1. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
CARDIOTOCOGRAPHY
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

2. Cardiotocography (CTG)
(kardia=heart, tokos=labour)
…is the term that best describes the continuous monitoring of FHR and uterine contractions
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

3. Tracing acquisition
Half-sitting, upright
Supine recumbent position
Prolonged monitoring in this position should be avoided (aorto-caval compression)
Lateral recumbent
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

4. Telemetry (wireless) Allows mother to move freely
Should be preferred when available
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

5. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Paper scales
1, 2 or 3 cm/min
1cm/min
20 or 30 bpm/cm
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

6. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Some experts feel that 1 cm/min provides sufficient detail for clinical analysis, and has the advantage of reducing tracing length
Other experts feel that the small details are better evaluated using higher papers speeds
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

7. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
The paper scale should be the one with which healthcare professionals are most familiar
1 cm/min
3 cm/min
Inadvertent use of paper scales to which staff are unaccustomed may lead to erroneous interpretations
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

8. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
External FHR monitoring
(Doppler US)
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

9. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Spike removal
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

10. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Signal modulation
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

11. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Autocorrelation t
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

12. Provides an approximation to true FHR,
but sufficiently accurate for analysis
May not record arrhythmias
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

13. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Artefacts (particularly during 2nd stage)
Half-counting
MHR monitoring
Double-counting
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

14. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Internal FHR monitoring
(ECG) t
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

15. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Membranes ruptured
Clear identification of presenting part
Avoid delicate fetal structures
CONTRA-INDICATIONS
Active genital herpes
Seropositive hepatitis B, C, D and E
Seropositive HIV
Suspected fetal blood disorders
If artificial ROM is inappropriate
Uncertainty about presenting part
Preferably avoided < 32 weeks (unless there is no alternative)
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

16. Careful repositioning of probe in 2nd stage
External FHR is recommended for routine monitoring, if quality is acceptable
Careful repositioning of probe in 2nd stage
In all atypical tracings exclude MHR (auscultation, US, internal FHR)
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

17. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Indications for internal FHR
Acceptable record not possible with external FHR
Suspected fetal cardiac arrythmia
… and no contra-indications
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

18. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
External UC monitoring
(Tocodynamometer)
PRESSURE SENSOR
GUARD RING
increased myometrial tension measured through abdominal wall
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

19. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
incorrect toco placement or displacement
reduced tension on elastic band
abdominal adiposity
… may lead to failed registration
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

20. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Frequency of contractions
Intensity and duration
Basal intra-uterine pressure
YES NO
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

21. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Internal UC monitoring
(IUP)
Quantitative information on intensity and duration of contractions and basal uterine tone
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

22. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Disposable catheter (expensive)
Requires ruptured membranes
Contra-indications: haemorrhage, low lying placenta
Small risk of fetal injury, placental haemorrhage, infection
Not recommended for routine clinical use
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

23. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Monitoring of twins
Preferably with dual channel monitors
Duplicate monitoring of same twin may occur (alarms)
Some experts believe that the presenting twin should preferably be monitored internally (signal quality)
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

24. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
↑ 20 bpm
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

25. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Simultaneous MHR monitoring
Should be considered,
if available and not causing discomfort
(especially in the 2nd stage when accelerations coincide with contractions and/or the MHR is elevated)
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING

26. 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING
Tracing storage
Identification
Name, place
Paper speed, date and time of start and end
Part of patient record
Digital CTG archives
Secure file backup system
Tracings readily available for review
2015 FIGO CONSENSUS GUIDELINES ON
INTRAPARTUM FETAL MONITORING