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Done by: Teacher: Ibtesam Jahlan Teacher: Ibtesam Jahlan

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Introduction A Cardiotocograph (CTG) is a record of the fetal heart rate (FHR) either measured from a transducer on the abdomen or a probe on the fetal scalp. In addition to the fetal heart rate another transducer measures the uterine contractions over the fundus

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Abbreviation: CTG = Cardiotocograph What does "Cardiotocograph" mean? Cardio = heart Toco = contractions (of uterus during labour) Graph = machine to record Cardiotocograph = machine to record the heart rate (fetal heart) and contractions of uterus during labour

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Physiology During labour the fetus can become stressed. The heart rate of the fetus is monitored throughout labour so stress can be detected early. The contractions are monitored also so that the midwife and mother know when the contraction is occurring and also to check for fetal distress during the contraction.

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Units of measurement Fetal heart rate: BPM (beats per minute) Contractions: contractions\ 10 minutes. IUP: mmHg

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Typical values Fetal heart rate: 100 160 BPM Contractions: 3-4contractions \10min. IUP: 0 - 70 mmHg

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Interpretation The CTG trace generally shows two lines. The upper line is a record of the fetal heart rate in beats per minute. The lower line is a recording of uterine contractions from the toco. The trace may also have markings on it that are indications that the mother has felt a fetal movement (operated by a switch given to the mother)

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Baseline Rate This should be between 100 and 160 beats per minute (BPM) and is indicated by the FHR when stable (with accelerations and decelerations absent). It should be taken over a period of 5 - 10 minutes. The rate may change over a period of time but normally remains fairly constant.

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Bradycardia This is defined as a baseline heart rate of less than 110 bpm. If between 110 and 100 it is suspicious whereas below 100 it is pathological. A steep sustained decrease in rate is indicative of fetal distress and if the cause cannot be reversed the fetus should be delivered

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Tachycardia A suspicious tachycardia is defined as being between 160 and 170 whereas a pathological pattern is above 170. Tachycardias can be indicative of fever or fetal infection and occasionally fetal distress (with other abnormalities). An epidural may also induce a tachycardia in the fetus

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Baseline variations The short term variations in the baseline should be between 10 and 15 bpm (except during intervals of fetal sleep which should be no longer than 60 minutes). Prolonged reduced variability along with other abnormalities may be indicative of fetal distress

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Accelerations This is defined as a transient increase in heart rate of greater than 15 bpm for at least 15 seconds. Two accelerations in 20 minutes is considered a reactive trace. Accelerations are a good sign as they show fetal responsiveness and the integrity of the mechanisms controlling the heart

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Decelerations These may either be normal or pathological. Early decelerations occur at the same time as uterine contractions and are usually due to fetal head compression and therefore occur in first and second stage labour with decent of the head. They are normally perfectly benign. Late decelerations persist after the contraction has finished and suggest fetal distress.

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A normal CTG is a good sign but a poor CTG does not always suggest fetal distress. A more definitive diagnosis may be made from fetal blood sampling but if this is not possible or there is an acute situation (such as a prolonged bradycardia) intervention may be indicated

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Uterine contractions monitoring Count the number of contractions to determine the pattern of uterine contractions is it normal, hypoactive, or hyperactive. Normal number of contractions 3-4 contractions \10 min. Determine the strength of the contractions (IUP) as apeare in the trace by mmHg.

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Nursing Interventions if Uterine Hyperstimulation or Fetal Distress Occur: RationalInterventions 1-To improve fetal-placental blood flow. 1-Turn woman on her left side. 2-To provide adequate intravascular volume, support maternal BP, and I.V route for emergency medications. 2-Increase primary I.V rate up to 200 ml/hr unless contraindicated.

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Continue RationalInterventions 3-To saturate the blood with oxygen as much as possible to prevent fetal anoxia. 3-Give oxygen 6 to 10 l/min ( per protocol) by face mask. 4-This indicate induction failed. If membrane intact discontinue induction and try again later. If membrane ruptured cesarean birth may be necessary. 4-Notify doctor

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