1. CTG
V.D.P.

4. Steps of external monitoring

6. 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.

7. 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

11. DECCELERATIONS EARLY : Head compression LATE : U-P Insufficiency
VARIABLE : Cord compression
Primary CNS dysfn

12. EARLY

13. LATE

14. VARIABLE

15. Late deceleration
Late deceleration followed by normal baseline – mild compromise
Late deceleration followed by reduced baseline variability and tachycardia – severe compromise
V.D.P.

23. Management
Fetal HR Pattern classification
Normal means fetal health is well
Suspicious means
Continue observation
Additional tests
Pathological means
intervention

26. 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

28. CLINICAL CTG SCENARIOS
V.D.P.

29. 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.

30. variable deceleration
Cause: had cord prolapse, may lost baby before Management: CS
V.D.P.

31. variable deceleration
Cause: had cord prolapse, may lost baby before Management: CS
V.D.P.

32. prolonged bradycardia
V.D.P.

33. prolonged deceleration
V.D.P.

34. reduced base line variability with deceleration and bradychardia
V.D.P.

35. Late deceleration,
V.D.P.

36. hypertonic contraction with bradycardia.
Deceleration
hypertonic contraction with bradycardia.
V.D.P.

37. V.D.P.

38. Normal
V.D.P.

39. in fetal anemia, Rh, fetal hhage, cordocentesis, .
SINUSOIDAL PATTERN :
in fetal anemia, Rh, fetal hhage, cordocentesis, .
V.D.P.

40. SINUSOIDAL PATTERN RH –ve, IUGR COOMBS +ve,1:64, 34 weeks LSCS
, died after 5 days
V.D.P.

41. PROLONGED BRADYCARDIA
Immediate CS
V.D.P.

42. THANK YOU !!!
V.D.P.