At the CTG they said that the uterus should prepare for. Why and how is CTG done during pregnancy? What to do if CTG indicators are borderline between norm and pathology

CTG during pregnancy - what is it? Decoding CTG - cardiotocography. With the help of this procedure, it is possible to make a complete assessment of the condition of the fetus: the results regarding the child's cardiac activity and heart rate, as well as his motor activity, the frequency of uterine contractions and the baby's response to these contractions.

What does CTG show during pregnancy?

CTG during pregnancy, together with Doppler ultrasound and ultrasound, makes it possible to determine in time certain deviations in the normal course of pregnancy, to study the contractile activity of the uterus and the reaction of the baby's cardiovascular system to them.

With the help of CTG during pregnancy, you can confirm or deny the presence of conditions that are dangerous for the mother and baby, such as:

Fetal hypoxia;
intrauterine infection;
little or polyhydramnios;
anomalies in the development of the fetal cardiovascular system;
premature maturation of the placenta or threat premature birth.

If the suspicions of one or another deviation are confirmed, this makes it possible for the doctor to determine in a timely manner the need for therapeutic measures, to adjust the tactics of managing the pregnant woman.

Watch the video where the obstetrician-gynecologist answers the question: why is CTG done?

How is CTG done during pregnancy?

There are several stages of the procedure:

First, the doctor uses a stethoscope (a special tube, one part of which the doctor inserts into his ears, and the other part is applied to the mother's abdomen) to determine the point at which the fetal heartbeat is best heard.

Then an ultrasonic transducer with Doppler function is installed. This sensor is installed at the point of the best listening to the fetal heart rate and is fixed to the mother's abdomen.
After that, a strain gauge is installed. This probe is placed in the area of ​​the fundus of the uterus (that is, in the woman's upper abdomen), where uterine contractions are best detected.

In some cases, a woman can be given a special device with a button in her hand, which she will have to press at the moment when she feels the movement of the fetus. At the same time, other devices register the movement data automatically. After the end of all preparations, recording and registration of CTG begins.

The received data is recorded on special paper, which is pulled out of the machine at a very slow speed. At the same time, you can see 2 curved lines on it. The upper line characterizes the heart rate (heart rate) of the fetus, and the lower (tocogram) - the contractile activity of the uterus. After a certain time, characteristic curves are formed on this paper, which the doctor examines when assessing the condition of the fetus.

How long does CTG take during pregnancy?

The duration of the procedure is on average 30 - 40 minutes. At the same time, in some cases, the study may end in 10-15 minutes, or vice versa, last more than an hour.

The fetus moves intensively only during the wakefulness phase, and during sleep it is relatively motionless, therefore, it will not be possible to register a "normal" CTG. Under normal conditions, the child's sleep cycle lasts about 30-40 minutes, as a result of which, during the half-hour study, he will have to wake up for at least a few minutes and begin to move. If at the same time characteristic changes are recorded on the cardiotocogram, the study can no longer be continued.

Also, the study can be completed earlier if, immediately after the start of the study, the child moves actively enough. At the same time, if the child is inactive or asleep during the beginning of the procedure, its duration can be up to 60 minutes or more.

One of the important studies in the third trimester is CTG during pregnancy. This research method allows you to comprehensively assess the condition of the fetus, whether the baby is suffering from hypoxia. It is carried out to almost all pregnant women in the third trimester, and especially in preparation for childbirth, as well as in the process of childbirth itself.

What is fetal CTG during pregnancy

Cardiotocography is performed during pregnancy in order to obtain data on the heart contractions and the work of the fetal heart in combination with its motor activity, uterine contractions and the fetus's reactions to this.

Usually, this study in pregnant women is combined with ultrasound and dopplerometry (a special study of blood flow in the vessels of the placenta, umbilical cord and fetus).

These examinations allow you to identify any abnormalities during pregnancy that interfere with the normal development of the child, which will allow the doctor to prescribe treatment on time.

When is CTG prescribed during pregnancy

Until this time, the organs of the fetus are still immature, and the data may turn out to be not entirely accurate and true. When conducting CTG, it is desirable that the child be relatively calm, since the results obtained with CTG will also depend on his movements.

Therefore, the exact timing of the procedure will be set by the doctor as indicated. Thus, the answer to the question of how long CTG is done during pregnancy will be from 30-32 before childbirth.

How often is CTG done during pregnancy?

If the pregnancy proceeds without any complications, then CTG will not be frequent - they are prescribed no more than twice during the third trimester.

If any complications are detected during pregnancy, CTG is prescribed more often, up to daily monitoring - this study does no harm to the fetus and mother.

