CTG

KARDIOTOKOGRAFI
 Categorisation of fetal heart rate features
Feature Baseline (bpm) Variability (bpm) Decelerations Acceleration
s

Reassuring 110-160 >5 None Present

Non-reassuring 100-109 <5 Early The absence

161-180 (40 to 90 mins) Variable of
Single accelerations
prolonged (<3 on an
mins) otherwise
normal CTG
is of
uncertain
significance

Abnormal <100 <5 Atypical

>180 ( >90mins) variable
Sinusoidal (>10mins) Late
Single
prolonged
(>3mins)
 Normal
All 4 features reassure
Suspicious
1 non-reassuring
(3 reassuring) features
Pathological
2 or more non-reassuring
or
1 or more abnormal
 Decelerations
• Early: mirrors the contraction
• Typically occurs as the head enters the pelvis and is
compressed, i.e. it is a vagal response
• Late: Follows every contraction and exhibits a
slow return to baseline
• Is quite rare but is the response of a hypoxic myocardium
• Variable: Show no relationship to contractions
• Mild
• Moderate
• Severe
 DESELERASI LAMBAT

• Penurunan DJJ yang terjadi beberapa

saat setelah kontraksi dimulai.
Tidak ada batasan mengenai
besarnya penurunan DJJ.
• Deselerasi lambat yang berulang
merupakan keadaan patologis:
- insufisiensi plasenta
- hipoksia/asfiksia janin.
• Besarnya penurunan DJJ tidak
berhubungan dengan derajat
beratnya hipoksia janin.
 DESELERASI VARIABEL

• Deselerasi yang bervariasi dalam bentuk,

lama, dan saat terjadinya.
• Jenis deselerasi yang paling sering
dijumpai (terutama dalam partus kala II).
• Terjadi akibat kompresi tali pusat.
• Kebanyakan tidak berbahaya bagi janin.
• Beratnya derajat deselerasi variabel
berhubungan langsung dengan beratnya
derajat hipoksia janin.
 Umbilical Arterial Occlusion

Fetal Hypertension Fetal Hypoxemia

Fetal Baroreceptor Fetal Chemoreceptor

Stimulation Stimulation

Central Vagal Hypoxemic

Stimulation Myocardial
Depression
Blocked by Atropine

FHR Deceleration

Freeman RK et al, 2003

 Umbilical Arterial Occlusion

Fetal Hypertension Fetal Hypoxemia

Fetal Baroreceptor Fetal Chemoreceptor

Stimulation Stimulation

Central Vagal Hypoxemic

Stimulation Myocardial
Depression
Blocked by Atropine

FHR Deceleration

Freeman RK et al, 2003

11
 DESELERASI LAMBAT
DECREASED UTEROPLACENTAL OXYGEN
TRANSFER TO THE FETUS

Chemoreceptor Stimulus

Alpha Adrenergic Stimulus

Without anemia
With anemia Fetal Hypertension

Baroreceptor Stimulus

Parasympathetic Response

Myocardial Depression
Deceleration
JJE-20080212 Freeman RK et al, 2003
 DECREASED UTEROPLACENTAL OXYGEN
TRANSFER TO THE FETUS

Chemoreceptor Stimulus

Alpha Adrenergic Stimulus

Fetal Hypertension

Baroreceptor Stimulus

Parasympathetic Response

Freeman RK et al, 2003

Myocardial Depression
Deceleration
13
 Birth Asphyxia : ACOG
1. Profound umbilical artery metabolic or
mixed acidemia (pH < 7.0 , base deficit > 20)
2. Five minute Apgar of 0 to 3
3. Neonatal neurologic sequelae such as
seizure, coma, and hypotonia
4. Multiorgan system dysfunction

