CTG Interpretation

Interpretation of
the CTG
DR. C BRAVADO
DR – Define Risk A- Acceleration
C - Contractions D – Deceleration
BRA – Baseline Rate O – Overall Impression
V - Variability
DR – Define Risk
DR – Define Risk
C - Contractions
• Record the number of contractions present in a 10 minute period.
• Each big square on the example CTG chart below is equal to one minute,
so look at how many contractions occurred within 10 big squares.
• Individual contractions are seen as peaks on the part of the CTG monitoring
uterine activity.
• Assess contractions for the following:

Duration: How long do the contractions last?
Intensity: How strong are the contractions (assessed using
palpation)?
In the below example, there are 2 contractions in a 10 minute period
(this is often referred to as “2 in 10”).
C - Contractions
BRA – Baseline Rate
• The baseline rate is the average heart rate of
the fetus within a 10-minute window.
• A normal fetal heart rate is between 110-160 bpm.
The baseline rate is the average heart rate of the fetus within a 10-minute window.
V - Variability
• Refers the variation of fetal heart rate from one beat to the next.
• Variability occurs as a result of the interaction between
the nervous system, chemoreceptors, baroreceptors and cardiac
responsiveness.
Variability categorization
• Reassuring: 5 – 25 bpm
• Non-reassuring:
* less than 5 bpm for between 30-50 minutes
* more than 25 bpm for 15-25 minutes
• Abnormal:
* less than 5 bpm for more than 50 minutes
* more than 25 bpm for more than 25 minutes
* sinusoidal
V - Variability
V - Variability
A- Acceleration
• An abrupt increase in the baseline fetal heart rate
of greater than 15 bpm for greater than 15 seconds.
• The presence of accelerations is reassuring.
• Accelerations occurring alongside uterine contractio
ns is a sign of a healthy fetus.
A- Acceleration
D – Deceleration
• Decelerations are an abrupt decrease in
the baseline fetal heart rate of greater than 15 bpm
for greater than 15 seconds.
Different types of decelerations:
• Early decelerations
• Variable decelerations
• Late decelerations
D – Deceleration
Early deceleration
• start when the uterine contraction begins and
recover when uterine contraction stops.
• This is due to increased fetal intracranial pressure
causing increased vagal tone. It therefore quickly
resolves once the uterine contraction ends and
intracranial pressure reduces.
D – Deceleration
Early deceleration
D – Deceleration
Variable deceleration
• observed as a rapid fall in baseline fetal heart
rate with a variable recovery phase.
• They are variable in their duration and may not have
any relationship to uterine contractions.
• They are most often seen during labour and in
patients’ with reduced amniotic fluid volume.
D – Deceleration
Variable deceleration
Variable decelerations are usually caused by umbilical
cord compression. The mechanism is as follows:
1. The umbilical vein is often occluded first causing an
acceleration of the fetal heart rate in response.
2. Then the umbilical artery is occluded causing a
subsequent rapid deceleration.
3. When pressure on the cord is reduced another
acceleration occurs and then the baseline rate returns.
D – Deceleration
• The accelerations before and after a variable deceleration are
known as the shoulders of deceleration. Their presence
indicates the fetus is not yet hypoxic and is adapting to the
reduced blood flow. Variable decelerations can sometimes resolve
if the mother changes position. The presence of persistent variable
decelerations indicates the need for close monitoring. Variable
decelerations without the shoulders are more worrying, as it
suggests the fetus is becoming hypoxic.
D – Deceleration
D – Deceleration
Late deceleration
• Late decelerations begin at the peak of the uterine
contraction and recover after the contraction ends.
• This type of deceleration indicates there is insufficient
blood flow to the uterus and placenta
Reduced uteroplacental blood flow can occur due to:
• Maternal hypotension
• Pre-eclampsia
• Uterine hyperstimulation
D – Deceleration
D – Deceleration
Prolonged deceleration
• A prolonged deceleration is defined as a deceleration that
lasts more than 3 minutes
A prolonged deceleration is defined as a deceleration that lasts more than 3 minutes
D – Deceleration
Sinusoidal pattern
• A sinusoidal CTG pattern
is rare, however, if present it
is very concerning as it is
A prolonged deceleration is defined as a deceleration that lasts more than 3 minutes
associated with high rates of
fetal morbidity and mortality.
• A smooth, regular, wave-
like pattern
O – Overall Impression
• The overall impression can be described as
either reassuring, non-reassuring or abnormal.
The overall impression can be described as either reassuring, suspicious or abnormal.
Reassuring
• Achieved baseline heart rate, variability,
and variable decelerations with no
concerning characteristics for less than 90
minutes
Non-reassuring
• Suspicious baseline heart rate, variability
(Less than 5 for 30 to 50 minutes more than 25 for 15
to 25 minutes)
• Variable decelerations with no concerning
characteristics for 90 minutes or more.
• Variable decelerations with any
concerning characteristics in up to 50% of
contractions for 30 minutes or more.
Abnormal
• Baseline heart rate below 100 bpm and above 180 bpm
• Variability
< 5 for more than 50 minutes,
> 25 for more than 25 minutes
Sinusoidal
Decelerations
• Variable decelerations with any concerning characteristics in
over 50% of contractions for 30 minutes Late decelerations for
30 minutes Acute bradycardia, or a single prolonged
deceleration lasting 3 minutes or more.

CTG Interpretation

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Interpretation of

BRA – Baseline Rate O – Overall Impression

• Assess contractions for the following:

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