CTG Interpretation and Management

Miss Philippa MothLocum Consultant Obstetrician and

GynaecologistMaidstone and Tunbridge Wells NHS Trust

• NICE Guidelines

• Definitions and normal limits

• Acting on abnormal CTGs

• Common pitfalls

Who Gets Continuous Monitoring?

Maternal• Hypertension• IOL / Augmentation• DM• Pyrexia• Previous Caesarean• Patient Request

Fetal• Abnormal intermittent

monitoring• IUGR• Oligo• Postdates• Multiple Pregnancy• Breech• Epidural• Meconium

NICE Guidance

Category Definition

Normal A FHR trace in which all four features are classified as reassuring

Suspicious A FHR trace with one non reassuring feature

Pathological A FHR trace with two or more non reassuring features or one or more abnormal

DR C BRAVADO

• DR Define Risk• C Contractions• BRA Baseline Rate• V Variability• A Accelerations• D Decelerations• 0 Overall Impression

Accelerations

Decelerations

• Early

• Variable - Typical- Atypical

• Late

Early Decelerations

• Due to head compression

Typical Variable Decelerations

• Due to cord compression

Atypical Variable Decelerations

Late Decelerations

• Due to Fetal Hypoxia

Normal Variability

Reduced Variability

Acting on CTGs

• Normal• Suspicions / pathological

- review in a set amount of time

- FBS

- Deliver

Bradycardia

Sinusoidal CTG

Common Pitfalls

• Interpretation of CTGs outside of labour

• Situations to think carefully about FBS- VBAC- Pyrexia- Intrapartum haemorrhage

Common Pitfalls

Fresh Eyes

• Never hesitate to ask for a second opinion