Evaluation of CTG results
When the expectant mother feels fetal movement, it is wonderful: the pregnant woman knows that the baby is doing well. But by motor activity, it is impossible to assess the possible onset of intrauterine suffering in a child.
In order to detect and prevent problems in time, it is necessary to use ultrasound methods of examination (CTG, ultrasound and dopplerometry). Cardiotocography (CTG) of the fetus is a simple and affordable method for assessing the heartbeat of a baby, with which you can notice the initial signs of oxygen deficiency.
In addition, you can identify changes in the muscle tone of the uterus in women, which can cause premature birth. CTG is a technique for recording uterine tone and heart rate on special calibration paper. That is, there are 2 graphs, some devices can record the child's physical activity:
- ultrasound-controlled heartbeats
- uterine tone, determined by a strain gauge
Indications for CTG
The most informative method in the last trimester of pregnancy. It is after 30 weeks that the fetal biorhythms are fully established (activity-sleep cycles) and a specific reflex is formed (palpitations during fetal movements), by which one can judge the full-fledged provision and normal intrauterine development of the child (see calculator of pregnancy). The main indications for CTG during pregnancy include:
- Rh negative blood in a woman
high risk of hemolytic
- past presence
- reduced fetal activity
opinion of the woman herself
- low location or placenta previa
- improper presentation of the fetus
- multiple fetus
- high water run-off
- fever of a pregnant woman
- disturbance of blood flow in the placenta
- intrauterine growth retardation
- mismatch of fetal size during pregnancy
- anomalies of the placenta and umbilical cord
- reduction in fetal movement
- change in the quality of amniotic fluid
- heart diseases
- vascular diseases
- endocrine problems
In the cases listed in the table, CTG should be performed more frequently, including daily. The condition of the fetus and the effectiveness of labor activity also makes it possible to evaluate cardiotocography in real time.
Most often, the examination is carried out at 32 - 34 weeks of pregnancy. CTG is performed in the position of the pregnant on the back with a small roller under the right side (the optimal pose is a slight turn on the left side). Perhaps the implementation of CTG in a position lying on its side, or sitting, leaning back in his chair.
- First, the doctor with the help of a stethoscope finds a point on the abdomen, where the heart of the child is best heard.
- An ultrasonic sensor is placed on this place, and a sensor for assessing muscle tone is placed on the bottom of the uterus.
- To notice the movements of the baby, a woman is given a special device with a button, which she will press when feeling intrauterine movements.
- Recording time is 40-60 minutes.
When CTG is made, the study is carried out using sensors with a frequency of ultrasonic waves of 1.5-2 MHz, which is absolutely safe for the fetus even with prolonged exposure. Any modern apparatus has the ability to assess the vital activity of two fruits at the same time, which is used in women with twins.
Types of devices
In medical institutions there are various possibilities for assessing the baby's heartbeat. Most often, the doctor simply listens to the rhythm of the baby's heart with the help of an obstetric stethoscope, but if any doubts arise (or if indicated) it is necessary to use a special apparatus. What are the types of CTG instruments?
- CTG without automatic analysis
These outdated devices, as a rule, are quite rare in modern hospitals, but they can still be found in remote corners of our country. The main disadvantage of these devices is that the doctor should independently evaluate the fetal heartbeat graph. If the doctor has experience and owns this technique, then the effectiveness of these devices is no lower than that of new CTG apparatus.
- CTG with computer analysis
Modern cardiotocographs not only record the schedule, but also independently process the data. The doctor only needs to read the finished result and decide on the need for treatment. This option CTG is used in medicine most often.
The modern mobile era offers an excellent option for monitoring the baby with a special sensor attached to the skin of the abdomen, and a smartphone connected to the Internet. Fetal heartbeat information is transmitted in real time to a web portal, processed and provided as a ready report to a doctor. Unfortunately, while CTG-online is used quite rarely.
Interpretation of CTG: pathology or norm
The table below presents the assessment of the fetal condition on CTG, proposed by Dr. Savelyeva, which takes into account all the indicators:
- basal rhythm - the average frequency of fetal heart contractions
- variability - change in the frequency and amplitude of the heart rhythm (deviation from the frequency of the basal rhythm
- acceleration - acceleration of the heart rate from the basal, more than 15 beats, lasting over 10-15 seconds.
