CTG Flashcards
pathological CTG initial management
obtain review by obstetrician and senior MW exclude acute events correct underlying causes start >1 conservative measures talk to woman and birth partner
if FBS cannot be obtained and no scalp stimulation
expedite birth
abnormal: baseline
<100 or >180
late decelerations in >50% contractions for <30minutes, with no risk factors
non-reassuring
reassuring: baseline
110-160
variable decelerations with any concerning characteristics in >50% contractions <30mins
non-reassuring
overall normal CTG
all features reassuring
if CTG still pathological after fetal scalp stimulation
consider FBS
consider expediting birth
take woman’s preferences into account
acute bradycardia or decelerations >3min
abnormal
if FBS borderline and no accelerations to scalp stimulation
2nd FBS no more than 30 minutes later if still indicated by CTG
FBS abnormal
<7.20
>4.9
abnormal: variability
<5 x >50min
or
>25 for >25min
or sinusoidal
reassuring: decelerations
none or early
variable with no concerning characteristics for <90min
if CTG still pathological after conservative measures:
obtain further review
offer digital scalp stimulation
variability <5 x>50min
abnormal
overall suspicious CTG
1 non-reassuring and 2 reassuring
absence of accelerations
does not indicate fetal acidosis
if FBS cannot be obtained but scalp stimulation present
consider continuing or expediting birth
variable decelerations with any concerning characteristics in >50% of contractions for 30 minutes (or less if risk factors)
abnormal
concerning characteristics decelerations
lasting more than 60s reduced variability within deceleration failure to return to baseline biphasic shape no shouldering
variability >25 x >25min
abnormal
non-reassuring: baseline
100-109 or 161-180
FBS borderline
- 21-7.24
4. 2-4.8
early decelerations
if no non-reassuring or abnormal features should not prompt further action
variable decelerations with no concerning characteristics for >90min
non-reassuring
non-reassuring: variability
<5 x 30-50min
or
>25 x 15-25min
overall pathological CTG
1 abnormal feature
or
2 non-reassuring features
sinusoidal
abnormal
FBS normal pH/lactate
> 7.25
<4.1
variable decelerations with any concerning characteristics in up to 50% contractions for>30min
non-reassuring
if FBS normal and no accelerations to scalp stimulation
2nd FBS no more than 1hr later if still indicated
suspicious CTG management
correct underlying causes perform set of obs start >1 conservative measure inform senior document plan for reviewing talk to woman and birth partner
late decelerations for 30 minutes
abnormal
reassuring: variability
5-25
