Cardiotocogram (CTG)
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Cardiotocography (CTG) or electronic fetal monitoring (EFM) is the most widely used technique for assessing fetal wellbeing in labour in the developed world. The primary purpose of fetal surveillance by CTG is to prevent adverse fetal outcomes. www.thewomens.org.au/Labo...

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Accelerations (increase by 5bpm for > 15secs) to stimulation such as contraction or palpation are reassuring. Likelihood of acidosis in the presence of accelerations is low. #ref

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Jul 12, 2011
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Early decelerations - reassuring and benign (vagal response to head compression) follows uterine contraction #ref

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High sensitivity, but low specificity. Many infants with normal oxygenation will have abnormal CTG patterns. #ref

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If CTG abnormalities are present, correct reversible causes. Maternal position change (tilt to eliminate any aortocaval compression), treat hypotension (legs up, IV fluid, vasopressor), stop/slow syntocinon

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Feb 25, 2012
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Late deceleration (onset after contraction finishes, nadir occurs >20secs after peak of contraction) is concerning and indicative of uteroplacental deficiency.

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Normal baseline fetal heart rate is 110-160bpm #ref

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May 18, 2011
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Normal baseline variability 5 - 25 bpm

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Normal baseline variability represents the continuous interaction and balance between the sympathetic and parasympathetic. Suggests adequate CNS activity and oxygenation.

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Prolonged deceleration (90sec-5min) -
Usually benign, associated with maternal hypotension (eg epidural or IVC compression) but if unprovoked think hypoxia from abruption or ruptured uterus. #ref

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Apr 16, 2012
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Scalp lactate.
<4.1 acceptable in first stage, <7 is acceptable in second stage labour #ref

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Sinusoidal pattern indicates fetal anemia. (infant of Rh isoimmunised mother, trauma)

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Variable decelerations (variable size & shape)
- indicates cord compression. Quick return to normal is what matters. Slow and decreased baseline variability might indicate hypoxia #ref

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Good review from the Royal Women's Hospital Mebourne www.thewomens.org.au/uplo...

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