- deceleration - reduction of the fetal heart rate from the basal, more than 15 beats, lasting more than 10 seconds.
- fetal motor activity
Poor CTG during pregnancy will be detected when the following indicators:
- prolonged increase in fetal heart rate (tachycardia) over 160 beats per minute
- slower baby’s heart rate less than 110 beats per minute
- increase in rhythm variability with an amplitude of more than 25 beats per minute
- reduction in variability below 5 beats per minute
- sinusoidal rhythm in which a monotonous and monotonous heartbeat occurs without any fluctuations and changes in variability
- appearance of decelerations
By counting the points, the condition of the fetus is assessed:
- 5 or less - the state of fetal hypoxia, the child is experiencing oxygen starvation
- 6, 7 points - the first signs of hypoxia
- 8, 9, 10 points - no hypoxia, the child feels well
The motor activity in the Savelyevoy method is not taken into account, but one should be aware that the increased, excessive mobility of the fetus or vice versa, its absence indicates the presence of oxygen starvation in the fetus.
However, even if deviations are detected, this is not always indicative of serious problems in a child. It is necessary to take into account not only CTG during pregnancy, the decoding of which indicates the presence of hypoxia in the baby, but also the duration of the pregnancy, the presence of complications in the pregnant woman, ultrasound data and dopplerometry.
What to do with bad CTG
All methods for assessing the condition of the fetus are required for the timely conduct of therapy aimed at reducing fetal hypoxia, the results of CTG in pregnancy for this are among the most informative. This is especially true in the case when the examination reveals pronounced suffering of the fetus and it is necessary to quickly make a decision about saving the life of the child. As a rule, in this situation, a caesarean section is performed on an emergency basis.
In case of occurrence of moderate signs of insufficient blood supply to the fetus, detected by CTG, complex treatment is carried out. It is best to do this in the hospital, in conditions of the antenatal department.
- Pregnant shows complete rest
- Improving the placental blood circulation (blood flow between the mother and the fetus)
Drugs are used to reduce the tone of the uterus, which leads to a better flow of blood from the uterine vessels to the placenta. To do this, use Ginipral solution for intravenous administration in the form of daily droppers. Good effect give antispasmodics (papaverine, but-shpa). Also shown are Magne B6, Bricanil.
- Preparations for improving cellular oxygen permeability
It requires the appointment of drugs that improve metabolism - glutamic acid, vitamins C, E, glucose, neuroprotectors, antihypoxic drugs. As well as drugs that improve cell permeability - Esentiale Forte, Lipostabil.
- Decreased blood viscosity
Considering that small vessels predominate in the placenta, it is necessary to improve the fluidity of the blood in order to prevent the formation of small blood clots. Curantil, Trental, Actovegin, Rheopoliglukine is prescribed, small doses of Aspirin can be used - ¼ tablets twice a day (see aspirin during pregnancy reduces the risk of gestosis)
- Treatment of complications of pregnancy and illness of a woman
With high blood pressure in a pregnant woman, antihypertensive therapy is indicated. With anemia, it is necessary to increase the level of hemoglobin, which carries blood with oxygen to the fetus (see Iron supplements for anemia). Correction of endocrine disorders and disorders of the kidneys in a woman are important.
- Accelerate the ripening of lungs
With a gestation period of up to 36 weeks, the fetus has not yet matured respiratory system, and the child may have problems with the first breath. If there is a risk of early delivery due to severe suffering of the fetus, then the development of lung tissue in a child should be accelerated. To do this, use the injection of corticosteroid (dexamethasone).
A woman can independently take an oxygen cocktail, which can be purchased at pharmacies or special departments of stores for mothers and babies (Ecoteyl). Cocktail is made very simply, the package includes gas cartridges, bags with a mixture. Having diluted the mixture with apple juice, it turns out a solution that is filled with oxygen through a special tube, 5 minutes and the cocktail is ready. During hypoxia in a child or for prophylaxis, it should be used 3 times a day after 30 weeks (or even the entire pregnancy with 15 day breaks).
