What is Cardiotocography (CTG)?

Cardiotocography (CTG) in pregnancy involves monitoring both the fetal heart rate
and uterine contractions. This is commonly done during labor to assess the well-being
of the baby. The CTG provides valuable information to healthcare providers about the
fetal heart rate patterns and helps them make decisions regarding the management of
labor. It is a non-invasive way to monitor the baby's response to contractions and
identify any signs of distress.

Cardiotocography (CTG) is commonly used in pregnancy for various indications,

including:

● Routine Antenatal Monitoring: Regular monitoring during pregnancy to assess

the well-being of the fetus.
● Monitoring During Labor: Continuous monitoring during labor to observe fetal
heart rate patterns and uterine contractions, helping healthcare providers make
informed decisions about the management of labor.
● High-Risk Pregnancies: In cases where there are identified risk factors, such as
gestational diabetes, preeclampsia, or intrauterine growth restriction.
● Post-Term Pregnancy: Monitoring when the pregnancy extends beyond the due
date to ensure the well-being of the baby.
● Decreased Fetal Movement: When a pregnant woman notices a decrease in
fetal movements, CTG may be used to assess fetal well-being.
● Maternal Health Conditions: In situations where the mother has pre-existing
health conditions that may impact fetal well-being

Interpreting a Cardiotocography (CTG) reading involves analyzing the fetal heart

rate (FHR) patterns and uterine contractions. The key components include:

● Baseline Fetal Heart Rate (FHR): The average heart rate of the fetus during a
10-minute window, excluding accelerations or decelerations.
● Variability: Fluctuations in the fetal heart rate. Normal variability indicates a
healthy nervous system.
● Accelerations: Temporary increases in fetal heart rate, which are generally a
positive sign indicating fetal well-being.
● Decelerations: Temporary decreases in fetal heart rate. Early decelerations are
usually benign, while late or variable decelerations may indicate potential issues.
● Uterine Contractions: Frequency, duration, and strength of contractions are
monitored to ensure they are not causing stress to the fetus.

PRO'S of CTG:
 ● Fetal Monitoring: CTG provides continuous monitoring of the fetal heart rate
and uterine contractions, offering valuable insights into the well-being of the baby
during pregnancy and labor.
● Early Detection of Issues: It can help identify early signs of fetal distress or
abnormalities in heart rate patterns, allowing for timely interventions.
● Objective Data: CTG provides objective data that healthcare providers can use
to make informed decisions about the management of labor and potential
interventions.
● Improved Outcomes: When used appropriately, CTG can contribute to
improved outcomes by facilitating timely responses to changes in fetal well-
being.
● High Sensitivity: It is sensitive to changes in fetal heart rate, providing a real-
time assessment of the baby's response to contractions.

Negative Sides of CTG;

● False Alarms: CTG can sometimes generate false alarms, leading to

unnecessary interventions or stress for both the healthcare providers and the
expectant mother.
● Reduced Mobility: Continuous CTG monitoring may restrict a woman's mobility
during labor, as she needs to stay close to the monitoring equipment.
● Interpretation Challenges: Reading and interpreting CTG traces require skill
and experience. Misinterpretation may lead to unnecessary interventions or a
failure to detect actual problems.
● Limited Predictive Value: CTG is not foolproof in predicting adverse outcomes,
and abnormal readings do not always correlate with poor outcomes. Conversely,
normal readings do not guarantee the absence of issues.
● Increased Cesarean Section Rates: Continuous CTG monitoring has been
associated with higher rates of cesarean sections, potentially due to concerns
arising from false alarms or misinterpretations.
● Inconsistency in Guidelines: There can be variations in the interpretation of
CTG readings among healthcare providers and institutions, leading to
inconsistencies in decision-making.