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CTG – Cardiotocography Explained Simply

A CTG (cardiotocography) is a monitoring method used during pregnancy and labour to simultaneously record the unborn baby´s heart rate and the mother´s uterine contractions.

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A CTG (cardiotocography) is a monitoring method used during pregnancy and labour to simultaneously record the unborn baby´s heart rate and the mother´s uterine contractions.

What is a CTG?

CTG stands for cardiotocography and is a medical monitoring technique used during pregnancy and labour. The device simultaneously records the fetal heart rate (the heartbeat of the unborn baby) and the uterine contractions (labour activity) of the mother. The name derives from the Greek words kardia (heart), tokos (birth), and graphein (to write).

How Does a CTG Work?

Two sensors are attached to the pregnant woman´s abdomen using an elastic belt:

Ultrasound sensor (Doppler probe): Measures the baby´s heart rate using ultrasound waves.
Pressure sensor (tocometer): Records the contractions or tightening of the uterus.

The measured values are displayed as waveform traces on a paper printout or digital screen and are evaluated by medical professionals.

When is a CTG Performed?

A CTG is used in a variety of situations:

From week 36 of pregnancy onwards as a routine check-up
In high-risk pregnancies, such as those involving high blood pressure, diabetes, or multiple pregnancies
During labour for continuous monitoring of the baby
When reduced fetal movement or other concerns are noted
After an accident or fall during pregnancy

What Does a CTG Measure?

CTG recordings are assessed based on several key parameters:

Baseline Heart Rate

The baseline heart rate refers to the average fetal heart rate when the baby is not moving. A normal range is between 110 and 160 beats per minute. Values outside this range may indicate that the baby is under stress.

Variability

Variability describes the beat-to-beat fluctuations in the fetal heart rate. Normal variability (5–25 beats per minute) is a reassuring sign indicating that the baby is well-oxygenated and alert.

Accelerations

Accelerations are brief increases in the fetal heart rate, often associated with fetal movement. They are a positive indicator of fetal well-being.

Decelerations

Decelerations are drops in the fetal heart rate. Depending on their type and timing in relation to contractions, they may indicate reduced oxygen supply to the baby and require medical attention.

Interpreting CTG Results

CTG findings are typically evaluated using internationally recognised classification systems. The FIGO (International Federation of Gynecology and Obstetrics) classification is widely used and divides CTG findings into three categories:

Normal: All parameters are within the normal range; the baby is well.
Suspicious: One or more parameters are abnormal; further monitoring is required.
Pathological: Multiple parameters are abnormal; immediate action is needed.

Risks and Limitations of CTG

CTG is a non-invasive and risk-free procedure that involves no radiation for either the mother or the unborn baby. However, CTG has its limitations: false-positive and false-negative results can occur. For this reason, CTG is often used alongside other assessments such as ultrasound or biophysical profile scoring to provide a more comprehensive picture of fetal well-being.

References

Ayres-de-Campos D, Spong CY, Chandraharan E; FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. International Journal of Gynecology and Obstetrics. 2015;131(1):13-24.
National Institute for Health and Care Excellence (NICE). Fetal monitoring in labour. NICE Guideline NG229. London: NICE; 2022.
Pschyrembel Clinical Dictionary. 268th Edition. De Gruyter, Berlin 2020.

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