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CTG
Features of a CTG
Baseline
Short term
variability
Accelerations
Decelerations
Response to stimuli
Contractions
Fetal movements
Other
Accelerations
Must be >15 bpm and >15 sec above
baseline
Should be >2 per 15 min period
Always reassuring when present
May not occur when fetus is sleeping
Should occur in response to fetal movements
or fetal stimulation
Non reactive periods usually do not exceed
45 min
(>90 min and no accelerations is worrying)
Decelerations
Early: mirrors the contraction
Typically occurs as the head enters the pelvis and is
compressed, i.e. it is a vagal response
Alteration of FHR
Fetal tachycardia baseline >160 bpm over 10 minutes or
more
- can be nonpathologic, considered a normal rate in the
premature fetus
Causes :
- maternal :
- chorioamnitis
- other causes of infection causing fever
- use of B-sympathomimetics
-
fetal
cardiac arrhythmias
fetal anemia
acute fetal blood loss
abnormal fetal conduction system
Accelerations
Upward deflection in the baseline
fetal heart rate of at least 15 bpm
lasting for at least 15 seconds.
In pregnancies of fewer than 32
weeks of gestation, accelerations are
defined as having a peak 10 beats
per minute or more above the
baseline and duration of 10 seconds
or longer.
Decelerations
Reductions in fetal heart rate of at
least 15bpm lasting for at least 15
seconds
4 types :
- Type 1 (early)- physiological
- Type 2 (late)- pathological
- variable
- prolonged
Early deceleration
consists of a gradual decrease and return
to baseline associated with a contraction.
Result of a physiologic chain of events
that begins with head compression
during a uterine contraction
the degree of deceleration is generally
proportional to the contraction strength
and rarely falls below 100 to 110
beats/min or 20 to 30 beats/min below
baseline.
Variable deceleration
Inconsistent time of onset when
compared to uterine contraction
The onset of deceleration commonly
varies with successive contractions .
The duration is less than 2 minutes.
represent fetal heart rate reflexes that
reflect either blood pressure changes
due to interruption of umbilical flow or
changes in oxygenation
Prolonged deceleration
isolated deceleration lasting 2 minutes
or longer but less than 10 minutes
from onset to return to baseline.
Causes :
1)Total umbilical cord occlusion (cord
prolapse)
2)Maternal hypotension
3)Uterine hypertonia
4)VE or artificial ruptured of membrane
Sinusoidal pattern
regular, smooth, undulating form typical
of a sine wave that occurs with a
frequency of 2-5/minute and an
amplitude range of 5-15 bpm
also characterized by a stable baseline
heart rate of 120 to 160 bpm and absent
beat-to-beat variability
Occurs in severe fetal anemia, as occurs
in cases of Rh disease or severe hypoxia
Sinusoidal Pattern
Saltatory pattern :
- rapidly recurring couplets of
acceleration and deceleration causing
relatively large oscillations of the
baseline fetal heart rate
- sympathetic stimulation overrides
parasympathetic dominance in response
to acute but temporary hypoxemia
( umbilical cord compression )
- almost exclusively seen during labour