CTG Interpretation & Intrauterine Resuscitation
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
CTG interpretation must be integrated with the full clinical picture and change over time. A trace label alone is not a management plan.
Assessment & interpretation
- Review baseline, variability, decelerations, contractions and changes from earlier recordings alongside gestation, labour progress, meconium, maternal observations and risk factors.
- Differentiate maternal and fetal heart rates and escalate uncertainty about signal quality.
Decisions that change management
- Identify reversible causes and request the level of obstetric review appropriate to the whole picture.
- For acute bradycardia or a prolonged deceleration lasting at least 3 minutes, obtain urgent obstetric review and prepare for urgent birth while addressing reversible causes.
- Reduce or stop oxytocin when excessive uterine activity contributes. Do not give maternal facial oxygen routinely for fetal resuscitation; use oxygen for a maternal indication such as hypoxia.
Follow-up & safety-netting
- Record review findings, actions, response and the time for reassessment. Continue reassessing the risk factors rather than relying on an earlier reassuring classification.
Clinical pitfalls
- A transient improvement does not automatically remove the need for escalation when the broader clinical picture remains concerning.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- An abnormal trace, persistent reduced movements, bleeding, hypertension, growth concern or suspected infection requires escalation and admission when further monitoring/treatment or birth is indicated.
When clinic, day care or home care may be suitable
- A reassuring CTG supports, but does not alone establish, safe home care. Interpret it with gestation, symptoms, fetal movement, examination and other risks.
Before going home
- A competent clinician has reviewed the full assessment, resolved or explained the concern and documented any further test/birth plan.
- Do not discharge a symptomatic patient solely because one CTG snapshot appears normal.
Discharge medicines and treatment changes
- No home medicine is prescribed simply to improve a CTG. Reconcile treatment for the underlying condition.
Tests, pending results and their reviewer
- Record the trace interpretation, actions and any scan/laboratory result still needing review.
Home care and counselling
- Explain the finding and exactly when to return; continued/recurrent reduced movement is a fresh reason to contact the unit.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
Before leaving | Book any indicated scan or repeat assessment with a named reviewer. |
If symptoms recur | Repeat clinical assessment promptly; previous reassurance does not rule out a new problem. |
Return urgently
- Reduced/absent fetal movements, bleeding, severe abdominal pain or fluid loss requires prompt maternity assessment.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
- CONSERVATIVE MEASURES (intrauterine resuscitation):
- Left-lateral tilt/position change
- Stop oxytocin; consider tocolysis for tachysystole (terbutaline 250 mcg SC slow)
- IV fluid bolus if hypotensive (esp. post-regional)
- Oxygen only if maternal hypoxia (routine O2 not beneficial)
- Bladder emptying; review analgesia (hypotension post-epidural)
- Reassess CTG after measures: PATHOLOGICAL persisting ~30 min despite measures -> escalate for birth decision
Definitive treatment
- Operative delivery thresholds: pathological pattern unresponsive to resuscitation, prolonged bradycardia per clock, pH/equivocal adjuncts confirming compromise
- Mode: instrumental if fully dilated+low; else category caesarean
Monitoring
- Continuous CTG once classified suspicious/pathological
- Document decisions + times each 15-30 min cycle
- Senior review documented for any operative-birth decision
Response assessment
- Return of normal variability/accelerations; decel resolution
- Birth of vigorous neonate
Treatment failure
- Deterioration despite resuscitation -> birth NOW
- Consider causes missed: abruption (pain+tone!), cord prolapse, rupture in scarred uterus
Escalation
- Senior obstetrician + anaesthetist for all operative conversions
- Neonatal team alerted for compromised births
⑮ Complications & their management
HIE (neonate)
Cooling eligibility within 6 h; gases + Apgar documentation
Missed abruption behind "distress"
Tense uterus/pain -> abruption pathway simultaneously
Post-treatment care
- CTG trace stored + annotated
- Debrief + incident review for category conversions
- Parental explanation of events
Diagnosis & assessment
- PROLONGED BRADYCARDIA <100 bpm >3 min -> call help; >9 min -> prepare operative birth (NG235-era thresholds)
- Sinusoidal pattern (severe anaemia/hypoxia)
- Repeated late decelerations + reduced variability
- Category III equivalent (absent variability with recurrent decels)
Definition: Cardiotocograph features assessed as a whole (not isolated parameters) per NICE classification framework.
Initial assessment
- Classify: baseline rate (110-160), variability (5-25 bpm), accelerations, deceleration type/timing vs contractions
- Assign category: NORMAL / SUSPICIOUS (one feature) / PATHOLOGICAL (2+ non-reassuring or 1 abnormal)
- Correlate clinically: contractions frequency/tone, maternal vitals, progress, risk factors
Investigations
| Test | Looking for |
|---|---|
Maternal obs + lactate where available | Sepsis/hypotension contributors |
Fetal scalp stimulation/lactate (where available) | Secondary confirmation when equivocal |
Differential diagnosis
| Condition | Clue |
|---|---|
Cord compression | Variable decelerations |
Uteroplacental insufficiency | Late decelerations |
Head compression (benign) | Early decels mirroring contractions |
Fetal anaemia/sepsis | Sinusoidal/reduced variability |
Maternal factors | Fever/hypotension/drugs mimic patterns |
Algorithm
Sources (8)
2023-09-29 · updated 2026-06-09 · checked 2026-08-23 · verified-live
Open source ↗
NICE overview + Update information page (dates above confirmed)
14 December 2022 · updated 25 March 2026 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for ctg-fetal-monitoring. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/disch…
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for reduced-fetal-movements. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/di…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.