In addition, CTG can be performed even during childbirth, this is required in cases where it is necessary to determine the general condition of the child and make a decision on the further management of childbirth.

Special control will be required for children in complicated childbirth, with an umbilical cord entanglement or with other pathologies of pregnancy.

How is CTG done during pregnancy

CTG during pregnancy is an absolutely safe and painless procedure. It will not harm either the mother herself or the fetus in any way. It is especially interesting to conduct CTG for those women who will encounter it for the first time and are interested in what they will do?

First of all, in the office, the doctor will ask the woman to take a comfortable lying or reclining position, sometimes sitting, so that you can comfortably spend the next hour. It will be important to relax and behave calmly. Several sensors are attached to the abdomen:

• one of the ultrasonic sensors, it will register the fetal heartbeat;
• the second is a strain gauge, with the help of which the contractions of the walls of the uterus will be fixed;
• there may also be an additional sensor for movements or a button in the woman's hand, which she clicks with each distinct movement.

Cardiotocography is performed in the phase of fetal activity; if the fetus is asleep, the results may be questionable. The recording is carried out for 30 to 60 minutes, all the data obtained by the device are recorded in the form of special graphs with teeth on special tapes.

There are modern devices that record and analyze graphs, giving the results in a point system.

CTG during pregnancy: how to prepare

Although the procedure is not difficult, it requires some preparation.

First of all, a woman needs to have a good sleep and rest before the procedure, if the pregnant woman is in a stressful or tired state, the results can be dubious or bad.

Before the procedure, it is worth having a snack, as you will have to sit for a long time without moving too much, go to the toilet and relax, forgetting about all the problems and events.

Be sure to turn off your phone and not talk. Before the procedure, it is worth moving a little so that the baby does not sleep, and the recording was successful.

It is worth getting comfortable during the procedure so as not to change the position of the body much in the future and not to influence the recording, since on average, the recording lasts at least half an hour, and usually about an hour.

This is necessary in order to accurately establish the frequency of contractions of the fetal heart and the response to the contraction of the walls of the uterus. The most reliable results are obtained in the absence of any problems during pregnancy.

Sometimes women receive poor CTG during pregnancy, while they feel great, and there are no abnormalities in the state of pregnancy, this requires a second study in order to exclude the fetal sleep phase and influence the results of side effects.

Usually, accurate results are obtained by passing at least 2-4 studies in a row if there are any deviations, no conclusions can be drawn from one study!

CTG during pregnancy: the norm

Modern devices can immediately issue a form with completed results and CTG assessment. Good results are:

• heart rate in the range of 108-160 bpm with a calm state of the fetus and 125-180 bpm with movement. In this case, a uniform heart rate should be detected;
• the spread of the heart rate is from 5 to 25 beats / min;
• the slowing down of heart contractions rarely occurs, while the reduction does not exceed 15 beats / min;
• acceleration of contraction of the heart occurs no more than twice per study with an amplitude of no more than 15 beats / min;
• the number of uterine contractions does not exceed the rate of contraction of the child's heart by more than 15%.

The assessment of indicators is carried out by points, the sum of points is a maximum of 12 units. CTG with a total of 9 to 12 points is considered a good result.

In the presence of 6-8 points, repeated examinations and CTG removal are performed, if the result is stable, the child has mild, removable hypoxia.

With a score of 0-5, serious deviations in the development of the fetus are put, hypoxia threatens his life and urgent measures are needed. In this case, pregnant women are immediately prescribed therapy or decide on a caesarean section (if it is CTG in childbirth).

CTG during pregnancy is an absolutely harmless procedure that allows you to relatively quickly and accurately assess the condition of the child, and in childbirth it helps with the further tactics of labor management.

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One of the most important studies helping to assess the condition of the child is cardiotocography (CTG) of the fetus during pregnancy. This is a kind of cardiogram of the heart of an unborn baby, which allows detecting hypoxia, placental insufficiency, intrauterine infections.

CTG is performed using special sensors that are fixed on the pregnant woman's abdomen so that the device can pick up the baby's heart sounds. The device should record how a small heart behaves during periods of physical activity. In a number of antenatal clinics the mother is given a small remote control with a button that must be pressed with every movement of the baby.

You should also prepare for the procedure itself. You can not do it on an empty stomach or immediately after eating, which can increase the intensity of fetal movements and distort the results. Mom's emotional state also matters.

The procedure is regularly carried out on later dates pregnancy, after 32 weeks, when the baby's cardiac activity is closely related to his physical activity. Deciphering the results allows us to conclude about the condition of the fetus. In the case of serious violations, the doctor may decide on an operative delivery by caesarean section.

