Handbook of CTG Interpretation: From Patterns to Physiology

 

Description:

This book promotes an evidence-based paradigm of fetal heart rate monitoring during labour, with a move away from the traditional 'pattern-based' interpretation to physiology-based interpretation. Chapters are presented in a systematic and accessible format, covering topics such as non-hypoxic causes of fetal brain injury, pre-existing hypoxia, types of intrapartum hypoxia, erroneous monitoring of maternal heart rate, fetal scalp blood sampling and fetal ECG (STAN), intermittent auscultation and medico-legal issues. Sections on 'pearls' and 'pitfalls' highlight good practice and common errors to promote best practice. End-of-chapter exercises allow the reader to engage with the theory and test their knowledge of key areas. This is a highly practical manual aimed at obstetricians and midwives, particularly those undergoing CTG training. The book will also be very useful to midwifery and medical students and to all those involved in multiprofessional intrapartum care.

 

Table of Contents:

 

1 ‘An Eye Opener’: Perils of CTG Misinterpretation

Introduction

Effects of CTG Misinterpretation

CTG Interpretation: What Is the Problem?

Further Reading

2 Fetal Oxygenation

Introduction

Placentation: Impact on Fetal Oxygenation

Normal Placentation

Impact of Placental Reserve on Fetal Growth and Well-being

Fetal Adaptation to Hypoxic Intrauterine Environment

Abnormal Placentation

Fetal Response to Hypoxic Stress

Summary

Further Reading

3 Physiology of Fetal Heart Rate Control and Types of Intrapartum Hypoxia

Physiology of Fetal Heart Rate Control

Parasympathetic Nervous System

Baroreceptors

Chemoreceptors

Role of Sympathetic System and the Fetal Adrenal Glands

The Somatic Nervous System

Features of a Normal CTG

Baseline FHR

Variability

Accelerations

Decelerations

Types of Intrapartum Hypoxia

Acute Hypoxia

Subacute Hypoxia

Gradually Evolving Hypoxia

Long-Standing (Chronic) Hypoxia

Preterminal CTG

Exercises

Further Reading

4 Understanding the CTG

Introduction

Parts of the Machine

CARDIOtocograph – Records the Features of the FHR

Transabdominal Monitoring – Noninvasive Monitoring

Fetal Scalp Electrode - Invasive Monitoring

CardioTOCOgraph – Measurement of Uterine Activity

Internal Pressure Transducers - Invasive Monitoring

CardiotocoGRAPH– Display of the CTG Trace

Paper Printout

Electronic Display and Storage

Pitfalls

Doubling of FHR

Halving of FHR

Erroneous Monitoring of Maternal Heart Rate as FHR

Loss of Contact or Poor Signal Quality

Interference

Incorrect Placement of Thermosensitive Paper

Further Reading

5 Applying Fetal Physiology to Interpret CTG Traces

Adult Physiological Response to Hypoxic Stress

Fetal Physiological Response to Hypoxic Stress

Physiological Approach to CTG Interpretation: ‘8Cs’ Approach to Management

Key Messages on Physiology-Based CTG Interpretation

Exercises

CTG Exercise A

CTG Exercise B

6 Avoiding Errors

Key Facts

Key Features on the CTG Trace

Key Pathophysiology behind Patterns Seen on CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Common Pitfalls

Consequences of Mismanagement

References

7 Antenatal Cardiotocography

Key Facts

Indications for Antenatal Fetal Testing

Role of Antenatal Cardiotocography

Pathophysiology behind CTG Features

Interpretation of a CTG Trace

Baseline Heart Rate

Fetal Tachycardia

Fetal Bradycardia

Variability

Accelerations

Decelerations

Sinusoidal Pattern

Types of CTG Examinations

Contraction Stress Test

Non-Stress Test

Computerized CTG

Pearls: CTG in Clinical Practice

Pitfalls

Consequence of Mismanagement

Possible Future Developments

Conclusions

References

8 Intermittent (Intelligent) Auscultation in the Low-Risk Setting

Key Facts

Recommended Method

Physiology behind IA

Pitfalls

Exercises

Further Reading

9 Current Scientific Evidence on CTG

Key Facts

Current Evidence

Interpretation of Current Evidence

Future Developments

Further Reading

10 Role of Uterine Contractions and Intrapartum Reoxygenation Ratio

Key Facts

Key Features (Increased Uterine Activity)

