Cardiotocography

Cardiotocography, timing, purpose, indication, contraindication,procedure

1. CARDIOTOCOGRAPHY Kanchan Mehra M.Sc Nursing 1 st year PCNMS 1

2. INTRODUCTION Cardiotocography (CTG) is a technical method for recording ( graphy ) the foetal heartbeat using ultrasound (cardio) and the uterine contractions ( toco ) during pregnancy, typically in the third trimester. Fetal monitoring was invented by Doctors Alan Bradfield, and Edward Hon. A refine version ( cardiotocograph ) was later developed for Hewlett Packard by  Konrad Hammacher 2

3. DEFINITION Cardiotocography  (CTG) is a technical means of recording the fetal heartbeat  and the uterine contractions during pregnancy. The machine used to perform the monitoring is called a  cardiotocograph , more commonly known as an  electronic fetal monitor ( EFM ). 3

4. TIMING OF CTG Antepartum and on admission to the labor room (admission CTG) the usual (minimum) duration of recording is 30 minutes. Particularly in the third trimester of pregnancy the CTG should be obtained with the mother placed in a left lateral position to prevent vena cava syndrome. 4

5. PURPOSE OF CTG The purpose of CTG recordings is to identify when there is concern about fetal well-being to allow interventions to be carried out before the fetus is harmed. The focus is on identifying fetal heart rate (FHR) patterns associated with inadequate oxygen supply to the fetus. 5

6. INDICATION OF CTG Alterations in fetal HR present during auscultation. If FHR is less than 110bpm High-risk delivery like Polyhyramnios , pre- echlampsia , echlampsia Induced labor. If there is decrease fetal monitoring If there is a twin pregnancy. 6

7. CONTRAINDICATION Uterine hemorrhage of unknown cause Placenta previa , It may also be associated with a small risk of fetal injury Placental hemorrhage Uterine perforation Vaginal Infection 7

8. ARTICLE NEEDED FOR CARDOTOCOGRAPHY Electronic fetal monitoring Ultrasound transducer Tocotransducer 8

9. Monitor strip Ultrasound gel Belt to hold the transducers in place 9

10. METHOD EXTERNAL CARDIOTOCOGRAPHY:- It is for continuous or intermittent monitoring. The fetal heart rate and activity of the uterine muscle are detected by two transducers placed on the mother’s abdomen(one above the fetal heart and other at the fundus ). Doppler ultrasound provides the information which is recorded on a paper strip known as Cardiotocograph (CTG). 10

11. INTERNAL CARDIOTOCOGRAPHY :- This method can be useful if membrane has ruptured either spontaneously or artificially. Uses an electronic transducer connected directly to the fetal scalp through the cervical opening and is connected to the monitor. This type of electrode is sometimes called a spiral or scalp electrode. Internal monitoring provides a more accurate and consistence transmission of the fetal heart rate than external monitoring because factor such as movement do not affect it. Internal monitoring may be used when external monitoring of the fetal heart rate is inadequate, or closer surveillance is needed. 11

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13. INTERPRETATION Baseline fetal heart rate :- It is the fetal heart rate between uterine contraction. A rate more than 160bpm is termed baseline tachycardia. A rate slower than 120bpm is called baseline bradycardia . Either may be indicative of fetal hypoxia. A constant baseline rate between 110 and 120 bpm may indicate cord compression as in cord prolapsed. 13

14. Baseline Variability:- When feto placental function is normal, the fetal heart rate has term variability greater than 7bpm at least 4 acceleration of more than 15bpm in 20minutes internal spontaneously or in response to Braxton Hicks Contractions or fetal movements. 14

15. Response of the fetal heart to uterine contractions:- The fetal heart rate will normally remain steady or accelerate during contraction. Decelerations of fetal heart rate, if recorded must be assessed for their relationship to uterine contractions. 15

16. Early decelerate:- Begins at or after the onset of a contraction and returns of the baseline rate by the contractions has finished. An early deceleration is commonly associated with compression of fetal head. 16

17. Late deceleration:- Begins during or after a contraction, reaches its lowest point after the peak of the contraction and has not recovered by the time that contraction has ended. Sometimes the deceleration has barely recovered by the onset of the next contraction. The time lag between the peak of the contraction and the lowest point of the deceleration is more significant of severity than the drop in the fetal heart rate. This always indicates fetal hypoxia and the physician must be informed. 17

18. COMPLICATION Premature rupture of membranes. Preterm labor. Nerve injuries. 18

19. CARE AFTER PROCEDURE Clean the gel that is used during procedure. Make the client in comfortable position. Replace all article to the utility room. Wash hands Record the date and time of CTG Document the recording 19

20. ROLES AND RESPONSIBILITY OF MIDWIFERY Explain the procedure to the patient. Provide privacy. Maintain a safe, comfortable position for the client. Gather all the article needed for CTG The woman must empty her bladder. Patient should be lie in semi fowler’s or left lateral position. FHR is then maintained for approximate 20-30 min. It is important that fetus not be in sleep state during entire procedure. 20

21. SUMMARY Cardiotocography  (CTG) is a technical means of recording the  fetal heartbeat  and the uterine contractions during pregnancy. The machine used to perform the monitoring is called a  cardiotocograph , more commonly known as an  electronic fetal monitor ( EFM ). Cardiotocography (CTG) is a technical method for recording ( graphy ) the foetal heartbeat using ultrasound (cardio) and the uterine contractions ( toco ) during pregnancy, typically in the third trimester. Fetal monitoring was invented by Doctors Alan Bradfield,  Orvan Hess  and  Edward Hon . A refine version ( cardiotocograph ) was later developed for  Hewlett Packard  by  Konrad Hammacher . 21

22. BIBLIOGRAPHY https://www.uptodate.com/contents/decreased-fetal-movement-diagnosis-evaluation-and-management/abstract/51 https://www.cochrane.org/CD006066/PREG_continuous-cardiotocography-ctg-form-electronic-fetal-monitoring-efm-fetal-assessment-during-labour Beischer NA, Markay EV, Coldits PB, Obstetric and the Newborn An Illustrated Textbook.3 rd edition, W.B.Saunders company Ltd, Page No-125- 127 22