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Cardiotocography

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 Table Contents
✓Definition
✓Introduction
✓Types of Cardiotocography
✓Basic Concepts of Cardiotocography
✓Working of Cardiotocography
✓Uses of Cardiotocography
✓Conclusion

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 Definition
Cardiotocography (CTG) is a technique used to
monitor the fetal heartbeat and the uterine
contractions during pregnancy and labour. The
machine used to perform the monitoring is called a
cardiotocograph.

3
 Introduction

• CTG monitoring is widely used to assess fetal

wellbeing by identifying babies at risk of hypoxia
(lack of oxygen).
• CTG is mainly used during labour. A review found
that in the antenatal period (before labour), there
is no evidence to suggest that monitoring women
with high-risk pregnancies benefits the mother or
baby, although research around this is old and
should be interpreted with caution.
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5
 Types of Cardiotocography
• External cardiotocography can be used for
continuous or intermittent monitoring.
• The fetal heart rate and the activity of the
uterine muscle are detected by two
transducers placed on the mother's
abdomen, with one above the fetal heart to
monitor heart rate, and the other at the
fundus of the uterus to measure frequency of
contractions.
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 Types of Cardiotocography
• Internal cardiotocography uses an electronic
transducer connected directly to the fetus.
• A wire electrode, sometimes called a spiral or
scalp electrode, is attached to the fetal scalp
through the cervical opening and is
connected to the monitor. Internal
monitoring provides a more accurate and
consistent transmission of the fetal heart
rate, as unlike external monitoring, it is not
affected by factors such as movement.
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 Basic Concepts of CTG
Basal frequency (BF)
• It is the most common predominating
instantaneous frequency on CTG.
• It refers to the mean level of fetal HR around
which instantaneous frequency alterations
take place.
• The basal frequency is assessed between
“the gaps” of short term changes.

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 Basic Concepts of CTG
Variability
• The duration of the cardiac cycle is different
for each fetus and is constantly changing.
These changes are termed instantaneous
frequency variability or simply “variability”.
• Variability is composed of two components:
short-term and long-term variability.

●●●
9
 Basic Concepts of CTG
Accelerations
• They are defined as a short and rapid
increase in fetal HR.
• It is the cardiac response to fetal
movements, also known as the
“Myocardial Reflex”, characterized by an
increased HR in response to physical
activity.

●●●
10
 Basic Concepts of CTG
Decelerations
• They are defined as a short-term decline in
fetal HR.
• Given two main factors - deceleration form
and relationship between decelerations and
the onset and the end of the uterine
contraction, decelerations are classified into
three main groups: variable, early and late.

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 Working of Cardiotocography
• CTG uses sound waves called ultrasound
to detect the baby's heart rate.
• Ultrasound is a high-frequency sound that
you cannot hear but it can be sent out
(emitted) and detected by special
machines.
• Ultrasound travels freely through fluid and
soft tissues.

●●●
12
 Working of Cardiotocography
• Another example is that when ultrasound
travels though bile in a gallbladder it will
echo back strongly if it hits a solid
gallstone.
• So, as ultrasound 'hits' different structures
in the body, of different density, it sends
back echoes of varying strength.

●●●
13
 Working of Cardiotocography
• In CTG monitoring, a special type of
ultrasound, called Doppler, is used. This
type of ultrasound is used to measure
structures that are moving, making it
useful for monitoring heart rate.
• The other plate on the CTG measures how
tense the mother's tummy (abdomen) is.
This measurement is used to show when
the uterus is contracting.
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 Uses of Cardiotocography
In a normal, low-risk delivery, CTG is not usually
needed. The midwife will listen to your baby's
heart rate from time to time to check it is normal.
However, in certain situations, continual
monitoring with CTG is advised.
These include:
• Your baby is coming early or seems smaller
than expected.
• You have high blood pressure.
• You have a high temperature (fever).
●●●
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 Uses of Cardiotocography
• You have an infection.
• You pass fresh blood whilst in labour.
• You are expecting more than one baby (twins
or more).
• The baby has opened its bowels (passed
meconium) into the amniotic fluid.
• The midwife thinks there may be a problem,
having listened with a Pinard or Doppler
machine.
• If your baby is in an unusual position.
●●●
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 Uses of Cardiotocography
• If your membranes have ruptured more
than 24 hours before your labour starts.
• You have labour speeded up with
Syntocinon or need an epidural for pain
relief.
• If you have an epidural for pain relief during
labour, CTG may be used for half an hour
after an epidural has been put in, or after
top-ups for the epidural.
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 Conclusion

✓ Cardiotocography (CTG) is a continuous recording

of the fetal heart rate obtained via an ultrasound
transducer placed on the mother's abdomen.
✓ CTG is widely used in pregnancy as a method of
assessing fetal well‐being, predominantly in
pregnancies with increased risk of complications.

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References
• Google.com
• Wikipedia.org
• Studymafia.org
• Slidespanda.com
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