Why and when CTG is performed

A routine examination is scheduled for a period of 30 weeks and more and allows you to determine the state of health of the fetus. The formation of a small organism is almost complete, and CTG is able to exclude factors threatening health. At delivery, CTG is mandatory if the ultrasound scan showed that the umbilical cord is entwined around the neck. More accurate data can be obtained after 32 weeks of pregnancy, when the change in the resting and activity phase is clearly recorded in the fetus.

The study is carried out once every 10 days, but if complications are detected, CTG can be prescribed at intervals of 5-7 days. Daily tests are advisable in the diagnosis of fetal hypoxia, when the child's condition is monitored until it is normalized. If there is a threat to the life of the fetus, an emergency delivery is performed.

How is CTG performed correctly?

During pregnancy, only the indirect CTG method is used; at present, its use is most widespread in childbirth.

For indirect cardiography, an external ultrasound probe is placed on the anterior abdominal wall mothers in the place where the fetal heart sounds are best heard. A layer of special gel is applied to the surface of the sensor to ensure optimal contact with the skin. An external strain gauge sensor is applied in the area of ​​the uterine fundus; no gel is applied to its surface. The patient, using a special device for recording fetal movements, independently notes each episode of movement.

CTG is performed in the position of a pregnant woman (parturient woman) on her side or half-sitting in order to avoid the occurrence of compression syndrome of the inferior vena cava.

To obtain the most accurate information about the state of the fetus, cardiac monitoring should be carried out for at least 20-30 minutes. This duration of the study is due to the presence of periods of sleep and activity in the fetus.

The direct CTG method is carried out only during childbirth after the outflow of OS and when the cervix is ​​opened at least 2 cm.When using internal sensors, a special spiral electrode is applied to the skin of the fetal head; an intra-amnial catheter is used to register the contractile activity of the uterus.

Indicators of a cardiotocogram

The following indicators are most informative:

Basal rhythm is the main rhythm that prevails on CTG, it can be assessed only after 30-40 minutes of recording. In simple words, this is a certain average value that reflects the heart rate that is characteristic of the fetus during the resting period.

Variability is a measure that reflects short-term changes in heart rate from basal rhythm. In other words, it is the difference between basal rate and leaps in rhythm.

Acceleration is the acceleration of the rhythm by more than 15 beats per minute, which lasts more than 10 seconds in time.

Deceleration - slowing down the rhythm by more than 15 beats. in min. lasting more than 10 seconds. Decelerations, in turn, are divided according to their severity into:

dip 1 - lasts up to 30 seconds, after which the baby's heartbeat is restored.

dip 2 - last up to 1 minute, while being characterized by a high amplitude (up to 30-60 beats per minute).

dip 3 - long, more than 1 minute, with high amplitude. They are considered the most dangerous and indicate severe fetal hypoxia.

How CTG is done

Before undergoing this procedure, a pregnant woman must follow a number of recommendations. First, you need to be in a state of sleep. Secondly, it is undesirable for the expectant mother to be hungry during CTG. It is better if a woman goes to CTG after a 2-hour break after eating. Thirdly, the study cannot be performed immediately after intravenous glucose administration. If these recommendations are not followed, the device may give an inaccurate result, which will interfere with making a correct assessment of the baby's condition. The research process consists of the following steps:

1. Before starting CTG, a pregnant woman needs to take a half-sitting position of the body or lying on the left side. If you lie on right side, that is, the risk of complications due to the pressure of the uterus directed towards the inferior vena cava;
2. Before doing the analysis, a woman needs to visit a gynecologist and listen to the fetal heartbeat with a stethoscope in order to find out the exact position in the tummy;
3. Having learned about the position of the child, the doctor installs 2 sensors, which are fixed by means of a belt to the abdomen. The action of the first sensor is aimed at fixing the heart rate. The second sensor is engaged in registering contractions of the uterus and the child's reaction to this state of the mother;
4. A woman, through a special remote control and a button on it, gives a sign that the child is moving;
5. The duration of the study is from half an hour to an hour;
6. At the end of the recording, the pregnant woman is given the result in a paper graphic version.

What to do if the CTG result is bad

We emphasize once again that decoding CTG should be dealt with by an obstetrician-gynecologist. It is the doctor who, having evaluated all the indicators of the cardiotocogram, decides whether its result is satisfactory. Further actions of the doctor will depend on how bad the result is:

Repeated recording of CTG during the day, as well as CTG monitoring, that is, daily recording for several days in a row.

Ultrasound examination of the fetus with dopplerometry - measurement of blood flow in the uterus, placenta and vessels of the fetus.

