cardiotocography (CTG) cardiotocography (CTG) is a technical means of recording the fetal heartbeat and uterine contractions during pregnancy. It is a non-invasive procedure. It is done during the third trimester of pregnancy to determine the fetal wellbeing. CTG is used both before birth and during labor, to monitor the baby for any signs of distress. By looking at various aspects of the baby’s heart rate, doctors can see how the baby is coping. Purpose: ●To record Fetal Heart Rate (FHR) ●To record uterine activity ●To get full information about fetus such as rhythm, rate, fetal movement, etc Benefits: CTG is done to assess the fetal well being. This technique lowers the fetal death rate. The machine used to perform the monitoring is called cardiotocograph commonly known as Electronic Fetal Monitoring (EFM) Conditions in which CTG is needed: If the mother is suffering from some diseases like gestational diabetes, hypertension, asthma, previous caesarian section, premature ruptured membrane, third trimester bleeding, intrauterine growth retardation then CTG is necessary. CTG is also required if complications like post date gestation preeclampsia and meconium liquor etc occur. cardiotocography (CTG) are of two types: 1) External cardiotocography (CTG): External cardiotocography is done for continuous or intermittent monitoring. Before starting procedure the patient is reassured. It is most commonly carried out. Assure that the mother should be in a supine position. The equipment used to monitor the baby’s heart is placed on the abdomen of the mother . An elastic belt is placed around the mother’s abdomen. It consists of two electrodes, one of them is used to measure fetal heart rate by placing it on the fetal heart and the other electrode is placed on abdomen three fingers above the umbilical cord to record uterine contractions. In this way, it is able to show when each contraction happens and an estimate of how strong it is. The switch is given to mother’s hand she is directed to press the button when the baby moves. At this stage, the mother’s cooperation is needed. The mother is instructed to avoid unnecessary movements like coughing, sneezing position changing, etc in order to get the accurate graph. The time required for CTG is 30 mins. Advantages: ●External CTG is useful in showing the beginning and end of contractions as well as frequency but not the strength of contractions. ●External CTG is considered to be safer than internal CTG because of internal CTG, there is a chance of transmission of viral diseases like Herpes simplex etc to the fetus. 2) Internal cardiotocography (CTG): In cases where information on the strength or precise timing of contractions is needed, an internal CTG is more appropriate. To get proper information about fetus and mother, Internal CTG is carried out. Small and circular wire electrode is attached to the fetal scalp by passing through the cervical opening and is connected to the monitor. This wire electrode is also called a fetal scalp electrode or spiral electrode. It also consists of switch which further has two wires red wire for fetus scalp and blue wire for the uterus of the mother. The switch is placed on the mother’s thigh by using a bandage. Advantage: ●This provides more accurate and consistent transmission of fetal heart rate than external monitoring because of factors like the movement does not affect. ●Internal CTG is done when external monitoring does not give adequate information about mother and fetus health. ●Internal CTG gives 100% clear information about the mother’s uterine contractions, fetal movement and fetal heart rate. This procedure is used in the membrane has ruptured and the cervix is open. The time required for internal CTG is 30 min. If proper information is not obtained then CTG is done at the intervals of 30 min Interpretations: Uterine contractions: Normal <5 contractions in 10min High >5 contractions in 10 min Fetal heart rate: Reassuring: 110-160 beat per min (Normal) Non-reassuring: 100-109 beat per min (Low) 161-180 beat per min (High) If CTG is normal, continue CTG or remove after 20 min if there are no reassuring or abnormal features and no ongoing risk factors. Not – reassuring suggests that fetal health is not good or there is any abnormality. Then the necessary treatment is given to the patient accordingly. It is challenging to discuss the results with women to enable them to make an informed decision without compromising the normality of labor.