CTG V.D.P.
Steps of external monitoring
Terminology Baseline Heart Rate ( BHR ) – 110 – 150 bpm Bradycardia – BHR < 110 bpm Mod – 100 – 110 bpm Tachycardia - BHR > 150 bpm Mod – 150 – 170 bpm Acceleration / Deceleration - > 15 bpm for 15 sec. Baseline Variability - 10 – 25 bpms Silent - 0 – 5 bpm Reduced - 5 – 10 bpm Saltatory - > 25 bpm (Sleep or Quiet phase, Prematurity, Anaemia, Infection, Anaesthetics, Sedatives, Anti hypertensive all ↓ variablity ) V.D.P.
Baseline variability The minor fluctuations in baseline FHR occurring at three to five cycles per minute. It is measured by estimating the difference in beats per minute between the highest peak and lowest trough of fluctuation in a one-minute segment of the trace
DECCELERATIONS EARLY : Head compression LATE : U-P Insufficiency VARIABLE : Cord compression Primary CNS dysfn
EARLY
LATE
VARIABLE
Late deceleration Late deceleration followed by normal baseline – mild compromise Late deceleration followed by reduced baseline variability and tachycardia – severe compromise V.D.P.
Management Fetal HR Pattern classification Normal means fetal health is well Suspicious means Continue observation Additional tests Pathological means intervention
Ephedrine An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [PubChem] Usual Adult Dose for: Adams-Stokes Syndrome Depression Myasthenia Gravis Narcolepsy Hypotension Asthma - Acute
CLINICAL CTG SCENARIOS V.D.P.
resulting from descent of fetus causing head compression, early decelerations resulting from descent of fetus causing head compression, returning to normal in between contractions , V.D.P.
variable deceleration Cause: had cord prolapse, may lost baby before Management: CS V.D.P.
variable deceleration Cause: had cord prolapse, may lost baby before Management: CS V.D.P.
prolonged bradycardia V.D.P.
prolonged deceleration V.D.P.
reduced base line variability with deceleration and bradychardia V.D.P.
Late deceleration, V.D.P.
hypertonic contraction with bradycardia. Deceleration hypertonic contraction with bradycardia. V.D.P.
V.D.P.
Normal V.D.P.
in fetal anemia, Rh, fetal hhage, cordocentesis, . SINUSOIDAL PATTERN : in fetal anemia, Rh, fetal hhage, cordocentesis, . V.D.P.
SINUSOIDAL PATTERN RH –ve, IUGR COOMBS +ve,1:64, 34 weeks LSCS , died after 5 days V.D.P.
PROLONGED BRADYCARDIA Immediate CS V.D.P.
THANK YOU !!! V.D.P.