CTG of the fetus transcript analysis, norms and deviations

Under what circumstances is CTG prescribed

Cardiotocography (CTG) is a research method that is based on an analysis of the variability of the fetal heart rate (in medical terminology, the fetus is the unborn baby from the eighth week of fetal development until birth). With CTG of the fetus, the frequency of the baby’s movements and the contractile activity of the uterus are also recorded.

Analyzing the CTG results, it is possible to evaluate the functional state, the frequency of fetal movements, to understand whether it is comfortable for him, whether there is enough oxygen, the frequency and strength of uterine contractions. Thanks to the fetal CTG procedure, the doctor can timely notice abnormalities during the course of pregnancy and provide the necessary assistance to the pregnant woman and the unborn baby in time.

Usually, if the pregnancy is proceeding well, the woman passes the fetus in the 3rd trimester at least twice, if there are indications (burdened obstetric history, cord entrapment, uterine scars, fetoplacental insufficiency, multiple or low water levels, features of the development of the fetal cardiovascular system) – more often according to the doctor’s testimony.

You are pregnant, you feel how your baby is growing, kicking, and your meeting with him will take place very soon, but the doctor has not yet prescribed you a CTG? Why? Perhaps your pregnancy is proceeding well, and its term has not approached 32 weeks, you have no indications for an earlier conduct. This is only a reason for joy, and in no way a cause for concern.

2How does the procedure go?

CTG of the fetus. Sensors

CTG of the fetus is completely painless for both the future mother and her future baby. A woman occupies a comfortable position half-sitting or reclining on her back or side, while lying down, the procedure is not recommended, because in the prone position, compression of the inferior vena cava may occur and the recording results will be distorted. Two sensors are attached to the pregnant woman’s stomach connected to the monitor. One sensor detects fetal heart rate, and the second – uterine contractions.

In older cardiomonitors, there is another fetal movement sensor with a button, it is placed in the woman’s hands, and she must press the button every time she feels her baby’s movements. In new modern devices there is no such device. The procedure lasts 30-35 minutes, so before it is carried out, the woman is recommended to sleep, go to the toilet. If the child during the CTG is not active and will sleep in the mother’s stomach, the procedure will not be informative.

To increase the activity of the fetus, a woman in the absence of allergies is recommended to eat one or another slice of chocolate. A woman is not recommended to worry, upset, worry, these factors can contribute to the distortion of the results. The procedure of CTG of the fetus is perfect, harmless, painless, has no contraindications and side effects from both the mother and the fetus. Also, CTG of the fetus can be carried out directly during childbirth to understand how the baby feels.

4 What parameters does the doctor evaluate?

Assessment of the condition of the fetus

Deciphering CTG of the fetus is the prerogative of gynecologists, but each woman can have an idea of ​​what the results of CTG mean, what are the indicators and whether they are the norm of CTG. As a rule, by the 32nd week a cardiac reflex in the child is already formed, and for every movement he has a reaction of the cardiovascular system in the form of an increase in heart rate.

Sensors record these indicators, which are recorded in the form of a curve on a tape – a cardiotocogram. The gynecologist estimates the curve in scores from 1 to 10. According to this assessment, it can be concluded how the child feels in utero, how much his body, including the cardiovascular system, is provided with oxygen, whether there is fetal hypoxia.

Normal CTG of the fetus

It is difficult for an unprepared person to say what a cardiotocogram means. It shows an unbroken line and teeth, directed mainly upward, less often – downward. But how to decipher these indicators? On the cardiotocogram of the fetus, the doctor evaluates the following indicators:

  • The basal rhythm is the arithmetic average of the fetal heart rate in 10 minutes. The normal frequency of the basal rhythm is 110-160 beats per minute.
  • basal rhythm variability (amplitude and frequency). On the film, variability stands out in the form of teeth and teeth. Sometimes such jumps scare a woman, in fact, it’s even good. The CTG line should not be straight.
  • acceleration is an increase in heart rate by 15 beats or more within 15 seconds. At CTG, they look like teeth upward. Occur when the fetus moves. Normal acceleration is 2-3 or more in 10 minutes.
  • Deceleration is a slowdown in heart rate of 15 or more for 15 seconds in response to a scrum or during uterine activity. On CTG, they look like prongs pointing down. If the decelerations are rare, shallow, after them the normal basal rhythm is quickly restored, then there is no reason for concern. Doctors should beware of frequent, high-amplitude heart rate reductions on film.

Fischer Grade Scale

For each of the four indicators, the doctor accrues points from 0 to 2. And then, summing up the result, he receives a final number of points, which gives an assessment of the condition of the fetus and its cardiac activity.

The Fischer grading scale is as follows:

  • 8-10 points – the norm of CTG of the fetus, the condition of the child is good. The future mother has no reason to worry.
  • 6-7 points – a borderline condition that requires repeating the procedure and reinforcing the results with additional research methods (ultrasound with dopplerography).
  • 5 points and below – a threatening condition of the fetus. 1-2 points of CTG during pregnancy – critical points, require the patient to be hospitalized as soon as possible in the hospital and to decide on further tactics of pregnancy management.

5 Normal results

Normal indicators of CTG are a concept that fits into completely specific criteria, namely: the basal rhythm should be 119-160 beats per minute, the deviation amplitude is 7-25 beats per minute, at least 2 accelerations per 10 minutes, absence Decelerations or slight slowdowns of heart rate. These are normal indicators.

But you always need to remember that one record does not make a diagnosis, and small deviations from the norm are not a pathology. The schedule data may vary depending on whether the baby is sleeping or awake, is in a calm or active state, and also on what week of pregnancy the examination is performed.

6 indicators that should alert

Hypoxia fetal CTG

Doctors should be wary of CTG results that have significant deviations from the normal range: if the basal rhythm is less than 110 or more than 190 beats per minute. A low frequency of 110 or less indicates a slowing of the heartbeat of the fetus, and a high one, on the contrary, indicates a pronounced increase in frequency. Both that and another can indicate fetal hypoxia, oxygen starvation.

Deep and frequent decelerations always alarm the doctor, they may indicate a violation of placental blood flow and require careful study. A monotonously variable basal rhythm or amplitude of less than 10 or more than 25 beats also raises questions from the doctor. If decoding CTG of the fetus gives a doubtful result of 6-7 points, it is necessary to repeat the study and supplement it with other examination methods to find out the reasons that led to this result. But do not immediately panic, it can only harm the state of the future baby.

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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.