Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Practical Cardiotocography
AK Debdas
CHAPTER 1:
What is Cardiotocography
CHAPTER 2:
Pioneers of Cardiotocography
CHAPTER 3:
Scope of Use of Cardiotocography
ANTENATALLY
INTRANATALY
CHAPTER 4:
The Need for Cardiotocographic Monitoring
THE TECHNICAL NEED
During Antenatal Period
During Intranatal Period
PHYSIOLOGICAL NEED
THE SOCIAL NEED
THE PROFESSIONAL NEED
THE NEED FROM MANPOWER ANGLE
THE MEDICO-LEGAL NEED
CHAPTER 5:
Methods Used for Picking Up Fetal Heart Activity
EXTERNAL METHOD
INTERNAL METHOD
EXTERNAL METHOD OF FETAL HEART (FH) PICK UP
EXTERNAL CARDIOTOCOGRAPHY (EXTERNAL METHOD OF FETAL MONITORING)
Principle
Structure and Types of Ultrasound (US) Transducer
‘Y’ Shaped Transducer
Two-in-One Transducer
Triple Transducer
Beltless Transducer
How FHR is Computed from Echo Signal
Materials Required for FH Pick up by US Mode
Ultrasonic Transducer
Aquasonic Gel
Abdominal Belt
Actual Technique of External Cardiotocography
Some Operational Problems and Their Solutions
Erratic Digital Display
Intermittent Dotty Tracing
Questionable (very low) Heart Rate
Too Thick Tracing Line
Drawbacks of the External Fetal Monitoring
Mechanism of ‘Doubling’
Mechanism of ‘Halving’
Special Advantages of the External Monitoring
INTERNAL METHOD OF FH SIGNAL PICK UP
INTERNAL CARDIOTOCOGRAPHY (INTERNAL FETAL MONITORING)
Physical Principle
Structure and Types of Fetal ECG Electrode
The Electrode Applicator
How FHR is Computed from Fetal ECG
Materials Required for Internal Cardiotocography
Spiral Electrode
Connector Cable Set (Fig. 5.7)
Thigh Belt
Actual Technique of doing Internal CTG
Procedure of Application of Scalp Electrode
Electrical Connection
Technique of Operation of CTG machine
When to Remove the Electrode
How to Remove the Electrode
Fetal Arrhythmia and How to Record It
Some Operational Problems and their Solutions
Problems
The Possible Causes
Solution
Drawbacks of Internal Fetal Monitoring
Special Advantages of Internal (CTG) Monitoring
CHAPTER 6:
Methods of Picking Up Uterine Activity—Tocography
EXTERNAL TOCOGRAPHY
Appliance Used
Applicability
Mechanism of Working
Fixing the Transducer
Baseline Setting
Reading the Trace on CTG Paper
Information that can be Obtained by External Tocography
Drawbacks of External Tocography
INTERNAL TOCOGRAPHY
Aim
Scope
Methods Available
Fluid-Filled Intra-Uterine Catheter Method
Catheter tip pressure transducer method (Fig. 6.8) (Sonicaid-Gaeltec and others)
Catheter cum Pressure Transducer Method with Amnioport (Fig. 6.9) (Intran)
Drawbacks of Internal Tocometry
Place of Internal Tocometry
UTERINE ELECTROMYOGRAPHY (EMG)
CHAPTER 7:
General Description of Ctg Machine and its Various Switches, Control and Displays
MACHINE ON/OFF SWITCH
FEATURES CONCERNED WITH FETAL HEART MONITORING
FEATURES CONCERNED WITH UTERINE CONTRACTION MONITORING
SWITCHES FOR THE RECORDER
PRINTER FACILITY
SWITCHES FOR ANNOTATION
LCD DISPLAY FACILITY
MEMORY
HOME/DISTANCE MONITORING
FEATURES OF CTG TRACING PAPER
Paper Width
Recording Channels
Fhr range—As Printed on the Chart Paper