If the results of the studies establish mild or moderate fetal hypoxia, then the patient is prescribed drugs that improve the fetal-uterine blood flow - antispasmodics, pentoxifylline, kuratil, actovegin and others.

With mild degrees of hypoxia, hyperbaric oxygenation is indicated. For this, the pregnant woman is placed in a special chamber, where an increased atmospheric pressure is created, which facilitates the absorption of oxygen by the tissues.

It is also important to eliminate conditions that cause hypoxia from the outside - a sedentary lifestyle of a pregnant woman, to correct the level of hemoglobin, blood pressure, to find out if the pregnant woman has a Rh-conflict with the fetus.

In severe cases of hypoxia, immediate hospitalization of the patient to a hospital is indicated and, most often, early delivery in the name of saving the child.

It is very important in case of certain questions with CTG to carefully follow the doctor's recommendations, since this method is very informative and really accurately predicts the well-being of the fetus.

What is the norm of CTG

The CTG result is displayed on the tape in the form of a curved line, according to the indications of which the doctor determines the condition of the baby and the presence or absence of deviations.

Indicator norm:

The heart rate (HR) at rest of the baby is 110-160 beats / minute, while moving - 130-190 beats / min.

The rate of rhythm variability (height of deviations) is 5-25 beats / minute.

Slowdowns of heart contractions (deseleration) should be as rare as possible, their depth should be no more than 15 beats / minute. Slow deseleration should be absent.

The number of accelerations (the frequency of contraction of the heart muscle is accelerating) is more than two in 30 minutes, the amplitude is about 15 beats.

The activity of the uterus (tocogram) is allowed no more than 15% relative to the heart rate of the child in 30 seconds.

The data below are parameters for assessing the state of the fetus by CTG:

• basal rhythm - the average heart rate of the fetus
• variability - a change in the frequency and amplitude of the heart rate (deviation from the basal rate
• Acceleration - acceleration of the heart rate from the basal, more than 15 beats, lasting over 10-15 seconds.
• deceleration - a decrease in the heart rate of the fetus from the basal, by more than 15 beats, lasting more than 10 seconds.
• fetal motor activity

Bad CTG during pregnancy will be when the following indicators are found:

• prolonged increase in fetal heart rate (tachycardia) more than 160 beats per minute
• rare heart rate in a baby - less than 110 beats per minute
• increased rhythm variability with an amplitude of more than 25 beats per minute
• decrease in variability below 5 beats per minute
• sinusoidal rhythm, in which there is a monotonous and monotonous heartbeat without any fluctuations and changes in variability
• the appearance of decelerations

After counting the points, the condition of the fetus is assessed:

• 5 or less - a state of fetal hypoxia, the child is experiencing oxygen starvation
• 6, 7 points - the first signs of fetal hypoxia
• 8, 9, 10 points - no hypoxia, the child feels well

Physical activity not taken into account, however, you should know that increased, excessive fetal mobility or, on the contrary, its absence, indicate the presence of oxygen starvation in the fetus.

However, even when deviations are found, this does not always indicate serious problems in the child. It should be taken into account not only CTG during pregnancy, the decoding of which indicates the presence of hypoxia in the baby, but also the duration of pregnancy, the presence of complications in a pregnant woman, data

During the period of carrying the child, the expectant mother learns many new letter abbreviations for herself - ultrasound, BPR, DBK, hCG. They become understandable and even familiar. In the last trimester, another "classified" diagnostic study is assigned in the letter code - CTG. Its implementation usually does not raise questions, but only a few can decipher the results. How to understand what is written in the conclusion of the CTG, we will tell in this material.

What it is?

Cardiotocography (this is how the name of the examination stands) is a non-invasive, safe and painless way to find out what state the baby is in, how he feels. Such a survey is carried out, starting from 28-29 weeks of pregnancy. Most often, expectant mothers receive a referral to CTG at 32-34 weeks for the first time, and then the study is repeated just before the onset of the labor process.

During the birth itself, CTG is often used to determine if the baby has acute hypoxia in the process of passing through the birth canal.

If the pregnancy is going well, there is no need for additional CTG. If the doctor has concerns that it is proceeding with complications, then CTG is assigned individually, some have to take it weekly or even every few days. There is no harm from such a diagnosis for either the child or the mother.

Cardiotocography allows you to find out features of the baby's heartbeat. The child's heart reacts immediately to any unfavorable circumstance, changing the frequency of its beating. In addition, the method detects contractions of the uterine muscles. Registration of changes occurs in real time, all parameters are recorded simultaneously, synchronously and displayed in graphs.

