CTG interpretation Medical Presentation

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CTG INTERPRETATION PREPARED BY : KALEESWARI PARAMANANTHAM
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INTRODUCTION Two thirds of fetal deaths occur before the onset of labor, many of which are due to utero placental insufficiency. CTG is an indirect, non-invasive procedure used to evaluate fetal heart rate and uterine contractions.
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OBJECTIVES At the end of the session participants will be able to: Define Cardiotocography Differentiate the characteristics of Cardiotocography Interpret Cardiotocography findings
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DEFINITION Cardiotocography(CTG) is a technical means of recording (-graphy) the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester. The machine used to perform the monitoring is called a Cardiotocograph, more commonly known as an Electronic Fetal Monitor (EFM).
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WHY CARDIOTOCOGRAPHY IS NECESSARY? To know the fetal wellbeing. To rule out some maternal conditions like uterine rupture. To know the progress of labor. Fetal distress.
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EXTERNAL AND INTERNAL MONITORING Recordings are performed by TWO separate transducers; One for the measurement of the fetal heart rate and a second one for the uterine contractions. Each of the transducers may be either external or internal. 1)External measurement: Means taping or strapping the two sensors to the abdominal wall. This is called an indirect measure
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Internal measurement ( direct ) requires a certain degree of cervical dilatation, As it involves inserting a pressure catheter into the uterine cavity, as well as attaching a scalp electrode to the child's head to adequately measure the electric activity of the fetal heart. Internal measurement is more precise, and might be preferable when a complicated childbirth is expected.
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CHARECTERISTICS OF CARDIOTOCOGRAPHY Baseline Rate Baseline variability Accelerations Decelerations Uterine activity (contractions)
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BASELINE RATE • The baseline FHR should be determined over 5 to 10 minutes And expressed in bpm • Normal 110 – 160 bpm • Bradycardia <110 bpm • Tachycardia >160 bpm The average rate between peaks and depressions over a period of time that doesn’t include accelerations or decelerations of the heart rate.
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BASELINE VARIABILITY Fluctuations in the fetal heart rate of more than 2 cycles per minute. No distinction is made between short-term variability (or beat-to-beat variability) and long-term Variability • Normal 11 – 25 bpm (moderate) • Increased > 25 bpm (marked SALTATORY) • Reduced 6 – 10 bpm (minimal) • Absent < 5 bpm Variability is indicative of a mature fetal neurologic system
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ACCELERATION Transient increases in FHR of 15 bpm or more above the baseline and lasting 15seconds or more Two accelerations in 20 minutes is considered a reactive trace. Accelerations are a reassuring sign as they show fetal responsiveness and the integrity of the mechanisms controlling the heart.
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DECELERATION Periodic or Episodic Decelerations Periodic refers to decelerations that are associated with contractions; Episodic refers to those not associated with contractions. Deceleration = decrease in baseline FHR.
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TYPES Four Types of Decelerations: Early Decelerations: Late Deceleration: Variable Deceleration: Prolonged Deceleration
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EARLY DECELERATION The early deceleration begins at the onset of the contraction and ends with the end of the contraction <30 seconds. Early deceleration is caused by vagal stimulation from head compression. Early decelerations are not a sign of fetal problems .
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Early Decelerations Occur Most Frequently In The Following Clinical Situations: 1.During sterile vaginal examinations 2.In second stage of labor during pushing 3.During application of internal FHR electrode 4.With cephalo pelvic disproportion 5.After amniotic sac has ruptured 6.With vertex presentations
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LATE DECELERATION: •Late decelerations are transitory decreases in heart rate caused by utero placental insufficiency, compromised blood flow to the baby that does not deliver the amount of oxygen needed to withstand the stress of labor. •The late deceleration begins after the onset of the peak or middle of the contraction and ends after the contraction. (MORE THAN 30SEC)
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VARIABLE DECELERATION Variable decelerations are transitory decreases in fetal heart rate caused by umbilical cord compression. > 30 sec and less than 2 minutes. A variable deceleration is unrelated to contractions. They may appear V-shaped or U-shaped.
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PROLONGED DECELERATIONS Decrease of FHR below the baseline of more than 15 bpm for longer than 90 seconds but less than 5 minutes
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SINUSOIDAL
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UTERINE CONTRACTION Normal-3-5 contractions in 10mins. Hyper stimulation -more than 5. Hypo stimulation-less than 5.
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OMINOUS PATTERNS SUGGEST POSSIBLE FETAL COMPROMISE 1.Persistent late decelerations, especially with decreasing variability. 2.Variable decelerations with loss of variability. 3.Tachycardia, or late return to baseline 4.Absence of variability 5.Severe bradycardia
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INTERPRETATION
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MANAGEMENT Check Machine Has the mother lie on her left side(remember, lying on her back invites hypotension which affects baby’s oxygen supply) or in a knee chest position.To alleviate possible cord compression. Reduce or stop any oxytocin she may be receiving. Initiate tocolytics-to decrease uterine activity and increase placental blood flow. (0.25 mg SC Terbutaline )
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Increase IV fluid -to increase maternal blood flow volume Give her oxygen by mask-to promote oxygenation across the placenta Apply an internal monitor-to verify the accuracy of external monitor readings. If the heart rate is not restored to normal within 30 minutes, prompt delivery is needed. Cesarean section may then become necessary
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CONCLUSION Cardiotocography is a vital procedure during intrapartum period to decide whether the mother can go for normal vaginal delivery or not. The result is interpreted by its characteristics and treated as soon as to reduce maternal and fetal morbidity and mortality rate.
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REFERENCE The Use of Electronic Fetal Monitoring. Inherited Clinical Guideline. National Institute for Clinical Excellence. RCOG Press, London 2001. Confidential Enquiry into Stillbirths and Deaths in Infancy 7th Annual Report. Maternal and Child Health Research Consortium, London 2000. Nicolaides KH, Sadovsky G, Visser GH. Heart rate patterns in normoxaemic, hypoxaemic and anemic second- trimester fetuses. Am J Obstet Gynecol. 1989 May;160(5 Pt 1): 1034- Antenatal and intrapartum fetal monitoring guideline.
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THANKYOU THANKYOU