Steps of FHR Increment and Decrement Depiction
Paper Features of toco Tracing
Paper Speed
Recommendation
ARRANGEMENT FOR ALARM
For FHR
For Toco
Advantages of Portability
CHAPTER 8:
How to Choose a Machine
MACHINES MEANT FOR ‘EXTERNAL’ MONITORING ONLY
MACHINES MEANT FOR BOTH ‘EXTERNAL AND INTERNAL’ MONITORING
For Picking-up FH Activity
For Picking-up Uterine Activity
MACHINES WITH SPECIAL ‘TWIN MONITORING’ FACILITY
MACHINES WITH AUTOMATIC FETAL MOVEMENT PROFILE MONITORING FACILITY
MACHINES WITH AUTOMATIC ‘COMPUTER ANALYSIS AND INTERPRETATION’ FACILITY
MACHINES WITH TELEMETRY FACILITY
CTG MACHINE WITH WATER RESISTANT TRANSDUCERS
CTG MACHINE WITHOUT RECORDER
RECOMMENDATION FOR STORAGE OF TRACINGS
Combined Fetal and Maternal Monitoring System
CHAPTER 9:
Electrical Requirement and Environment
POWER SOURCES AND CONSUMPTION
Power Consumption
Earthing Facility
PRECAUTIONS
ROOM TEMPERATURE
ELECTROMAGNETIC INTERFERENCE
CHAPTER 10:
Machine Testing by the User
COMPREHENSIVE SELF-TESTING
TESTING ULTRASONIC FH TRANSDUCER
Technique I
Technique II
Technique III
TESTING TOCO TRANSDUCER
CHAPTER 11:
Machine Servicing
SELF-SERVICING
Basic Care
Regular Cleaning
Sterilization
PROFESSIONAL-SERVICING
CHAPTER 12:
CTG Interpretation—Theoretical Considerations
FEATURES TO SEE IN A CTG TRACING
BASELINE FHR—GENERAL CONSIDERATIONS
CTG Definition of Baseline FHR
Clinical definition
Note
Norms of Baseline FHR for CTG
Other View (Arulkumaran, 1992)
Neurohormonal Control of Baseline FHR
Autonomic Nervous Control
Humoral Control
Types of Baseline Abnormality
TACHYCARDIA
Causes of Baseline Tachycardia
Stress
Hypoxia
Infection
Epidural analgesia
Pre-term fetus
Drug treatment
Anemia
Cardiac failure
Fetal heart tachyarrhythmia
Degrees and Types of Tachycardia
Incidental Tachycardia
Complicated Baseline Tachycardia
BRADYCARDIA
Causes of Baseline Bradycardia
Hypoxemia
Tissue Hypoxia
Local Anesthetic Agent
Narcotic Drugs
Mild (Partial) Umbilical Cord Compression
Postdated Fetus (40 Plus Weeks)
Head Compression
Heart Block
BASELINE VARIABILITY OF FHR
Definition
Mechanism of Its Occurrence
Magnitudes of Variability and Their Significance
How to Find Out the Magnitude of Baseline Variability
Best Time to Assess Variability During Labor
Physiological Explanation of Normal Variability
Causes of Changes in Baseline Variability
Hypoxia
Fetal Acidosis
Prematurity
Fetal Sleep
Administration of CNS Depressant Drugs
Local Anesthetic Drugs
Fetal CNS Abnormality
Fetal Heart Malformation
Baseline Tachycardia
Types of Baseline Variability
Short-term Variability
Long-term Variability
Sinusoidal Pattern
Wandering Baseline
ACCELERATIONS
Definition
Cause
Primary Cause
Acceleration coinciding with ‘uterine contraction’
Acceleration in Response to ‘Fetal’ Stimulation
Significance of Occurrence of Acceleration
DECELERATIONS
Definition
A Clever Definition of Deceleration
Significance
Types
Early Deceleration (Type I DIP)
Nomenclature
Classical Features (see Figs 12.10 and 13.9)
Degree of Early Deceleration
Causes of Early Deceleration
Significance of Early Deceleration
Note
Management of Early Deceleration
