The article was professionally consulted by Specialist Doctor I Nguyen Thi Man – Department of Obstetrics and Gynecology – International General Hospital webgiaidap.com Da Nang. Doctor has more than 10 years of experience in diagnosis, consultation and treatment in the field of Obstetrics and Gynecology.
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The CTG assessment is a systematic and comprehensive assessment. Any deviations beyond the normal curves should be recognized and analyzed in order to arrive at a correct conclusion during labor monitoring, to avoid late or inappropriate intervention. essential for mother and fetus. Therefore, fetal health monitoring by CTG plays an important role especially during labor.
What is CTG measurement? Measure CTG is fetal heart rate measurement and the action of uterine contractions by fetal heart monitor called obstetric monitoring. Obstetric Monitor (or EFM) refers to the simultaneous recording of fetal heart rate and uterine contractions. The resulting plot is called a Cardiotocogram (CTG).
Cardiotocography (CTG) is performed during uterine contractions. On paper monitoring will record the progress of uterine contractions and fetal heart rate. So what is the normal fetal heart curve?
If 120-160 beats/min for term fetus: Normal; If >160 beats/minute: Tachycardia;Basic fetal heart rate between 100-120 beats/minute: Suspicious; Muscle fetal heart rate copy
What is abnormal fetal heart curve? If it’s over 160 beats, it’s called tachycardia, or if it’s less than 100 beats, it’s called deceleration. In the range of 100-120, there are suspicious signs:
Fast tempo:Tachycardia is often related to the fetus’s ability to cope with some threat to health. Tachycardia without increased rhythms with decrease or loss of intrinsic oscillation, or delayed deceleration indicates severe fetal hypoxia; Causes of fetal tachycardia include: maternal fever, anxiety, hyperactivity thyroid, amniotic fluid, fetal anemia, fetus with viral or infectious infection, hypoxic fetus, after a prolonged decrease in rhythm, after epidural anesthesia, cardiovascular disease;
Other typical basic fetal heart curves:
Baseline fetal heart rate shift: The basal fetal heart rate shift can occur in an upward or downward direction. If ascending, it may be due to an infection in the uterus, the fetus is hypoxic from any cause (umbilical cord compression). Shifts in the basal fetal heart rate during the 2nd stage of labor are often associated with low cord blood pH;Baseline undulating: Severe bradycardia may be seen in cases of umbilical cord circulation obstruction, placental abruption, or maternal complications such as hypotension, shock, convulsions, uterine rupture, or uterine muscle overstimulation. . In cases where the undulating baseline is present within a limited period of the normal fetal heart rate, it may also reflect fetal neurological damage;Baseline unknown: The baseline fetal heart rate could not be determined. The reason for the unknown baseline could be a series of increased beats, intrinsic hyperoscillation, successively variable decelerations, or fetal arrhythmia.Acceleration rate: Is an indicator of a healthy fetus, also known as a responsive fetal heart curve;
Fetal heart rate fluctuations always decrease prior to fetal death, as a consequence of prolonged hypoxia and acidosis. One Fetal heart curve is flat or flat (intrinsic range of 0-2 beats/min) is one of the most worrisome fetal heart rhythms. However, we must always remember that a dying fetus can still maintain a fetal heart rate within normal limits.
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Decreased rate Premature deceleration: Clinically early deceleration is usually due to a neurological reflex when the fetal head is compressed into the pelvis during each uterine contraction; Variable deceleration: Variable deceleration is routine for umbilical cord compression, may be partial or complete. The combination of variable tachycardia, decreased intrinsic oscillation, relative tachycardia, and no apparent bradycardia is often associated with meconium aspiration syndrome; late deceleration Delayed tachycardia with onset, reaching poles urination and ends at least 15 seconds later than uterine contractions. A late deceleration associated with decreased intrinsic oscillation in the absence of an increase in rhythm is a very late sign of a critical fetal condition.
2.1 Non-Stress Test (NST)
Is the chart record fetal heart rate in the absence of uterine contractions to investigate the subsequent increased fetal heart rate response to fetal movements. The minimum execution time is 30 minutes. The test is done in the Fowler position, slightly left side. A clear conclusion is required when reading the CTG;Presence or absence of a rising beat – satisfying the stated criteria for duration and amplitude – over a given period of 20-30 minutes;Fetal heart rate flat, losing internal oscillations. Estimating the percentage of the flat histogram relative to the whole histogram will help to assess the prognosis of the fetus;If the above conditions are strictly adhered to, the chromosomal sensitivity reaches 97%;Contrary to a single Chromosomal nonresponsiveness, it is necessary to rule out fetal sleep (the average fetal sleep-wake cycle is about 70-90 minutes, of which the dormant phase lasts about 30 minutes), review of current medications. The most used are sedatives, as well as changing the patient’s position when doing chromosomes. An unresponsive chromosome has only an alarming value, not a diagnostic value. The positive predictive value of chromosomes is only 15%. Often will do more Stress test or strengthen the monitoring of fetal health.
2.2 Stress Test (ST)
The aim of the experiment is to produce the same number of uterine contractions as during the active phase of labor, sufficient to assess the fetal condition. After achieving this goal, we stop stimulating the uterus. The fetal heart rate recording must continue for another 15-20 minutes, until the artificial contraction is completely gone; Contraindication to ST: threatened preterm birth, low placenta, open uterus. ST is considered positive when there is bleeding. shows a decrease in heart rate when performing this test. Called suspect when the dips appear in the interval
Good practice obstetric monitoringin combination with ultrasound and clinical examination can enable obstetricians to analyze and interpret the results of fetal heart chart, detect abnormalities of the fetal heart and uterine contractions that may occur during pregnancy and labor so that the best treatment can be given to the fetus and the mother.
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If you have unusual symptoms, you should be examined and consulted with a specialist.
Topic: Reproductive health Pregnancy CTG index Fetal heart monitor CTG Fetal heart rate CTG measurement Fetal heart rate curve