The first graph is a tachogram showing changes in the baby's heartbeat. The second is a graphic representation of uterine contractions and fetal movements. It is called a hysterogram or tocogram (women often use the abbreviation "toko"). The heart rate of the crumb is determined by a highly sensitive ultrasound sensor, and the tension of the uterus and movements are captured by a strain gauge.

The data obtained is analyzed by a special program that displays certain numerical values ​​on the research form, which we have to decipher together.

Technique

An expectant mother should come to CTG in a calm mood, because any worries and feelings of a woman can affect the heartbeat of her baby. It is advisable to first eat, go to the toilet, because the examination takes quite a long time - from half an hour to an hour, and sometimes more.

You should turn off your cell phone, sit comfortably in a position that will allow you to spend the next half hour with comfort. You can sit down, lie on the couch, take a reclining position of the body, in some cases CTG can be performed even while standing, the main thing is that the expectant mother is comfortable.

An ultrasonic sensor is attached to the abdomen in the area of ​​the child's chest, which will record the slightest changes in the heartbeat pattern and heart rate.

A wide belt is put on over it - a strain gauge, which will be based on minor fluctuations in the volume of the abdomen future mother determine when the uterine contraction or movement of the baby has occurred. After that, the program turns on and the study begins.

At this stage, a pregnant woman may have two questions - what do the percentages on the fetal monitor mean and what the sounds that come during CTG say. We will help you figure it out:

• Sounds during research. The sound of a child's heartbeat, already familiar to the expectant mother, does not need an explanation. Earlier, ultrasound specialists have probably already let a woman listen to a small heart beating. During CTG, a woman, if the device is equipped with a speaker, will hear it constantly. Suddenly, a woman may hear a long, loud noise that looks like interference. This is how the child's movements are heard. If the device suddenly begins to beep, this indicates a loss of signal (the baby turned and moved significantly away from the ultrasonic sensor, the signal transmission was disrupted).
• Percentage on the screen. Percentages indicate the contractile activity of the uterus. The more actively the main female reproductive organ contracts, the more reason a doctor has for hospitalizing a woman. If the values ​​are close to 80-100%, we are talking about the beginning of labor before childbirth. Indicators in the range of 20-50% should not scare a woman - it is definitely early to give birth to her.

Decoding the results

Understanding the abundance of numbers and complex terms is not as difficult as it seems at the first glance at the CTG result. The main thing is to understand and have a good idea of ​​what concepts we are talking about.

Basal heart rate

The baseline, or basal, heart rate is the average value of your baby's heart rate. A mother who comes to CTG for the first time may be surprised that the heart of the crumbs beats very unevenly, the indicators change with every second - 135, 146, 152, 130 and so on. All these changes do not slip away from the program, and for the first ten minutes of the examination, it displays the average value, which for this baby will be the base or basal value.

This parameter in the third trimester does not change depending on the specific week, as some pregnant women think. And at 35-36 weeks, and at 38-40, the basal heart rate only reflects the average values ​​of the frequency of the baby's heartbeat and in no way indicates either the gestational age or the sex of the child.

The norm of the basal heart rate is 110-160 beats per minute.

Variability

As you can understand from the sound of the word, this concept hides variants of something. In this case, options for deviation of the heart rate from the baseline values ​​are considered. In medicine, another name for this phenomenon is used, which can also be found in the conclusion - oscillations. They are slow and fast.

Fast ones reflect the slightest changes in real time, because, as already mentioned, each fetal heart beat displays a different heart rate. Slow oscillations are low, medium, and high. If in a minute of real time the frequency of contractions of the child's heart was less than 3 beats per minute, they speak of low variability and low oscillation. If the swing per minute was from three to six beats, then we are talking about the average variability, and if the fluctuations in one direction or another amounted to more than six beats, the variability is considered high.

To imagine this more clearly, let us give an example: in a minute, the device registered a change in fetal heart rate from 150 to 148. The difference is less than 3 beats per minute, which means that this is a low variability. And if the heart rate has changed from 150 to 159 per minute, then the difference is equal to 9 beats - this is a high variability. The norm for a healthy baby in an uncomplicated pregnancy is fast and high oscillations.

Slow oscillations are of several types:

• monotonous (heart rate changes by five or less beats per minute);
• transient (heart rate per minute changes by 6-10 beats per minute);
• wavy (heart rate changes by 11-25 beats per minute);
• galloping (more than 25 beats per minute).

If in a minute the heart rate jump looks like this: 140-142 beats / min, then we are talking about a monotonic slow oscillation, if in a minute the heart rate has changed from 130 to 160, then we are talking about a jumping slow oscillation. Wave-like oscillations are considered normal for a healthy baby, and other types almost always accompany various pathologies of pregnancy - cord entanglement, hypoxia, Rh-conflict.

