CTG

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The first central concept of standardized intrapartum FHR interpretation is that all clinically significant FHR decelerations (variable, late, or prolonged) reflect interruption of the pathway of oxygen transfer from the environment to the fetus at 1 or more points . 11/20/2018 mcu pgc '10

The second central concept of standardized intrapartum FHR interpretation is that intrapartum interruption of fetal oxygenation does not result in CP unless the fetal response progresses to the stage of significant fetal metabolic acidemia (umbilical artery pH <7.0 and base deficit ≥12 mmol/L). 11/20/2018 mcu pgc '10

The third central concept of intrapartum FHR interpretation is that moderate (normal) variability and / or accelerations reliably predict the absence of fetal metabolic acidemia at the time they are observed. 11/20/2018 mcu pgc '10

Category I: NORMAL FHR tracings include ALL of the following: Baseline rate: 110–160 beats per minute (bpm) Baseline FHR variability: moderate Late or variable decelerations: absent Early decelerations: present or absent Accelerations: present or absent Strongly predictive of normal acid-base status at time of observation. Routine care; no specific action required 11/20/2018 mcu pgc '10

Category III: ABNORMAL FHR tracings include EITHER of the ff: Absent baseline FHR variability and any of the ff: Recurrent late decelerations Recurrent variable decelerations Bradycardia Sinusoidal pattern 11/20/2018 mcu pgc '10

Category II: INDETERMINATE includes all FHR tracings NOT categorized as Category I or III. NOT predictive of either normal or abnormal fetal acid-base status. requires continued surveillance and re-evaluation- second recommendation is incomplete 11/20/2018 mcu pgc '10

TERMINOLOGIES 11/20/2018 mcu pgc '10

VARIABILITY

Grades of fluctuation are based on amplitude range (peak minus trough): 11/20/2018 mcu pgc '10

Classifications of Variability Absent: amplitude range undetectable. Minimal: amplitude range ≤5 bpm. Moderate: amplitude range 6-25 bpm. Marked: amplitude range >25 bpm. 11/20/2018 mcu pgc '10

BASELINE FHR PATTERNS

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110 BPM 11/20/2018 mcu pgc '10

160 BPM 11/20/2018 mcu pgc '10

Variable Deceleration

From the onset of the deceleration to the beginning of the FHR nadir of <30 seconds. The decrease in FHR is ≥15 beats per minute, lasting ≥15 seconds, and <2 minutes in duration 11/20/2018 mcu pgc '10

Variable Decelerations Severe ≥ 60 seconds in duration & < 70 beats/min OR ≥ 2 mins in duration & < 80 beats/min Moderate 30-60 sec in duration & < 70 beats/min OR ≥ 60 sec in duration & < 80 beats/min Mild All other decelerations are mild 11/20/2018 mcu pgc '10

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Variable Decelerations - Notice that the decelerations are not related to the contraction, beginning well before the contraction even begins. 11/20/2018 mcu pgc '10

Late Deceleration

from the onset to the nadir of the deceleration of ≥30 seconds. The nadir of the deceleration occurring after the peak of the contraction. In most cases, the onset, nadir, and recovery of the deceleration occur after the beginning, peak, and ending of the contraction, respectively. 11/20/2018 mcu pgc '10

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Late Deceleration with Absent Variability – Notice the decrease in the fetal heart rate only begins to decline after the contraction peaks. 11/20/2018 mcu pgc '10

Early Deceleration

from the onset to the FHR nadir of ≥30 seconds. The nadir of the deceleration occurs at the same time as the peak of the contraction. n most cases the onset, nadir, and recovery of the deceleration are coincident with the beginning, peak, and ending of the contraction, respectively. 11/20/2018 mcu pgc '10

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Sinusoidal Pattern

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Pseudo-sinusoidal Pattern 11/20/2018 mcu pgc '10

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