- After improvement
At decrease in signs of a hypoxia of a fruit and improvement of a condition of the pregnant the aqua-gymnastics, respiratory gymnastics, UFR is recommended.
Combined therapy of fetal hypoxia is carried out under regular CTG control. With the ineffectiveness of treatment or deterioration of the cardiotogram over a period of over 28 weeks to save the life of the child, doctors can make a decision about emergency delivery.
How do CTG
To record CTG, a woman comes to a special room where the cardiotocograph apparatus is located. The cardiotogram can be recorded while sitting, lying down or even standing. Two sensors are fixed on the bare belly of a pregnant woman - fetal and uterine. For convenience, the sensors are fixed with elastic bands. On average, the procedure takes 20 minutes. In the most successful case, you will have to wait 10 minutes, and sometimes the record extends to an hour.
Most modern devices have a special button that a woman should press with each movement of the fetus. Good physical activity of the fetus - the key to fast and high quality recording.
The result CTG - cardiotogram - is a paper tape with a graphic image of the curve of cardiac activity of the fetus, the curve of uterine contractility and points indicating movement of the fetus. Modern CTG machines have the function of automatic analysis of the record, so at the end of the tape we have a list of various numbers and letters. Next, we'll talk in more detail what these numbers mean, as well as how to evaluate CTG.
How is CTG evaluated
Just want to note that the assessment of the results of the CTG recording is the immediate task of the obstetrician. It is absolutely unacceptable to try to decipher the record yourself, guided by some mythical tables and charts found on the Internet. CTG is one of the most informative and important studies, so you don’t need to take responsibility for the health of your unborn baby. Below, we present the basic principles for evaluating a cardiotocography recording solely to familiarize expectant mothers with the essence of the study.
Over the long history of cardiotography, foreign and domestic scientists have developed many tables and criteria for evaluating the record. They are based on several key indicators:
- Fetal heart rate - heart rate. The rate of this indicator is in the range of 120-160 beats per minute.
- Special characteristics of the curve - acceleration and deceleration. This is the rise and fall of the fetal heart activity by more than 15 beats per minute. On the graphic image, they are pronounced "teeth" directed upwards or downwards.
- Fetal heartbeat response to own movements and uterine contractions. The fetal heart reaction to labor in labor is one of the most important indicators of its well-being.
- Rhythm variability. Normally, the recording curve should not be monotonous. As obstetricians themselves say, a good CTG is a “fence”.
- The presence or absence of the so-called pathological rhythms - sinusoidal, "failing" and linear.
All of the above criteria are the basis for the two most basic rating scales used in global obstetrics: Fisher and Douze-Redman. We will talk about them further.
What is the cardiotogram score on a 10-point scale
Cardiotogram is represented by several indicators. These are: the heart rate of the child at rest, the change in the frequency and amplitude during movements of the baby or contractions of the uterus. But each doctor could interpret them in his own way, consoling or, conversely, scaring mother with the results of decoding.
Hence, some scientists proposed scales on which the doctors first, and then the computer program itself, with which the cardiotograph apparatus was equipped, began to assess the condition of the fetus on a 10- or 12-point scale.
The main condition in which the conclusion of a doctor working at a cardiotocograph is valid is the duration of the pregnancy. If you have passed CTG earlier than your child turned 28 (or better, 30-32) weeks - the result can not be trusted.
Until that time, there is still no complete relationship between the autonomic and central parts of the nervous system and the heart muscle. Namely, for this purpose, according to how the fetus will react to the load, it is judged whether there is intrauterine hypoxia or not.
Therefore, if you are looking for an answer to the question of how to understand the conclusion of a cardiotocograph and a specialist doctor, calculate whether your term is accurate - more than 28 weeks.
The first was the scientist Fisher who suggested using numerical designations, therefore the scale is called “Fisher scores”.
Based on his evaluation criteria, a CTG of 8 points is a good result, but if it has 7 points, it is the borderline condition of the fetus that requires treatment, a quick re-check of the cardiotogram, perhaps even a hospitalization of a pregnant woman.