Acceleration and deceleration

Quantitative change is oscillation, and qualitative change is acceleration and deceleration. Increased rhythm - acceleration. On the graph, it looks like a peak, a clove. A decrease in rhythm - deceleration, is graphically depicted as a peak with the top down, that is, a failure. Acceleration is an increase in the baby's heart rate by 15 beats per minute or more and maintaining this rhythm for more than 15 seconds.

Deceleration is a decrease in the heart rate value from the baseline value by 15 beats downward and maintaining this rhythm for 15 or more seconds.

There is nothing wrong with the accelerations themselves if more than two of them are registered in 10 minutes. However, too frequent accelerations, of the same duration and occurring at regular intervals, is an alarm signal, the child is uncomfortable. Deceleration (reduction) is generally not characteristic of a healthy baby, but a small number of them, with other normal cardiotocography parameters, may be a variant of the norm.

Stirring

How many movements should be, the question is quite difficult, because there is no definite answer to it. All children have different physical activity, they are influenced not only by their own well-being, but also by factors that do not depend on it - the mother's nutrition, her mood and emotional state, and even the weather outside the window.

If the baby wants to sleep exactly at the moment when he needs to do CTG, his movements will be minimized.

It is considered a good sign if at least several movements are recorded in the child during CTG: in half an hour - not less than three, in an hour - not less than six. Too frequent sharp movements are an alarming sign that may indicate violations in the state of the baby. Too rare movements are also not a very good indicator. However, if all other CTG values ​​are normal, then the doctor will assume that the child has simply slept for the entire hour, and will ask the woman to come back for examination again in a few days.

It is not the movements themselves that are considered important, but the relationship between them and the number of accelerations. Normal healthy child when moving, the heart rate increases. If this connection is broken and perturbations are not accompanied by rises in heart rate, and the accelerations themselves arise spontaneously and are not associated with movement, the well-being of the crumbs is called into question. On the graph, the movements look like dashes in the lower part, where uterine contractions are noted.

Uterine contractions

Contractions of the uterine muscles are depicted in the lower graph. Visually, they look like wavy drops, because the contraction begins smoothly and ends no less smoothly. They should not be confused with movements, they are marked with short vertical lines. Interestingly, the strain gauge belt records even those contractions that the woman does not physically feel.

Percentages represent contractile activity.

It is unambiguously impossible to determine the tone of the uterus on CTG, because the pressure inside the uterus can really be measured in only one way - to insert a thin long sensor-electrode into its cavity, but this is impossible until fetal bladder safe and sound, and labor has not begun. Therefore, the value of the tone of the uterus is constant - the base rate is taken as 8-10 millimeters of mercury. A program that analyzes all indicators, according to the contractile ability of the main female reproductive organ, can "conclude" that this pressure is exceeded. Only then can the doctor suspect a tone, but for confirmation, a manual examination on a gynecological chair and an ultrasound scan will be needed.

Sinusoidal rhythm

If the conclusion indicates "sinusoidal rhythm - 0 min", then this is a very good indicator. Such a rhythm, indicated on the graph as sinusoids repeating at equal intervals of time, of the same duration, speaks of severe pathologies. The number of accelerations and decelerations is minimal or absent altogether. If this graphical picture persists for about 20 minutes, doctors may suspect a big problem.

This rhythm occurs in children with severe uncompensated hypoxia, severe intrauterine infection, severe Rh-conflict. Seven out of ten babies who showed a sinusoidal rhythm on CTG for 20 minutes or more die in utero or immediately after birth.

Table of norms of basic indicators:

Assessment of fetal health - points

To assess the condition of the fetus, doctors use scoring techniques. In women, well-grounded questions are often raised, which means 4 or 5-6 points on CTG, which can be indicated by 10, 11 or 12 points. The interpretation depends on which method of calculation the program operated or how the doctor calculated the result if the assessment was made “manually”.

The Fischer grading system is the most commonly used.

This is a twelve-point system in which a certain number of points is awarded for each indicator.

By Fischer

Fischer scoring table (Krebs modification):

The interpretation of the results looks like this:

9,10, 11, 12 points- the child is healthy and feels quite comfortable, his condition does not cause concern;

6,7,8 points- the life of the baby is not in danger, but his condition raises concerns, since such an indicator may be a sign of initial pathological changes and adverse effects from the outside. A woman should do CTG more often in order to monitor the baby in dynamics;

5 points or less- the child's condition is threatening, there is a high risk of intrauterine death, stillbirth, neonatal death in early postpartum period... The woman is sent to a hospital, where an urgent diagnosis is carried out, and in most cases everything ends in an emergency caesarean section to save your baby's life.

