CTG of the uterus and fetal heart rate:6, 7, 8, 9 points

Update: December 2018


  • Indications for CTG
  • Research methodology
  • Types of devices
  • Interpretation of CTG: pathology or norm
  • What to do with bad CTG

When the expectant mother feels the fetal movement, it
замечательно: беременная женщина знает, что у малыша все OK. But
by motor activity it is impossible to estimate the possible onset
fetal distress in a child.

To detect and prevent problems in time,
use ultrasound methods (CTG, ultrasound and
doplerometry). Cardiotocography (CTG) of the fetus is simple and
available method for assessing the heartbeat of a baby by which
You may notice the initial signs of oxygen deficiency.

In addition, you can identify changes in the muscle tone of the uterus in
women who may cause preterm labor. CTG –
This method of recording the tone of the uterus and heart rate on
special calibration paper. That is, there are 2 graphics,
some devices can record motor activity

  • ultrasound-controlled heartbeats
  • uterine tone, determined by a strain gauge

Is cardiotocography harmful to the fetus?

This is an absolutely safe procedure for both the fetus and
women do not cause discomfort and can be carried out according to indications
even daily (in case of fetal hypoxia), to evaluate the effectiveness
ongoing therapy and emergency decision making

Indications for CTG

The most informative method in the last trimester of pregnancy.
It is after 30 weeks that the fetal biorhythms are fully established.
(“activity-sleep” cycles) and a specific reflex is formed
(increased heartbeat during fetal movements), which can
judge full support and normal intrauterine
child development (see calculator for calculating gestational age). TO
основным показаниям для TOТГ во время беременности относятся:

  • Rh negative blood in women at high risk
    hemolytic disease in the fetus
  • presence in the past of a woman of premature birth, cases
    fetal death
  • decrease in fetus activity according to the woman herself
Complicated during pregnancy:

  • preeclampsia
  • low location or placenta previa
  • wrong presentation of the fetus
  • multiple fetus
  • high water run-off
  • post-pregnancy
  • fever in a pregnant woman
Diseases of the fetus, identified by ultrasound examination:

  • disturbance of blood flow in the placenta
  • intrauterine growth retardation
  • mismatch of fetus size during pregnancy
  • anomalies of the placenta and umbilical cord
  • reduction in fetal movement
  • change in the quality of amniotic fluid
Serious Diseases in a Pregnant Woman:

  • diabetes
  • heart diseases
  • vascular diseases
  • endocrine problems
  • anemia

В перечисленных в таблице случаях, проведение TOТГ должно
be more frequent, even daily. Fetal condition and
the effectiveness of labor activity also allows you to evaluate
real-time cardiotocography.

Research methodology

Most often, the survey is conducted at 32 – 34 weeks
of pregnancy.  TOТГ выполняется в положении беременной на спине
with a small roller under the right side (optimal posture – easy
turn on the left side). Возможно выполнение TOТГ в положении, лежа на
side, or sitting, leaning back in his chair.

  • First, the doctor with a stethoscope finds a point on the abdomen,
    where the heart of the child is best heard.
  • At this place impose ultrasonic sensor, and at the bottom of the uterus
    – a sensor to assess muscle tone.
  • To notice the movements of the baby, the woman is given a special
    device with a button that she will press when feeling
    intrauterine movement.
  • Recording time is 40-60 minutes.

TOогда делают TOТГ, исследование проводится с использованием
sensors with a frequency of 1.5-2 MHz ultrasonic waves, which is absolutely
safe for the fetus even with prolonged exposure. Any
modern apparatus has the ability to assess life
two fruits at the same time, which is used in women with twins.

Types of devices

Medical facilities have various options for
assess the heartbeat of the baby. Most often the doctor just listens to the rhythm
your baby’s heart with an obstetric stethoscope, but with any
doubts that arise (or if indicated) must
use a special apparatus. TOакие бывают виды TOТГ

  • TOТГ без автоматического анализа

These outdated devices are usually quite rare.
are found in modern hospitals, but they can still be found in
remote corners of our country. The main disadvantage of these devices
– the doctor should independently evaluate the fetal heartbeat chart.
If the doctor has experience and owns this technique, then the effectiveness
этих приборов ничуть не ниже, чем у новых TOТГ-аппаратов.

  • TOТГ с компьютерным анализом

Modern cardiotocographs not only record a schedule, but also
independently process the data. The doctor only needs to read
the finished result and decide on the need for treatment. This
вариант TOТГ used in medicine most often.

  • CTG online

The modern mobile era offers a wonderful option.
monitor the baby using a special sensor,
attached to the skin of the abdomen, and a smartphone connected to
The internet. Real-life fetal heartbeat information
time is transmitted to the web portal, processed and provided
in the form of a finished report to the doctor. TO сожалению, пока CTG online
rarely used.