LATE DECELERATION (TYPE II DIP)
Variable Deceleration
Nomenclature
Etiology
Predisposing Factors
Degree of variable deceleration
Prognosis of Variable Deceleration
Management of Variable Deceleration
Combined Deceleration
Definition
Shape
Cause
Significance
Management
FORMULA OF 15 FOR CTG INTERPRETATION
For Acceleration
For Deceleration
ABNORMAL FHR TRACING→TO→ACIDOSIS INTERVAL
TRACING CHARACTER SEQUENCE AND DEGREE OF HYPOXIA
CHAPTER 13:
CTG Interpretation—Examples of Tracings and Analysis— ‘CTG Made Easy’
LIST OF TRACINGS PRESENTED
A Non-Reactive ‘Non-Stress Test’ (NST) (Fig. 13.1)
A Reactive Non-Stress Test (Fig. 13.2)
Flat CTG (Fig. 13.3)
Absolutely Inert VAST-Fetal Hemorrhage (Fig. 13.4)
Late Deceleration with Baseline Tachycardia (Fig. 13.5)
Shallow but Prolonged Late Deceleration (Fig. 13.6)
Deep Type II Dip (Fig. 13.7)
Degrees of Late Deceleration (Fig. 13.8)
Type I Dip/Early Deceleration (Fig. 13.9)
Combined Decelerations (Early and Late) (Fig. 13.10)
Peculiarities of CTG Tracing of Second Stage of Labor
Done through external technique (Fig. 13.11)
Complicated Baseline Tachycardia (Fig. 13.12)
Complicated Baseline Tachycardia (Fig. 13.13)
Oxytocin induced Profound Bradycardia (Fig. 13.14)
Hyperstimulation by Oxytocin (Fig. 13.15)
Nipple Stimulation Stress Test (Fig. 13.16)
FHR Response to Hyperstimulation of Uterus (Fig. 13.17)
Active Awake Fetus (Fig. 13.18)
Deceleration with Fetal Movement (Fig. 13.19)
Variable Deceleration (Fig. 13.20)
Variable Deceleration (Fig. 13.21)
Variable Deceleration-Follow Up (Fig. 13.22)
Variable Deceleration (Fig. 13.23)
Variable Deceleration due to Head Compression in Second Stage of Labor (Fig. 13.24)
Sinusoidal Pattern (Fig. 13.25)
Vibroacoustic Stimulation Test (VAST) (Fig. 13.26)
Vibroacoustic Stimulation Test (Fig. 13.27)
Atypical Spiky VAST (Fig. 13.28)
Atypical Spiky VAST (Fig. 13.29)
An Unusual Response to VAST (Fig. 13.30)
Biphasic VAST (Fig. 13.31)
Episodes of Deceleration (Fig. 13.32)
Progressive Baseline Bradycardia (Fig. 13.33)
Atypical Acceleration with Contraction (Fig. 13.34)
Uterine Polysystole (Fig. 13.35)
Admission Test (Fig. 13.36)
Scalp Stimulation Test (Fig. 13.37)
Scalp Stimulation Test (Fig. 13.38)
Scalp Stimulation Test (Fig. 13.39)
Effect of Pethidine on FHR Tracing (Fig. 13.40)
Effect of Diazepam on FHR Tracing (Fig. 13.41)
latrogenic CTG Abnormalities (Fig. 13.42)
CTG Characteristics of Pre-term Pregnancy (Fig. 13.43)
CTG Characteristics of Pre-Term Pregnancy (Fig. 13.44)
Sequence of FHR Pattern from Fetal Distress to Fetal Death (Fig. 13.45)
Terminal FHR Pattern (Fig. 13.46)
False Fetal Distress (Fig. 13.47)
False Fetal Distress (Fig. 13.48)
Fetal Actocardiograph (Fig. 13.49)
Biophysical Profile by Actocardiography (Fig. 13.50)
CHAPTER 14:
Problems in Interpretation of CTG and Solution
THE NATURE OF PROBLEM
Endeavour Towards Solution
Clinical
Gadgetry
CTG SCORING SYSTEM
Problems with the Scoring System
COLOR CODING OF CTG TRACES
CHAPTER 15:
Applied Cardiotocography—Antenatal
NON-STRESS TEST (NST)
The Criteria to be Assessed in an NST/NSA Tracing
What does the Word “Non-Stress” Imply?
