CARDIOTOCOGRAPHY (CTG)

CTG stands for Cardiotocography. This is a medical test used to monitor the fetal heart rate
and contractions of the uterus during pregnancy. This test is non-invasive and it involves placing two
sensors on the mother's abdomen. One sensor records the fetal heart rate, while the other one
records the contractions of the uterus. The results are usually recorded on a graph, which can help
doctors to evaluate the health of the fetus, especially in pregnancies with a higher risk of problems

WHAT IS THE PURPOSE OF CTG MONITORING?

Cardiotocography is a procedure that isusually performed during the third trimester of

pregnancy and is important since it helps in detecting any potential problems with the baby's well-
being.

By monitoring the fetal heart rate, doctors can determine if the baby is receiving enough
oxygen and nutrients from the placenta. On the occasion that the baby's heart rate is too high or too
low, it may indicate that the baby is in distress and may require medical intervention. To execute
interventions before the fetus is injured, CTG recordings are used to detect when problems about the
fetal well-being arises. Identification of fetal heart rate (FHR) patterns linked to insufficient oxygen
supply to the fetus is the main goal. Similarly, monitoring uterine contractions can help determine
whether or not the mother is experiencing any complications during labor. Such complicartions may
include uterine hyperstimulation or it could also be insufficient contractions.

Overall, CTG is an important tool in ensuring the safety and well-being of both mother and
baby during pregnancy and childbirth. If you are pregnant, it is important to discuss with your
healthcare provider if CTG is necessary for your specific situation.
HOW TO READ A CTG

To interpret a CTG you need a structured method of assessing its various characteristics. The most
popular structure can be remembered using the acronym DR C BRAVADO:

 DR: Define risk

 C: Contractions
 BRa: Baseline rate
 V: Variability
 A: Accelerations
 D: Decelerations
 O: Overall impression

WHAT IS NORMAL IN CTG?

The normal fetal heart rate varies with vagal and sympathetic tone adjustments and, therefore,
varies with gestational age due to maturation of the fetal nervous system. Accepted normal
parameters for the term fetus are reported as follows (Gribbin 2006; RCOG 2001).

1) Baseline fetal heart rate of 110 to 160 beats per minute.

2) Baseline variability should be greater than five beats per minute.
3) Presence of two or more accelerations of the fetal heart rate exceeding 15 beats per minute,
sustained for at least 15 seconds in a 20‐minute period ( Devoe 1990) ‐ this pattern is termed
reactive.
4) Absence or early onset of decelerations.

OVERALL IMPRESSION

The overall impression can be described as either reassuring, suspicious or abnormal.

Overall impression is determined by how many of the CTG features were either reassuring, non-
reassuring or abnormal. The NICE guidelines below demonstrate how to decide which category a
CTG falls into.3
Reassuring

 Baseline heart rate

 110 to 160 bpm
 Baseline variability
 5 to 25 bpm
 Decelerations
 None or early
 Variable decelerations with no concerning characteristics for less than 90 minutes

Non-reassuring

 Baseline heart rate

 Either of the below would be classed as non-reassuring:
 100 to 109 bpm
 161 to 180 bpm
 Baseline variability
 Either of the below would be classed as non-reassuring:
 Less than 5 for 30 to 50 minutes
 More than 25 for 15 to 25 minutes
 Decelerations
 Any of the below would be classed as non-reassuring:
 Variable decelerations with no concerning characteristics for 90 minutes or more.
 Variable decelerations with any concerning characteristics in up to 50% of contractions for 30
minutes or more.
 Variable decelerations with any concerning characteristics in over 50% of contractions for less
than 30 minutes.
 Late decelerations in over 50% of contractions for less than 30 minutes, with no maternal or fetal
clinical risk factors such as vaginal bleeding or significant meconium.

Abnormal

 Baseline heart rate

 Either of the below would be classed as abnormal:
 Below 100 bpm
 Above 180 bpm
 Baseline variability
 Any of the below would be classed as abnormal:
 Less than 5 for more than 50 minutes
 More than 25 for more than 25 minutes
 Sinusoidal
 Decelerations
 Any of the below would be classed as abnormal:
 Variable decelerations with any concerning characteristics in over 50% of contractions for 30
minutes (or less if any maternal or fetal clinical risk factors – see above).
 Late decelerations for 30 minutes (or less if any maternal or fetal clinical risk factors).
 Acute bradycardia, or a single prolonged deceleration lasting 3 minutes or more.
 Regard the following as concerning characteristics of variable decelerations:
 Lasting more than 60 seconds
 Reduced baseline variability within the deceleration
 Failure to return to baseline
 Biphasic (W) shape
 No shouldering
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