CTG (cardiotocography) of the fetus what it is and how it is done

The period of bearing a child is the most important stage in the life of every woman. Expectant mothers, taking care of the health of the unborn baby, diligently follow all the recommendations of doctors, and undergo the necessary examinations. Along with the delivery of numerous laboratory tests, today, pregnant women are assigned such a type of study as cardiotocography.

Fetal CTG is a progressive research method that allows timely identification of problems that threaten the life and health of the unborn child. Thanks to this modern technique, doctors register uterine contractions, control the baby’s cardiac activity, and can identify and eliminate the causes of fetal hypoxia in time.

When the procedure is prescribed

Today, fetal cardiotocography is mandatory for all future mothers. The timing of this procedure is set based on the characteristics of the intrauterine development of the fetus. As a rule, for the first time the doctor recommends a woman to be examined at 30 weeks of pregnancy, then this type of diagnosis is carried out at intervals of several weeks until the onset of labor.

In special cases, when the normal bearing of a child is threatened, or the woman’s condition is alarming, an unscheduled, and sometimes even emergency, examination is prescribed. Often it is carried out with a severe course of labor.

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An important point! With the help of KGT during childbirth, you can monitor the condition of the child. This is especially important in cases when the umbilical cord entanglement is observed in children.

Good to know! Cardiotocography is carried out exactly at the time when the activity of the baby can be assessed.

The essence of the method

The main task that cardiotocography of the fetus helps doctors solve is the ability to comprehensively assess the indicators of the state of the fetus. This technique is not the only one. It has long been introduced into medical practice such types as ultrasound and pre-measurement.

A cardiotocogram is an absolutely safe method for mom and the unborn baby. It is carried out using special equipment that records the fetal heart rate, and also helps to determine the tone and condition of the uterus. The examination process is carried out using an ultrasonic sensor. The obtained data are displayed on a computer monitor, then the operator displays the indicators on a special calibrated tape. Data on paper is displayed as graphic signals.

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For what purpose is the diagnosis carried out?

Usually the whole examination process takes no more than an hour. During this time, the specialist assesses the vital activity of the fetus, fixing the heart rate in an active state, at rest, with uterine contractions. There are also observed the results of the influence on the fetus of a number of other factors. So, in the process of CTG diagnostics, the doctor determines how the nervous system of the unborn child reacts to external stimuli. This is the fetal reactivity index – an indicator that is closely related to the indicators of the placenta.

Thanks to this type of diagnosis, today doctors can successfully combat hypoxia, which adversely affects the development of the fetus and can provoke all sorts of complications during childbirth.

It can be concluded that the cardiotocogram, in addition to important parameters, also shows how comfortable the baby feels in the mother’s womb, how external and internal factors affect his life.

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Advantages of CTG in comparison with other types of research

Fetal cardiography is one of the most advanced technologies, so it has many advantages. This examination gives doctors the opportunity to determine the presence of cardiac pathologies in a child already during the period of intrauterine development, it allows them to judge the nature of the upcoming birth, which is also important.

In addition to the listed qualities, several more noteworthy characteristics should be highlighted:

  • The procedure is absolutely painless and safe for mom and baby.
  • This method is considered the most reliable and informative.
  • The device automatically registers every movement of the child.
  • The presence of two sensors makes it convenient to conduct an examination even with twins.
  • Diagnostic equipment registers contractions, which provides significant assistance to doctors during obstetrics.

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What types of CTG exist

In diagnostics, two types of examination are actively used:

  • The external method is used to obtain a stable, deepest signal. We will apply this method only when there is no violation of the integrity of the fetal bladder. To obtain the result, the sensors are attached at certain points on the woman’s abdomen.
  • The internal method is usually given just before delivery. To assess the intrauterine pressure in this case, an electrode is inserted directly into the cavity of this organ.

Important! In pregnancy, which proceeds even without deviations, cardiotocography is prescribed for each woman, both in the antenatal period (the time of the full cycle of fetal development up to childbirth) and at the intrapartum stage (the actual period of labor).

Scheduled CPC schedule

In the normal course of pregnancy, the doctor directs the expectant mother for cardiography at 30 weeks, but according to indications, the examination may be carried out earlier. Typically, the procedure is done twice during the third trimester. If the diagnosis was carried out at about 28 weeks, then the next study should be carried out at 34 weeks of pregnancy, and then before the planned date of delivery. This chart is applicable for a normal pregnancy.

If there are complications, then, according to the recommendations of the Ministry of Health, the study is carried out in the following order:

  • at 28 weeks – initial examination,
  • with post-term pregnancy – CTG is done every 5 days after the date for which the birth was planned,
  • if the pregnancy is high in water, or the fetus has malformations, CTG is prescribed once a week,
  • women over 35 are sent for the procedure every 10 days,
  • if the Rh factor is incompatible, it is carried out with an interval of 14 days,
  • large-fetal pregnancies require monitoring every 10 days.

