see also: [[Pregnant trauma]], [Geeky medics -- how to read a CTG](https://geekymedics.com/how-to-read-a-ctg/), [RMH pregnant trauma - CTG](x-devonthink-item://420321F5-FD81-4817-8A00-BDEEFB6A4C03?page=5) - [Prompt](https://app.prompt.org.au/download/200391?code=f876c916-e502-47e8-afb5-c595743ed270), [RWH - CTG interpretation](x-devonthink-item://02F9A1AB-5426-4F44-83DA-283E20C04730) - [prompt](https://app.prompt.org.au/download/192241?code=42ccd8ea-d776-4ffc-b9cb-5ce5a72451c7), [RMH - Pregnant Trauma](x-devonthink-item://420321F5-FD81-4817-8A00-BDEEFB6A4C03?page=5) > **Normal fetal heart rate**: 110-160 BPM ; average 140 > [! important] can be used on viable pregnancies > 23 weeks gestation > - monitors fetal heart rate and uterine activity Features of fetal distress: 1. fetal bradycardia <100 bpm for >5 min 2. absent baseline variability 3. late or prolonged decelerations 4. complicated/variable decelerations -- fetal tachy, slow return to baseline # Indications - All women over 29/40 weeks gestation with abdominal pain, or are otherwise critically unwell - [[Maternal Sepsis]] - [[#Trauma CTG guideline|Pregnant Trauma]] - \>23 gestation (difficult <26; USS may be easier) ***Antinatal indications:*** - the list is long, look at the guideline, but here are a few. - abnormal antnatal CTG - [[antepartum haemorrhage]] - breech presentation - decreased fetal movements - diabetes where medication is indicated or poorly controlled, or fetal macrosomia - [[Pre-eclampsia]] or essential HTN - maternal age ≥ 42 - BMI ≥ 40 - multiple pregnancy - oligohydramnios or polyhudramnios - ==other current or previous obstetric or medical conditions which constitute a significant risk of fetal compromise, eg cholestasis, isoimmunisation, substance abuse== - prior uterine scar / c-section - prolonged rupture of membranes ≥ 24 hours - suspected intrauterine growht restriction There is also a whole list of indications to "consider" CTG which I find rather vague, eg: - gestation >41 weeks - maternal pyrexia ≥ 37.8 > Broadly speaking, if you are unsure about whether or not you should place a woman on CTG, discuss with obstetrics and have a low threshold to do so independently. # Trauma CTG guideline see also: [[Pregnant trauma]] > There is some equivocation if the "4 hours of monitoring" refers to 4 hours post injury or 4 hours of total monitoring; I have seen multiple pregnant trauma patients go into labour *after* 4 hours of monitoring of relatively minor injuries (one of which we delivered in ED), so my practice is to do at least 4 hours of monitoring and advocate for at least overnight admission for CTG monitoring in term pregnant patients. | condition | CTG suggestion | | ------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------ | | -ve FAST, minor injuries, no fetal distress | - 4 hours of CTG monitoring before being discharged<br>- will need instructions about preterm labour, bleeding, and abdo pain | | -ve eFAST and complex injuries | - admission<br>- CTG for at least 4 hours<br>- obstetrician review before ceasing monitoring | | positive eFAST or haemodynamically unstable | CTG until injuries stabilised and obviously patient may need emergency delivery and be ready for [[Resuscitative Hysterotomy]] | # Interpretation | feature | interpretation | | ---- | ---- | | fetal bradycardia <110<br>(severe is <80 for >3 min) | postdate gestation, severe *hypoxia* → *cord compression* or prolapse, epidural anaesthesia, maternal seizure, rapid fetal descent | | fetal tachycardia >160 BPM | *hypoxia*, chorioamnionitis, anaemia | | early decelerations<br>![[Pasted image 20231202120942.png]] | decrease in baseline fetal HR when uterine conraction begins and recovers when uterine contraction stops. *physiological*, not pathological | | late decelerations<br>![[Pasted image 20231202121202.png]] | begin at peak of uterine contraction and recover after contraction ends. indicates their is *insufficient blood flow to the uterus and placenta*<br>eg:<br>- maternal hypotension<br>- pre-eclampsia | | complicated/variable deceleration<br>![[Pasted image 20231202121041.png]] | rapid fall in baseline fetal HR with variable recovery phase<br>usually caused by *umbilical cord compression* | | variability | *reassuring* -- 5-25 BPM<br>non-reassuring -- <5 BPM for 30-50 min ir <25 BPM<br>abnormal -- <5BPM for >50 min, sinusoidal, >25 BPM for 25 min<br><br>reduced variability can be caused by : fetal sleeping, acidosis, drugs (opiates, benzos, etc), prematurity | | accelerations | *reassuring*, can occur alongside uterine contractions | ![[Pasted image 20240311160509.png|normal (reassuring) CTG in a non-labouring patient]] # fetal well-being *CTG variability* - variations in fetal heart rate is normal - **absence of variability may be indication of fetal compromise** - decelerating fetal HR also sign of compromise # premature labour or abruption **increase in uterine activity** on CTG suggests premature labour or abruption - ==POCUS has poor sensitivity for placental abruption and more than half of cases will be missed== ![[Pasted image 20240317111146.png]] # Related Questions ## cardiotocograph - [ ] 1Q: [Third Trimester Abdominal Pain](x-devonthink-item://93BDB055-D606-4878-9FA5-0BEFF977FEF7?page=7) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=3) ## ctg - [ ] 3Q: [Eclampsia](x-devonthink-item://2CB6E202-E7C1-46E8-B49F-435AB6C937F0?page=14) -- [Answer](x-devonthink-item://78503782-404C-41A2-A3AE-B1A26F578DF5?page=17) - [ ] 4Q: [Eclampsia](x-devonthink-item://310EEEDE-D794-4365-8865-5B3DD1C20510?page=14) -- [Answer](x-devonthink-item://6D5125AD-DE4D-435B-8D13-6EA35DB8E785?page=19) -- [prop](x-devonthink-item://D0A460D5-938B-4002-A684-EFD9189B08C1?page=7) - [ ] 5Q: [Trauma + pregnancy](x-devonthink-item://85167CB5-A7B5-4BF3-9BC7-AC46D5538A42?page=6) -- [Answer](x-devonthink-item://5B03E66C-E043-4EB7-A5F6-7389CB927BD7?page=8)