The Impact of Physiological Interpretation of Cardiotocogram (CTG) in Conjunction with Fetal ECG (STAN) on Intrapartum Emergency Caesarean Sections

Edwin Chandraharan

doi:10.19080/gjorm.2021.08.555738

Abstract

The Impact of Physiological Interpretation of Cardiotocogram (CTG) in Conjunction with Fetal ECG (STAN) on Intrapartum Emergency Caesarean Sections

Highlights

Cardiotocograph (CTG) was introduced into clinical practice in late 1960s to recognize features of intrapartum fetal hypoxic stress
The rate of hypoxic ischaemic encephalopathy (HIE) due to CTG misinterpretation was reduced by 50% following the training on Physiological Interpretation of CTG
Late onset placental failure resulting in a relative uteroplacental insufficiency (RUPI), presence of infection and inflammation, the rapidity of development of hypoxic stress may blunt effective fetal compensatory mechanisms predisposing to neurological injury and perinatal death

Summary

Introduction

Cardiotocograph (CTG) was introduced into clinical practice in late 1960s to recognize features of intrapartum fetal hypoxic stress. The different terminologies and classification systems about intrapartum fetal heart rate monitoring illustrate the degree of confusion regarding the fetal pathophysiological responses to intrapartum hypoxic stress and an evolution of understanding over time resulting in a significant inter-observer [5,6,7] and intra-observer variation in CTG interpretation [8,9,10] Such inter- and intra-observer variability due to the use of these “pattern recognition” guidelines may result in poor neonatal outcomes due to under classification and increased intrapartum emergency operative interventions to the mother due to over classification, they may result in a variation in clinical practice amongst clinicians. Fetal ECG (ST-Analyser or STAN) was introduced into clinical practice to reduce the false positive rate of the CTG

Methods

Findings

Discussion

Conclusion