Physiological Basis of Key Element of NST (i.e. FM Acceleration)
Technique of doing NST
Duration of Monitoring
Special allowance for Gross IUGR Cases
Interpretation of NST
CTG Interpretation Ready Reckoner
Predictability of NST
False-negative Rate
False-positive Rate
Frequency of Antenatal CTG Testing
‘Practical Policy’ of Antenatal Fetal Monitoring by ctg
CTG as ‘Dominant Method’ of Fetal Monitoring
CTG as a ‘Secondary Method’ of Fetal Monitoring
Main Use of CTG for Antenatal Fetal Monitoring
Causes ‘Other than Hypoxia’ that can produce Abnormal CTG Tracing during Antenatal Period
Planning Action on CTG Findings
Summary of Interrelation between Hypoxia and ctg Changes
CONTRACTION STRESS TEST (CST)
Oxytocin Challenge Test (OCT)
Method
Qualifying Contraction
Observation and Inference
Indications of CST
Predictability of CST
Nipple Stimulation Stress Test (NSST)
Special Advantage of Contraction Stress Tests (CST) (i.e. OCT and NSST)
Drawbacks of CST
FETAL ACTOGRAM/ACTOCARDIOGRAM
Principle
Mechanism
Correlation
Advantage
CTG ASSISTANCE IN DFMC BY MOTHER
Reasons for High Acceptance of Antenatal Fetal Monitoring by CTG
CHAPTER 16:
Uterine Activity— Normal and Abnormal
CHARACTERISTICS OF UTERINE CONTRACTION
Frequency of Contraction
Normal
Abnormalities in Frequency
Management of Abnormalities in Frequency
Note
Duration of Contraction
Abnormality
Amplitude
Normal
Second stage
Abnormality
Management of Abnormality of Amplitude of Contraction
Note
Basal Uterine Tone
Shape of the Contraction Curve
Units of Measurement of Uterine Power
Montevideo Unit
Alexandria Unit
Clinical Correlation of Uterine Contraction with Intrauterine Pressure
The ‘Reality’ of Uterine Contraction Monitoring
Relation of Uterine Contraction with the Position of the Patient
Supine position
Lateral Position
Erect Position
Difference in Character of Contraction between Spontaneous and Induced or Augmented Labor
Obesity and Uterine Contractility
PRACTICAL APPROACH TO TOCOMETRY IN LABOR
Total Uterine Activity – A Simple Phenomenon and Logic
TOCOLYSIS
Scope of Use of CTG for Tocolysis
Indication of Tocolysis
Contraindications of Tocolysis
CHAPTER 17:
Applied Cardiotocography—Intranatal
PROBLEM OF CLINICAL METHODS OF FETAL MONITORING IN LABOR
How CTG can Help to Overcome the Above Problem?
