CTG

Question 1

What two parameters does a CTG monitor?

Answer 1

Fetal heart rate and maternal contractions

Question 2

Describe the acronym employed to interpret CTGs?

Answer 2

DR C BRAVADO

Define risk
Contractions
Baseline rate 
Accelerations
Variability 
Decelerations
Overall impression

Question 3

Define fetal tachycardia and name some causes (5)

Answer 3

HR > 160

Causes:

• fetal hypoxia
• chorioamnionitis
• Fetal/maternal anaemia
• Hyperthyroidism
• Fetal tachyarrythmia

Question 4

Define fetal bradycardia?

Answer 4

< 100 bpm

Question 5

In what situations is it common to have a fetal HR between 100 and 120 bpm?

Answer 5

Postdates gestation

Occiput posterior or occiput transverse presentations

Question 6

Define prolonged severe bradycardia and what this indicates?

Name some causes of prolonged severe bradycardia (5)

Answer 6

HR < 80 for > 3 minutes.
Indicates severe hypoxia.

Causes:
cord prolapse
cord compression
Epidural and spinal anaesthesia
Maternal seizures 
Rapid fetal descent

Question 7

Variability is an indicator of what?

Answer 7

fetal nervous system, baroreceptors, chemoreceptorsand cardiac responsiveness.

A healthy fetus will be constantly adapting its heart rate in response to changes in its environment.

It indicates an intact neurological system in the fetus.

Question 8

What is the normal range for HR variability?

Answer 8

5-25bpm

Question 9

Define non-reassuring and abnormal fetal HF variability?

Answer 9

Non-reassuring:

• less than 5bpm for between 30-50mins
• > 25 bpm for 15-25mins

Abnormal:

• < 5bpms for > 50 mins
• > 25bpm > 25 mins
• sinusoidal

Question 10

what is the most common cause for reduced fetal variability?

Answer 10

fetal sleeping. Should last for no more than 40 mins.

Question 11

Name causes for reduced variability?

Answer 11

fetal sleeping (most common cause).
Fetal acidosis, more likely if late decels are present.
Fetal tachycardia.
Drugs: opiates, benzos, methyl-dopa, MgSO4-
Prematurity: variability is reduced at younger gestations.
Congenital heart abnormalities.

Question 12

Define an acceleration?

Answer 12

An abrupt increase in the fetal HR of greater than 15bpm for > 15 secs.
Are reassuring.
when occur alongside uterine contractions is a sign of a healthy fetus.

Question 13

What does the absence of accelerations in an otherwise normal CTG indicate?

Answer 13

uncertain significance.

Question 14

Define a deceleration?

Why do these occur?

Answer 14

An abrupt decrease in fetal HR by > 15bpm for > 15 secs.

Occurs in response to hypoxia. In response to hypoxic stress, the fetus reduces its heart rate to preserve myocardial oxygenation and perfusion.

Question 15

How are decelerations described?

Answer 15

early, late and variable.

Question 16

Define early decelerations

Answer 16

Start when uterine contractions begin and recover when uterine contractions stop. This is due to increased fetal intracranial pressure causing increased vagal tone. It therefore quickly resolves once the uterine contraction ends and intracranial pressure reduces. This type of deceleration is, therefore, considered to be physiological and not pathological.

Question 17

Define a variable deceleration?

Answer 17

Variable decelerations are observed as a rapid fall in baseline fetal heart rate with a variable recovery phase.
Variable in duration and may not have any r/s to uterine contractions.
They are most often seen during labour and in patients’ with reduced amniotic fluid volume.

Question 18

Describe the normal mechanism of a normal variable decel?

Answer 18

Variable decelerations are usually caused by umbilical cord compression. The mechanism is as follows:1

1. The umbilical vein is often occluded first causing an acceleration of the fetal heart rate in response.
2. Then the umbilical artery is occluded causing a subsequent rapid deceleration.
3. When pressure on the cord is reduced another acceleration occurs and then the baseline rate returns.

Question 19

What is a reassuring feature of a variabl decel?

Answer 19

The accelerations before and after a variable deceleration are known as the shoulders of deceleration. Their presence indicates the fetus is not yet hypoxic and is adapting to the reduced blood flow. Variable decelerations can sometimes resolve if the mother changes position. The presence of persistent variable decelerations indicates the need for close monitoring.

Question 20

What is a non-reassuring sign of a variabl decel?

Answer 20

The presence of persistent variable decelerations indicates the need for close monitoring. Variable decelerations without the shoulders are more worrying, as it suggests the fetus is becoming hypoxic.

Question 21

Define a late decel?

What do late decels indicate?

Answer 21

Late decelerations begin at the peak of the uterine contraction and recover after the contraction ends.

This type of deceleration indicates there is insufficient blood flow to the uterus and placenta. As a result, blood flow to the fetus is significantly reduced causing fetal hypoxia and acidosis.

Question 22

Describe causes of reduced uteroplacental blood flow?

Answer 22

maternal hypoxia
PET
Uterine hyperstimulation

Question 23

Define a prolonged deceleration?

Define non-reassuring and abnormal

Answer 23

a decel that lasts > 2 mins

Non-reassuring 2-3 mins
> 3 mins = abnormal

Question 24

Describe the characteristics of a sinusoidal CTG shape?

Answer 24

A sinusoidal CTG pattern has the following characteristics:

A smooth, regular, wave-like pattern
Frequency of around 2-5 cycles a minute
Stable baseline rate around 120-160bpm
No beat to beat variability

Question 25

What does a sinusoidal CTG indicate?

Answer 25

Severe fetal hypoxia Severe fetal anaemia Maternal/fetal haemorrhage.

Question 26

Overall impression of a CTG is described as (3)

Answer 26

reassuring, non-reassuring/suspicious, abnormal.

Question 27

What are concerning features for variable decels?

Answer 27

``` Lasting more than 60 seconds Reduced baseline variability within the deceleration Failure to return to baseline Biphasic (W) shape No shouldering ```

Question 28

Describe features of variable decels that render them complicated? (

Answer 28

1. Rising baseline 2. Reduced/reducing variability 3. persistent large amplitude (> 60 bpm) and or duration (> 60 secs) 4. Slow to return to the baseline after the contraction has ended 5. Smooth post-deceleration overshoot NB: a loss of shouldering that was previously seen may indicate a fetus that is no longer responding appropriately to insults.

Question 29

What are prolonged decels?

Answer 29

Decels between 90s - 5 minutes | Caused by hypoxia.

Question 30

Name some causes of prolonged decels? (7)

Answer 30

1. Prolonged contractions 2. Uterine hyperstimulation 3. Supine hypotension 4. Post-epidural insertion 5. Vaginal examination 6. Placental abruption 7. Ruptured uterus.

Question 31

What are late decelerations? | What causes them?

Answer 31

Late decels are generally caused by contractions in the presence of hypoxia. There are no features of a well oxygenated fetus i.e. normal variability, early/variable decels. - chronic fetal hypoxia (i.e. uteroplacental insufficiency) - acute fetal hypoxia (i.e. uterine hyperstimulation) Late decels: - Uniform in timing relative to contractions - repetitive in nature - and will occur with each contraction. The are contraction dependent (they may differ slightly with each contraction). They start after the start of the contraction and teh bottom of the decel is usu more than 20 secs after the peak of hte contraction. They return to the baseline after the contraction has finished.