An Acute Increase in Uterine Activity (e.g. Immediately after Increasing Oxytocin Infusion)

Effects of Continuing Increase in Uterine Activity over Time

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Pearls

Pitfalls

Consequences of Mismanagement

Exercises

References

11 Intrapartum Monitoring of a Preterm Fetus

Key Facts

Key Features on the CTG Trace

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Pitfalls

Consequences of Mismanagement

Exercises

Further Reading

12 Role of Chorioamnionitis and Infection

Key Facts

Key Pathophysiology of Infection and CTG

Key Features on the CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Pitfalls

Consequences of Mismanagement

Exercises

Further Reading

13 Meconium

Key Facts

Recommended Management

Common Pitfalls

Consequences of Meconium

Further Reading

14 Intrapartum Bleeding

Key Facts

Key Features on the CTG Trace

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Pitfalls

Consequences of Mismanagement

Exercise

Further Reading

15 Labour with a Uterine Scar

Key Facts

Key Features on the CTG Trace

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Pitfalls

Consequences of Mismanagement

Exercise

Further Reading

16 Impact of Maternal Environment on Fetal Heart Rate

Introduction

Key Facts

Conditions Causing Maternal Metabolic Acidosis

Conditions Causing Chronic Maternal Hypoxia

Conditions Reducing Placental Perfusion

Maternal Autoantibodies

Drugs

Maternal Temperature

Key Changes on the CTG Trace

Raised Baseline Fetal Heart Rate (FHR)

Reduced Baseline FHR

Reduced Variability

Chemoreceptor-Stimulated Decelerations

Prolonged Decelerations

Key Pathophysiology behind the Features Observed on the CTG Trace

Raised Baseline FHR

Reduced Baseline FHR

Reduced Variability

Chemoreceptor-Simulated Decelerations

Prolonged Decelerations

Management

Key Tips for Optimizing the Outcome

Common Pitfalls

Consequences of Mismanagement

Exercise

Further Reading

17 Use of CTG with Induction and Augmentation of Labour

Key Facts

Key Features on the CTG Trace

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Pitfalls

Consequences of Mismanagement

Exercise

Further Reading

18 Recognition of Chronic Hypoxia and the Preterminal Cardiotocograph

The Fetal Neurologic State

Physiology of FHR Regulation and Variability

Fetal Response to Hypoxia-Ischaemia

FHR Characteristics of a Chronically Hypoxic Fetus

Other Markers of Chronic Hypoxia in the Fetus

The Preterminal CTG

Conclusions

References

19 Unusual Fetal Heart Rate Patterns

Key Facts

Key Features on the CTG Trace

Key Pathophysiology of Sinusoidal and Saltatory FHR Patterns

Recommended Management

Key Tips to Optimize Outcome

Pitfalls

Consequences of Mismanagement

Exercise

References

20 Intrauterine Resuscitation

Key Facts

Key Features on the CTG Trace

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Pitfalls

Consequences of Mismanagement

Exercise

Further Reading

21 Management of Prolonged Decelerations and Bradycardia

Key Facts

Management of Prolonged Decelerations

Causes of Prolonged Decelerations

Nonreversible Causes of Prolonged Decelerations

Reversible Causes of Prolonged Decelerations

Maternal Hypotension

Management of Hypotension

Excessive Uterine Activity (Tachysystole)

Management of Uterine Hyperstimulation

CTG Parameters That Predict Recovery of Prolonged Decelerations

Assessment of CTG Parameters

When Should Delivery Occur?

After the Prolonged Deceleration Has Resolved

When Is It Safe to Restart Oxytocin?

Suggested Approach to Management of Prolonged Decelerations

Management of Prolonged Decelerations

Management of Fetal Bradycardia

Common Pitfalls

Exercise

References

22 ST-Analyser (STAN)

Key Facts

Key Features on the STAN

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key Tips to Optimize Outcome

Common Pitfalls

Consequences of Mismanagement

Recent Developments

Further Reading

23 ST-Analyser

Key Principles

Case 1. Commencement of STAN

Case 2. STAN Events on a Normal CTG Trace

Case 3. Nonsignificant ‘Episodic’ STAN Events

Case 4. Abnormal CTG without Significant ST Events

Case 5. Abnormal CTG with a Significant STAN Events

Pitfalls with the Use of STAN

Conclusions

Further Reading

24 Role of a Computerized CTG

Introduction

Cardiotocography

Adjuncts to CTG

Fetal Blood Sampling

Fetal ECG (STAN)