The Fisher rating scale consists of the following criteria:
- The basal rhythm is the arithmetic average of the heart rate. If it is normal (120-160 beats per minute) it is “2”, if from 120 to 100 or 161-180 - “unit”, “0” - if the frequency is more than 180 or less than 99 per minute.
- CTG variability is an indicator consisting of two criteria:
- Acceleration - the acceleration of heart rate in response to the movement of the fetus or the contraction of the uterus. They should be 5 or more (add the number "2"), 1-4 "peak" - plus "1", when there is no acceleration at all - "0".
- Deceleration - slowing down the rhythm. On the "2" they should not be or they are rare and early (type I or Dip1), "unit" - they are called "variable" (type III or Dip3) and quite a lot of them, "0" - variable and late deceleration (II and type III, Dip2, Dip3).
- The amplitude of the CTG oscillations is the deviation of the heart rate from the basal level. They are evaluated where there are no gentle peaks - “slow accelerations”. Amplitude is considered normal if it is 6-25 per minute (we add to the previous digit “2”), “1” we add, if 3-5 beats per minute, “0” - if less than 3 beats
- The frequency of deviations from the basal rhythm: 2 points (normal) - there are more than 6, “one” - 3-5, less than 3 – respectively, “0”.
CTG analysis is performed on the sum of the indicators. And if Fisher CTG with a pregnancy is 8 points or more is good.
On the cardiotogram of the fetus 9 and 10 points: this means that the result is excellent. You need not worry. The next study, if the pregnancy proceeds normally - after 10 days, but if you are observed more often, then you need to be examined when the doctor says.
CTG 8-9 points also means that the result is good. CTG of the fetus 8 points - the lower limit of normal, treatment and hospitalization is not yet required.
If CTG during pregnancy is 7 or 7-8 points - this means that the situation becomes borderline, that is, if no action is taken, the fetus will suffer from hypoxia. If they write that the result - 6-7 points - you need treatment. Perhaps - in a hospital, it may be possible to get along with day hospital and walks in the fresh air - to decide the attending physician.
This is another rating scale on which they also score points. В ней критерии базального ритма, акцелераций и децелераций, частоты и амплитуды осцилляций оцениваются точно так же, как и по шкале Фишера. Отличается она тем, что здесь есть еще и такой параметр, как число шевелений малыша за полминуты:
- 5 шевелений и больше – 2 балла
- 1-4 – плюс «1»
- не было – «0».
В итоге максимальное количество единиц получается не 10, а 12. CTG diagnosis on the Krebs scale is assessed:
- rate - 9-12 points
- 0-8 - pathology.
About the criterion on which the conclusion was issued, can be understood as follows:
- if it is indicated that the score is on the Fisher scale, then the norm is considered as 8-10 points,
- if after the number of points there is no indication, then the assessment is on the Krebs scale.
CTG 11 points indicates that the device takes into account precisely this scale, and this is a good result. If 9 points is a good result, too, on any scale, but still, if the words “Fisher” are not written anywhere, it is better to consult with your doctor immediately after receiving such a result.
If the conclusion is a figure less than "8"
If CTG is exactly 8 points - this means that the baby’s cardiovascular system responds adequately to physical exertion (that is, to a movement or contraction of the uterus), and there is no need to worry.
Come to the next visit to your doctor with this cardiotogram and consult with him if you should also carry out non-stress or stress tests for the next study. The doctor will set a deadline for the next study.
7 points on the cardiotogram of the fetus means that the consultation of an obstetrician-gynecologist should not be postponed. It would be better if you call him right after the study, without going home. If this is not possible, come to his appointment on the same day, without recording.
If CTG 6 points - what to do? This is a critical situation for the child. Most likely, there is hypoxia, which requires urgent hospitalization and correction. This result must be discussed with your midwife on the same day. If for some reason this is not possible, you should be advised by the head of the antenatal clinic or the doctor of the maternity hospital.
CTG 4 points indicates that the condition of the fetus is critical. The doctor who conducted the study is obliged to call an ambulance car, which takes you directly from the office to the hospital.