FIGO

This assessment table was adopted by the specialists of the International Association of Gynecologists and Obstetricians. It is less commonly used in Russia than the Fischer score, but it is more understandable for expectant mothers.

FIGO interpretation table:

PSP

It stands for "an indicator of the state of the fetus."

It is very difficult to visualize by what algorithms and mathematical formulas this calculation takes place, if there is no mathematics diploma on the shelf at home. This is not required. It is enough for a mother-to-be to know which PSP indicators are considered the norm and what they mean:

Memory bandwidth less than 1.0. This result means that the baby is healthy, he is comfortable, his health and condition are not disturbed. This is a good result, in which the doctor lets the pregnant woman with CTG go home with a clear conscience, because nothing bad should happen to the baby.

Memory bandwidth from 1.1 to 2.0... This result indicates a likely initial change that is different from the normal state of health. Violations with such a PSP are not fatal, but they cannot be ignored. Therefore, a woman is asked to come to CTG more often, on average - once a week.

Memory bandwidth from 2.1 to 3.0. Such indicators of fetal health are considered very alarming. They can indicate severe discomfort that the baby is experiencing in the womb. The cause of the baby's trouble can be Rh-conflict, a state of oxygen deficiency, entanglement with an umbilical cord, intrauterine infection. The pregnant woman is sent to the hospital. She is shown a more thorough examination and, possibly, an early delivery by cesarean section.

Memory bandwidth above 3.0. Such results may indicate that the child's condition is critical, he is threatened intrauterine death that can happen at any moment. The woman is hospitalized urgently, an emergency caesarean section is shown to save the baby.

Stress and non-stress tests

The usual CTG, which is done during pregnancy, is considered a non-stress test. But sometimes the situation requires a more careful and detailed study of the features of the work of a small child's heart, for example, if the result of the previous CTG is unsatisfactory or if a child's heart is suspected, then stress tests are performed.

In this case, the study is technically carried out in the same way as always, but before fixing the sensors on the belly of the expectant mother, she may be asked to walk up and down the stairs several times, breathe deeply and occasionally hold her breath during cardiotocography.

Sometimes, in order to understand how a child's heart and nervous system will behave in a stressful situation, a woman is injected with oxytocin, a drug that causes contractions of the uterine muscles.

Non-stress test eliminates provocative external factors... A woman, on the contrary, is asked to calm down, sit comfortably, not think about anything alarming and bad. How the baby's heart reacts to his own movements is analyzed, that is, the number of accelerations is counted.

Deciphering stress CTG is the task of specialists, the conclusion of the analyzer program alone will not be enough, doctors must make an adjustment for the stress factor. A good result is a negative non-stress test in which the baby “shows” two or more accelerations in 40 minutes.

Possible problems

Problems that can be indirectly indicated by such an examination as cardiotocography can be different - from congenital malformations to pathologies of pregnancy or external unfavorable factors, which the woman herself is subject to. But they will all be accompanied by one of the following deviations.

Tachycardia

This condition can be talked about if the basic heart rate exceeds the established norms, and the duration of the demonstration of the violation is 10 minutes or more. Mild tachycardia is indicated by an increase in heart rate to 160-179 beats per minute. A severe form of tachycardia is when the baby's heart beats at a frequency of 180 beats per minute or higher.

The most common cause is fetal hypoxia. With oxygen deficiency, the child begins to experience stress, his hormonal background changes, because of this, the heart begins to beat faster. But this is only for early stage hypoxia. With severe oxygen deficiency, the baby behaves differently.

Tachycardia is often a companion of intrauterine infection that struck the baby. Almost like a born child, a baby in a mother's belly can get sick. His immune defense will begin to work, and despite the fact that it is still very weak, the temperature will rise, and this will also immediately affect the heart rate. The reason for the child's tachycardia can be the unimportant state of health of his parent. If a woman's temperature rises, then the child's heart beats harder.

Also, the medications that the mother takes and any violations of her hormonal levels affect the heart rate of the fetus.

Bradycardia

If cardiotocography shows that the baby's heart beats below 100 beats per minute for 10 minutes or more, doctors diagnose bradycardia. This is a dangerous symptom that may indicate severe uncompensated hypoxia, in which oxygen deficiency is already critical, the child does not have the strength to move. If the slowdown in heart rate is recorded on CTG at the time of childbirth, then there is nothing dangerous in this, because with a decrease in heart rate, the baby reacts to passing through the birth canal when its head is pressed.