Changing Trend in the Use of CTG for Intrapartum Fetal Monitoring
Trends of Seventies
Trends of Eighties
Trends of Nineties
Trends of CTG Monitoring of this Millennium
ADMISSION TEST (ADMISSION CTG TEST)
Procedure
Observation and Plan of Management on the Admission Tracing
Absolutely Normal Trace
Grossly Abnormal Trace
Suspicious Trace/Equivocal Trace
Recent Report on the Value of Admission Test
PLACE OF ‘VAST’ IN LABOR
SCALP STIMULATION TEST
Methods of Scalp Stimulation
Experimental Evidence about the Validity of Scalp Stimulation Test
Indication of Use of Scalp Stimulation Test
Drawback
SPECIAL FEATURES OF CTG MONITORING IN SECOND STAGE
SOME UNUSUAL CAUSES OF DECELERATION DURING LABOR
CHAPTER 18:
Fetal Sleep, Rest, Activity and CTG
I – DURING THE ANTENATAL PERIOD
Four Levels of Fetal Activity and Sleep
Deep Sleep-like State
Light Sleep-like State
Quiet Awake State
Active Awake State
CTG Cycling
II - DURING LABOR
Intrauterine Fetal Environment during Labor
Un-nerving Natural Disturbances
Disturbance Created by Man Initiated Caring Endeavor
HOW TO EXCLUDE FETAL SLEEP BY CTG
Necessity for Embarking into such an Action
Management of Such a Trace
CHAPTER 19:
Fetal Vibroacoustic Stimulation Test (VAST) by CTG
BASIS OF VAST
PROCEDURE OF PERFORMING VAST
Vibroacoustic Stimulator
Duration of Stimulus
Qualifying Response/Acceleration
RESPONSE TO VAST
Reactive VAST (see Figs 13.26 and 13.27)
Non-Reactive VAST (see Fig. 13.4)
FACTORS THAT MAY INFLUENCE THE RESULT OF VAST
HABITUATION (TO VAST)
VAST—AN EIGHT PARAMETER TEST
VAST AND PRE-TERM FETUS
Predictive Value of Vast for Antenatal Fetal Surveillance
PLACE OF VAST FOR INTRAPARTUM FETAL MONITORING
USES AND ADVANTAGES OF VAST AS A METHOD FOR FETAL SURVEILLANCE
COMPARABILITY OF VAST WITH OTHER INTRAPARTUM FETAL SURVEILLANCE TESTS
SAFETY OF VAST
CHAPTER 20:
Computer Analysis of CTG Trace
THE NEED
THE AIM
THE BASIS
Software Specification
Accelerations
Decelerations
Long-term Variation
Episode of High (and Low) Variation
Basal Heart Rate
Short-term Variability
The Mother's Assessment of Fetal Movement
Uterine Contraction
Signal Loss
Dawes-Redman Criteria of Normalcy
Operation
Special Advantages of the Autoanalysing CTG Machines
Scope
Future of Computerisation of CTG Tracing and Reporting
CHAPTER 21:
CTG Cum Fetal ECG—An Approach Towards Precision
BASIS
SCOPE
Pathophysiological Basis of Using F-ECG (Rosen, 2003)
Biophysics
Biochemistry
Note
Understanding ST Events (Rosen, 2003)
Clinical Examples of Intracardiac Imbalance
Technical Requirement for Doing Fetal ECG
Clinical Results
Alternatives to F-ECG
Fetal Blood Sampling (FBS) and pH Estimation
CTG Plus Pulse Oximetry
Technical Advantages of F-ECG
CHAPTER 22:
Non-reassuring CTG Trace
MANAGEMENT OF NON-REASSURING CTG TRACE
Management of the Trace
Management of the Case
Conclusion
CHAPTER 23:
Beyond CTG
LASER SPECTROSCOPY
FETAL MAGNETOCARDIOGRAPHY (F-MCG)
FETAL MONITORING PARAMETERS THAT F-MCG TECHNIQUE CAN PROVIDE TOTALLY NON-INVASIVELY
‘ABDOMINAL’ F-ECG RECORDING THROUGH WIRELESS ‘WEARABLE’ SYSTEMS
CHAPTER 24:
Role of CTG for Patients Getting Epidural Analgesia in Labor
MECHANISM OF CAUSATION OF FHR ABNORMALITY
By Causing Maternal Hypotension
By Quinidine Like Effect of Local Anesthetic Agents (Caine Drugs) on Fetal Myocardium
By Causing Pyrexia
Aorta-Caval Compression
Increased Uterine Activity
TYPES OF FHR ABNORMALITY
Likely Clinical Causes for FHR Abnormality
Management of Abnormal ctg Trace due to Caine Drugs
Recommendation
CHAPTER 25:
Effects of Narcotic Drugs on CTG
CHAPTER 26:
Special Problems of CTG Monitoring of Preterm Pregnancy
NORMAL PATTERN
Baseline Rate and Baseline Variability
Sleep-Activity Cycle
Fetal Movement
Response of FHR to Fetal Movement
Variable Deceleration
ABNORMAL PATTERN
Tachycardia and Reduced Variability
‘Absent’ Variability, Late Deceleration and Combined Deceleration (i.e. Variable Plus Late Deceleration)
REVISED DEFINITION OF ACCELERATION FOR PRE-TERM PREGNANCY
SPECIAL RISKS OF FHR ABNORMALITIES FOR PRETERM FETUSES
CHAPTER 27:
Monitoring Twins by CTG
NON-INVASIVE MONITORING
Caution
INVASIVE MONITORING
PROBLEM OF MONITORING TWINS BY CTG IN LABOR
CHAPTER 28:
CTG Through Telemetry
WHAT IS TELEMETRIC MONITORING?