So, you now know what a CTG record means 8 points, what to do if this indicator on CTG is 7 points. With the results of "7" and below, you need a consultation from an obstetrician, who, on the basis of the inspection data and the results of the ultrasound and Doppler study, will tell you if everything is so bad and what will be the medical tactic in your case. The main thing is not to postpone the examination, but also not to despair, because the conclusion of the cardiotogram is not a diagnosis.
In what cases is assigned CTG?
The study by cardiotocography is carried out with the aim of early diagnosis of the pathological condition of the fetus. A CTG examination is carried out starting from 28-32 weeks of pregnancy. However, for obtaining high-quality and reliable results, the 32nd week is considered the best period. This period is associated with the cycle of fetal activity, when active stirring gives way to calm. The highest activity of the baby falls from 8 am to 13-14 days and in the evening from 20 to 24 hours.
Indications for the appointment of CTG:
- If a pregnant woman has a negative rhesus blood factor, there is a risk of hemolytic disease in newborn babies.
- In cases where miscarriages have occurred before or pregnancy was terminated by an artificial method (abortion), also during preterm labor.
- When complications occur during pregnancy, for example, a too severe manifestation of toxicosis, subfebrile body temperature, a multiple or late pregnancy occurs.
- Various abnormalities in the development of the fetus and placenta, which were identified earlier during ultrasound.
- When a history of a pregnant woman has abnormalities in the endocrine system, as well as systemic diseases (such as anemia, diabetes, heart and vascular disease).
- If the movement of the fetus observed deviations. Future moms feel their baby and know his behavior. Some babies, in my mother's tummy, behave very agile and sleep for a very short time. And it happens when a baby sleeps during the day, and at night it begins to actively move. If the baby’s behavior has suddenly changed, this may be cause for concern.
- If a woman has had flu or ARVI, which had a bad effect on general health.
- In the case when the future baby was previously treated with any complications. After therapy, pregnant women are prescribed CTG for some time (from 2 to 4 weeks).
- During the manifestation of pregnant preeclampsia. This condition may contribute to violations in the blood supply to the fetus, the consequence of which is a delay in the development of the unborn child.
- Women who continue to drink alcohol during pregnancy and smoke. This group also includes pregnant drug addicts, and those who are in remission.
- If a pregnant woman has chronic diseases.
Cardiac examination takes place once if a woman does not complain about anything. Sometimes the first study shows some pathology, then CTG is prescribed again.
How is CTG examination performed during pregnancy?
For CTG, a specialized sensor with the effect of ultrasonic waves is used. This unit is based on the Doppler effect. Device for CTG, fixed on the abdomen of a pregnant woman, in the area where the fetal heartbeat is most clearly heard. In order to correctly determine the area where this device will be strengthened, the obstetrician will listen to the woman’s abdomen with a special obstetric stethoscope. From the sensor is a signal ultrasonic wave, which reaches the heart of the child. After that, she, reflecting from the heart, returns again to the same sensor.
The principle of the sensors in CTG-examination
Information obtained as a result of this process is transformed into the results of contractions of the baby’s heart in 1 minute. The results of CTG appear on a specialized tape by various methods: by schedule, sound and light.
If pregnancy passes with complications and excellent indicators of previous methods of examination of the fetus, CTG are held about once every seven days.
CTG is not done on a full stomach. After eating food, in terms of blood sugar increases, and this affects the baby, provoking its activity and increasing sensitivity to environmental factors.
CTG score on the Fisher scale
Using the Fisher scale, an assessment of the results of the survey is carried out using a 10-point system. According to this scale, for each indicator of the research, they put from 0 to 2 points. After that, the resulting numbers are summarized. Based on the total number of points, the specialist assesses the state of the future baby, and also determines the presence of pathological processes in the development of the fetus. And then the gynecologist assesses the CAP, that is, an indicator of the condition of the fetus.
How are the final indicators of CTG?
