Electronic

Fetal Monitoring (EFM)

Triono Adisuroso
MD, SpOG, Mmed, MPhil

Antenatal fetal surveilance

Maternal-fetal movement assessment

ContracCon stress test (CST) CTG
Non-stress test (NST) CTG
Biophysical prole (BPP)
Modied BPP
Umbilical artery Doppler USG

EFM - Cardiotocography (CTG)

Primary purpose is to prevent adverse fetal
outcomes
Assess fetal wellbeing in labour
Guidelines for clinicians
High sensiCvity and low specicity
Very good for well fetuses but poor for unwell fetuses

PPV is low, NPV is very high

Poor inter-observer and intra-observer

DeniCons
Baseline fetal heart rate (FHR)
Mean level of FHR, stable excluding
acceleraCon and deceleraCon
Determined > 5-10 minutes
Beats per minute (bpm)
Normal: 110 -160 bpm
Tachycardia: >160 bpm
Bradycardia: <110 bpm

Baseline variability
Minor uctuaCon in baseline FHR
Highest and lowest trough of uctuaCon
Normal variability: 6-25 bpm
Reduced variability: 3-5 bpm
Absent variability: <3 bpm
Increased variability (saltatory): >25 bpm

Accelera7ons
Transient increases of FHR 15 bpm above the
baseline, conCnue 15 seconds.
32 weeks: as above but < 2 minutes to
return.
<32 weeks: 10 bpm, 10 sec, <2 mins.
Prolonged acceleraCon: duraCon 2 mins, but
<10 mins.
A baseline changes if duraCon 10 mins

Decelera7ons
Transient decreases below baseline >15 bpm and at least 15
seconds.

Early decelera7ons
Symmetrical gradual decrease and return related to uterine
contracCon
A gradual decrease is 30 secs from onset to nadir
Nadir of deceleraCon occurs at the same Cme as a peak of
contracCon
Late decelera7ons
Symmetrical gradual decrease and return related to uterine
contracCon
A gradual decrease is 30 secs from onset to nadir
Nadir of deceleraCon occurs delayed a^er a peak of contracCon

Variable decelera7ons
Abrupt decrease in FHR <30 secs.
15 bpm, 15 seconds, and <2 mins.
Prolonged decelera7ons
Decrease in FHR below the baseline
15 bpm, 2 seconds, but <10 mins in duraCon.
If 10 mins, a baseline change.
Sinusoidal paCern
Smooth, sine wave-like undulaCng pa_ern.
A cycle frequency 3-5 per minute, persist 20 mins.

Uterine acCvity
Normal
5 contracCons or less in 10 minutes
Averaged over a 30-minute window

Tachysystole
>5 contracCons in 10 minutes
Averaged over a 30-minute window

InterpretaCons
Category I
FHR tracings are normal
Baseline rate: 110-160 bpm
Baseline variability: moderate
Late/variable deceleraCon: absent
Early deceleraCon: present/absent
AcceleraCon: present/absent

Category II
FHR tracings are indeterminate
Not Category I or III
Baseline rate:
Bradicardia without absent baseline variability
Tachycardia
Baseline variability
Minimal baseline variability
Absent with no recurrent deceleraCon
Marked baseline variability
AcceleraCon
Absent of induced acceleraCon a^er sCmulaCon

 Periodic/episodic deceleraCons
Recurrent variable deceleraCon with minimal
or moderate baseline variability
Prolonged deceleraCons >2 mins but <10 mins
Recurrent late deceleraCons with moderate
baseline variability
Variable deceleraCons with other
characterisCcs: slow return to baseline,
overshoots, shoulders

Category III
Absent variability with following recurrent late
deceleraCons, recurrent variable
deceleraCons or bradicardia
Sinusoidal pa_ern

ACOG 2009

ACOG 2009