CTG MADE EASY FOURTH EDITION (Susan M Gauge)

Fetal heart rate monitoring during labour has become an accepted means of assessing the well-being of a baby. However, in order for the resulting data to be of value it is vital that midwives, bstetricians and students have a knowledge of the methods of fetal heart rate monitoring available, the physiology of fetal heart rate bnormalities, the recommended terminology that should be used when interpreting data ( National Collaborating Centre for Women’s and Children’s Health 2007 ) and the appropriate management of such abnormalities.

It is important that women have a choice in the method of fetal heart rate monitoring during labour. Professionals must be able to give an explanation, based on available evidence, as to the risks and beneﬁ ts of both intermittent auscultation and continuous electronic fetal heart rate monitoring, and these discussions are included in this text.

Developments in fetal heart rate monitoring are ongoing, particularly regarding the use of decision support software packages ( Barber et al. 2010 ; Jameen et al. 2010 ). Whilst we aim to provide women with as normal experience as possible, electronic fetal heart rate monitoring is recommended for high-risk women in

labour and the technology is becoming more complicated and, in some instances, more invasive. Professionals involved in the care of women in labour should be aware of these developments and the effects they may have on intrapartum care.

CONTENTS:

Part 1 Assessing fetal well-being

in labour 1

Introduction 2

Intermittent auscultation 3

Continuous electronic fetal heart rate

monitoring 4

Adjuncts to CEFM for fetal surveillance 6

Conclusion 8

References 8

Part 2 Interpretation of the CTG 11

Control of the fetal heart rate 12

Interpretation of the CTG 13

Features of the cardiotocograph 14

Basic patterns 14

Periodic changes 17

Interpretation of the data 22

Management of a suspicious CTG 23

Management of a pathological CTG 23

References 24

Part 3 Litigation and the CTG 27

Andrew Symon

Introduction 28

Background to CTG litigation 28

The CTG in litigation 29

Conclusion 33

References 34

Part 4 Case studies 35

Section 1: Normal 37

Section 2: Bradycardia 49

Section 3: Tachycardia 57

Section 4: Reduced variability 67

Section 5: Early decelerations 83

Section 6: Late decelerations 91

Section 7: Variable decelerations 97

Section 8: Prolonged decelerations 111

Section 9: Complex 115

Section 10: Miscellaneous 129

Part 5 Good practice guide 157

Introduction 158

Developing guidelines 158

Audit 158

Communication 158

Training and development 158

Supervisors of midwives 159

Practical guides 159

Risk assessment chart 159

Web addresses 161

References 161

Index

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