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CTG(Cardiotocography)

-Def: monitoring FH while he is under stress of contraction *labor*

-how to read any CTG? Dr C BrVADO (determine risk *Hx* , uterine
contraction: No. , baseline assessment, variability , acceleration ,
deceleration , order)
1-Baseline rate: Normal: 110 to 160 b/min , >160 tachycardia , <110
bradycardia
2-Variability: take long segment and takes highest - lowest point = the
Normal fluctuates between 5 and 26 beats/minute
↓ beat-to-beat variability <5 :
*ASD* : asphyxia, sleep(physiological and last for 25 minutes) or
drugs(pethidine or Mg sulfate)
-FHR Changes:
1.Acceleration: FHR ↑ by 15bpm for at least 15s (This is a normal
response “Ynz3g mn alcontraction and move” -> sympathetic activated -> ↑
FHR.
2.No change:
3.Deceleration: FHR ↓ by 15BPM for at least 15s
-Decelerations may be: early, late, variable, or mixed.
All except early decelerations are abnormal
- Early deceleration (head compression):
- This pattern: onset, peak, recovery of deceleration are co-incident with
onset, peak, and recovery of uterine contraction (mirroring)
- uterine contraction compressing fetal head ->↑ I.C.P-> vagal
response-> deceleration (normal physiological response)
- Mang: observe only.
-
-
- Late deceleration (U.P insufficiency ) :
This pattern : onset, peak, and recovery
of deceleration are shifted to right
*lag* in relation to uterine contraction
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Severe repetitive late decelerations : indicates Chronic asphyxia-> shunt
of blood to vitals and shift to anaerobic metabolism-> fetal Acidosis ->
hypercalcemia->slow conduction of nerve->delayed response of FH
Causes: pre-uterine -> hypotension /
Uterine -> tachysystole *PG or oxytocin*
Intra uterine : insufficiency in PTP /PIH / APH
-Variable deceleration (cord compression):
This pattern: variable in onset , shape*W* , intensity
caused: cord compression ->causes a sudden increase in BP in circulation of
fetus -> carotid body stretch -> vagal response
-late decelerations with variability of <5 beats/ minute -> indicates severe
fetal distress

Small box = 15s in duration

Strategies for Intervention :

Variable and Late DECELERATIONS during labor:
-intra uterine Resuscitation :
1-ABC: 100% o2 mask -> inc blood perfusion
2-maternal position to right or left lateral (relieves fetal pressure on the cord
and IVC)
3-Empty u.bladder
4-Stop oxytocin infusion
5-TOCO: Terbutaline
6-Amnioinfusion : NS is infused to amniotic sac particularly for variable.
If its in 2nd stage + vertex >=+1 station -> do instumental
delivery*‫ *آسرع لك‬, If not ? EM C/S
if there is no accelerations + lack of beat-to-beat variability
*<5 —> Acidosis or sleep: do acoustic stimulation or
DSS(Waking baby)-> acceleration? -> absence of acidosis

FETAL TACHYCARDIA: FHR >160 for > 10 min

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tachycardia : fetal anemia ,*choriamonits* , post-term pregnancy ,
epidural
Tachycardia for 15 to 30 minutes are associated with excessive oxytocin
augmentation of labor (moves a lot)
FETAL BRADYCARDIA : FHR <110 for >10min —> deliver immediately
either by c-section or assisted vaginal delivery
Causes: narcotics , heart block , severe acidosis
FHR <110 for more than 2 minute-> prolonged deceleration.
Order :
Category (I): tracing predictive of normal acid-base status
Features:
-Baseline rate 110 to 160
-variability moderate
-absent Late or variable decelerations
-present or absent Early decelerations
Category (III): tracing predictive of abnormal acid-base status
Features: Absent variability and any of the following:
- Recurrent late decelerations
- Recurrent variable decelerations
- Bradycardia
- Sinusoidal patten
- Category (II): ‫ ينحط هنا‬٢ ‫ وال‬١ ‫اي شي مو‬
pt on syntocinon to induce labour :
-If there is >5 contraction per 10m -> uterine hyper-stimulation(tachysystole)
-Uterine vesseles every time with contraction close -> deceleration
1st thing you do : stop syntocinon
notes : Supine hypotensive syndrome (IVC compression syndrome) is
caused by gravid uterus compresses IVC in a supine position ->leading to
decreased venous return. ... In severe cases, women can have loss of
consciousness , and fetal bradycardia
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Suggest severe anemia or hypoxia

Exercise :
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