Handbook of CTG Interpretation

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.

    Chapters include key messages, key CTG pathophysiology, common pitfalls and CTG exercises to re-enforce knowledge and test readers' understanding of key areas
    Covers medico-legal aspects in detail, enabling the reader to get a better understanding of the medico-legal costs of CTG misinterpretation and how to avoid common errors
    Reflects the multidisciplinary nature of intrapartum care, making this manual suitable for a wide audience including midwives, obstetricians and neonatologists who wish to have a greater understanding of CTG

Table of Contents

List of contributors
Preface
Acknowledgment
Glossary
1. 'An eye opener': perils of CTG misinterpretation. Lessons from confidential enquiries and medico-legal cases Edwin Chandraharan
2. Physiology of fetal heart rate control and types of intrapartum hypoxia Anna Gracia-Perez-Bonfils and Edwin Chandraharan
3. Fetal oxygenation Anna Gracia Perez-Bonfils and Edwin Chandraharan
4. Understanding the CTG: technical aspects Harriet Stevenson and Edwin Chandraharan
5. Applying fetal physiology to interpret CTG traces: predicting the NEXT change Edwin Chandraharan
6. Avoiding errors: maternal heart rate Sophie Eleanor Kay and Edwin Chandraharan
7. Antenatal cardiotocography Amar Bhide and Francesco D'Antonio
8. Intermittent (intelligent) auscultation in the low risk setting Virginia Lowe and Abigail Archer
9. Current scientific evidence on CTG Ana Piñas Carrillo and Edwin Chandraharan
10. Role of uterine contractions and intrapartum re-oxygenation ratio Sadia Muhammad and Edwin Chandraharan
11. Intrapartum monitoring of a preterm fetus Ana Piñas Carrillo and Edwin Chandraharan
12. Role of chorioamnionitis and infection Jessica Moore and Edwin Chandraharan
13. Meconium: why is it harmful? Leonie Penna
14. Intrapartum bleeding Edwin Chandraharan
15. Labour with a uterine scar: the role of CTG Ana Piñas Carrillo and Edwin Chandraharan
16. Impact of maternal environment on fetal heart rate Ayona Wijemanne and Edwin Chandraharan
17. Use of CTG with induction and augmentation of labour Ana Piñas Carrillo and Edwin Chandraharan
18. Recognition of chronic hypoxia and the preterminal cardiotocograph Austin Ugwumadu
19. Unusual fetal heart rate patterns: sinusoidal and saltatory patterns Madhusree Ghosh and Edwin Chandraharan
20. Intrauterine resuscitation Abigail Spring and Edwin Chandraharan
21. Management of prolonged decelerations and bradycardia Rosemary Townsend and Edwin Chandraharan
22. ST-Analyser: case examples and pitfalls Sabrina Kuah and Geoff Matthews
23. Role of a computerised CTG Sabrina Kuah and Geoff Matthews
24. Peripheral tests of fetal wellbeing Charis Mills and Edwin Chandraharan
25. ST-Analyser (STAN): principles and physiology Ana Piñas Carrillo and Edwin Chandraharan
26. Operative interventions for fetal compromise Mary Catherine Tolcher and Kyle D. Traynor
27. Non hypoxic causes of CTG changes Dovilė Kalvinskaitė and Edwin Chandraharan
28. Neonatal implications of intrapartum fetal hypoxia Justin Richards
29. Role of the anaesthetist in the management of fetal compromise during labour Anuji Amarasekara and Anthony Addei
30. Medico-legal issues with CTG K. Muhunthan and Sabaratnam Arulkumaran
31. Ensuring competency in intrapartum fetal monitoring: the role of GIMS Virginia Lowe and Edwin Chandraharan
32. Physiology-based CTG training: does it really matter? Sara Ledger and Edwin Chandraharan
Index

Edwin Chandraharan is Lead Consultant on the Labour Ward at St George's University Hospitals NHS Foundation Trust and Honorary Senior Lecturer at St George's Hospital Medical School, University of London.
Contributors

Edwin Chandraharan, Anna Gracia-Perez-Bonfils, Harriet Stevenson, Sophie Eleanor Kay, Amar Bhide, Francesco D'Antonio, Virginia Lowe, Abigail Archer, Ana Piñas Carrillo, Sadia Muhammad, Jessica Moore, Leonie Penna, Ayona Wijemanne, Austin Ugwumadu, Madhusree Ghosh, Abigail Spring, Rosemary Townsend, Sabrina Kuah, Geoff Matthews, Charis Mills, Mary Catherine Tolcher, Kyle D. Traynor, Dovilė Kalvinskaitė, Justin Richards, Anuji Amarasekara, Anthony Addei, K. Muhunthan, Sabaratnam Arulkumaran, Virginia Lowe, Sara Ledger