CARDIOTOCOGRAPY (CTG)

Setyorini irianti
Dept.Obstetrics and Gynecology,
Faculty of Medicine
Universitas Padjadjaran/
Hasan Sadikin Hospital
CARDIOTOCOGRAPHY
ELECTRONIC TOOLS FOR MONITORING
FETAL HEART AND MOVEMENT OR
UTERINE CONTRACTION
MONITORING MACHINE FOR FETAL WELL
BEING EVALUATION BASED ON FETAL
HEART RATE PROFILE AGAINST THE
FETAL OXIGENATION (HYPOXIA)
CONDITIONS FOR
RUNING THE MACHINE

IS TRANSDUCER HR & TOCO READY
AGE OF PREGNANCY
ANTE/INTRAPARTUM STAGE
PAPER VELOCITY
FETAL PRESENTATION
SINGELTON/TWINS
MOTHER POSITION
DRUG USED
FASTING/AFTER MEAL
POSITION OF THE FHR/TOCO PEN/NEEDLE 0
VARIABLES MONITORED
1. Fetal heart activity
Base line
variability
acceleration
Deceleration

2. Uterine activity
Contraction: frequency, amplitude
Resting tone
Rhythm
Configuration

3. Fetal movement
B
ANTE/INTRA PARTUM
MONITORING
Correlation between :
Heart rate activity,
uterine contraction,
fetal movement
FREQUENCY / HEART BEAT
NORMAL : 120-160 BPM
TACHYCARDIA: SLIGHT = 160-180 BPM
SEVERE = > 180 BPM
BRADICARDIA : SLIGHT = 100-109 BPM
SEVERE = < 100 BPM
TERMINOLOGY
NORMAL BASELINE RATE
BASELINE TACHYCARDIA
TACHYCARDIA, CAUSES :
1. FETAL HYPOXIA
2. OTHERS :
- PREMATURITY (< 30 WEEKS)
- INFECTION
- HYPERTHYROIDISM
- EXHAUSTION
- DRUGS: ATROPINE, SCOPOLAMINE,
RITRODINE, ISOSUPRINE
- FETAL TACHYARYTHMIA
BASELINE BRADYCARDIA
BRADIKARDIA NON HYPOXIA :
POSTDATISM/SEROTINUS
HEART ANOMALIES
HYPOTERMIA
DRUGS : PROPANOLOL, ANALGETICS
FETAL BRADYCARDIA
1. VARIABILITAS JANGKA PENDEK
(SHORT-TERM VARIABILITY)

2. VARIABILITAS JANGKA PANJANG
(LONG-TERM VARIABILITY)
NORMAL VARIABILITY
SHORT TERM VARIABILITY
LONG TERM VARIABILITY
RANGE OF VARIABILITY
OSCILLATORY CHANGES
VARIABILITY
INTERPRETATION:
NORMAL : AMPLITUDE 6-25 BPM
DECREASE: -- 2-5 BPM
LOSS : -- < 2 BPM
SALTATORY: -- > 25 BPM
Cause of Decrease Variability :
1. Hypoxia
2. Others :
- Fetal sleep
- Anencephalus
- Prematurity
- Drug : DIAZEPAM
- Heart anomalies
PERIODIC ACCELERATION
PERIODIC DECELERATION
SHAPE : UNIFORM /
NON-UNIFORM
LAG TIME
Late onset (lag time)
PURE ACCELERATION
COMPENSATORY
ACCELERATION
EARLY DECELERATION
Mirror image
Frequency decrease > 20 Bpm
Duration time < 90 Sec.
Baseline and Variability : Normal

Early Deceleration
Late Deceleration
Revealed 20-30 Sec. after initial
contraction
Disappeared after 20-30 Sec.
Duration time, 40-90 Sec.
Changes of Baseline and Variability
LATE DECELERATION
Variable Deceleration
Varies : U,V,W Shapes
RULE OF SIXTY :
Freq. Decreased up to 60 BPM
Nadir Freq. 60 BPM
Time of Deceleration > 60 Sec.
VARIABLE DECELERATION
UTERINE ACTIVITY
CONTRACTION
- AMPLITUDE
- TIME/DURATION
- FREQEUNCY
BASAL TONE / RESTING TONE
RYTHM
SHAPE/CONFIGURATION
UTERINE ACTIVITY
BASAL TONE
RHYTHM (COUPLING)
RHYTHM (TRIPLING)
CONFIGURATION
PATOLOGICAL CONTRACTION:
HYPOTONIC
HYPERTONUS
Antepartum

Normal pattern
1) Baseline rate 110-150 bpm
2) Amplitude of baseline variability 5-25 bpm
3) Absence of decelerations expect for sporadic, mild
decelerations of very short duration
4) Presence of two or more accelerations during a
10 minute period

Suspicious pattern
Any one of the following :
1) Baseline rate 150-170 bpm 110-100 bpm
2) Amplitude of variability between 5-10 bpm for more
than 40 minutes
3) Increased variability above 25 bpm
4) Absence of accelerations for more than 40 minutes
5) Sporadic decelerations of any type unless severe
Antepartum


Pathological pattern
Any one of the following :
1) Baseline heart rate below 100 bpm or above 170 bpm
2) Variability less than 5 bpm for more than 40 minutes
3) Periodically recurring and repeated decelerations of
any type
4) Sporadic and non-recurrent severe variable,
prolonged or late decelerations
5) A sinusoidal pattern: frequency < 6 cycles/minute;
amplitude > 10 bpm; duration > 20 minutes
Intrapartum


Normal pattern
1) Baseline rate between 110 bpm and 150 bpm
2) Amplitude of heart rate variability between 5 bpm
and 25 bpm

Suspicious pattern
1) Baseline heart rate between 150 bpm and 170 bpm
or between 110 bpm and 100 bpm
2) Amplitude of variability between 5 bpm and 10 bpm
for more than 40 minutes
3) Increased variability above 25 bpm
4) Variable decelerations
Pathological pattern


1) Baseline heart rate below 100 bpm or above 170 bpm
2) Variability less than 5 bpm for more than 40 minutes
3) Severe variable decelerations or severe, repetitive
early decelerations
4) Prolonged decelerations
5) Late decelerations: the most ominous trace is a
steady baseline without baseline variability and with
small decelerations after each contraction
6) Sinusoidal pattern
12. STAN (ST Segment Analysis)