Fetal hypoxia

Oxygen starvation can be very dangerous for a child at any time, it leads to disorders of the central nervous system, and sometimes to fetal death. Early hypoxia, while it is still compensated by the protective mechanisms of the baby's body, is characterized by tachycardia, and late hypoxia, hypoxia in an advanced stage - bradycardia. In addition, CTG shows low variability, the same periodic acceleration, sinusoidal rhythm, monotony.

The memory bandwidth in this state of affairs is in the range of 1.1 - 3.0. And according to Fischer, the child's condition is estimated at 5-8 points, depending on the severity of the oxygen deficiency. In severe hypoxia, urgent delivery is indicated, regardless of how long the pregnant woman is - at 37 weeks or only at 33 weeks. In any case, there will be more chances for such a baby to survive outside the mother's womb.

Therefore, it is impossible to treat the conclusion of the CTG as the ultimate truth. The survey gives only a general picture, but only additional diagnostics will help to confirm or deny negative results, as well as to establish the reasons for the baby's unusual behavior.

Usually these are laboratory blood tests, ultrasound scanning, ultrasound (Doppler ultrasound).

An erroneous CTG may be due to the fact that the woman did not prepare for the examination - she came sleepy, worried about personal problems. The veracity of CTG is also doubtful if the pregnant woman took any medications and did not warn the doctor about it, because some medicines can noticeably raise and lower the heart rate of not only the mother, but also the fetus. An erroneous CTG can be in the event of a malfunction of the equipment on which the study is carried out.

Therefore, all dubious results must be rechecked with repeated CTGs, as well as with the help of ultrasound. All bad CTG results are also rechecked, but already in a hospital setting, so as not to risk the health of the mother and child.

Among the important studies in the third trimester of pregnancy, it occupies a special place. This type of diagnosis allows you to comprehensively assess the intrauterine state of the fetus and make sure that the child does not suffer from oxygen starvation. This study is especially relevant in preparation for childbirth, as well as in the very process of delivery. This procedure is harmless for both the woman and the baby.

Cardiotocography allows you to obtain data on the work of the fetal heart against the background of its motor activity and response to uterine contractions. CTG, as a rule, is carried out in conjunction with ultrasound and Doppler ultrasound. Although this procedure is not difficult, proper preparation for CTG during pregnancy will not be superfluous.

How to wake your baby up for correct results?

Unlike other tests, cardiotocography is not done on an empty stomach and you do not need to drink large amounts of water before it. But the main task of a pregnant woman is to achieve wakefulness of the fetus. If the child is in the sleep phase during the examination, then receive reliable result it will be impossible.

The mother's motor activity and glucose stimulate the baby's movements, so those who have been preparing for CTG share these recommendations:

• Breathing exercises... Holding the breath for a short time causes oxygen deficiency, to which the child reacts with movements and behaves restlessly. However, not everyone approves of this method. In such a matter, you need to show balance so as not to harm the baby.
• Physical activity... Walk, swim in the pool, climb or descend stairs. And you can also perform simple exercises, permissible in the 3rd trimester, with a fitball.
• Eat something sweet... It can be a chocolate bar, a handful of dried fruits, freshly squeezed juice, sweet tea with cream.

The test results will be more accurate if the baby wakes up naturally. Pounding on the belly, applying ice, or watering the belly with a jet cold water unacceptable. This can stress the baby and hurt him or her.

During the preparation process, it will be right if the woman has a good sleep and rest before the procedure, because in a stressful or tired state, you can get dubious results.

In the process of performing CTG, you should turn off your mobile phone and other electronic devices

In the office of cardiotocography

The procedure can last from 30 to 60 minutes, so when thinking about how to prepare for CTG, a woman should take into account the following points:

• Do not come to diagnostics hungry.
• Before starting the procedure, empty bladder.
• Take a blanket and a pillow with you to make yourself comfortable.
• Relax and try to forget about your problems at least for a while.

During CTG, a woman can be in a reclining position, sit or lie on her side. The horizontal position on the back is not suitable, because in this way, the vena cava is compressed and this can distort the CTG results.

Sometimes women get poor CTG results with a healthy pregnancy and well-being. In this case, it is required to conduct the study again, during which you need to try to exclude the influence of side factors and achieve the wakefulness of the baby. If deviations were found, then to confirm the result, the study should be repeated more than two times. Relying only on the results of one CTG, one should not draw conclusions.

The attending specialist is responsible for decoding the results.

If a woman has additional questions about how to prepare for CTG, then the specialist or functional diagnostics doctor leading her pregnancy will be happy to answer them. But as a rule, neither the procedure itself nor the preparatory period for it causes difficulties for expectant mothers.