CARDIOTOCOGRAPH

Y IN THE PRETERM
GESTATION

RHODA LICARDO
1ST YEAR MFM FELLOW
 • Physiology and behavior of
“STRESS RESPONSE” IS the preterm fetal heart rate,
the response to hypoxia and
N O T F U L LY patterns on cardiotocography
FUNCTIONAL IN A differs from that of the
TERM fetus
PRETERM FETUS

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C HA R A C T E R I ST I C S OF F E TA L HE A RT R AT E I N A
PR E T E R M F E T U S

• BASELINE FHR • BASELINE VARIABILITY

- Higher baseline FHR because of - Reduced baseline variability
the unopposed effect of the
sympathetic NS
- At 30th AOG, parasympathetic
effect results in a gradual lowering
of the baseline rate
C HA R A C T E R I ST I C S OF F E TA L HE A RT R AT E I N A
PR E T E R M F E T U S
• ACCELERATION • DECELERATION
- before 32 weeks AOG- 10 beats - 20-30 weeks AOG, FHR
above the baseline lasting for 10 decelerations may occur
seconds - - decreased amount of amniotic
fluid, Wharton jelly in the umbilical
cord, underdevelopment of the fetal
myocardium
 EFM

Baseline FHR 150

Variability Reduced

Acceleration (+)

Deceleration variable

Contraction none

G3P2 (2002) Pregnancy Uterine 28 Weeks 6 Days AOG by Ultrasound, Cephalic not in Labor
Preeclampsia with Severe Features Advanced Maternal Age
Obese II
INTERPRETING [ 24 -26 weeks ]
EFM AT
- Prognosis of fetus dependent on
DIFFERENT AGE fetal weight and maturity
OF GESTATION  Higher baseline FHR ( 150-160s)
 Reduced baseline variability due to
underdevelopment of ANS and
medications
 Reduced amplitude of acceleration
 with decelerations- normal
physiology of the cardio
regulatory process

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INTERPRETING
[ 26-28 weeks ]
EFM AT
DIFFERENT AGE - Similar with 24- 26 weeks
OF GESTATION - variability becomes normal
- benefits of delivery should be
weighed carefully against risk of
adverse perinatal outcome

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 EFM

Baseline FHR 140

Normal with
Variability areas reduced
variability

Acceleration (+)

Deceleration variable

Contraction none

G3P2 (1102) Pregnancy Uterine 28 weeks and 2 days AOG by LMP

In threatened preterm labor, Chronic Hypertension with superimposed Preeclampsia with Severe Features;
Previous LTCS I for Antepartum Eclampsia (2019, QMMC)
INTERPRETING [ 28-32 weeks ]
EFM AT - - significant development in fetal
DIFFERENT AGE ANS
 Decreasing baseline FHR at 30-32
OF GESTATION weeks
 variable decelerations gradually
disappear after 30 weeks
- uteroplacental insufficiency is present
when there are persistent late
decelerations

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 EFM

Baseline FHR 140

Variability normal

Acceleration (+)

Deceleration variable

Contraction none

G2P1 (1001) Pregnancy Uterine 29 Weeks 2 Days AOG by LMP

Chronic Hypertension with Superimposed Preeclampsia with Severe Features
INTERPRETING
[ 32-34 weeks ]
EFM AT - physiologic state of the cardiovascular
DIFFERENT AGE system is similar to fetus at 37 weeks

OF GESTATION
- baseline FHR and variability ~ term
fetus
- Accleleration greater than 15 \bom
from baseline- parameter of good fetal
well being
- - decelerations classified according ot
term fetus

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 EFM

Baseline FHR 140

Variability Normal

Acceleration (+)

Deceleration none

Contraction none

G4P3(2102) Pregnancy Uterine 32 Weeks 5 Days AOG by LMP

Gestational Diabetes Mellitus – Diet Controlled
Poor OB History for 1 Preterm IUFD
Previous CS I for Unknown Indication (Pfannenstiel, 2018, Cagayan Valley Hospital)
 PITFALLS IN
ANTEPARTUM AND
INTRAPARTUM
CARDIOTOCOGRAPHY
ANTEPARTUM • 1. Improper maternal positioning

MONITORING - Left lateral position or a semirecumbent

position with an empty bladder
2. Get to know the Machine before
use
3. Improper labeling of the tracing
4. Improper Application of
Transducers
5. Improper Supervision of tests
6. Erroneous signal Acquisition

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INTRAPARTUM MONITORING
• 1. Maternal Heart Rate Artifact
• 2. Interpretation should be correlated
clinically with the different stages of labor
• 3, CTG monitoring of SGA and her fetus
- Fetus with IUGR requires close monitoring
during labor for they are prone to hypoxic
ischemic changes
First stage -normal trace, latent phase of labor
of labor
- Immdeiate intensive resuscitative
measures if tracing is not Normal.
Second - Changes in CTG tracing due to bearing
stage of
labor down efforts, head compression ,
dehydration and maternal exhaustion,
PPROM causing cord compression
- Change in baseline, variability and
deceleration [pattern are expected to
revert back to a normal tracing after each
contraction
- If there is sign of fetal compromise,
expedite delivery is recommneded
 PITFALLS IN
ANTEPARTUM AND
INTRAPARTUM
CARDIOTOCOGRAPH
Y