates the need for further invasive
investigation & ultimately may lead to emergency CS

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-Usually every 7 days (i.e. weekly)
-Twice-weekly testing is advocated by some in :
 Post term pregnancy
 Diabetes mellitus
 Fetal growth restriction,
 Gestational hypertension
- Additional testing is performed for maternal
or fetal deterioration regardless of time
elapsed
-Others perform non-stress tests daily or even
more frequently

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6.  The machine used is called cardio-tocograph.
 It involves the placement of 2 transducers on the
abdomen of a pregnant woman: one transducer records
the fetal heart rate using ultrasound beam , the other
transducer records uterine contractions by measuring the
tension of the maternal abdominal wall. This provides
indirect indication of the intrauterine pressure.
 These recordings are blotted on a special paper.
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Internal fetal monitoring
FSE

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 The machine used is called cardio-tocograph.
 It involves the placement of 2 transducers: a
fetal scalp electrode( FSE): an internal fetal heart
monitor , and intrauterine pressure
catheter(IUPC): an internal uterine contraction
monitor
 These recordings are shown on a screen and
may be blotted on a special paper.

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Horizontal Scale
Paper speed is set to 1,2,or 3 cm /minute.
Vertical Scale:
 Sensitivity displays are set to 20 or 30 beats per
minute (bpm) /cm.
 FHR range displays of 30–240 bpm .
 Uterine Activity: Internal 0-100 mmHg
External 0-100 relative units

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 To interpret a CTG you need a structured
method of assessing its various characteristics.
 The most popular method can be remembered
using the acronym DR C BRAVADO
- DR=Define Risk .
- Bra= Baseline Rate
- A= Accelerations
- C= Contractions
- V=Variability
- D= Decelerations
- O= Overall impression

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 You first need to assess if this pregnancy
is high or low risk
 This is important as it gives more context
to the CTG reading ;e.g. If the pregnancy is
high risk, your threshold for intervening
may be lowered.

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High-risk pregnancies:

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 Record the number of contractions present in a 10
minute period - e.g. 3 in 10
 Each big square is equal to 1 minute, so you look
how many contractions occurred in 10 squares
 Individual contractions are seen as peaks on the part
of the CTG monitoring uterine activity
 You should assess contractions for the following:
 Duration – how long do the contractions last?
 Intensity – how strong are the contractions? (assessed using palpation)

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 The baseline rate is the average heart rate of
the fetus in a 10 minute window.
 Look at the CTG & assess what the average
heart rate has been over the last 10 minutes
 Ignore any Accelerations or Decelerations
 A normal fetal heart rate is between 120-160
bpm.

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Reduced variability can be caused by:
1. Fetus sleeping - this should last no longer than 40 minutes – most common cause
2. Fetal acidosis (due to hypoxia) – more likely if late decelerations also present
3. Fetal tachycardia
4. Drugs – opiates, benzodiazipine’s, methyldopa, magnesium sulphate
5. Prematurity – variability is reduced at earlier gestation (<28 weeks)
6. Congenital heart abnormalities

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-Once you have assessed all aspects of the CTG you need to give your
overall impression. The overall impression can be described as either:
 Reassuring
 Suspicious
 Pathological
-The overall impression is determined by how many of the CTG features were
either reassuring, non-reassuring or abnormal. The NICE guideline
demonstrates how to decide which category a CTG falls into:
1Normal CTG= All four features are classified as reassuring.
2Suspicious CTG= One feature is classified as non-reassuring whilethe
remaining features are reassuring
3Pathological CTG= ≥ 2 features non-reassuring, or ≥ 1 feature
classified as abnormal

17. Continuous EFM In Low-risk Women:
Indications:
1. Significant or light Meconium-stained liquor
2. Abnormal FHR detected by intermittent auscultation
(< 110 bpm; or > 160 bpm, or any decelerations after a
contraction.
3. Maternal pyrexia (defined as 38.0 °C once or 37.5 °C on
two occasions 2 hours apart)
4. Fresh bleeding developing in labor
5.Oxytocin use for augmentation
6. The woman’s request.

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Continuous EFM In Low-risk Women:
Evaluation :
 There was a borderline evidence that continuous EFM
were more likely to have an instrumental birth
compared with the auscultation group although there
was no evidence of differences in:
 Augmentation
 Perinatal mortality
 Other neonatal morbidities