CTG during pregnancy: what is it for and how to do it correctly?

To monitor the development and condition of the child during pregnancy, the expectant mother is prescribed various tests. These include ultrasound, Doppler and cardiotocography (CTG). A test is ordered to evaluate the baby’s heart function, motor activity, and how the baby responds to uterine contractions.

How does the procedure work and what does it show?

To take readings, two sensors are attached to the expectant mother’s belly. One records information on uterine contractions, the second monitors how the baby’s heart reacts to this. Normally, the heart rate should be 120–140 beats per minute, the permissible acceleration is up to 160. If the rhythm slows down, then this may be normal with a short slowdown and abnormal with a lack of oxygen.

Cardiotocography does not make a diagnosis, but allows you to collect data to correlate it with data from other examinations and determine whether there are any problems. Diagnostics are done once. But if the procedure is carried out and the doctor is confused by its results, then the expectant mother is invited to a CTG the next day or within several days to exclude any suspicions.

Features of the study

Cardiotocography (CTG) is a method whose essence is the use of special sensors that are connected to a recording device. They are installed on the woman's stomach. The fetal heart rate is recorded using sensors. Additionally, the frequency and strength of uterine contractions are recorded. Data in the form of a graph is recorded by the device on special paper.

The information obtained, together with test results and data from other studies, is used by the doctor to assess the condition of the fetus. This method allows you to confirm or refute:

• Hypoxia.
• Impaired development of the placenta.
• Presence of intrauterine infection.
• Polyhydramnios or oligohydramnios.
• Pathologies of the cardiovascular system.
• Threat of premature birth.

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• a wide range of services and areas of work: pediatrics, gynecology, pregnancy management, cardiology, dermatology, neurology, endocrinology, etc.;
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• Modern, highly functional equipment is used for diagnosis and treatment;
• The clinic employs experienced, qualified specialists;
• each patient receives a special, individually developed plan for the prevention and treatment of diseases;
• has its own clinical laboratory.

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When is CTG performed?

Today, during pregnancy, all women undergo CTG three times in the third trimester and during childbirth. Recommended period after 32 weeks. According to indications, it can be shifted to a period after 28 weeks. Research on earlier dates is not informative. During the birth process, CTG is done every 3 hours.

If abnormalities are detected in the fetus, CTG during pregnancy may be prescribed more often in order to monitor the dynamics of changes. If the development of hypoxia is confirmed, then the study can be carried out daily until a decision is made about emergency delivery.

The optimal time for conducting a planned study is during the day from 9 to 14 and in the evening from 19 to 24. This requirement is explained by the fact that the unborn child must be in a state of activity, otherwise the data will be unreliable.

CTG (cardiotocography) of the fetus

CTG during pregnancy is an absolutely safe method for both the health of the child and the mother. At the same time, it allows us to identify pathologies that often remain invisible during traditional ultrasound scanning.

In a normal pregnancy, CTG is usually prescribed no more than once every 10–14 days. If pathological changes are determined during the study, the frequency of repetitions of the diagnostic procedure increases - the child’s heartbeat can be checked every other day or even daily.

Under special supervision of specialists are women who are at risk for the pathological course of pregnancy. They are recommended to do a CTG at 30–32 weeks (sometimes at 25–28 weeks), and then regularly repeat the procedure.

Indications for more frequent examinations:

• age over 35 years;
• multiple births;
• experience of frozen pregnancy, spontaneous miscarriage or stillbirth;
• long-term infertility, IVF;
• incompatibility of the blood of mother and fetus according to the Rh factor or the ABO system;
• some diseases of a pregnant woman - anemia, diabetes, kidney disease and cardiovascular disease.

For women at risk, CTG prices are measured not in rubles, but in the ability to safely carry and give birth to a healthy baby. After all, diagnosing various changes in the “mother-placenta-fetus” system allows the gynecologist to carry out the necessary treatment and prevent the development of serious complications. Therefore, it is important to undergo CTG as often as prescribed by the attending physician.

Fetal cardiotocography helps monitor the baby’s health not only in the last months of intrauterine development, but also during childbirth. The main indications for conducting research at the time of delivery:

• multiple births;
• presence of a scar on the uterus;
• gestosis;
• premature birth;
• post-term pregnancy;
• carrying out stimulation of labor;
• use of epidural anesthesia.

The study allows us to assess the condition of the fetus at different stages of labor, timely diagnose the development of complications and carry out the necessary therapeutic measures.

Fetal cardiotocography (CTG) is one of the safest diagnostic procedures, so there are no contraindications. But some conditions can reduce the reliability of the study result, for example:

• poor health of the expectant mother due to stress or illness, after active physical activity;
• hunger and/or thirst;
• eating a large meal immediately before the procedure;
• overweight woman.

In these cases, doctors recommend postponing the procedure or take these circumstances into account when interpreting the results of the study.

Fetal CTG study

Fetal CTG studies are carried out to determine the fetal heart rate and uterine tone. For this purpose, two sensors are used, which are applied to the woman’s abdomen: one sensor is installed near the generating node of the uterus, the second sensor is in the place where the fetal heartbeat is best heard (depending on the position of the fetus in the uterus). Contractions of the fetal heart are recorded using an ultrasound sensor, and the tone of the uterus is determined using a strain gauge. This allows you to obtain two graphic images at once - a tachogram and a hysterogram. CTG devices also record fetal movements. Fetal CTG is carried out in two ways - externally and internally.

The external method (indirect CTG) is performed during pregnancy or childbirth, when the amniotic sac is in an intact state. A sensor for taking a hysterogram is attached to the fundus of the uterus to record the fetal heart rate - in the place most accessible for recording the fetal heartbeat.

