The CTG

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3 W s

Why do we need CTG?

What is CTG?

When to use CTG?

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Why Do We Need CTG?

Used to monitor the foetal well

being in utero

to identify the already

compromised or likely to become

compromised fetus of anapparently normal / low-risk

pregnancy upon admission

* Any one with a suspicious

Admission Test (AT) should have

continuous CTG from early inlabour

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What Is It?

Measures Foetal

Heart Tracings and

Contractions

Interpretation is KEY

Cardiotocograph

Pressure TransducerUSProbe

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When to Use it?

Not ALL women need it

Restricts MOBILITY

Only in High Risk

Pregnancies

Diam diam

Tak boleh Makan,

Minum

Tak Boleh Kencing

Sendiri, Masuk Tiub,

Tak Boleh Jalan,

Sebab Pasang CTG

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NICE Recommendation

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Criteria of normal CTG

Normal -

(1) Baseline 110-160 bpm

(2) Baseline variability 5-25 bpm

(3) No decelerations / sporadic mild

deceleration of short duration

(4) 2 accelerations during a 10

minutes period

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B. Suspicious -(1) Baseline 160-170 or 110-100 bpm

(2) Variability 5-10 bpm for > 40 min

(3) Variability > 25 bpm(4) No accelerations > 40 min

(5) Sporadic mild decelerations of any type (6)

Variable deceleratopms

Antepartum - (1) - (5) any one / combination

Intrapartum - (1) - (4) & (6) any one /

combination

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C. Pathological :Antepartum

(1) Baseline < 100 or > 170 bpm

(2) Variability < 5 bpm for > 40 min(3) Recurring and repeated decelerations of

any type

(4) Sporadic noncurrent severe variable,

prolonged or late decelerations

(5) Sinusoidal pattern Any one or in

combination

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Abnormal Pattern

The following alone and in combinationsignify developing hypoxia and acidosis

Absence of accelerations

baseline FHR baseline variability

Late decelerations

Variable decelerations with abnormal

features

Early decelerations with abnormal

features

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Talking in TALK

We need to talk in

the same language

to avoid confusion

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DR C BRAVADO

DRDefine Risk

CContractions

BRBaseline Rate

A - Accelerations

Va - Variability

D - Decelerations

O - Others

Breaks up the

reading of the CTG

Reminds us to look

at the cases as a

whole!!

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Part 1 CTG: Foetal Heart Trace

BASELINE RATE

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VARIABILITY

Variation in Baseline

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DECELERATIONS

Reduction in Baseline by 15bpm for 15 seconds

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FHR Features

Described as

Reassuring

Non ReassuringAbnormal

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FHR FeaturesFeature Baseline

(bpm)

Variabilitity

(bpm)

Decelerations Accelerations

Reassuring 110-160 >5 None

Non

Reassuring

100-109

161-180

10 min

30mins

Late Decelerations

>30 mins

Single prolonged

Deceleration >3mins

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CTG Description

NORMAL

SUSPICIOUS

PATHOLOGICAL

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NORMAL CTG

Feature Baseline Variability Decelerations Accelerations

Reassuring 110-160 >5 None

Non

Reassuring

Abnormal

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DR C BRAVADO

DRDefine Risk

CContractions

BRBaseline

Rate A- Accelerations

Va- Variability

D- Decelerations O - Others

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DRDefine Risks

C -Contractions: 1 in 10 mins

BR - Baseline Rate: 140 bpm

A- Accelerations: 3

Va - Variability: >5 bpm

DDecelerations: NIL

O- Others

NORMAL CTG

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Suspicious CTG

Feature Baseline Variability Decelerations Accelerations

Reassuring

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Pathological CTGFeature Baseline Variability Decelerations Accelerations

Reassuring None

Non

Reassuring

100-109

161-180

5 None

Non Reassuring

Abnormal 180

Sinusoidal

pattern

>10 minutes

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DR C BRAVADO

DRDefine Risk

CContractions

BRBaseline

Rate A- Accelerations

Va- Variability

D- Decelerations O - Others

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DRDefine Risks



A- Accelerations: NIL

Va - Variability: >5 bpm (10-20 bpm)

DDecelerations: (+)

OOthers

PATHOLOGICAL CTG

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Management of Suspicious CTG

Correctable Factors: Hydration

Left Lateral Position

Hyperstimulation? Others (i.e. fever)

Repeat CTG tracing after correction

The Management of

a Suspicious CTG is

NOTrepeat till CTGnormal.

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Management of Pathological CTG

Can we wait?Additional Testing Required

Foetal Blood Sampling

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Thank you very much.

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Q1?

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A1

DRDefine Risks

C -Contractions: NIL



Va - Variability:

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Q2?

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A2

DRDefine Risks



A- Accelerations: 3

Va - Variability: (+) (5-10 bpm)

DDecelerations: NIL

OOthers

NORMAL CTG

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Q3?

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A3

DRDefine Risks




Va - Variability: reduced variability 5-10bpm

DDecelerations: NIL >40mins

OOthers

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Q4?

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A4

DRDefine Risks: fetus with severe anemia




Va - Variability: NIL

DDecelerations: NIL

OOthers: tracing showing tachycardia & sinusoidal fetal heart rate with

absent of short-term variability

PATHOLOGICAL CTG

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Q5?

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A5

DRDefine Risks

C -Contractions: 4 in 10

BR - Baseline Rate: 135-140 bpm


Va - Variability: 5-10 bpm

DDecelerations: Variable suggesting cord compression

OOthers: Fetal scalp blood pH may be necessary if baseline rate rises

and/or the variability becoming

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Q6?

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A6

DRDefine Risks





DDecelerations: Variable with ominous featureslate

recovery and combined or biphasic decelerations (i.e.

variable and late)

OOthers

PATHOLOGICAL CTG

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Q7?

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A7

DRDefine Risks: augmentation of labour with oxytocin infusion


BR - Baseline Rate: 140 - 150 bpm

A- Accelerations: (+)


DDecelerations: Hyperstimulation, with increased basal tone, resulted in a

prolonged bradycardia

OOthers

PATHOLOGICAL CTG

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Q8?

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A8

DRDefine Risks





DDecelerations: Variable with sudden bradycardia to 70 bpm

OOthers: Cessation of pushing should be advised and arrangements for

assisted vaginal delivery made unless spontaneous delivery is imminent

PATHOLOGICAL CTG

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Q9?

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A9

DRDefine Risks





DDecelerations: Repetitive late decelerations

OOthers

PATHOLOGICAL CTG

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Q10?

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A10

DRDefine Risks





DDecelerations: NIL

OOthers: Twin FHR signals offset by 20 bpm

NORMAL CTG

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Some Interesting Facts

Even the most PATHOLOGICAL ofCTGs is associated with acidosis in

50% cases

Use of EFM in low risk pregnancies: Increase in intervention

Reduce incidence of neonatal seizures

No difference in long term handicap ormortality

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Take Home Messages

CTG is not for everyone

Treat the WOMAN not

the CTG

Interpretation is the KEY CTG is only a screening

test

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For More Information

www.nice.org.uk/CG055fullguideline

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Thank You

Documents

The CTG