Interpretation of CTG: pathology or norm

The table below presents the assessment of the fetal condition by CTG,
proposed by Dr. Saveleva, which takes into account all

  • basal rhythm – the average frequency of fetal heart contractions
  • вариабельность —  изменение частоты и амплитуды сердечного
    rhythm (deviation from the frequency of the basal rhythm
  • acceleration – acceleration of the heart rate from the basal, more
    than 15 strokes, lasting over 10-15 seconds.
  • deceleration – reduction of fetal heart rate from
    basal, more than 15 strokes, lasting more than 10
  • fetal motor activity

Poor CTG during pregnancy will be detected following

  • prolonged increase in fetal heart rate (tachycardia)
    more than 160 beats per minute
  • slower baby’s heart rate less than 110 beats per minute
  • increase in rhythm variability with an amplitude of more than 25 beats per
    a minute
  • снижение variability ниже 5 ударов в a minute
  • sinusoidal rhythm at which a monotonous and
    monotonous heartbeat without any hesitation and changes
  • appearance of decelerations
2 points 1 point 0 points
Базальный ритм, уд/мин 110-160 100-110 or 160-170 less than 100 or more than 170
Вариабельность частоты  сокращений сердца
(number of deviations from the basal rhythm in minutes)
more than 6 3-6 less than 3
Амплитуда осцилляций (отклонения от базального
10-25 5-9 or more than 25 less than 5 or sinusoidal rhythm
Acceleration regular, 2 or more periodic or absent absent
Decoupling absent, появляются одновременно с сокращением матки rare and short pronounced and long lasting

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

  • 5 и менее  — состояние гипоксии плода, ребенок испытывает
    oxygen starvation
  • 6, 7 points – the first signs of fetal hypoxia
  • 8, 9, 10 points — гипоксии нет, ребенок чувствует себя

Physical activity in the Savelyevoy method is not taken into account
however, be aware that increased, excessive mobility of the fetus
or vice versa, its absence indicates the presence of oxygen
starvation of the fetus.

However, even when deviations are detected, this is not always the case.
indicates serious problems in a child. Should not consider
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, ultrasound data and dopplerometry.

What to do with bad CTG

All methods for assessing the condition of the fetus are required for timely
therapy aimed at reducing fetal hypoxia,
CTG pregnancy results for this are among the most
informative. This is especially true in the case when
examination reveals severe suffering of the fetus and is necessary
make quick decisions about saving a child’s life. As a rule,
this situation, a caesarean section is performed in an emergency

In case of moderate signs of inadequate
blood supply to the fetus, detected by CTG, is carried out comprehensive
treatment. It is best to do this in the hospital, in conditions of prenatal

  • Pregnant shows complete rest
  • Improving the placental blood circulation (blood flow between
    mother and fetus)

Used drugs that reduce the tone of the uterus, which
leads to better blood flow from the uterine vessels to
placenta. To do this, use Ginipral solution for intravenous
introduction in the form of daily droppers. Give a good effect
antispasmodics (papaverine, but-shpa). Also shown are Magne B6,

  • Preparations for improving cell permeability for

Requires prescription of drugs that improve
metabolism – glutamic acid, vitamins C, E, glucose,
neuroprotectors, antigipokanty. As well as drugs that improve
cell permeability – Esentiale Forte, Lipostabil.

  • Decreased blood viscosity

Considering that small vessels predominate in the placenta,
improve blood flow to prevent the formation of small
blood clots. Curantil, Trental, Actovegin, Reopoliglyukin,
small doses of Aspirin can be used – ¼ tablets twice a day
(see aspirin during pregnancy reduces the risk of preeclampsia)

  • Treatment of complications of pregnancy and illness of a woman

With high blood pressure in pregnant
antihypertensive therapy. With anemia, you need to increase the level
hemoglobin, which carries blood with oxygen to the fetus (see
Iron preparations for anemia). Endocrine correction matters
disorders and disorders of the kidney work in women.

  • Accelerate the ripening of the lungs of a baby

With a gestation period of up to 36 weeks, the fetus has not yet matured
respiratory system, and a child may have problems with the first
inhale. If there is a risk of premature delivery due to
severe suffering of the fetus, then the development of pulmonary
tissue in a child. To do this, use the injection of corticosteroid

  • Oxygen cocktail

A woman can independently take an oxygen cocktail,
which can be purchased at pharmacies or special departments
shops for mothers and babies (“Ekoteyl”). Cocktail is made
very simple, the kit includes gas cartridges, bags with
a mixture. Having diluted the mixture with apple juice, a solution is obtained which
filled with oxygen through a special tube, 5 minutes and
cocktail is ready. During hypoxia in a child or to prevent it
need to be used 3 times a day after 30 weeks (or even all
pregnancy with 15 day breaks).

  • After improvement

By reducing the signs of fetal hypoxia and improving the condition
pregnant women recommended aquagymnastics, breathing exercises,

Combined therapy of fetal hypoxia is performed under regular CTG.
control. With treatment failure or deterioration
cardiotogram over 28 weeks to save life
baby doctors can decide on an emergency

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