Special note! Pregnancy, burdened in the first trimester by a viral infection, also requires close attention. In such situations, diagnostics are carried out every ten days.

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Where is the diagnosis carried out

All types of examinations for the expectant mother are prescribed by a gynecologist who observes the pregnant woman. The specialist, focusing on the planned dates and condition of the woman, writes her a referral for research. If such equipment is available in the consultation at the place of observation of the pregnant woman, then the procedure is done in due time within the walls of this institution.

But often circumstances develop in such a way that a woman cannot get a service where she lives. This situation should not be a cause for despair, since fetal ctg is being done everywhere today. Qualitatively performed diagnostics can be obtained in specialized medical centers or paid clinics. The price for the service, as can be seen from the table below, is quite affordable and approximately the same in different parts of the country.

No. City name Service cost (rub.) 1. Moscow and region 1400-2700

(service together with specialist advice)

(the amount includes the cost of a specialist appointment)

4. Smolensk From 800 (depending on related services) 5. Rostov-on-Don On average about 1000

The fairly comfortable price and the availability of the service allow pregnant women to undergo diagnostics within the time frame set by the doctor.

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List of indications

In order not to miss a possible complication, expectant mothers are often offered to additionally undergo a CTG examination. The following factors may serve as a reason for such a medical decision:

  • As a result of the previous examination, developmental anomalies or some pathology of the fetus were revealed.
  • Past pregnancies were resolved by stillborn babies or miscarriages.
  • If one of the parents has genetic abnormalities.
  • Finding a woman at the time of conception in a region where the epidemic is unstable.
  • The threat of termination of pregnancy in the first two trimesters.
  • If a woman has undergone medical treatment at any stage.
  • The presence of chronic diseases in the future woman in labor, even without exacerbation, as well as autoimmune pathologies.
  • If the expectant mother belongs to a social risk group and, despite her position, smokes, uses alcohol or drugs.

Note! A woman may feel quite well, but if she falls into one of the above categories, there is a huge risk of having a baby with developmental defects. Highly accurate timely diagnostics will help to minimize negative consequences.

Survey procedure

The procedure for cardiotocographic research consists of several stages, therefore, a pregnant woman should be informed about the rules of conduct at the preparatory stage and during the diagnosis. The preparation of the expectant mother consists of the following steps: she should sleep well, have a light snack and tune in to a positive mood.

You can eat a few pieces of chocolate for your baby to demonstrate that he is active. Since the procedure is long enough, the woman must empty the bladder before it. The examination is carried out on a couch using an ultrasonic and strain gauge transducer.

Important! The behavior of the expectant mother largely influences the results of the examination. Therefore, for the sake of their reliability and the well-being of the baby, a woman should calm down and follow all the recommendations of doctors.

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Features of diagnosis at the initial stage of labor

CTG during labor helps to avoid severe injuries, asphyxia and other complications in the newborn. Contractions should be regular, which indicates the onset of labor. In this case, the procedure takes no more than twenty minutes. But there are some features of its implementation. There are two ways to obtain data using the CTG apparatus: non-stress testing and stress testing.

  • The first type is non-stress testing: The doctor performing the diagnosis evaluates the intensity of contractions, the motor activity of the fetus against the background of the altered tone of the uterus, and monitors the work of the little heart.
  • Stress testing is done if the first method gives an unsatisfactory result. A bad CTG is when the following actions are ineffective:
  • administration of oxytocin to stimulate contractions,
  • exposure of the fetus to sound stimuli,
  • stimulation of the nipples (this action can also cause contractions),
  • palpation of the fetus.

Note! The use of CTG during delivery helps to minimize all risks and reduce the number of difficult births.


All diagnostic results are displayed graphically in the form of a diagram, on which the state of the fetus is indicated by curved lines. The indicator of the state of the fetus should be assessed only by the doctor, because he can notice not only the obvious facts, but also the inconsistency of the data caused by the weak activity of the child. A woman is only required to learn how to correctly interpret the data. It is better to do this kind of preparation before undergoing the examination, so that during the diagnosis process you do not worry about hearing incomprehensible terms.

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What is the interpretation of the results

The most important stage in the process of CTG diagnostics is data decoding. This is necessary for the final diagnosis. Decoding of the results is carried out in several ways, and then the data obtained is analyzed. In this case, the doctor must take into account not only the graphic indicators, but also a number of factors: these are unfavorable weather conditions, the excitement of the woman in labor, too active behavior of the fetus.

In modern medical practice, two assessment systems are more popular: this is the Krebs scale – it is 12 points, and the Fisher’s scale – 10 points. As a rule, physicians actively use both methods, and in the conclusion they give two estimates.

An important point: It must be taken into account that the assessment results obtained on different scales must coincide. There can be no more than 3 discrepancies.

Let’s take a closer look at how decoding occurs on the Fisher scale. As noted, this is a scoring system. Points are awarded by a specialist for each parameter from 0 to 2, then they are all summed up and the result already obtained is considered as a conclusion.