The interpretation of the final CTG indices is carried out by a specialist taking into account such data as: fetal heart rate variability, basal rhythm, acceleration, deceleration and fetal motor activity. Such indicators, at the end of the survey, are displayed on the tape, and have the form of graphs, different in form. So, let's take a closer look at the above indicators:
- Variability (or amplitude) refers to violations of the frequency and regularity of contractile movements of the rhythm and the amplitude of the heart, which are based on the results of the basal rhythm. If no developmental pathology of the fetus is observed, the heart rate indicators should not be monotonous, this can be clearly seen by visualizing the constant change of numerical indicators on the monitor, during the CTG examination. Changes within the normal range can range from 5-30 beats per minute.
- The basal rhythm indicates the average heart rate of the baby. Indicators of the norm is the heartbeat from 110 to 160 beats per minute during the calm of the fetus and the woman. If the child is actively moving, the heart rate will last from 130 to 180 beats for one minute. Indicators of the basal rhythm within the normal range mean the absence of the hypoxic state of the fetus. In cases where the indicators are below normal or higher, it is considered that a hypoxic state is present, which adversely affects the nervous system of the baby, which is in an immature state.
- Under the acceleration imply a rapid heart rate, a relatively level of indicators of the basal rhythm. Acceleration indicators are reproduced on the cardiotocogram in the form of teeth, the norm is two to three times in 10-20 minutes. Perhaps not a big increase in frequency up to four times in 30-40 minutes. Pathology is considered if the acceleration is completely absent over a period of 30-40 minutes.
- Deceleration is a decrease in the frequency of heart beats compared with the degree of basal heart rate indicators. Deceleration rates are in the form of dips or otherwise negative teeth. Within the normal functioning of the fetus, these indicators should be completely absent or very slightly manifest in depth and duration, and very rarely occur. After 20-30 minutes of CTG research with the manifestation of deceleration, there are suspicions of deterioration of the future baby. Great concern in the development of the fetus is caused by the repeated and diverse manifestation of deceleration during the entire examination. This may be a signal of the presence of decompensated stress in the fetus.
The importance of fetal status indicators (PSP)
After the graphical results of the CTG study are ready, the specialist determines the value of the fetal status indicators. For the normal development of the child, these values will be less than 1. When the PSP indicators range from one to two, this indicates that the condition of the fetus begins to deteriorate and some unfavorable changes appear.
Fetus condition score 4 points
When the PSP is over three, it means that the fetus is in a critical condition. But if only such data are available, the specialist cannot make any decisions; first, the history of the course of pregnancy will be considered completely.
It should be understood that not only pathological processes in the development of a baby can cause deviations from the norm, it can also be some conditions of a pregnant woman and a baby that do not depend on disorders (for example, elevated temperatures in a pregnant woman or if the baby is in a state of sleep).
What scores CTG are considered the norm when conducting CTG, is considered a pathology?
The results of cardiotocography are evaluated on a special Fisher scale - assigning 0-2 points to each of the above indicators. Then the points are summed up and a general conclusion is made about the presence or absence of pathological changes in the fetus. The result of CTG from 1 to 5 points declares an unfavorable prognosis - the development of hypoxia in the fetus, 6 point value may indicate incipient oxygen deficiency.
What does a CTG score of 7 points mean?
CTG 7 points - such an assessment is considered an indicator of the onset of fetal oxygen deficiency. In this state, the specialist prescribes appropriate treatment to avoid the occurrence of hypoxia, as well as to improve the condition of the baby if present. With an assessment of 7 points at week 32, therapeutic measures begin to be carried out without delay. A doctor who monitors the course of a pregnancy can urgently send a woman to an inpatient treatment or be limited to droppers at a day hospital.
During the lightweight fasting phase of oxygen, they are more frequent and longer in the open air, if the weather permits. Or taking medication to prevent this condition.
Even if, after deciphering the CTG examination, the specialist determines the result of 7 points, which is an alarming sign, do not panic, because modern medicine can help the future baby to get rid of this condition.
With the identified pathological processes in the cardiovascular system of the baby, which are a reaction to the contractions of the uterus, it is necessary urgently to contact a gynecologist with the results of the study. After evaluating the results, the specialist will be able to prescribe competent treatment, as well as send for re-passage of CTG.
What pathological processes can be identified in the study of CTG?
