Transcript CTG Interpretation and Management

CTG Interpretation and
Management
Miss Philippa Moth
Locum Consultant Obstetrician and
Gynaecologist
Maidstone and Tunbridge Wells NHS Trust
• NICE Guidelines
• Definitions and normal limits
• Acting on abnormal CTGs
• Common pitfalls
Who Gets Continuous Monitoring?
Maternal
• Hypertension
• IOL / Augmentation
• DM
• Pyrexia
• Previous Caesarean
• Patient Request
Fetal
• Abnormal intermittent
monitoring
• IUGR
• Oligo
• Postdates
• Multiple Pregnancy
• Breech
• Epidural
• Meconium
NICE Guidance
Category
Definition
Normal
A FHR trace in which all four features are classified as
reassuring
Suspicious
A FHR trace with one non reassuring feature
Pathological
A FHR trace with two or more non reassuring features or one
or more abnormal
DR C BRAVADO
•
•
•
•
•
•
•
DR
C
BRA
V
A
D
0
Define Risk
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
Overall Impression
Accelerations
Decelerations
• Early
• Variable - Typical
- Atypical
• Late
Early Decelerations
• Due to head compression
Typical Variable Decelerations
• Due to cord compression
Atypical Variable Decelerations
Late Decelerations
• Due to Fetal Hypoxia
Normal Variability
Reduced Variability
Acting on CTGs
• Normal
• Suspicions / pathological
- review in a set amount of time
- FBS
- Deliver
Bradycardia
Sinusoidal CTG
Common Pitfalls
• Interpretation of CTGs outside of labour
• Situations to think carefully about FBS
- VBAC
- Pyrexia
- Intrapartum haemorrhage
Common Pitfalls
Fresh Eyes
• Never hesitate to ask for a second opinion