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Fetal heart monitoring

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Fetal heart monitoring

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Fetal heart monitoring

  1. 1. Fetal Heart Monitoring
  2. 2. What is CTG? • Cardiotocography (CTG) is used in pregnancy to monitor both the fetal heart as well as the contractions of the uterus. • Used in the 3rd trimester. • It’s purpose is to monitor fetal well-being & allow early detection of fetal distress. • An abnormal CTG indicates the need for more invasive investigations & ultimately may lead to emergency caesarean section.
  3. 3. • The primary goal of FHR monitoring is to identify hypoxemic and acidotic fetuses in whom timely intervention will prevent death. • A secondary goal is to avoid fetal neurologic injury, if possible. • The two commonly used modalities for intrapartum FHR monitoring are continuous electronic FHR monitoring and intermittent auscultation.
  4. 4. • Continuous electronic FHR monitoring for high risk women • Intermittent auscultation for low risk women
  5. 5. How does it work? • It involves the placement of 2 transducers on the  abdomen of a pregnant women. • One transducer records the foetal heart rate using  ultrasound. • The other transducer monitors the contractions of  the uterus. • It does this by measuring the tension of the maternal  abdominal wall and provides an indirect indication of  intrauterine pressure. • The CTG is then assessed by the midwife & obstetric  medical team.
  6. 6. CTG monitoring
  7. 7. CTG interpretation • Uterine activity (contractions) • Baseline fetal heart rate (FHR) • Baseline FHR variability • Presence of accelerations • Periodic or episodic decelerations • Changes or trends of FHR patterns over time.
  8. 8. How to read a CTG? • To interpret a CTG you need a structured method of assessing it’s 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
  9. 9. • Define risk
  10. 10. Contractions • Record the number of contractions present in a 10 minute period - e.g. 3 in 10 • Each big square is equal to 1 minute, so you look how many contractions occurred in 10 squares • Individual contractions are seen as peaks on the part of the CTG monitoring uterine activity • You should assess contractions for the following: • Duration – how long do the contractions last? • Intensity – how strong are the contractions? (assessed using palpation)
  11. 11. • Severe prolonged bradycardia (< 80 bpm for > 3 minutes) indicates severe hypoxia • Causes of prolonged severe bradycardia are: • Prolonged cord compression • Cord prolapse • Epidural & Spinal Anaesthesia • Maternal seizures • Rapid foetal descent  
  12. 12. Variability • Normal variability is between 10-25 bpm • Variability can be categorised as: • Reassuring – ≥ 5 bpm • Non-reassuring – < 5bpm for between 40-90  minutes • Abnormal – < 5bpm for >90 minutes
  13. 13. Accelerations • Accelerations are an abrupt increase in baseline heart rate of >15 bpm for >15 seconds • The presence of accelerations is reassuring • Antenatally there should be at least 2 accelerations every 15 minutes • Accelerations occurring alongside uterine contractions is a sign of a healthy fetus • However the absence of accelerations with an otherwise normal CTG is of uncertain significance
  14. 14. Decelerations • Decelerations are an abrupt decrease in baseline heart rate of >15 bpm for >15 seconds • There are a number of different types of decelerations, each with varying significance -early -late -variable
  15. 15. • A typical CTG output for a woman not in labour. A: Fetal heartbeat; B: Indicator showing movements felt by mother (caused by pressing a button); C: Fetal movement; D: Uterine contractions
  16. 16. Overall impression • Reassuring • Suspicious • Pathological • The overall impression is determined by how many of the CTG features were either reassuring, non-reassuring or abnormal.
  17. 17. • Assessment of the fetus during labor is a challenging task. • The rationale for monitoring the fetal heart rate (FHR) is that FHR patterns are indirect markers of the fetal cardiac and medullary responses to blood volume changes, acidemia, and hypoxemia, since the brain modulates heart rate.
  18. 18. • The FHR pattern recorded by an electronic FHR monitor is typically interpreted as reassuring or nonreassuring.
  19. 19. Effect on management • A Cochrane Collaboration review has shown that use of cardiotocography reduces the rate of seizures in the newborn, but there is no clear benefit in the prevention of cerebral palsy,perinatal death and other complications of labour. • In contrast, labour monitored by CTG is slightly more likely to result in instrumental delivery (forceps or vacuum extraction) or Caesarean section.

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