How to perceive the results of CTG? Relying only on the data obtained by CTG, it is impossible to finally determine the diagnosis, since pathological deviations from a 10-point norm can be a temporary state in response to any external stimulus. This technique is simple to perform and will help to identify abnormalities in fetal development without special expenses.
The CTG method will help identify the following pathologies:
- entanglement with umbilical cord or its pressing: this state is dangerous because the oxygen supplied to the fetus from the mother may not reach the child in full. In this initial condition, the fetus compensates for an insufficient amount of beneficial substances and if the necessary treatment is not performed in time, to improve blood flow in the umbilical cord, this condition can worsen,
Umbilical cord embryo
When abnormalities were detected during CTG decoding, the doctor prescribes an ultrasound scan, as well as Doppler sonography. If required, the pregnant woman is given treatment and repeated CTG.
Planned CTG and CTG control
With a healthy pregnancy, planned CTG is performed in two main cases. In trimester III, 2-3 records of CTG are performed by all pregnant women. With a successful pregnancy this is quite enough and a woman can expect that the baby will be born healthy.
CTG is done to all pregnant women upon admission to the delivery room. And in the future, the frequency of control will be determined by the obstetrician depending on the clinical situation of the specific woman in labor. In the second half of the generic process, the fetal heart rate is measured after each maternal attempt.
CTG control is performed in such cases:
- Multiple pregnancy. Particular attention is paid to identical twins, because they have one for two fetal bladder and general nutrition. This means that there is a risk that one of the babies may begin to experience hypoxia due to insufficient oxygen distribution in his direction.
- Low water / plenty. With low water, the fetus also increases the risk of oxygen starvation. An excessive amount of amniotic fluid accumulated by a pregnant uterus may develop against the background of diseases associated with metabolic disorders, which are infectious in nature, and may also be caused by other factors that adversely affect the fetal condition.
- Increased duration of pregnancy. If the term surely passed for 41 weeks, then they begin to sound the alarm.
- Reduced fetal mobility. When interviewing a patient, an obstetrician-gynecologist is always interested in the mobility and movement of the child. If there are any doubts about this, it is necessary to indicate them to the doctor.
- There are good reasons to believe that the fetus develops intrauterine pathologies. As a rule, ultrasonography with doppler is preliminarily performed and, with questionable results, CTG recording is performed to clarify the condition of the fetus.
- Placental impairment. Women with renal and cardiac insufficiency, stimulants and smokers are at particular risk. But such a pathology may also affect pregnant women, who, at first glance, seem to be completely healthy.
- The threat of preterm birth. Late toxicosis. If previous pregnancies and childbirth proceeded with complications, then the current pregnancy requires special attention.
- Repeatedly holding CTG against the background of dubious results obtained during the previous recording.
How is the assessment done?
This research method is truly unique. The physician can obtain the necessary information about the condition of the child, even without conducting any invasive examinations. It is very convenient and well tolerated. This contributed to the great popularity of its holding during pregnancy.
During the examination, the doctor determines how often the baby's heart beats, as well as how the walls of the uterus of his mother are reduced. Using this method, you can also determine the state of the motor activity of the fetus.
The uniqueness of this study is that it can be carried out at very different periods of carrying a baby. It can even be performed directly during childbirth. Such monitoring allows you to determine the viability of the baby, as well as timely identify various violations of labor.
Experts believe that pathological disorders are best determined at 32-34 weeks of intrauterine development of the baby. In this period, the baby, who is in the tummy, has its own daily cycles of physical activity. So, in the first half of the day it is more active. Also, the baby can be active in the evening, after 19-20 hours.
To determine the studied parameters of the doctor using a special device with a sensor. It is strengthened on the tummy of the future mother. Afraid of this study is not worth it. Оно не приносит никакой болезненности или неприятных ощущений. Чем спокойнее будет женщина во время проведения обследования, тем лучше перенесет его и ее ребенок.
Место для наложения специальных датчиков выбирается не случайным образом. Предварительно с помощью стетоскопа доктор определит место лучшего выслушивания сердечных сокращений малыша. This will help to get more accurate results.
During the study, ultrasonic waves are used. You can see the graphic image on the monitor of the device. Decoding of the obtained values is carried out in one minute.
