pengenalan ctg obstetri zayed

7/24/2019 Pengenalan CTG obstetri Zayed

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Gawat Darurat Ibu dan AnakGawat Darurat Ibu dan Anak(GDIA) Pusdiklat Sari Mulia(GDIA) Pusdiklat Sari Mulia

Fetal CardiotocographyFetal Cardiotoco

graphy

ayed !orwantoayed !orwanto

"an#ar$asin% & 'ktober *+"an#ar$asin% & 'ktober *+


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,lectronic -etal heart $onitoring.,FM/0

de1eloped in the *23s4

is achie1ed by either 0 5 internal or direct $onitoring%

by applying a bipolar electrode to the skin o-the

-etal scalp %the cer1i6 has to be dilated and$e$branes ruptured4

5 e6ternal or indirect $onitoring4

by using ultrasound %usually by 7

,6ternal toco dyna$o $etry with a pressure

transducer placed on the uterus4


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Indications -or ,FM

5low risk wo$en with7

nor$al 898 on auscultation % no $econiu$staining li:uor and nor$al progress o- labor

are e6tre$ely unlikely to deli1er an

asphy6iated in-ants4

Ad$ission test 0

initial $inutes ,FM screen in early laboris

enough to predict the likelihood o-subse:uent

-etal hypo6ia4


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5 high risk wo$en7 Maternal disorders0

; hypertensi1e diseases4

; diabetes $ellitus4

; renal diseases4

; cardiac diseases4

; AP94

; 89 isoi$$uni


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=abor co$plications 0

; dys-unctional labor ( slow progress)4

; o6ytocin aug$entation or induction 4 ; preter$ labor4

; >"AC4

Fetal co$plications 0

; I?G84

; pre1ious S"4

; $econiu$ staining4

; Post ter$ pregnancy4

; abnor$al F98 on auscultation4

; twins4


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;A: Fetal heartbeatA: Fetal heartbeat;;;B: Indicator showing movements felt by mother (caused byB: Indicator showing movements felt by mother (caused by

pressing a button)pressing a button);;

;C: Fetal movementC: Fetal movement;;

;D: terine contractionsD: terine contractions


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DoCtor BRaVADODoCtor BRaVADO

;DDe@ne 8iske@ne 8isk00=ow or 9igh=ow or 9igh

;CContractionsontractions00Fre:uency% =engthFre:uency% =ength

;BBaselineaseline RaRatete00"radycardia% !or$al% achycardia"radycardia% !or$al% achycardia

;VVariabilityariability00+B*bp$$in+B*bp$$in;AAccelerationsccelerations00Present or AbsentPresent or Absent

;DDecelerationsecelerations00Present or Absent% ypePresent or Absent% ype

;OOutco$e0utco$e0!or$al% Suspicious4 Pathological4!or$al% Suspicious4 Pathological4Manage$ent PlanManage$ent Plan


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ContractionContraction


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"aseline F980

5It is the rate recorded in between uterine

contractions4

5!or$ally ** *+ bp$4

5usually assessed o1er *+ $inute inter1al

during labor4

"ase =ine"ase =ine


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"aseline tachycardia

5It is a F98 abo1e *+ B *3 bp$4 5causes 0

; Fetal hypo6ia4

; Maternal or Fetal in-ection4 ; Drugs as ritodrine and atropine4

; Maternal hyperthyrodis$4

; $aternal dehydration4

; Fetal ane$ia 4 ; Fetal cardiac arhyth$ias4


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"aseline tachycardia


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"aseline bradycardia

5It is a F98 less than 2 B** bp$4 5It $ay be $ild ( 2 B** bp$4 ) or

se1ere ( E 2 bp$4 )4

5persistent $ild -etal bradycardia is usually

benign4 hile se1ere bradycardia causedby

-etal congenital heart block4


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"aseline bradycardia


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>ariability

5baseline or beat B to Bbeat 1ariability is

controlled by the balance between the

sy$pathetic and parasy$pathetic ner1ous

control o- the heart4

5nor$al 1ariability is + + bp$4

5it is reduced E + bp$4 in 0

; -etal hypo6ia4

; physiological during -etal sleep cycles4

; drugs as 7dethadine %barbiturates and

atropine4


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nor$al beat to beat 1ariability


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8educed beat to beat 1ariability


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Poor or absent 1ariability


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Periodic F98

periodic changes in the F98 $ay be either 0

A4 Accelerations 0

5 is associated with 7

; -etal $o1e$ents4

; uterine contractions4

5 are considered benign and its presence

indicates a well o6ygenated -etus4

AccelarationAccelaration


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nor$al F98 accelerations associated with -etal

