Continuous cardiotocography during labour: Analysis, classification and management.

نویسندگان

  • Ana Pinas
  • Edwin Chandraharan
چکیده

The use of continuous intrapartum electronic fetal heart rate monitoring (EFM) using a cardiotocograph (CTG) was developed to enable obstetricians and midwives to analyse the changes of fetal heart rate during labour so as to institute timely intervention to avoid intrapartum hypoxic-ischaemic injury. Although CTG was initially developed as a screening tool to predict fetal hypoxia, its positive predictive value for intrapartum fetal hypoxia is approximately only 30%. Even though different international classifications have been developed with the aim of defining combinations of features that help predict intrapartum fetal hypoxia, the false-positive rate of the CTG is high (60%). Moreover, there has not been a demonstrable improvement in the rate of cerebral palsy or perinatal deaths since the introduction of CTG into clinical practice approximately 45 years ago. However, there has been a significant increase in intrapartum caesarean section and operative vaginal delivery rates. Unfortunately, existing guidelines employ the visual interpretation of CTG based on 'pattern recognition', which is fraught with inter- and intra-observer variability. Therefore, clinicians need to understand the physiology behind fetal heart rate changes and to respond to them accordingly, instead of purely relying on guidelines for management. It is very likely that such a 'physiology-based' approach would reduce unnecessary operative interventions and improve perinatal outcomes whilst reducing the need for 'additional tests' of fetal well-being.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population.

OBJECTIVE To compare the effect of admission cardiotocography and Doppler auscultation of the fetal heart on neonatal outcome and levels of obstetric intervention in a low risk obstetric population. DESIGN Randomised controlled trial. SETTING Obstetric unit of teaching hospital PARTICIPANTS Pregnant women who had no obstetric complications that warranted continuous monitoring of fetal hea...

متن کامل

Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance

ST waveform analysis of fetal electrocardiogram (ECG) for intrapartum surveillance (STAN) is a newly introduced method for fetal surveillance. The purpose of this commentary is to assist in the proper use of fetal ECG in combination with cardiotocography (CTG) during labour. Guidelines and recommendations concerning CTG and ST waveform interpretation and classification are stated that were agre...

متن کامل

Admission cardiotocography as a screening test in high risk pregnancies and its co-relation with peri-natal outcome

Background: Birth asphyxia which results due to deprivation of oxygen to the foetus during the birth process is still the leading cause of perinatal death. So the labour should be monitored by an effective method. Electronic foetal monitoring is quite promising in this regard. The present study was done to project the effectiveness of cardiotocography (CTG) at admission to labour room in high r...

متن کامل

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.

BACKGROUND Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously publish...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Best practice & research. Clinical obstetrics & gynaecology

دوره 30  شماره 

صفحات  -

تاریخ انتشار 2016