1.CTG = cardiotocography CTG for the anaesthetist 6/13/20141 amr moustafa kamel. CTG for the anaesthetist

2. What is cardiotocography? A cardiotocograph is a device used in pregnancy to monitor both the fetal heart as well as the contractions of the uterus. It is usually only used in the 3rd trimester and mainly during labor. Its purpose is to monitor fetal well-being & allow early detection of fetal distress.An abnormal CTG indicates the need for more invasive investigations (e.g. fetal blood sample) & ultimately may lead to emergency caesarian section. 6/13/20142 amr moustafa kamel. CTG for the anaesthetist 3. It involves the placement of 2 transducers on the abdomen of a pregnant woman. One transducer records the fetal heart rate using ultrasound. The other transducer monitors the contractions of the uterus. It does this by measuring the tension of the maternal abdominal wall. This provides an indirect indication of intrauterine pressure 6/13/20143 amr moustafa kamel. CTG for the anaesthetist 4. Indications of CTG monitoring The UK National Institute of Health and Clinical Excellence (NICE) make recommendations for continuous CTG monitoring which include: 1. Meconium staining of liquor 2. Maternal pyrexia defined as 38.0 C or 37.5 C on two occasions two hours apart 3.The use of oxytocin for labour augmentation 4. Fresh bleeding developing in labour 5.At the womans request 6.Abnormal FHR detected during intermittent auscultation: FHR 160 bpm,Any decelerations after a contraction 8.Women receiving regional anesthesia/analgesia. Continuous electronic fetal monitoring is recommended for at least 30 minutes during establishment of regional analgesia and after administration of a further bolus of local anesthetic agent. In most UK centers, continuous CTG monitoring is performed after the insertion of a labour epidural. 6/13/20144 amr moustafa kamel. CTG for the anaesthetist 5. INTERPRETATION OF THE CTG 6/13/20145 amr moustafa kamel. CTG for the anaesthetist 6. Each big square equals to 1 min on the X axis Each big square is 20 fetal heart beats Uterine contractions 6/13/20146 amr moustafa kamel. CTG for the anaesthetist 7. Uterine contractions 6/13/20147 amr moustafa kamel. CTG for the anaesthetist 8. Baseline fetal heart rate The baseline fetal heart rate should be between 110 and 160 Bpm. Its done by looking at the average line of the fetal heart rate over 10 minutes (10 big squares) ignoring accelerations & decelerations 6/13/20148 amr moustafa kamel. CTG for the anaesthetist 9. Baseline Fetal bradycardia ( 40 weeks gestation) Congenital heart abnormality Cord prolapse Epidural & SpinalAnesthesia 6/13/201410 amr moustafa kamel. CTG for the anaesthetist 11. Baseline fetal tachycardia (>160 Bpm) 6/13/201411 amr moustafa kamel. CTG for the anaesthetist 12. causes of baseline fetal tachycardia Fetal tachycardia is associated with: Excessive fetal movement or uterine stimulation Maternal stress or anxiety Maternal pyrexia (especially due to chorioamnionitis) Fetal infection Chronic hypoxia Prematurity (