Focusing on the principles of physiological interpretation of CTG, this new edition promotes an evidence-based approach to interpreting fetal heart rate changes. Traditional classification systems are arbitrary and associated with increased caesarean sections without improvements in perinatal outcomes. Guiding the reader in the use of novel tools to help eliminate avoidable, intrapartum-related fetal hypoxic-ischaemic brain injuries and their long term consequences such as cerebral palsy and learning difficulties, this book moves away from traditional, illogical classification systems. Topics such as non-hypoxic causes of fetal brain injury, types of intrapartum hypoxia, and medico-legal issues are clearly explained, and new chapters on human factors in CTG interpretation and the development of new technologies that can reduce human errors are included. Methods discussed comply with the International Expert Consensus Statement on Physiological Interpretation of CTG (October 2024), authored by over 50 CTG experts from over 20 countries.
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A must-have resource for intrapartum care providers improving maternal and perinatal outcomes and reducing unnecessary interventions.
Introduction; Preface;
1. 'An eye opener': perils of CTG
misinterpretation. Lessons from confidential enquiries and medico-legal
cases;
2. Physiology of fetal heart rate control and types of intrapartum
hypoxia;
3. Fetal oxygenation;
4. Understanding the CTG: technical aspects;
5. Applying fetal physiology to interpret CTG traces: predicting the NEXT
change;
6. Avoiding errors: maternal heart rate;
7. Antenatal
cardiotocography;
8. Intermittent (intelligent) auscultation in the low-risk
setting;
9. Current scientific evidence on CTG;
10. Uterine Tachysystole and
Hyperstimulation;
11. Intrapartum monitoring of a preterm fetus; 12 a. Role
of chorioamnionitis and infection: understanding the pathophysiology; 12 b.
Role of chorioamnionitis and infection: fetal heart rate changes in
chorioamnionitis;
13. Meconium: why is it harmful?;
14. Intrapartum bleeding;
15. Labour with a uterine scar: the role of CTG;
16. Impact of maternal
environment on fetal heart rate;
17. Use of CTG with induction and
augmentation of labour;
18. Recognition of chronic hypoxia and the
preterminal cardiotocograph;
19. Unusual fetal heart rate patterns:
sinusoidal and saltatory patterns;
20. Intrauterine resuscitation;
21.
Management of prolonged decelerations and bradycardia;
22. ST-Analyser
(STAN): principles and physiology;
23. ST-Analyser: case examples and
pitfalls;
24. Role of intrapartum 'computerised' CTG;
25. Peripheral tests of
fetal wellbeing;
26. Fetal heart rate changes during operative vaginal
births;
27. Non hypoxic causes of CTG changes;
28. Neonatal implications of
intrapartum fetal hypoxia;
29. Role of the anaesthetist in the management of
fetal compromise during labour;
30. Medico-legal issues with CTG;
31.
Ensuring competency in intrapartum fetal monitoring: the role of BIMS;
32.
Principles of Intrapartum Monitoring in Fetal Growth Restriction
33. CTG
Changes in Maternal COVID-19 Infection;
34. Physiology-based CTG training:
does it really matter?;
35. How to implement physiological CTG interpretation
in daily clinical practice?;
36. Scientific Evidence for Physiological
Interpretation of CTG;
37. An update on International Consensus Guidelines on
CTG Interpretation;
38. The use of CTG in Twins and Breech Labour;
39.
Addressing Human Factors contributing to CTG misinterpretation;
40. Risk
Management and Root Cause Analysis after hypoxic-ischaemic brain injuries;
41. Intrapartum Fetal Heart Rate Monitoring: Quo Vadis?.
Edwin Chandraharan is Director of the Global Academy of Medical Education & Training, London, UK. He has conducted more than 150 Physiological CTG Masterclasses in over 20 countries and pioneered physiological interpretation of CTG in 2006.
