CTG report basics

Cardiotopography (CTG) reporting - basics

CTG: to record fetal heart rate during contractions
When reviewing the CTG trace, assess and document contractions and all 4 features of fetal heart rate: baseline rate; baseline variability; presence or absence of decelerations (and concerning characteristics of variable decelerations* if present); presence of accelerations.

1. check baseline rate

• normal rate: 110bpm to 160bpm
• continue usual care as the risk of fetal acidosis is low

2. Baseline Variability

• normal: 5bpm - 10bpm
• increased: >25bpm

3. Acceleration

• to be cautious and take necessary actions when
• >15bpm
• >15s
• The presence of fetal heart rate accelerations (if it is constant with contraction and within range), even with reduced baseline variability, is generally a sign that the baby is healthy.

4. Deceleration

• to be cautious and take actions when 
• >15bpm
• >15s-40s
• uniform and repetitive
• If it occurs with contraction < 20s, it is called early deceleration
• need constant monitor and stand by for Mx

5. To monitor frequency of contraction

• is it present or absent?

Notes:

1. If CTG is normal, can reexamine again in 7 days time. it varies and depends on situation 

2. If it is difficult to categorise or interpret a CTG trace, obtain a review by a senior midwife or a senior obstetrician

Tips:

1. Document the condition of the woman and unborn baby (including cardiotocography [CTG] findings)systematically every hour, or more frequently if needed. 

2. CTG findings alone could not determine what is the next action that is needed for the mother.

3. Take into account the mother's condition, any antenatal and intrapartum risk factors, the current wellbeing of her and unborn baby and the progress of labour. 

4. Ensure that the focus of care remains on the woman rather than the CTG trace.

5. Remain with the woman in order to continue providing one-to-one support.

6. Talk to the woman and her birth companion(s) about what is happening and take her preferences into account.

More explanation on the different types of situation click here.

References:
1. https://www.nice.org.uk/guidance/cg190/resources/interpretation-of-cardiotocograph-traces-pdf-248732173
2. Video: https://www.youtube.com/watch?v=N9hNCjaL_dE