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Cardiotocography in The Preterm Gestation
Cardiotocography in The Preterm Gestation
Y IN THE PRETERM
GESTATION
RHODA LICARDO
1ST YEAR MFM FELLOW
• Physiology and behavior of
“STRESS RESPONSE” IS the preterm fetal heart rate,
the response to hypoxia and
N O T F U L LY patterns on cardiotocography
FUNCTIONAL IN A differs from that of the
TERM fetus
PRETERM FETUS
07/02/2023 S a m p l e F o o t e r Te x t 2
C HA R A C T E R I ST I C S OF F E TA L HE A RT R AT E I N A
PR E T E R M F E T U S
Variability Reduced
Acceleration (+)
Deceleration variable
Contraction none
G3P2 (2002) Pregnancy Uterine 28 Weeks 6 Days AOG by Ultrasound, Cephalic not in Labor
Preeclampsia with Severe Features Advanced Maternal Age
Obese II
INTERPRETING [ 24 -26 weeks ]
EFM AT
- Prognosis of fetus dependent on
DIFFERENT AGE fetal weight and maturity
OF GESTATION Higher baseline FHR ( 150-160s)
Reduced baseline variability due to
underdevelopment of ANS and
medications
Reduced amplitude of acceleration
with decelerations- normal
physiology of the cardio
regulatory process
07/02/2023 S a m p l e F o o t e r Te x t 6
INTERPRETING
[ 26-28 weeks ]
EFM AT
DIFFERENT AGE - Similar with 24- 26 weeks
OF GESTATION - variability becomes normal
- benefits of delivery should be
weighed carefully against risk of
adverse perinatal outcome
07/02/2023 S a m p l e F o o t e r Te x t 7
EFM
Normal with
Variability areas reduced
variability
Acceleration (+)
Deceleration variable
Contraction none
07/02/2023 S a m p l e F o o t e r Te x t 9
EFM
Variability normal
Acceleration (+)
Deceleration variable
Contraction none
OF GESTATION
- baseline FHR and variability ~ term
fetus
- Accleleration greater than 15 \bom
from baseline- parameter of good fetal
well being
- - decelerations classified according ot
term fetus
07/02/2023 S a m p l e F o o t e r Te x t 11
EFM
Variability Normal
Acceleration (+)
Deceleration none
Contraction none
07/02/2023 S a m p l e F o o t e r Te x t 14
INTRAPARTUM MONITORING
• 1. Maternal Heart Rate Artifact First stage -normal trace, latent phase of labor
of labor
- Immdeiate intensive resuscitative
measures if tracing is not Normal.
• 2. Interpretation should be correlated Second - Changes in CTG tracing due to bearing
stage of
clinically with the different stages of labor labor down efforts, head compression ,
dehydration and maternal exhaustion,
PPROM causing cord compression
• 3, CTG monitoring of SGA and her fetus - Change in baseline, variability and
- Fetus with IUGR requires close monitoring deceleration [pattern are expected to
revert back to a normal tracing after each
during labor for they are prone to hypoxic contraction
- If there is sign of fetal compromise,
ischemic changes expedite delivery is recommneded
PITFALLS IN
ANTEPARTUM AND
INTRAPARTUM
CARDIOTOCOGRAPH
Y