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CTG cardiotocography interpretation fetal heart rate baseline variability accelerations decelerations
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CTG cardiotocography fetal heart rate tracing interpretation
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CTG suspicious pathological classification FIGO NICE guidelines management
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fetal heart rate prolonged deceleration variable deceleration sinusoidal pattern management
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Here is a detailed analysis of this CTG tracing.
CTG Analysis
Machine: Bistos BT-350L | Date/Time: 26/03/26 at 05:33 | Speed: 30 mm/min | Annotation: "Bustos / 5:45 A" (likely a clinician name and time note)
1. Baseline Fetal Heart Rate (FHR)
| Segment | Rate |
|---|---|
| Opening (left) | ~145–150 bpm |
| Middle (after drop) | ~120–125 bpm |
| Closing (right) | ~130–135 bpm |
The predominant baseline through most of the trace is approximately 130–145 bpm, which is within the normal range (110–160 bpm). There is a visible shift downward in the middle portion of the trace to ~120–125 bpm, still within normal limits.
2. Baseline Variability
Variability appears to be 5–10 bpm (moderate/normal) in most segments, though:
- The early left portion shows slightly reduced variability (appears narrower, ~3–5 bpm) — borderline.
- The right portion shows recovered moderate variability (~5–10 bpm) with good oscillations.
- The middle segment (after the large deceleration) briefly shows reduced variability, which is common in a post-deceleration recovery phase.
Normal variability = 5–25 bpm. Reduced = <5 bpm for ≥40 min is concerning.
3. Accelerations
There appear to be 1–2 possible accelerations visible on the left portion of the trace (mild transient rises above baseline). However, accelerations are not clearly prominent throughout this trace.
- Absence of clear accelerations over a 20–30 minute window would downgrade classification.
- In a non-stress context (antepartum), at least 2 accelerations of ≥15 bpm for ≥15 seconds within 20 minutes are required for a reactive trace.
This trace appears non-reactive or borderline reactive.
4. Decelerations — KEY FINDING
There is a large, prominent deceleration in the mid-trace:
| Feature | Description |
|---|---|
| Depth | ~50–60 bpm below baseline (drops from ~160 bpm to ~100 bpm) |
| Duration | ~1–2 minutes |
| Shape | Appears sharp descent with relatively rapid recovery |
| Timing | Not clearly associated with a visible uterine contraction (UC: X — no UC monitoring active) |
Classification of this deceleration:
- The sharp, abrupt onset and shape suggests a variable deceleration (cord compression pattern).
- Depth >60 bpm and/or duration >60 seconds = prolonged/severe variable deceleration — a concerning (amber/red) feature.
- Without uterine contraction data (UC is marked "X" = not recorded), late vs. variable distinction cannot be fully confirmed, but morphology favors variable.
There are also smaller dips visible throughout the trace (2–3 minor decelerations on the left side), which may represent mild variable decelerations.
5. Uterine Contractions
UC: X — uterine contraction monitoring is not active/recorded on this trace. This is a significant limitation:
- Cannot classify decelerations as early, late, or variable with full confidence.
- Relationship of FHR changes to contractions is unknown.
6. Overall Classification (FIGO 2015 / NICE NG229)
| Feature | Finding | Classification |
|---|---|---|
| Baseline FHR | 130–145 bpm | Normal |
| Variability | ~5–10 bpm (borderline in segments) | Normal / borderline |
| Accelerations | Absent or unclear | Suspicious |
| Decelerations | 1 large deceleration (severe variable pattern), minor dips | Pathological |
| UC monitoring | Not recorded | Limitation |
Overall: SUSPICIOUS to PATHOLOGICAL CTG
The presence of a severe/prolonged deceleration with absent clear accelerations and borderline variability in segments makes this trace at least suspicious, potentially pathological depending on clinical context.
7. Clinical Recommendations
- Review clinical context — gestational age, maternal position, recent events (cord prolapse risk, maternal hypotension, medications).
- Reattach uterine contraction (toco) monitor — essential for proper interpretation.
- Reposition mother (left lateral decubitus) — may relieve cord compression causing variable decelerations.
- IV fluids if maternal hypotension suspected.
- Escalate to senior obstetric review — a single severe deceleration without UC context on a borderline trace warrants prompt assessment.
- Continue monitoring — observe for recurrence of decelerations, recovery of variability, and emergence of accelerations.
- Consider fetal scalp electrode (FSE) if external monitoring quality is poor.
- Fetal blood sampling (FBS) or expedited delivery if features worsen or remain pathological.
Summary
This CTG shows a borderline-to-pathological pattern: normal baseline rate, borderline variability in parts, absent clear accelerations, and one large deceleration (likely severe variable) with minor additional dips. The absence of uterine contraction data is a major limitation. Urgent clinical correlation and senior review are warranted.
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