During pregnancy, you have to go through many different studies. Some of them are unusual and new, moreover, are carried out at different periods of bearing the baby. But the main goal of any diagnosis is to monitor the health of the mother and her baby. Particular attention is paid to these points during the beginning of labor. Thanks to modern technology, it is possible to take a photo during an ultrasound; on CTG, contractions are recorded on tape paper in the form of a diagram. The specialist easily decrypts the information received and can timely respond to any changes that occur at this moment.
Real fights
False and true contractions may occur during pregnancy. There are several ways to determine what a woman actually experiences. Brexton-Hicks contractions (training) occur at the beginning of the third trimester and indicate that in this way the body begins to prepare for the upcoming labor. A pregnant woman can feel her stomach tense at times, while the cramps are painless or cause minor discomfort. Everything comes back to normal after taking a warm bath or shower, antispasmodics, such as No-shpa, Papaverin, rest / sleep.
Starting from the 32nd week of pregnancy, a woman can be sent for CTG. What do training fights look like on decoding readings? Uterine contractions are poorly expressed, doctors note this fact, studying digital indicators. On the tape, the reduction rate will be below 110 beats per minute. At the same time, a pregnant woman may note that her baby shows increased activity.
How to understand that childbirth has begun?
The onset of labor does not immediately become intense and painful. Many women do sleep peacefully during the first phase of the opening of the cervix. If a pregnant woman is under the supervision of a doctor before giving birth, then how the contractions look at CTG, she can see it with her own eyes more than once. The women who arrived at the maternity hospital or perinatal center in the second or third phase, as a rule, no longer pay attention to the sensor, which can be urgently connected to it. Contractions at this stage become frequent, regular and painful. No painkillers help and even a warm shower saves only for a while. These are true fights.
Why do I need to control the intensity of uterine contractions
The baby advances to the birth canal and its movements coincide with the contractions of the muscles of the uterus. What does CTG look like during fights and why is this measurement taken? The main task is to follow the fetal heartbeat. During the fight, the intensity of the heartbeat increases, which indicates that the process goes naturally. But it is only necessary for the sensor to record a decrease in heart rate, as for the doctor this serves as an urgent signal for taking urgent measures. If the situation is not corrected, then the question may arise about the emergency conduct of cesarean section.
What is CTG?
Cardiotocograph refers to ultrasound methods. The results of his research are lined up in a graphic image that is displayed on a paper tape. The method is completely painless, easy to use and extremely informative. Doctors resort to it, not only during the prenatal diagnosis of the state of the mother and child, but also in the period when the woman began real contractions. At CTG, the tape is divided into two halves:
- In its upper part, the number of beats of the fetal heart per minute is recorded.
- At the bottom, contractions are displayed. If the uterus is at rest, it is kept within the lower border. As soon as the uterus contracts, the curve rises.
According to the results of cardiotocography, the doctor can also diagnose signs of fetal asphyxiation, deviations in terms of neurology, heart function or cord entanglement.
How is
Measurement is carried out when a woman lies on her side or back. She should take a comfortable pose, otherwise the information received may be distorted. In the first phase of labor, when the frequency and intensity of the contractions still do not cause severe discomfort, the mother in labor is asked to press the cardiotocograph button while the baby is moving. For the doctor, the obtained indicators are very important, since he can assess the situation regarding the well-being of the child at the moment.
A sensor is attached to the stomach of a pregnant doctor or nurse, fixed to the body with a belt. The device sends ultrasonic waves that make the way to the baby’s heart and back. In addition, the strain gauge determines the frequency of contractions of the uterus (frequency and duration of labor). Inside the cardiotocograph, the data obtained is combined, which is displayed as a graph on the tape.
Doctors use special terms - a histogram and a tachogram. Below you can see a photo of how the contractions on the CTG look.
The second part of the graph displays an image of the fetal heart rate. At the same time, the number of beats per minute is visible on the ordinate axis, and per second (minute) on the abscissa axis. If the curve “went” up, then the baby’s heart began to beat harder, if it went down, it means that the heartbeat slowed down. Modern and more advanced models allow us to determine the motor activity of the child inside the womb.
Types of cardiotocographs
Depending on the integrity of the placenta, it is customary to distinguish between two types of CTG. How do contractions look at different stages of childbirth or in a situation when they are of a training nature? This issue should concern the medical staff more than the pregnant. However, it will be useful to understand what the essence of the study is and why it is assigned. In fact, everything is quite simple and understandable, so you can figure it out once, more for personal development.
If the integrity of the fetal bladder is damaged by a doctor, internal cardiotocography can be used. The doctor inserts a spiral needle electrode into the area of the presentation of the fetus and fixes the heartbeat. The intensity of contractions is determined using a special sensor, which is introduced into the body of the uterus. Thus, the doctor can obtain information regarding the state of intrauterine pressure.