Internal CTG is used by doctors when the membrane of the amniotic sac is damaged. In this case, changes in the fetal heart rate are measured with a needle-shaped spiral electrode. The electrode is inserted into the presenting part of the fetus. To record myometrial contractions, a special catheter is inserted into the uterine cavity. It is used to measure intrauterine pressure.

CTG during pregnancy allows you to monitor the following indicators:

• Fetal basal rhythm
• Change in heart rate
• Increased heart rate with increased activity (fetal myocardial reflex)
• Changes in fetal heart rate that occur periodically

How to prepare so as not to repeat the procedure?

The diagnostic method under consideration does not require special preparation. However, it is worth considering brief but important rules:

• You need to eat before the procedure, but overeating is extremely undesirable;
• visit the toilet in advance and, if necessary, empty your bladder;
• quit smoking 2–3 hours in advance if a bad habit occurs;
• It is necessary to move a little before arriving at the desired office: this is required so that the child does not fall asleep while studying the data;
• It is worth turning off your phone for a while, as the waves it emits can cause unnecessary interference.

Take a fetal CTG at the Test Tube Babies clinic

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Cardiotocography (CTG) is necessarily performed for the first time in the third trimester, at the 32nd week of pregnancy. However, in some cases, the doctor may prescribe it at 28 weeks, if indicated. In the future, the frequency of cardiotocography is determined by the doctor managing the pregnancy.

The purpose of the procedure is to record the heart rate of the child in the womb at rest, movement, during uterine contractions and other conditions. Such an assessment of the fetus allows us to identify possible pathologies that are not diagnosed through ultrasound or tests. CTG is included in the list of mandatory diagnostic procedures during pregnancy.

When is research needed?

As a rule, fetal CTG is required to be done in the 3rd trimester; if good results were obtained, then in the future the procedure should be performed approximately once every 6–10 days or every week - this depends on the instructions of the attending physician. If you have satisfactory data, you should not abuse this form of research: there is no particular need for this.

3D ultrasound during pregnancy

If the expectant mother shows obvious signs of complications, monitoring is carried out more often than required. Special indications for regular examination include:

• the presence of several fetuses (multiple pregnancy);
• any developmental defects in the baby;
• increased or decreased amount of amniotic fluid;
• detection of chronic diseases in a pregnant woman (ARVI, influenza, etc.);
• complications expressed by convulsions, high blood pressure and edema (preeclampsia);
• premature births and miscarriages that occurred in the past;
• post-term pregnancy;
• bad habits – smoking, drinking alcohol and using drugs;
• the presence of a chronic infection.

Preparation and performance of CTG

Understanding what CTG is, you need to know how to properly prepare for the procedure. There are no special requirements, but in order to exclude unreliable results, the woman must be in a calm state. If a pregnant woman experiences the slightest discomfort, the examination must be rescheduled.

Eating immediately before the test may distort the results. In this case, the level of glucose in the blood will increase, and this will cause excessive activity of the fetus. In addition, within a couple of days you should stop eating foods that have a stimulating or depressing effect on the central nervous system and cardiovascular system of the mother and unborn child.

Knowing what CTG during pregnancy is, you need to understand that if during the study the unborn child is in the sleep phase, then the data will be unreliable. To speed up the procedure, you can try to wake him up using the following methods:

• Hold your breath for a short time.
• Give your body a little stress by doing simple physical exercises.
• Eat some sweets to increase blood glucose.

Cardiotocography is a lengthy procedure. Sometimes it may take about an hour to receive the data. Therefore, before starting it, you should definitely visit the toilet.

To ensure comfort during the procedure, you should use a pillow cover. You also need to buy a diaper to cover the couch, and dry wipes with which you can wipe your stomach after the procedure.

Cost of the procedure

Cardiotocography in the ART clinic “Test Tube Babies” is performed as follows: the patient lies on her side, and sensors are attached to her stomach in the area of ​​maximum audibility of the fetal heartbeats: to record the fetal heart rate and assess the tone of the uterus. The woman presses the remote control button every time she feels the baby move. After completion of the procedure, the results recorded on paper are assessed by the doctor. Our clinic is equipped with modern high-precision equipment, which allows, when a pregnant twin patient undergoes CTG, to separately record the heart rate of each child.

Fetal CTG - tachogram

Tachogram - this study records changes in the fetal heart rate over time. The graph shows study time in minutes and heart rate per minute. If the fetal heart rate increases, the curve goes up; if the fetal heart rate decreases, the curve goes down.

The condition of the fetus is assessed by basal rhythm - the average frequency of contraction of the fetal heart, acceleration - acceleration of the heart rate, deceleration - slowing of the heart rate, heart rate variability - the average height of deviations in the heart rate.

How is fetal cardiotocography done during pregnancy?

To record the necessary indicators, an ultrasound sensor is fixed to the pregnant woman’s abdomen. It is important to attach it at the point of best audibility of the fetal heartbeat. If twins are expected, two sensors are installed simultaneously or the heartbeat of both children is examined sequentially. Ultrasound waves are absolutely safe for both mother and child.

The duration of the study is from 30 to 90 minutes, which is explained by the periods of sleep and wakefulness of the fetus - if the child falls asleep or the indicators deviate from the norm, the study is extended.

The posture of pregnant women at the time of the study is an important factor influencing the results. Cardiotocography is recommended to be performed with patients lying on their left side. A sitting position is also allowed. Cardiotocography should not be performed while lying on your back. The results will be unreliable due to compression of the blood vessels by the uterus.

Another rule for conducting CTG is the use of a special acoustic gel. It is applied to a sensor that records the child’s heart activity. Sometimes the gel is applied not to the sensor, but to the pregnant woman’s belly. This is not considered an error. But the strain gauge must be left dry. The gel is also not applied to the place of its fixation.