A collection suite of final obstetrics and gynaecology CTG MD notes to ace your penultimate and final year exams!
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-Talley an...
Cardiotocography (CTG) (DRs BRaVADO)
monitor fetal heart rate and uterine contractions during pregnancy
FHR
FM
UC
10 mins Square = 30 seconds
Maternal Placenta Fetus
Check: • GDM • Placenta accrete • IUGR
• Correct PT • Gestational HTN • Placenta abruption • Mec-stained liquor
• Rate at recording (usu. 1cm = 1min) • Pre-eclampsia • Placenta infarction • Congenital malformation
• Substance abuse • Reduced FM
• Previous pre-term, LSCS • Oligohydramnios – cord
DR: Define risk compression
• Post-EDD
“when to upgrade from intermittent auscult
• Vasculitis (SLE)
® CTG?”
• Chronic disease (CHD, COPD, T1DM)
• 1 large box = 1min
C: Contractions • DDx = Braxton-hicks (non-painful, irregular) vs Pre-labour contraction (painful + cervix changes)
# of contractions in 10min
• XS contractions è stop syntocinon immediately
Fetal tachycardia Fetal bradycardia Reduced var Increased var
BRa: Baseline rate:
Non- > 160bpm < 110 bpm < 5 bpm for between > 25 bpm for 15-25
Ave. HR of the fetus in 10min where no 30-50 mins minutes
uterine contraction / acc/ decl reassuring
> 180bpm <100 bpm < 5 bpm for > 50 > 25 bpm for > 25
• Normal = 110-160bpm) Abnormal minutes minutes [sinusoidal]
• SNS driven
• Fever • Hypothermia • Infection •
• Hyperthyroidism • hypoTN • Dehydration
Maternal • Anaemia • hypoglycemia
FHR changes Mx: POISON ER • Dehydration • umbo cord
1. Check own and maternal pulse occlusion
2. Position • Arrythmia • Rapid descent • Inactivity / •
3. FiO2 100% sleeping
• Anaemia • Heart block
4. IVF – correct hypoTN
• Infection • Vagal stimulation • CNS anomalies
5. Scalp electrode, pH, lactate (pH Fetal
<7.2 = FETAL ACIDOSIS = ED LSCS) • Congenital (head compression) • Dysrhythmia
6. Oxytocin stopped anomalies • Hypothermia • Pre-term fetus
7. Need help
• Acidosis
8. Exam – vagina (cord prolapse)
9. Exc. fever, shock, premature, drugs • Early hypoxia • Late hypoxia • hypoxia • hypoxia
Utero- (abruption, HTN) • Acute cord • cord compression
placenta • Chorioamnionitis prolapse
• Hyper contractility
• SNS stimulants • BB • Narcotics (opiate) •
V: Variability • Anaesthetics • Sedatives
Variation of fetal HR after each beat Drugs
• BB,
(controlled by ANS, cardioreceptors, • MgSO4
baroreceptors, chemoreceptors)
Compared to intermittent auscultate , CTG:
1. ↓neonatal seizures
2. ↑LSCS
3. ↑Instrument device
4. No benefit to low risk women and
does not improve CP, perinatal death
CLINICAL PEARLS:
Ø ANY uterine contraction < 32GA is
ABNORMAL
Ø BP generally is lower (HR is higher
to maintain adequate cardiac
output)
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