If the fetal bladder is intact, then the sensor is attached externally. To obtain more accurate data, the obstetrician determines the source of the clearest fetal heartbeat signal. A strain gauge is attached to the bottom of the uterus.
Study duration
When conducting a prenatal diagnosis of a pregnant woman, it is recommended to undergo a cardiotocographic study, starting from the third trimester. Its duration is from 30 minutes to an hour. It happens that CTG shows contractions, which for a woman pass unnoticed. As a rule, they are rare and short-lived. More reminiscent of tone than true contractions. If a woman feels well during pregnancy, does not have a history of gestosis, pathologies, or other diseases that may affect the fetal health, then the effectiveness is very high. According to medical statistics, 95% of the 100 that the information received will show the true picture of the baby's well-being.
What is the norm
To know what the indicators should be within the normal range, it is necessary for the doctor to be able to give an objective interpretation of the received data. On the tape you can see not only what the contractions look like on CTG, but also the presence of deviations in the baby’s health status. What does the doctor pay attention to:
- Deceleration or reduction in heart rate. Their depth in the norm does not exceed fifteen beats per minute. A healthy heart should not have slow decelerations.
- The heart rate ranges from 100 to 160 per minute, if the baby is awake and active - 130-190. Deviations in heart rate variability from 5 to 25 beats per minute are allowed, normally it should be even. Within half an hour, the number of fetal movements should be at least two.
- A tokogram (uterine body activity) is evaluated along with the baby’s heart rate (HR). As a guide, a time period of 30 seconds is taken, which is evaluated by a doctor. The tokogram should normally not exceed heart rate by more than 15%.
Scores
During cardiotocography, each indicator of the condition of the fetus and uterus gets its own score in points (Fisher method). If the indicators are listed on the lower border, then for each point 1 point is assigned. Within the average value - 2 points. Three points for each indicator are put in case of exceeding the standards or fixing indicators on the upper boundary.
As a result, a set of 9 to 12 points is considered the norm, the doctor diagnoses that the baby feels well and is not in danger of his health. As a rule, doctors do not focus on each of these points, since they are not always easy to understand the first time. It is not at all necessary to know what the contractions look like on CTG. According to the results of the study, the doctor can state this fact without a visual demonstration of this phenomenon on the tape.
If a pregnant woman is given 6-8 points, then, most likely, the baby has signs of developing hypoxia. In the case of training contractions, when the birth is not soon, the woman may be prescribed therapy and recommendations regarding the increase of walks in the fresh air. To monitor the health of the baby and cases of recurrence of training contractions, a second CTG is prescribed in a few days. The most unfavorable result is less than 5 points. If such a diagnosis is made at a time when the start of labor is still a long way off, or at the first or second stage of labor, a cesarean section may be recommended.
PSP and FIGO
It is important to understand that the essence of the study is not only to find out whether CTG shows contractions, but also to establish the pathology or signs of its development in the fetus in time. There are two more criteria for evaluating how the baby feels inside the womb:
- PSP - an indicator of the condition of the fetus. A value of less than 1 is considered normal, which indicates the well-being and health of the child. If the numbers are from 1.1 to 2, then for the doctor it is a signal that changes in the baby's body begin to occur that can be affected. You can eliminate them with completely affordable medicines, vitamins. You should be wary if the indicators are from 2.1 to 3, which indicates that the child is experiencing severe discomfort. Perhaps the point is entangling the umbilical cord, the presence of an intrauterine infection. An unconditional reason for hospitalization, when PSP is more than 3, emergency cesarean is indicated.
- The FIGO assessment method is more common in Europe and much less in Russia. Despite this, its results are more understandable. For those who want to know how to determine the contractions and not only by CTG, there are three criteria for the condition of the fetus: normal, doubtful, pathology.
How safe is CTG?
Doctors say that this research method is absolutely safe for both the mother and the fetus. Nevertheless, some try to get information in advance about what it is and how contractions look at CTG. A photo usually does not provide as much information as the reviews of experienced mothers. First of all, it is worth listening to your feelings, changes in the behavior of the baby. Most pregnant women do not attach importance to the fact that at times the uterus begins to stone and at the same time grabs the lower back. These are training fights. Cardiotocography allows you to record not only the fight, but also how the child feels at this time. This is the most important indicator that describes the importance and feasibility of CTG. In this case, the body experiences less stress than with conventional ultrasound.
CTG for a period of more than 40 weeks
Women who delay pregnancy are more likely than others to visit the cardiotocography room. This is a mandatory procedure for monitoring the health of the baby and the ability to determine the onset of labor. An experienced doctor knows what contractions look like on CTG before delivery and can respond in a timely manner by sending a woman in labor at the maternity ward or, if she is already under supervision, in the prenatal ward.
Conducting research at this time allows you to plan delivery tactics. In particular, the issue of the need for additional stimulation is being addressed.