Third Edition
AK
Debdas
MD (Kol) FRCOG (Lond) FRCS (Edin) FICOG
Honorary Associate Professor MGM Medical College,
Jamshedpur
Visiting Consultant Tinplate Hospital,
Jamshedpur
Chairman Indian College of Obstetrics and Gynaecology
Ex-Chairman Practical Obstetrics Committee, FOGSI
Member Journal Committee, FOGSI
Peer Reviewer International Journal of Obstetrics and Gynaecology, British Journal of Obstetrics & Gynaecology
Member Representative Committee Royal College of Obstetricians and Gynaecologists of London - 4 terms
Past President Indian Society of Perinatology and Reproductive Biology
Past Vice-President FOGSI
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© 2013, AK Debdas
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This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Practical Cardiotocography
First Edition: 1998
Second Edition: 2005
Reprint 2008
Third Edition:
2013
9789350903568
Printed at
All women
Who must undertake
This serious responsibility
For the mankind
To
Disclaimer
Notice
The author has used his best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as the medical science is constantly changing and human error is always possible, neither the author nor the others involved with the publication of this book warrant that the information presented here are absolutely accurate or complete, nor they are responsible for omissions or errors in this book or for the results of using this information. Readers are advised to confirm the information contained in this book with other sources.
fm7
Preface to the Third Edition
This is what the FIGO President Prof S Arulkumaran said recently about CTG: “Until a perfect method is devised to detect intrapartum hypoxia, the importance of the judicious use and meticulous interpretation of the CTG will continue to dominate the science of fetal surveillance (D'Souza and Arulkumaran, 2009)”. Here is to add two future ‘mantras’ (charm words) to it:
greater specificity and total non-invasiveness.
Yes, several new devices are under trial which can pick-up excellent F-ECG from the maternal abdominal surface which would subserve both the above objectives. As regards to toco part of the monitor also, introduction of the completely external multi-parameter technique called uterine electromyography, which records the electrical activity of the uterine muscle, is expected to replace the present highly invasive intrauterine catheter technique.
Golden days for CTG are round the corner!
AK Debdas
Jamshedpur
fm9
Preface to the First Edition
Cardiotocography is here to stay for the foreseeable future (Carter and Steer, 1993) if not for its positive benefit but certainly for want of a better and simpler method than this of fetal monitoring. Past 25 years have seen phenomenal growth of its user especially in developed countries—the machine now features even in the private chambers of single-handed Obstetricians.
Serial NSTs for high-risk antenatal cases and those with diminished fetal movement is really the bare minimum objective antenatal fetal care that one can give today. As regards to fetal care in labour, a quick FAST with CTG on admission in labour to sort out which fetus should be monitored clinically, which electronically (by CTG), which continuously, which intermittently and which should be taken up straight for caesarean section is gradually coming in vogue. And hence, the pressing need for the obstetric staff—both doctors and midwives to be thoroughly conversant with this investigative technique.
The book is directed to the current user to help him or her to use the machine to the fullest and finest extent and to the prospective user to help to clear his or her doubt about the technique and interpretation and also to help one make the right choice of machine for one's particular requirement. For postgraduate students, it is a must for strengthening their foundation and stimulating their imagination and ingenuity.
I have tried to incorporate in this book my experience of this method since 1971, initially in UK and last 15 years in Telco Maternity Hospital at Jamshedpur, India where I have been training doctors and midwives in this technique for Indian College of Maternity and Child Health.
AK Debdas
fm11
Acknowledgments
This is not enough acknowledgment to just mention the name – Dr Mrs Rajkumari Debdas (my wife) – for the all-round help that I received from her at every step in preparation of this book right from its first edition and through its three editions.
Of course, to Shri Jitendar P Vij (Group Chairman) Jaypee Brothers Medical Publishers (P) Ltd. I am extremely grateful for being with me since the nineties when the use of CTG in India was very rare. I must express that it is a great service on his part to take upon himself to make this ‘made easy’ volume of a very complex technology available to the specialists at large in India.