1. CTG Interpretation and Management
Miss Philippa Moth
Locum Consultant Obstetrician and Gynaecologist
Maidstone and Tunbridge Wells NHS Trust

2. NICE Guidelines
Definitions and normal limits
Acting on abnormal CTGs
Common pitfalls

3. Who Gets Continuous Monitoring?
Maternal
Fetal
Hypertension
IOL / Augmentation DM
Pyrexia
Previous Caesarean
Patient Request
Abnormal intermittent monitoring
IUGR
Oligo
Postdates
Multiple Pregnancy
Breech
Epidural
Meconium

4. NICE Guidance Category Definition Normal
A FHR trace in which all four features are classified as reassuring
Suspicious
A FHR trace with one non reassuring feature
Pathological
A FHR trace with two or more non reassuring features or one or more abnormal

5. DR C BRAVADO DR Define Risk C Contractions BRA Baseline Rate
V Variability
A Accelerations
D Decelerations
0 Overall Impression

6. Accelerations

7. Decelerations
Early
Variable - Typical
- Atypical
Late

8. Early Decelerations
Due to head compression

9. Typical Variable Decelerations
Due to cord compression

10. Atypical Variable Decelerations

11. Late Decelerations
Due to Fetal Hypoxia

12. Normal Variability

13. Reduced Variability

14. Acting on CTGs Normal Suspicions / pathological
- review in a set amount of time
- FBS
- Deliver

15. Bradycardia

16. Sinusoidal CTG

17. Common Pitfalls Interpretation of CTGs outside of labour
Situations to think carefully about FBS
- VBAC
- Pyrexia
- Intrapartum haemorrhage

18. Common Pitfalls

19. Fresh Eyes
Never hesitate to ask for a second opinion