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The following indicators are evaluated:

  • Basal rhythm. This indicator should be in the range of 110-170 (beats/min.) The norm of this parameter is -2. With deviations of this indicator by 10 in one direction or another, one can judge about minor violations of fetal functions. If the rhythm is below 100, or above 180, there is a serious threat to the child’s life.
  • Variability or amplitude. This parameter depends on the degree of fetal activity, uterine contractions in relation to the basal rhythm. Here the rate is 10-25 (bpm). Results more or less than these numbers should be alarming. Usually, in such situations, the expectant mother is offered urgent hospitalization.
  • Pulse amplitude. A normal value of 6-25 (bpm) is 2 points. If less than 3 – 0, and from 3-5 – 1 point.
  • Acceleration denotes a biological rhythm, that is, the degree of its frequency. An indicator above 5 is considered normal, the permissible values ​​are from 4 -1, if even one rhythm is not fixed, there are deviations in the development of the fetus.
  • Another indicator reflects how the fetal heart responds to uterine contractions. It is called deceleration and registers the frequency of contractions in half an hour. Normally, there should be several decelerations in the first 10 minutes, then 2 points are set, if the rhythm appeared only after 20 minutes – 1, and in the complete absence – 0.

Criteria for evaluation

Deciphering the data, the doctor is obliged to approach this issue objectively, while he should not exclude all possible factors of influence on the research indicators.

  • If, when summing up, it turned out less than 5 points, it means that one can judge the presence of serious violations of the intrauterine development of the fetus,
  • If the total is 6 or 7 points, there are problems, but they are minimal. In such cases, the usual additional examination is prescribed.
  • From 8 points and above indicates a normal course of pregnancy.

Good to know: Thanks to the introduction of modern technologies in the field of medicine, today in many institutions of the industry, the process of diagnosis and evaluation of results is fully automated. Special computer programs decrypt data in minutes.

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Significance of CTG results

The indicators obtained during the diagnosis are entered into the pregnant woman’s card. After each next survey, the information is supplemented. The assessment should also take into account the gestational age, since this factor influences the result to some extent. So, for example, the data of the survey carried out at 32 and 35 weeks differ only in the frequency of the basal rhythm.

The table below illustrates how the points are calculated.

Evaluation criteria When 0 points are given 1 point 2 points 1. Basal rhythm (bpm)>, 100 and <, 180100 120-

120 – 1602. Variability (amplitude)>, 33-56-253. Frequency (variability)>, 33-66 + 4. Number of accelerations in 1/2 hour absence up to 4, single, single, but more than 55. Decelerations Late, atypical Early severe or

Completely absent or may be early, mild 6. Number of fetal movements Not more than 23 or more

The following table shows how the condition of the fetus is assessed by the overall score.

Points (total) State assessment Recommendations 9-12 satisfactory Observation over time 6,7,8 Hypoxia, no threat of death in the near future Repeated examination from 0 to 5 Severe hypoxia with threat of fetal death Emergency delivery

Important! From the two tables presented here, it can be seen that the result of cardiotocography, estimated at 10 points, is desirable for every expectant mother. But women should be aware that in each individual case, both serious and minor deviations from the norm can be observed. And only a specialist can give a real assessment of the changes.

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About the risk of CTG

There is an opinion that examination of a pregnant woman with the help of modern devices can harm the unborn child. This is a misconception, since ultrasonic waves act at the lowest frequencies during the procedure. Over the long years of the existence of cardiotocography, not a single negative case has been recorded. It is harmful for a child if a woman, relying on dubious reasoning, refuses to be examined.

Diagnostic errors

Like any other equipment, the cardiotocograph device can malfunction during operation. Therefore, this type of diagnosis should be considered an additional method that allows doctors to monitor the condition of the fetus. The final decision can be made only with a comprehensive examination.

Other assessment methods

In addition to the Krebs and Fischer scales, there are other methods for determining the development of a child. For example, obstetrician neonatologists have been using the Apgar scale in practice for over 60 years. Most parents are not familiar with this system, which is used by doctors in the first minutes of the birth of a baby.

According to the Apgar method, doctors assess the development of a newborn according to eight indicators: the cry of a child, breathing, skin color, muscle tone, cardiac activity and others. When 8 out of 8 parameters are normal, then both doctors and parents are happy. Because for an infant, such values ​​are considered optimal.

Conclusion: Thanks to innovative methods, modern women have an excellent opportunity to know about the course of pregnancy and child development. The fetal CTG method is unique in that everything perfectly copes with several tasks at once. It allows you to significantly reduce the number of dysfunctional births, to identify pregnancy pathologies. Therefore, it is no coincidence that experts consider it the most effective diagnostic method. Expectant mothers for the sake of the health of the baby, whose appearance they are looking forward to, simply must undergo a timely examination.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.