Training and Reducing Human Error

Computerized Decision Support

Conclusion

References

25 Peripheral Tests of Fetal Well-being

Key Facts

Fetal Scalp Blood Sampling

Fetal Scalp Lactate Analysis

Fetal Pulse Oximetry

Recommended Management

Consequences of Mismanagement

References

26 Operative Interventions for Fetal Compromise

Key Facts

Operative Vaginal Delivery

Anticipated CTG Changes Following Instrument Application

Failed Operative Vaginal Delivery

Decision to Delivery Interval

Pitfalls

Consequences of Mismanagement

References

27 Nonhypoxic Causes of CTG Changes

Key Facts

Key Features on the CTG Trace

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key tips to Optimize the Outcome

Pitfalls

Consequences of Mismanagement

References

28 Neonatal Implications of Intrapartum Fetal Hypoxia

Introduction

When Does Fetal Hypoxia Pose a Risk for the Fetus?

Mechanisms of Hypoxic Brain Injury

Clinical Features of Hypoxic-Ischaemic Encephalopathy

Management of HIE

Outcomes

References

29 Role of the Anaesthetist in the Management of Fetal Compromise during Labour

Key Facts

Key Pathophysiology

Recommended Management

Key Issues

Key Tips to Optimize Outcome

Pitfalls

References

30 Medico-legal Issues with CTG

Background

Key Facts

Key Features on the CTG Trace

Acute Hypoxia

Subacute Hypoxia

Gradually Developing Hypoxia

Long-standing or Preexisting Hypoxia

Anaemia and Sinusoidal CTG Trace

Key Pathophysiology behind Patterns Seen on the CTG Trace

Recommended Management

Key Tips to Optimize Management

Pitfalls

Fetus at Risk

Fetus at Possible Risk Due to Injudicious Management

Consequences of Mismanagement

Exercise

References

31 Ensuring Competency in Intrapartum Fetal Monitoring

Background

Objectives

Strategies

Intense Physiology-Based CTG Training

Use of Fetal ECG (STAN)

Competency Testing

Training and Assessment

Outcomes

Discussion

Conclusion

Further Reading

32 Physiology-Based CTG Training

Key Facts

Baby Lifeline’s Role in CTG Training

Centres and Delegates

Structure and Aim of Masterclass

Key Outcomes

Delegate Feedback

Impact of Training: Pre- and Post-Tests

Key Challenges to Multiprofessional Training in Physiology-Based CTG Interpretation

Conclusion

References

Appendix Rational Use of FIGO Guidelines in Clinical Practice

Clinical Decision

Implementation of FIGO Guidelines in Clinical Practice

Answers to Exercises

Chapter 3. Physiology of Fetal Heart Rate Control and Types of Intrapartum Hypoxia

Answer

Chapter 5. Applying Fetal Physiology to Interpret CTG Traces: Predicting the NEXT Change

CTG Exercise A

Answers

CTG Exercise B

Answers

Chapter 8. Intermittent (Intelligent) Auscultation in the Low-Risk Setting

Answers

Chapter 10. Role of Uterine Contractions and Intrapartum Reoxygenation Ratio

Answers

Chapter 11. Intrapartum Monitoring of a Preterm Fetus

Answers

Chapter 12. Role of Chorioamnionitis and Infection

Answers

Chapter 14. Intrapartum Bleeding

Answers

Chapter 15. Labour with a Uterine Scar: The Role of CTG

Answers

Chapter 16. Impact of Maternal Environment on Fetal Heart Rate

Answers

Chapter 17. Use of CTG with Induction and Augmentation of Labour

Answers

Chapter 19. Unusual Fetal Heart Rate Patterns: Sinusoidal and Saltatory Patterns

Answers

Chapter 20. Intrauterine Resuscitation

Answers

Chapter 21. Management of Prolonged Decelerations and Bradycardia

Answers

Chapter 30. Medico-legal Issues with CTG

Answer

Index

 

An aparitie	23 Feb. 2017
Autor	Edwin Chandraharan
Dimensiuni	15.6 x 1.47 x 23.39 cm
Editura	Cambridge University Press
Format	Paperback
ISBN	9781107485501
Limba	Engleza
Nr pag	256