Analysis of All 7 Pictures (CTG + USG Pairs)

Picture 6 (Рic 10 / Pic 6)

USG Findings

• Single intrauterine gestational sac
• Well-formed round structure, echogenic ring
• No free fluid, no adnexal mass visible

CTG Findings

• Baseline FHR = 140 bpm (labeled directly on trace)
• Variability: moderate (normal 6-25 bpm amplitude oscillations visible)
• Accelerations: present
• Decelerations: none seen
• Uterine contractions (lower channel): mild, regular

Diagnosis: Normal reactive CTG with normal intrauterine pregnancy

The FHR of 140 bpm is within the normal range of 110-160 bpm. Moderate variability with accelerations = Category I (reassuring) trace. USG confirms a normal intrauterine pregnancy.

Picture 01 (Рicture 01)

USG Findings (Doppler USG - MC Tomograph)

• PS: 26.92 cm/s
• ED: 12.80 cm/s
• RI: 0.55
• PI: 0.75
• TAmax: 19.55 cm/s
• NCC: 145.08 bpm
• EDPS: 0.45

CTG Findings

• Upper strip: Baseline ~140 bpm, moderate variability, accelerations present - reactive
• Lower strip (with large decelerations visible): Baseline ~140 bpm, but with large, deep, abrupt drops to ~80-100 bpm - these have an abrupt onset and variable timing relative to contractions = variable decelerations (Type III)

Diagnosis: Variable decelerations on CTG with normal Doppler indices

Variable decelerations suggest intermittent umbilical cord compression. The normal Doppler RI is reassuring, but cord surveillance is warranted. This is a Category II (indeterminate) trace requiring close monitoring.

Picture V2 (Страница 4 из 9)

USG Findings (Medison machine, 2nd trimester)

CTG Findings (Sonicaid Huntleigh, pages 4 of 9)

• Recording time: 27.12.2017, from 9:38 to 9:58
• Baseline FHR: approximately 130-140 bpm
• Variability: moderate to good - normal oscillations visible
• Accelerations: present (clearly visible peaks rising above baseline)
• Contractions (Toco channel): mild, irregular uterine activity
• No significant decelerations

Diagnosis: Reactive (normal) CTG - Category I

Good baseline rate, moderate variability, accelerations present, no decelerations. USG confirms 2nd trimester viable pregnancy with normal umbilical Doppler. This is a normal antepartum surveillance trace.

Picture 3 (Страница 5 из 9)

USG Findings (Medison, 2nd trimester)

CTG Findings (Sonicaid Huntleigh, pages 5 of 9)

• Recording: 27.12.2017, 10:08-10:28
• This is the most pathological trace in this series
• Baseline FHR: starts ~140 bpm but:
  • Prolonged episode of bradycardia visible - FHR dropping to ~80-100 bpm for an extended period
  • Deep, wide drops in FHR
  • Severely reduced variability during decelerations
• Toco channel: shows regular, strong uterine contractions
• The FHR drops coincide with and follow uterine contractions = LATE DECELERATIONS pattern with reduced variability

Diagnosis: Non-reassuring CTG - Category III (pathological)

Recurrent late decelerations with reduced variability indicate uteroplacental insufficiency and fetal hypoxia. This is an ominous pattern. Late decelerations with decreased variability represent prolonged asphyxia. Immediate obstetric review required. (Morgan & Mikhail, Clinical Anesthesiology 7e, p.1653)

Picture V5

USG Findings (Samsung machine)

• Placenta appears low-lying / covering the internal os
• No clear fetal head deep in the pelvis - presenting part appears high
• This appearance is consistent with placenta previa

CTG Findings

• Both strips: Baseline ~100-120 bpm (slightly low-normal to borderline)
• Variability: reduced/minimal - the oscillations are shallow
• No clear accelerations
• Large sinusoidal-like oscillations in one strip (slow, regular waves of ~10-15 bpm amplitude) - possible sinusoidal pattern
• The lower strip shows a baseline that dips and recovers in a wave-like fashion

Diagnosis: Placenta previa with non-reassuring CTG (possible sinusoidal pattern)

The USG appearance of a low placenta covering the os is consistent with placenta previa. The CTG shows reduced variability with possible sinusoidal pattern, which - per textbook - "is associated with fetal depression (hypoxia, drugs, and anemia secondary to Rh isoimmunization)" and represents a Category III abnormal pattern. In the context of placenta previa, fetal anemia from chronic blood loss is the likely cause of the sinusoidal CTG.

Picture 09 (Рic 09)

USG Findings (Medison machine)

• Плюк (fluid): 2.59 cm
• Ср.бер (average gestation): 17н2д±19а (approximately 17 weeks 2 days ± 19 days)
• Локіть (elbow): 2.11 cm
• ОАР: 09-09-2014
• Прошитий: 44.39 (?)
• ОАР: 15-09-2014

CTG Findings

• Upper trace (Fetal heart rate): Baseline ~130-150 bpm, moderate variability, with normal accelerations - reactive pattern
• Lower trace (Contraction of uterus): Shows regular uterine contractions with appropriate spacing
• The FHR accelerations correspond to fetal movements - reactive NST

Diagnosis: Normal reactive CTG (Category I) in a ~17-week pregnancy

Normal FHR with accelerations and good variability. The uterine contractions channel shows mild activity (possibly Braxton Hicks). USG shows a viable second trimester fetus. Overall this is a reassuring trace.

Summary Table

Key CTG Classification (per Morgan & Mikhail's Clinical Anesthesiology 7e, p.1652)

• Category I (Normal): Baseline 110-160 bpm, moderate variability, accelerations present, no late/variable decelerations
• Category II (Indeterminate): Does not predict abnormal acid-base status but needs monitoring
• Category III (Abnormal): Absent variability + recurrent late/variable decelerations, bradycardia, or sinusoidal pattern - predicts abnormal fetal acid-base status, requires prompt delivery planning

Clinical note: This analysis is for educational/examination purposes. All CTG traces with Category II-III features require correlation with clinical history, gestational age, and real-time obstetric assessment by a qualified clinician.