SISTER NIVEDITA GOVERNMENT NURSING COLLEGE
I.G.M.C, SHIMLA (H.P)
SUBJECT : OBSTETRIC AND GYNECOLOGICAL NURSING
ASSIGNMENT
ON
CARDIOTOCOGRAPHY
SUBMITTED TO: SUBMITTED BY:
Mrs. PREMA NEGI MAM HIMANSHU GARG
OBSTETRICS AND GYNECOLOGY M.S.C NURSING 1stYEAR
LECTURER ROLL NO.- 07
S.N.G.N.C, IGMC SHIMLA S.N.G.N.C, IGMC
SHIMLA
SUBMITTED ON:- 9-02-25
1
SR
CONTENT PAGE NUMBER
NO.
1 Introduction 3
2 Definition 3
3 Timing 3
4 Purpose 4
5 Indication 4-5
6 Contraindication 5
7 Methods 5-6
8 Interpretation 6-7
9 Complication 7
10 Care after procedure 8
11 Roles and Responsibilities 8
12 Conclusion 9
13 Bibliography 10
INDEX
INTRODUCTION:
2
Cardiotocography (CTG) is a technical method for recording (graphy) the fetal heartbeat
using ultrasound (cardio) and the uterine contractions (toco) during pregnancy, typically in the
third trimester.
INVENTION
Fetal monitoring was invented by Doctors Alan Bradfield, and Edward Hon. A refine version
(cardiotocograph) was later developed for Hewlett Packard by Konrad Hammacher
DEFINITION
Cardiotocography is a continuous electronic record of the fetus’s heart rate obtained via an
ultrasound transducer placed on the mothers abdomen.
It is sometimes referred to as “electronic fetal monitoring”.
Or
Cardiotocography (CTG) is a technical means of recording the fetal heartbeat and the uterine
contractions during pregnancy. The machine used to perform the monitoring is called a
cardiotocograph, more commonly known as an electronic fetal monitor (EFM).
TIMING OF CTG
Antepartum and on admission to the labor room (admission CTG) the usual (minimum)
duration of recording is 30 minutes. Particularly in the third trimester of pregnancy the CTG
should be obtained with the mother placed in a left lateral position to prevent vena cava
syndrome.
PURPOSE OF CTG
To record FHS continuously.
To check uterine activity.
To detect any fetal distress.
To gain information about rate, rhythm of the fetal heart rate and fetal movement.
The purpose of CTG recordings is to identify when there is concern about fetal well-
being to allow interventions to be carried out before the fetus is harmed.
3
The focus is on identifying fetal heart rate (FHR) patterns associated with inadequate
oxygen supply to the fetus.
INDICATION OF CTG
Maternal medical illness.
Gestational diabetes.
Hypertension.
Asthma.
Obstetric complications
Multiple gestation.
Post-date gestation.
Previous cesarean section.
Intrauterine growth restriction.
Polyhydramnios.
Pre- eclampsia.
Ecclampsia.
Third trimester bleeding.
Induced labor.
Meconium stained liquor.
Alterations in fetal HR present during auscultation.
If FHR is less than 110bpm.
If there is decrease fetal heart rate monitoring.
If there is a twin pregnancy.
CONTRAINDICATION
Uterine hemorrhage of unknown cause
Placenta previa, It may also be associated with a small risk of fetal injury
Placental hemorrhage
Uterine perforation
Vaginal Infection
4
ARTICLE NEEDED FOR CARDOTOCOGRAPHY
Electronic fetal monitoring
Ultrasound transducer
Toco-transducer.
Monitor strip.
Ultrasound gel.
Belt to hold the transducers in place.
METHODS:
1. EXTERNAL CARDIOTOCOGRAPHY:-
It is for continuous or intermittent monitoring. The fetal heart rate and activity
of the uterine muscle are detected by two transducers placed on the mother’s abdomen (one
above the fetal heart and other at the fundus). Doppler ultrasound provides the information which
is recorded on a paper strip known as Cardiotocograph (CTG).
2. INTERNAL CARDIOTOCOGRAPHY:- This method can be useful if membrane has
ruptured either spontaneously or artificially. Uses an electronic transducer connected directly to
the fetal scalp through the cervical opening and is connected to the monitor. This type of
electrode is sometimes called a spiral or scalp electrode. Internal monitoring provides a more
accurate and consistence transmission of the fetal heart rate than external monitoring because
5
factor such as movement do not affect it. Internal monitoring may be used when external
monitoring of the fetal heart rate is inadequate, or closer surveillance is needed.
INTERPRETATION
Baseline fetal heart rate :-
It is the fetal heart rate between uterine contraction. A rate more than 160bpm is
termed baseline tachycardia.
A rate slower than 120bpm is called baseline bradycardia. Either may be indicative of
fetal hypoxia.
A constant baseline rate between 110 and 120 bpm may indicate cord compression as
in cord prolapsed.
Baseline Variability:-
When feto placental function is normal, the fetal heart rate has term variability greater
than 7bpm at least 4 acceleration of more than 15bpm in 20minutes internal spontaneously or in
response to Braxton Hicks Contractions or fetal movements.
Response of the fetal heart to uterine contractions:-
The fetal heart rate will normally remain steady or accelerate during contraction.
Decelerations of fetal heart rate, if recorded must be assessed for their relationship to uterine
contractions.
6
Early decelerate:-
Begins at or after the onset of a contraction and returns of the baseline rate by the
contractions has finished. An early deceleration is commonly associated with compression of
fetal head. 16
Late deceleration:-
Begins during or after a contraction, reaches its lowest point after the peak of the
contraction and has not recovered by the time that contraction has ended. Sometimes the
deceleration has barely recovered by the onset of the next contraction. The time lag between the
peak of the contraction and the lowest point of the deceleration is more significant of severity
than the drop in the fetal heart rate. This always indicates fetal hypoxia and the physician must
be informed.
COMPLICATIONS
Premature rupture of membranes.
Preterm labor.
Nerve injuries.
CARE AFTER PROCEDURE
Clean the gel that is used during procedure.
Make the client in comfortable position.
Replace all article to the utility room.
Wash hands
Record the date and time of CTG
Document the recording
ROLES AND RESPONSIBILITY OF MIDWIFERY
Explain the procedure to the patient.
Provide privacy.
Maintain a safe, comfortable position for the client.
Gather all the article needed for CTG
The woman must empty her bladder.
7
Patient should be lie in semi fowler’s or left lateral position.
FHR is then maintained for approximate 20-30 min.
It is important that fetus not be in sleep state during entire procedure.
CONCLUSION:
8
Cardiotocography (CTG) is a technical means of recording the fetal heartbeat and the uterine
contractions during pregnancy. The machine used to perform the monitoring is called a
cardiotocograph, more commonly known as an electronic fetal monitor(EFM). Cardiotocography
(CTG) is a technical method for recording (graphy) the foetal heartbeat using ultrasound (cardio)
and the uterine contractions (toco) during pregnancy, typically in the third trimester. Fetal
monitoring was invented by Doctors Alan Bradfield, Orvan Hess and Edward Hon. A refine
version (cardiotocograph) was later developed for Hewlett Packard by Konrad Hammacher.
BIBLIOGRAPHY:
9
A Comprehensive Textbook of MIDWIFERY & GYNECOLOGICAL NURSING 6 th
Edition jaypee publishers page no.140-145
https://www.slideshare.net
https://www.slidesharenet
10
