2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING CARDIOTOCOGRAPHY 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Cardiotocography (CTG) (kardia=heart, tokos=labour) …is the term that best describes the continuous monitoring of FHR and uterine contractions 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Tracing acquisition Half-sitting, upright Supine recumbent position Prolonged monitoring in this position should be avoided (aorto-caval compression) Lateral recumbent 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Telemetry (wireless) Allows mother to move freely Should be preferred when available 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Paper scales 1, 2 or 3 cm/min 20 or 30 bpm/cm 1 cm/min 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Some experts feel that 1 cm/min provides sufficient detail for clinical analysis, and has the advantage of reducing tracing length Other experts feel that the small details are better evaluated using higher papers speeds 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

The paper scale should be the one with which healthcare professionals are most familiar 1 cm/min 3 cm/min Inadvertent use of paper scales to which staff are unaccustomed may lead to erroneous interpretations 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

External FHR monitoring (Doppler US) 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Spike removal 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Signal modulation 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Autocorrelation t 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Provides an approximation to true FHR, but sufficiently accurate for analysis May not record arrhythmias 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Artefacts (particularly during 2 nd stage) Half-counting MHR monitoring Double-counting 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Internal FHR monitoring (ECG) t 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Membranes ruptured Clear identification of presenting part Avoid delicate fetal structures CONTRA-INDICATIONS Active genital herpes Seropositive hepatitis B, C, D and E Seropositive HIV Suspected fetal blood disorders If artificial ROM is inappropriate Uncertainty about presenting part Preferably avoided < 32 weeks (unless there is no alternative) 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

External FHR is recommended for routine monitoring, if quality is acceptable Careful repositioning of probe in 2 nd stage In all atypical tracings exclude MHR (auscultation, US, internal FHR) 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Indications for internal FHR Acceptable record not possible with external FHR Suspected fetal cardiac arrythmia … and no contra-indications 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

External UC monitoring (Tocodynamometer) PRESSURE SENSOR GUARD RING increased myometrial tension measured through abdominal wall 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

• incorrect toco placement or displacement • reduced tension on elastic band • abdominal adiposity … may lead to failed registration 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Frequency of contractions Intensity and duration Basal intra-uterine pressure YES NO 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Internal UC monitoring (IUP) Quantitative information on intensity and duration of contractions and basal uterine tone 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Disposable catheter (expensive) Requires ruptured membranes Contra-indications: haemorrhage, low lying placenta Small risk of fetal injury, placental haemorrhage, infection Not recommended for routine clinical use 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Monitoring of twins • Preferably with dual channel monitors • Duplicate monitoring of same twin may occur (alarms) • Some experts believe that the presenting twin should preferably be monitored internally (signal quality) 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

↑ 20 bpm 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Simultaneous MHR monitoring Should be considered, if available and not causing discomfort (especially in the 2 nd stage when accelerations coincide with contractions and/or the MHR is elevated) 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING

Tracing storage Identification Name, place Paper speed, date and time of start and end Part of patient record Digital CTG archives Secure file backup system Tracings readily available for review 2015 FIGO CONSENSUS GUIDELINES ON INTRAPARTUM FETAL MONITORING