Freeman RK et al, 2003

14
NORMAL OXYGENATION

HYPOXIA

ACIDOSIS

TISSUE DAMAGE

DEATH
Freeman RK et al, 2003
15
 Medical Management of
Late Deceleration
1. Place patient on side
2. Administration 02 (100%) by tight face mask
3. Discontinue oxytocin
4. Correct any hypotension :
- Appropriate position change
- IV hydration with appropriate fluid
- Reserve pharmacologic pressor treatment (ephedrine)
for severe or unresponsive hypotension due to
conduction anesthesia
Freeman RK et al, 2003
16
• Toko : memeriksa kontraksi
• FHR : Bagian jantung bayi
FHR

TOCO
 VARIABEL YANG DINILAI
Variabel Keterangan Nilai Normal
Baseline Detak jantung bayi 120-160 dpm
Variabilitas 5-25 dpm
Akselerasi Peningkatan detak jantung 2x dalam 10 menit
bayi >10 dpm selama >10
detik
Deselerasi Penurunan detak jantung Tidak ada
bayi >10 dpm selama >10
detik

Gerak janin ada

His Sesuai
REASSURING SUSPICIOUS NON REASSURING
Baseline 120-160 dpm, Variabilitas < 5 dpm Baseline < 120 dpm,> 160 dpm
variabilitas 5-25 dpm, Tidak ada akselerasi Variabilitas < 5 dpm
akselerasi(+), Tidak ada deselerasi Akselerasi (-)
deselerasi (-), Deselarsi (+)
gerak jani (+), Gerak janin (+)
His Normal His (+)
Baseline : 125 dpm
Variabilitas : 5-20 dpm
Akselerasi :+
Deselerasi :-
Gerak janin : +
His : irreguler

REASSURING
Baseline : 140 dpm
Variabilitas : 5-12 dpm
Akselerasi :-
Deselerasi :-
Gerak janin :+
His : + 1x /10 menit

REASSURING
Baseline :150 dpm
Variabilitas : <5 dpm
Akselerasi :-
Deselerasi :+
Gerak janin :+
His : 1x
dalam 10 menit

NON REASSURING
Baseline :130 dpm
Variabilitas : <5 dpm
Akselerasi :-
Deselerasi :-
Gerak janin :+
His :-

SUSPICIOUS
Baseline :155 dpm
Variabilitas : <5 dpm
Akselerasi :-
Deselerasi :+,
deselerasi lambat
Gerak janin :+
His :+ 2-3x
dalam 10 menit

NON REASSURING
Baseline :140 dpm
Variabilitas : 5-15 dpm
Akselerasi :+
Deselerasi :-
Gerak janin :+
His :+ 5 kali/10 menit
REASSURING, Takisistole
Baseline :140 dpm
Variabilitas : 15-20 dpm
Akselerasi :+
Deselerasi :+, deselerasi lambat
Gerak janin :+
His :+ 1-2 kali/10 menit
Non REASSURING
Baseline :130 dpm
Variabilitas : 15-20 dpm
Akselerasi :+
Deselerasi :-
Gerak janin :+
His :+ 2 kali /10 menit
REASSURING
Baseline :145 dpm
Variabilitas : 15-20 dpm
Akselerasi :+
Deselerasi :-
Gerak janin :+
His :+2-3x/10menit
REASSURING
Baseline :140 dpm
Variabilitas : 15-20 dpm
Akselerasi :+
Deselerasi :-
Gerak janin :+
His :2-3x/10
REASSURING
Baseline :140 dpm
Variabilitas : 15-20 dpm
Akselerasi :+
Deselerasi :-
Gerak janin :+
His :+ 2-3 x/10 menit
REASSURING
Baseline :138 dpm
Variabilitas : 5-15 dpm
Akselerasi :+
Deselerasi :-
Gerak janin :+
His :+ 4-5x/10 menit
NON REASSURING
Baseline :138 dpm
Variabilitas : 5-15 dpm
Akselerasi :+
Deselerasi :-
Gerak janin :+
His :+ 4-5x/10 menit
REASSURING