CARDIOTOCOGRAPHY

Prepared by:
Student teacher
Luna Mahatara
Henisha Gurung
OBJECTIVES

General Objective:

• At the end of this session, B.Sc. Nursing 3rd year students will be
able to explain about cardiotocography
Specific Objectives:

• At the end of this session, B.Sc. Nursing 3rd year students will be able to

i. introduce cardiotocography

ii. list the purpose of cardiotocography

iii.describe the types of cardiotocography

iv.state the indication of cardiotocography

v. interprete the findings of cardiotocograph

Introduction

• Cardiotocograph (CT) is a record of the fetal heart rate (FHR) either

measured from a transducer on the abdomen and another transducer
measures the uterine contraction over the fundus.

• In medicine (obstetrics), cardiotocography (CT) is a technical means

of recording (graphy) the fetal heart beat (cardio) and the uterine
contraction (toco) during pregnancy, typically in the third trimester.
Purpose

i. To continuously record the fetal heart rate.

ii. To check uterine activity.

iii.To detect any fetal distress.

iv.To gain information about rate, rhythms of the fetal heart rate and
fetal movement.
Types
i. Internal cardiotocography

 It uses an electronic transducer connected directly to the fetal scalp.

 A wire electrode is attached to the fetal scalp through the cervical

opening and is connected to the monitor.

 This type of electrode is sometimes called a spiral or scalp electrode.

 Internal monitoring provides a more accurate and consistent
transmission of the fetal heart rate than external monitoring because
factors such as movement do not affect it.

 Internal monitoring may be used when external monitoring of the

fetal heart rate is inadequate, or closer surveillance is needed.
ii. External cardiotocography

 External cardiotocography is 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 (one
above the fetal heart and the other at the fundus).

 Doppler ultrasound provides the information which is recorded on a

paper strip known as a cardiotocograph (CTG).
 Indications
i. Maternal
 Post dated pregnancy
 Rh sensitization
 PIH/ hypertensive disorder
 Maternal age 35 or more
 Diabetes
 History of still birth
 Vaginal bleeding in 2nd and 3rd trimester
ii. Fetal
 Decreased fetal movement
 IUGR
 Oligohydramnious
 Polyhydramnious
 Multiple gestation
Interpretation

1. Uterine contraction: Time between contractions, which reduces as

childbirth progresses, they are quantified as the number of contraction
present in a 10 minutes widow and averaged over 30 minutes. Normal
are 5 or less contractions in 10 min, more than 5 contractions in 10
minutes represents tachysystole.
2. Baseline variability: Baseline variability is the minor fluctuation in
baseline FHR. It is assessed by estimating the difference in bpm
between the highest peak and lowest through of fluctuation in one
minute segments of trace.

3. Baseline heart rate: Average baseline FHR (normal 120-160 bpm)

4. Accelerations:

• Increases in fetal heart rate from the baseline by at least 15 beats per
minute, lasting for at least 15 seconds. There are normally present
indicating a reactive tracing. Acceleration in preterm fetuses may be
lesser amplitude and shorter duration. Two accelerations in 20 minute
is considered a reactive trace.
5. Deceleration:

• Decreases in fetal heart rate from the baseline by at least 15 beats per
minute, lasting for at least 15 seconds. They are normally minimal.

• There are three types of deceleration depending on their relationship

with uterine contractions.
a. Early deceleration: Early begin at start of uterine contraction and end
with conclusion of contraction a sign of increased vagal tone due to fetal
head compression uniform, repetitive decrease of FHR with slow onset
early in the contraction and slow return to baseline by the end of the
contraction.

b. Variable: Occur at any time repetitive or intermittent decreasing PHR; a

signs of umbilical cord compression. Time relationships with contraction
cycle may be variable but most commonly occur simultaneously with
contraction.
c. Late deceleration: Late deceleration begins at the peak of a
contraction and ends long after it, hence the late when compared to early
decels, a sign of fetal hypoxia due to uterine or placental insufficiency.

d. Prolonged decelerations: Prolonged decelerations decrease of FHR

below the baseline of more than 15 bpm for longer than 90 seconds but
less than 5 minutes.
6. Persistent tachycardia: When FHR is greater than 160 for more than
ten minutes.

7. Persistent bradycardia: When FHR is less than 120 for more than
ten minutes.
 REFERENCES:

 Ghimire, N. (2021). A Textbook of Midwifery Nursing (Intrapartum care).

Kathmandu. Dreamland Publication.
 Prasai, D. (2018). Textbook of Midwifery Nursing Part III (1st ed.).
Kathmandu: Akshav Publication.
 Dutta, D.C.(2004) Text Book of Obstetrics (6th Ed) Calcutta: New central
book agency
 Tuitui, R.(2016). Manual of Midwifery III (11th ed.). Bhotahity,
Kathmandu: Vidyarthi Pustak Bhandar.
 Shrestha, S.(2011). Midwifery and Gynaecological III (2nd ed.). Dillibazar,
Kathmandu: Makalu Publication