Introduction to Cardiotocography (CTG)

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Cardiotocography (CTG) is an electronic fetal monitoring?

True

External ctg put in said uterus?

False

Monitoring of the fetal heart rate and the activity of the uterine muscle is internal ctg?

False

Trasducers that put in fetal heart called ,toco, ?

False Signup and view all the answers

The tocodynamometer: It monitors the contractions of the uterus by measuring the tension of the maternal abdominal wall

True Signup and view all the answers

► Internal Cardiotocography: connected directly to the fetal scalp?

True Signup and view all the answers

Amniotic membranes must be ruptured ► Cervix dilated 2 cm. ► Presentation must be cephalic In external ctg?

False Signup and view all the answers

Intrapartum CTG Interpretation : Baseline fetal heart rate (FHR) -variability ► Presence of accelerations ► Decelerations ► (contractions)

True Signup and view all the answers

record the number of contractions present in a 15 minute period.

False Signup and view all the answers

Individual contractions are seen as peaks

True Signup and view all the answers

baseline fetal heart rate will usually be between 120 and 160 beats/minute.

False Signup and view all the answers

ascending infection, originating in the lower genitourinary tract and migrating to the amniotic cavity(Chorioamnionitis) its one of causes bradycardia

False Signup and view all the answers

causes of fetal tachycardia excepted:

DM Signup and view all the answers

Is Tachyarrhythmias ► Fetal heart failure ► Severe fetal anemia, fetal hydrops ► Maternal hyperthyroidism Cause bradycardia?

False Signup and view all the answers

Variability: between 5 and 25 beats/minute

True Signup and view all the answers

ntermittent periods of reduced baseline variability are abnormal, especially during periods of quiescence ('sleep').

False Signup and view all the answers

All thes cause decrease variability except:

Alkalosis Signup and view all the answers

Drug decreases variability

opiates Signup and view all the answers

Prematurity: variability is reduced at earlier gestation (<28 weeks), ► Pre-existing neurological abnormality it’s cause of increased variability?

False Signup and view all the answers

Increase in FHR greater than or equal to 15 bpm, for greater than or equal to 15 seconds from the onset to return to baseline is acceleration’s

True Signup and view all the answers

presence of accelerations, generally a sign that the baby is healthy, digital fetal scalp stimulation sign that the baby is healthy

True Signup and view all the answers

Decreases in fetal heart rate from the base line by at least 15b/m, lasting for at least 15 seconds is decelerations

True Signup and view all the answers

Early decelerations are a benign( kind/ gentle) finding caused by a vasovagal response as a result of fetal head compression by the contraction.

True Signup and view all the answers

Early declaration and contraction at the same level in gram

True Signup and view all the answers

Concerning characteristics of variable decelerations

Lasting more than 60 seconds Signup and view all the answers

(The accelerations before and after a variable deceleration are known as the shoulders of deceleration. Their presence indicates the fetus is not yet hypoxic and is adapting to the reduced blood flow) ……..if not found it’s not concerning?

False Signup and view all the answers

Late Decelerations: Onset of the decleration occurs after the beginning of the contraction(not on the same position in gram), and the nadir of the deceleration occurs after the peak of the contraction.

True Signup and view all the answers

We use EFM/CTGM in all the following except:

increases the rates of caesarean section Signup and view all the answers

Intermittent auscultation of the fetal heart rate to women at low risk of complications in established second stage of labour?

False Signup and view all the answers

ermittent auscultation immediately after a contraction for at least 1 minute, at least every 15 minutes in the first stage of labour and and at least every 5 minutes in the second stage and record it as a single rate.

True Signup and view all the answers

Maternal medical illness ,Gestational diabetes, Hypertension ,Asthma. ► Obstetric complications : Multiple gestation ,Post-date gestation ,Previous cesarean section ,Intrauterine growth restriction ,Oligohydramnios ,Premature rupture of the membranes, Congenital malformations ,Third-trimester bleeding. ► Oxytocin induction/augmentation of labor, Preeclampsia ,Meconium stained liquor……………………High-Risk pregnancies need continuous FHM :??

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We Continuous cardiotocography if this risk factors found:

Maternal pulse over 120 beats/minute on 2 occasions 30 minutes apart ► Temperature of 38°C or above on a single reading, or 37.5°C or above on 2 consecutive occasions 1 hour apart ► Suspected chorioamnionitis or sepsis ► Pain reported by the woman that differs from the pain normally associated with contractions ► The presence of significant meconium ► Fresh vaginal bleeding that develops in labour ► Severe hypertension: a single reading of either systolic blood pressure of 160 mmHg or more or diastolic blood pressure of 110 mmHg or more, measured between contractions ► Hypertension: either systolic blood pressure of 140 mmHg or more or diastolic blood pressure of 90 mmHg or more on 2 consecutive readings taken 30 minutes apart, measured between contractions ► A reading of 2+ of protein on urinalysis ► Confirmed delay in the first or second stage of labour ► Contractions that last longer than 60 seconds (hypertonus), or more than 5 contractions in 10 minutes (tachysystole) ► Oxytocin use. Signup and view all the answers

In categories ctg:

► suspicious: 1 non-reassuring feature and 2 reassuring features (but note that if accelerations are present, fetal acidosis is unlikely) ► pathological: 1 abnormal feature or 2 non-reassuring features Signup and view all the answers

CTG is normal: continue CTG, remove CTG after 20 minutes i

True Signup and view all the answers

If suspicious: commence conservative measures – left lateral position, oral/intravenous fluids, stop oxytocin, consider tocolysis.(to delay delivery)

True Signup and view all the answers

the CTG is abnormal: Offer to take fetal blood sample (FBS; for lactate or pH) after implementing conservative measures, or expedite birth if an FBS cannot be obtained and no accelerations are seen as a result of scalp stimulation.