$o1e$ents ( reacti1e !S )


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nor$al F98 accelerations with uterine

contractions


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DeccelarationDeccelaration


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Decelerations 0classically well de@ned decelerations

are described 7 early %1ariable and late4

*4 ,arly deceleration 0

; this deceleration ha1e a uni-or$ shape

( bell)% starts early in the contraction and $irrors it4 ; the $agnitude o- the deceleration is

E&bp$4 ; cause 0 head co$pression $ediated by 1agal reHe64 ; it occurs during the acti1e phase % they are benign 4


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early deceleration


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4>ariable deceleration 0

; it is the $ost co$$on deceleration pattern4

; it appears as abrupt -all and return in F98% preceded and -ollowed by s$all accelerations ( shoulders)4 ; they are 1ariable in shape > %? or shape % duration and ti$ing4 ; the $agnitude is usually +B bp$4 ; cause 0 cord co$pression4 i- it persists -etal hypo6ia occurs4 ; $ild 1ariable deceleration ( last E sec4) is

benign4 $oderate (last B3 sec4) and se1ere (last J 3sec4)

indicates -etal hypo6ia4


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>ariable deceleration4


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4 =ate deceleration0

; it ha1e a si$ilar shape and $agnitudeas

early deceleration but their ti$ing is

diKerent4

; it start as the contraction peaks anddoes

not return to the baseline F98 until a-ter

the end o- the contraction4

; cause 0 -etal hypo6ia4


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=ate decelerations


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Prolonged deceleration


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(up) Sinusoidal pattern% (down) PseudoBsinusoidal


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'utco$e'utco$e


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8eassuring ( nor$al ) F98 pattern4


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LAAG'8I I 0 Pola D !or$alLAAG'8I I 0 Pola D !or$al

;11..Frekuensi dasar D 0 ** *3 dp$Frekuensi dasar D 0 ** *3 dp$

;22..>ariabilitas D 0 $oderat (+ + dp$)>ariabilitas D 0 $oderat (+ + dp$)

;33..idak ada deselerasi la$bat dan 1ariabelidak ada deselerasi la$bat dan 1ariabel

;44..idak ada atau ada deselerasi diniidak ada atau ada deselerasi dini;55..Ada atau tidak ada akselerasiAda atau tidak ada akselerasi


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LAAG'8I II 0 Pola D ,kui1okalLAAG'8I II 0 Pola D ,kui1okal

;11..Frekuensi dasar D 0 "radikardia (E** dp$) yang tidak disertaiFrekuensi dasar D 0 "radikardia (E** dp$) yang tidak disertaihilangnya 1ariabilitas (absent 1ariability)hilangnya 1ariabilitas (absent 1ariability)

;22..akhikardia ( D J*3 dp$)akhikardia ( D J*3 dp$)

;33..>ariabilitas $ini$al (* + dp$)>ariabilitas $ini$al (* + dp$)

;44..idak ada 1ariabilitas% tanpa disertai deselerasi berulangidak ada 1ariabilitas% tanpa disertai deselerasi berulang;55..>ariabilitas J + dp$ ($arked 1ariability)>ariabilitas J + dp$ ($arked 1ariability)


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LLAAG'8I III 0 Pola D abnor$alAAG'8I III 0 Pola D abnor$al

;11..Deselerasi la$bat berulangDeselerasi la$bat berulang

;22..Deselerasi 1ariabel berulangDeselerasi 1ariabel berulang

;33..

"radikardia"radikardia;44..Pola sinusoid (sinusoidal pattern)Pola sinusoid (sinusoidal pattern)


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Manage$ent


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A. Reversible cause:

5 stop o6ytocin 4

5 treat hypotension4 5 $aternal repositioning

in le-t lateral position4

5 relie1e pain N -ear4 5 gi1e o6ygen to $other4

5 treat $aternal -e1er4 5 pel1ic e6a$0 ; to e6clude cord prolapse4

; c64 -ully dilated carry out assisted 1aginal deli1ery4


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B. Irreversible cause :

c64 is not -ully dilated with persistent nonB reassuring F98 patterns4

5 i$$ediate deli1ery and e6traB uterine

resuscitation4

5 -etal scalp blood p9deter$ination 0

; i- p9 JO4+ obser1e4; i- p9 O4 O4+ repeat4

; i- p9 EO4 CS4


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hank you

pengenalan ctg obstetri zayed

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