Indications for the use of continuous electronic fetal monitoring

Maternal problems
Previous caesarean section
Induced labour
Post-term pregnancy (>42 weeks)
Prolonged rupture of membranes (>24 h)
Hypertension
Diabetes
Antepartum hemorrhage (placental abruption)
Medical disorders such as systemic lupus erythematosus

Fetal problems
Fetal growth restriction
Prematurity
Oligohydramnios
Abnormal Doppler artery velocimetry
Multiple pregnancy
Meconium stained liquor
Intrauterine infection

Intrapartum risk factors

Oxytocin augmentation
Epidural analgesia
Vaginal bleeding in labour
Maternal pyrexia
Fresh meconium stained liquor
 Interpretation of CTG:

fl
DR C BRaVADO:
• DR: De ne risk (indications, above)
• C: Contractions
• BRa: Baseline rate 110-160
• V: Variability 5-25
• A: Accelerations (reassuring): abrupt ↑ FHR > 15 bpm for > 15 s.
• D: Decelerations: early (normal), late (abnormal, left lateral position, O2, uids,
stop oxytocin), prolonged (worst, immediate delivery), variable (inconclusive)
• O: Overall impression: reassuring, suspicious or abnormal.

Tachycardia (>160 bpm): Maternal fever, Fetal hypoxia, Fetal anemia, Ammonites, Fetal
tachyarrhythmia (SVT 200-240 bpm), Fetal heart failure, Drugs (Beta sympathomimetic)

Bradycardia (< 110 bpm): Heart block (little or no variability), Occiput posterior or transverse position,
Serious fetal compromise, hypoxia.

Decreased baseline variability: Fetal metabolic acidosis, Pre existing neurologic abnormality, CNS
depressants, Fetal sleep cycles (<40min), Anomalies, Prematurity, Fetal tachycardia, Normal variant,
Betamethasone.
 partogram
• A partogram or partograph is a graphical record
of key data (maternal and fetal)
during labour entered against time on a single
sheet of paper.
• Relevant measurements such as cervical
dilation, fetal heart rate, duration of labour
and vital signs
• It is intended to provide an accurate record of the
progress in labour, so that any delay or deviation
from normal may be detected quickly and treated
accordingly
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check
every←
half hour
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mecon.am,Blood
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←

We start partogram from the active

phase of labor (4cm) which is where
•
the alert line starts from. See the alert
line takes 6 hours which means cervix
would need to dilate at least with a
rate of 1 cm/h otherwise this will be
delayed labor and need to check it
(powers, passages, passenger). If
powers are sufficient (either itself or
by oxytocic drug), then the problem is
either passage or passenger which
×
needs either instrumental delivery or
C/S when reachs action line.
If patient presented at any time of
active phase, you will start it on
action
alert line e.g 6 cm as X here

/ → ←

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P V done - 2←

every 4 h ←

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+ ←
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+ 2←
weight& t i m e o f delivery
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of Labor
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ate
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