Types of Telemetric Monitoring
Two Types
Procedure of Transmitter Telemetry
Transmitter
Receiver
CTG Machine
Procedure of Telephonic CTG Telemetry
Advantages of Telemetry
During Labor
During Antenatal Period
SOME NEWER MODELS
Basic Technology
Features
Advantages
CHAPTER 29:
Clinical Considerations in Interpretation of Abnormal Trace and its Management
CHAPTER 30:
Medicolegal Consideration of CTG
AUTHOR'S VIEW
CHAPTER 31:
Drawbacks and Deficiencies of CTG Monitoring
CHAPTER 32:
Place of CTG Today
UNIVERSAL MONITORING
SELECTIVE MONITORING
ANTENATAL CTG—CRITICAL APPRAISAL
INTRANATAL CTG—CRITICAL APPRAISAL
INTERMITTENT AUSCULTATION— THE GROUND REALITY
TWO INSUPERABLE PROBLEMS OF CTG MONITORING
CTG THROUGH THE EYES OF “MEDICAL ECONOMISTS”
UNDISPUTED PLACE
CHAPTER 33:
Special Features of CTG of Second Stage of Labor
CHAPTER 34:
NICE Guidelines for CTG Interpretation
CHAPTER 35:
CTG, BPP and Doppler—Comparative Scope and Inter-relation
SCIENTIFIC PHILOSOPHY OF USING THE ABOVE THREE METHODS
Doppler
BPP—Biophysical Profile
CTG
COMPARATIVE SCOPE OF USE OF THE ABOVE METHODS IN RELATION TO THE STATE OF PREGNANCY—WHETHER ANTENATAL OR INTRANATAL
For Fetal Monitoring during Antenatal Period
For Fetal Monitoring during Intrapartum Period
COMPARATIVE CLINICAL INDICATION OF USE OF THESE METHODS
WHERE BPP AND DOPPLER END—CTG BEGINS
CONCLUSION
CHAPTER 36:
CTG and Fetal Acidosis
ABNORMAL FHR TRACING→TO→ACIDOSIS INTERVAL
CORRELATION BETWEEN CTG FINDING AND SCALP PH VALUE
CHAPTER 37:
CTG and Cerebral Palsy
FETAL HEART RATE PATTERNS AND BRAIN DAMAGE
CRITERIA NECESSARY TO CONSIDER BIRTH ASPHYXIA AS A CAUSE OF CEREBRAL PALSY (ACOG, 2006B)
CONCLUSION
CHAPTER 38:
Assumptions and Presumptions about CTG Monitoring
CHAPTER 39:
Training and Education for CTG Interpretation
WHO SHOULD BE TRAINED?
eFM - RCOG
CHAPTER 40:
CTG—Complications and Contraindications
EXTERNAL METHOD
INTERNAL METHOD
Due to Malapplication of Electrode of the Fetus
Due to Malapplication of Intrauterine Catheter
CONTRAINDICATIONS TO DOING CTG
INDEX
TOC
Index
×
Chapter Notes
Save
Clear