Doctors use a special scale to assess performance. It contains a variety of evaluated indicators. These include: variability, acceleration, active movements of the baby, deceleration, as well as the basal rhythm.
Each of the estimated indicators is assigned its own number of points. In the end, they are summarized, and the final result is obtained. It is his and evaluates the doctor.
Many future moms try to carry out an independent interpretation of the values obtained. Immediately it is worth noting that it is very difficult. In order not to be mistaken, you need to consult with a specialist.
How to decrypt?
The Fisher scale used in this study is used in different countries of the world. Each of the studied clinical indicators included in it is assigned from zero to two points. Then they are added up, and another estimated parameter is obtained, called by specialists the fetal status indicator (PSP).
In order to understand how the obtained results will be interpreted, it is necessary to tell about what the estimated indicators are. The average heart rate is also called basal rhythm. They show how often the baby's heart beats.
The following estimated indicator - variability. Experts identify several clinical types - short-term and long-term. The vegetative nervous system significantly influences the results obtained in the future. If the baby's heart rate is variable, then this is a good sign. Its decline is already an unfavorable sign.
Deviations from the basal rhythm of 15 or more beats are called acceleration. They are assessed, as a rule, within 10 minutes.
Decoupling - reduction of the basal rhythm by 15 or more beats per minute, which also lasts at least 15 seconds. This condition can be compensatory if it occurs after a period of fetal activity.
To assess the pathology, spontaneous slowdowns of the baby’s heart rate occurring during the rest period of the mother are also taken into account. The appearance of this clinical sign requires a more thorough diagnosis.
The baby at a certain stage of its prenatal development begins to actively respond to various external stimuli. Acceleration appears on such an impact. This reaction is quite physiological and indicate a normal development of the child in the maternal tummy.
A comprehensive assessment of the obtained values is carried out taking into account the following indicators:
- Under normal conditions of pregnancy, the basal rhythm should be in the range of 120-159 in 60 seconds. This indicator is very important to assess when a woman is at rest.
- Rhythm variability in the normal course of pregnancy should be in the range of 10 to 25 beats in 60 seconds.
- In ten minutes, the number of accelerations normally should be from two or more.
- With the normal development of pregnancy, deceleration is not recorded.
These figures are recorded if the course of pregnancy develops well. Different pathologies lead to the fact that these indicators change.
If only one estimated parameter changes, then this cannot be assessed as a serious violation. Assessment is complex. That is why these indicators are summarized. In the future, only their sum is estimated.
It is important to note that the duration of the study is very important. If it is carried out earlier than at 32 weeks gestation, some of the parameters studied may be changed. The shorter term of prenatal development of the baby is manifested by lower variability.
What does the result mean?
8/10 points obtained as a result of the study, are very good indicators. This indicates that the process of intrauterine development of the child proceeds as it should.
8/9 points, obtained after conducting a study at 36-37 weeks of pregnancy, also means that the future mother and her baby there are no severe pathologies.
The sum of the values obtained may vary. Obstetricians and gynecologists note that, at present, it is less and less common when conducting research in the 3rd trimester of pregnancy. PSP is 8/10 points. Such a normal result is an indication for further monitoring of the future mom and her baby’s health.
Reducing it to 7/8 points requires more careful attention. In such a situation, expectant mothers can be assigned ancillary research methods that require the exclusion of pathologies during her pregnancy. In this case, you may need to re-conduct cardiotocography.
How to save the result?
Many future mothers are concerned about the question of what they should do to ensure that CTG indices remain good until the very birth. First of all, it is not worthwhile to strongly emphasize only on cardiotocography.
For a comprehensive assessment of the condition of the future mother and her baby, other studies can also be conducted. One of these is an ultrasound scan or lab test. The indications for their conduct are established by the attending physician, who oversees the course of pregnancy.
8/10 points obtained by CTG are a good result. In order to support this expectant mother should carefully monitor their daily routine. The closer the delivery, the more closely you should monitor your diet and daily schedule.
Regular walks in the fresh air will help provide the body of the future mother and her baby with oxygen. This will help keep the baby's physical activity at the proper level. The duration of the walk should not be less than 30-40 minutes.