Objectives

Definition Principles of CTG Components of CTG tracing Normal CTG CTG signs suggestive of foetal compromise

Definition
CTG Cardiotocography is a technical means of recording (-graphy) the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester. The machine used to perform the monitoring is called a cardiotocograph.

Principles
Utilizes the principle of the Doppler Effect to detect Fetal heart motion. Mother should be in semirecumbent/left-lateral position.

Principles
External ultrasound transducer (monitoring fetal heart) + tocodynometer(mo nitor uterine activity) secured overlying the uterus. Recordings are made for 30 mins

Components of a CTG
Basal Heart Rate Baseline variability Accelerations Decelerations Response to stimuli
Contractions

Acceleration

Baseline Heart Rate

Baseline Variation

Deceleration

Contraction

Baseline Fetal Heart Rate

Falls with advancing gestational age due to maturing fetal parasympatethic tone. Best determined over 5-10mins. Term=110 to 150 bpm Prior to term = 160bpm as upper limit. Faster in early pregnancy Below 110 = baseline bradycardia Below 80 = severe bradycardia

Accelerations
Increases in the baseline fetal heart rate. Must be >15 bpm and >15 sec above baseline Should be >2 per 20-30 min for a reactive trace. Good sign of fetal health May not occur when fetus is sleeping Should occur in response to fetal movements or fetal stimulation Non reactive periods usually do not exceed 45 min
(>90 min and no accelerations is worrying)

Baseline Variability
(short-term variability)
Under normal physiological conditions, the interval between successive heart rate varies. Increases with advancing gestational age. The most important feature of any CTG Is a reflection of competing acceleratory and decelerating CNS influences on the fetal heart And therefore represents the best measure of CNS oxygenation Will be affected by fetal sleep states, infection, hypoxia, and drugs suppresing fetal CNS opiods, hypnotics. Will be reduced in the pre term fetus

Decelerations
Transient reductions in fetal heart rate, > 15 bpm, >15 seconds. Occasional decelerations are seen in a normal CTG. If decelerations occur with other abnormal features i.e reduce variability/baseline tachycardia, fetal hypoxia is likely. Early: mirrors contraction Typically occurs as the head enters the pelvis and is compressed, i.e. it is a vagal response Late: Follows every contraction and exhibits a slow return to baseline Is quite rare but is the response of a hypoxic myocardium Variable: Show no relationship to contractions Mild Moderate Severe