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CTG Interpretation and Management
Miss Philippa MothLocum Consultant Obstetrician and
GynaecologistMaidstone and Tunbridge Wells NHS Trust
• NICE Guidelines
• Definitions and normal limits
• Acting on abnormal CTGs
• Common pitfalls
Who Gets Continuous Monitoring?
Maternal• Hypertension• IOL / Augmentation• DM• Pyrexia• Previous Caesarean• Patient Request
Fetal• Abnormal intermittent
monitoring• IUGR• Oligo• Postdates• Multiple Pregnancy• Breech• Epidural• Meconium
NICE Guidance
Category Definition
Normal A FHR trace in which all four features are classified as reassuring
Suspicious A FHR trace with one non reassuring feature
Pathological A FHR trace with two or more non reassuring features or one or more abnormal
DR C BRAVADO
• DR Define Risk• C Contractions• BRA Baseline Rate• V Variability• A Accelerations• D Decelerations• 0 Overall Impression
Accelerations
Decelerations
• Early
• Variable - Typical- Atypical
• Late
Early Decelerations
• Due to head compression
Typical Variable Decelerations
• Due to cord compression
Atypical Variable Decelerations
Late Decelerations
• Due to Fetal Hypoxia
Normal Variability
Reduced Variability
Acting on CTGs
• Normal• Suspicions / pathological
- review in a set amount of time
- FBS
- Deliver
Bradycardia
Sinusoidal CTG
Common Pitfalls
• Interpretation of CTGs outside of labour
• Situations to think carefully about FBS- VBAC- Pyrexia- Intrapartum haemorrhage
Common Pitfalls
Fresh Eyes
• Never hesitate to ask for a second opinion
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