CTG

Question 1

What are the maternal indications for CTG?

Answer 1

Moderate to severe gestational hypertension or preeclampsia
 Recurrent APH or fresh vaginal bleeding in labour
 Previous CS
 Diabetes or other medical conditions that can impact on fetal well being
 IOLoroxytocinuse
 Regional analgesia
 Presence of significant meconium
 Suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
 Prolonged 1st or 2nd stages of labour

Question 2

What are the foetal indications for CTG?

Answer 2

Twin pregnancy
 Breech presentation
 Preterm labour
 Oligohydramnios
 Fetal growth restriction
 Abnormal Doppler
 Abnormal FHR on auscultation

Question 3

What are the features fo the baseline FHR?

Answer 3

Reassuring: 110-160
Non-reassuring: 100-109/161-180
Abnormal: <100 or >180

Question 4

What are the causes of foetal tachycardia?

Answer 4

Increased fetal activity
Prematurity
Fetal anaemia
Maternal tachycardia, pyrexia or dehydration 
Fetal compromise
chorioamnionitis
hypoxia

Question 5

What are the causes of foetal bradycardia?

Answer 5

Fetal heart block (SLE) 
Maternal hypotension 
Maternal vagal stimulation
 Fetal compromise
 Increased fetal vagal tone
maternal beta-blocker use

Question 6

What are the features of variability?

Answer 6

Reassuring: 5 or more
Non-reassuring: <5 for 30 to 50 minutes or >25 for 15 to 25 minutes
Abnormal: <5 for more than 50 minutes or >25 for more than 25 minutes or Sinusoidal pattern (saw toothed pattern rather than smooth wave)

Question 7

What causes reduced variability?

Answer 7

Fetal sleep
Prematurity: <32 weeks
Medications: Opioids, beta blockers, magnesium

Question 8

What needs to be specified when describing decelerations?

Answer 8

the duration of the individual decelerations
 their timing in relation to the peaks of the contractions whether or not the fetal heart rate returns to baseline
 how long they have been present for
 whether they occur with over 50% of contractions.

Question 9

What do the timings fo decelerations show?

Answer 9

Early: head compression
Late: cord compression
Variable: placental insufficiency

Question 10

What is the management for a suspicious CTG? (1 non-reassuring, 2 normal)

Answer 10

Increased risk of fetal acidosis; if accelerations are present, acidosis is unlikely
Correct any possible underlying causes
- Change position
- Iv fluids
- Rx pyrexia
- Rx hyper-stimulation
Inform seniors

Question 11

What is the management for a pathological CTG? (1 abnormal or 2 non-reassuring)

Answer 11

More likely to be associated with fetal acidosis
Fetal scalp stimulation
Consider FBS after implementing conservative measures/fetal scalp stimulation, or expedite birth if an FBS cannot be obtained

Question 12

What is the management for a need for urgent intervention CTG? (Bradycardia or a single prolonged deceleration persisting for
3 minutes or more)

Answer 12

Think about possible underlying causes, Exclude acute events, Inform seniors
Make preparations for urgent birth
Expedite birth if persists for 9 minutes