True Signup and view all the answers

The pH of the fetus has been shown to drop at the rate of 0.01 every 2–3 minutes. This afraid sign

True Signup and view all the answers

Normal(PH:>=7.25)(second fetal blood sample no more than 1 hour)…………Borderline (PH 7.24-7.21):(mild acidosis)(taking a second fetal blood sample no more than 30 minutes l)………….. Abnormal (PH<7.2) : Delivery.

True Signup and view all the answers

Sinusoidal CTG

smooth, regular, wave-like pattern Signup and view all the answers

Sinusoidal CTG: if present it is very concerning as it is associated with high rates of fetal morbidity and mortality.1

True Signup and view all the answers

sinusoidal pattern usually indicates all of the following except:

Gout Signup and view all the answers

Introduction to Cardiotocography (CTG)

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Questions and Answers

Cardiotocography (CTG) is an electronic fetal monitoring?

External ctg put in said uterus?

Monitoring of the fetal heart rate and the activity of the uterine muscle is internal ctg?

Trasducers that put in fetal heart called ,toco, ?

The tocodynamometer: It monitors the contractions of the uterus by measuring the tension of the maternal abdominal wall

► Internal Cardiotocography: connected directly to the fetal scalp?

Amniotic membranes must be ruptured ► Cervix dilated 2 cm. ► Presentation must be cephalic In external ctg?

Intrapartum CTG Interpretation : Baseline fetal heart rate (FHR) -variability ► Presence of accelerations ► Decelerations ► (contractions)

record the number of contractions present in a 15 minute period.

Individual contractions are seen as peaks

baseline fetal heart rate will usually be between 120 and 160 beats/minute.

ascending infection, originating in the lower genitourinary tract and migrating to the amniotic cavity(Chorioamnionitis) its one of causes bradycardia

causes of fetal tachycardia excepted:

Is Tachyarrhythmias ► Fetal heart failure ► Severe fetal anemia, fetal hydrops ► Maternal hyperthyroidism Cause bradycardia?

Variability: between 5 and 25 beats/minute

ntermittent periods of reduced baseline variability are abnormal, especially during periods of quiescence ('sleep').

All thes cause decrease variability except:

Drug decreases variability

Prematurity: variability is reduced at earlier gestation (<28 weeks), ► Pre-existing neurological abnormality it’s cause of increased variability?

Increase in FHR greater than or equal to 15 bpm, for greater than or equal to 15 seconds from the onset to return to baseline is acceleration’s

presence of accelerations, generally a sign that the baby is healthy, digital fetal scalp stimulation sign that the baby is healthy

Decreases in fetal heart rate from the base line by at least 15b/m, lasting for at least 15 seconds is decelerations

Early decelerations are a benign( kind/ gentle) finding caused by a vasovagal response as a result of fetal head compression by the contraction.

Early declaration and contraction at the same level in gram

Concerning characteristics of variable decelerations

(The accelerations before and after a variable deceleration are known as the shoulders of deceleration. Their presence indicates the fetus is not yet hypoxic and is adapting to the reduced blood flow) ……..if not found it’s not concerning?

Late Decelerations: Onset of the decleration occurs after the beginning of the contraction(not on the same position in gram), and the nadir of the deceleration occurs after the peak of the contraction.

We use EFM/CTGM in all the following except:

Intermittent auscultation of the fetal heart rate to women at low risk of complications in established second stage of labour?

ermittent auscultation immediately after a contraction for at least 1 minute, at least every 15 minutes in the first stage of labour and and at least every 5 minutes in the second stage and record it as a single rate.

We Continuous cardiotocography if this risk factors found:

In categories ctg:

CTG is normal: continue CTG, remove CTG after 20 minutes i

If suspicious: commence conservative measures – left lateral position, oral/intravenous fluids, stop oxytocin, consider tocolysis.(to delay delivery)

the CTG is abnormal: Offer to take fetal blood sample (FBS; for lactate or pH) after implementing conservative measures, or expedite birth if an FBS cannot be obtained and no accelerations are seen as a result of scalp stimulation.

The pH of the fetus has been shown to drop at the rate of 0.01 every 2–3 minutes. This afraid sign

Normal(PH:>=7.25)(second fetal blood sample no more than 1 hour)…………Borderline (PH 7.24-7.21):(mild acidosis)(taking a second fetal blood sample no more than 30 minutes l)………….. Abnormal (PH<7.2) : Delivery.

Sinusoidal CTG

Sinusoidal CTG: if present it is very concerning as it is associated with high rates of fetal morbidity and mortality.1

sinusoidal pattern usually indicates all of the following except:

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