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CTG cardiotocography trace image for teaching beginners interpret

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I have a real textbook CTG image with 5 different patterns. Here is your self-test!

CTG Self-Test - Beginner Level

Here is a real CTG trace from Tintinalli's Emergency Medicine showing 5 different patterns (A to E). Each panel shows the fetal heart rate (top) and uterine contractions (bottom).

Your Questions

Look at each panel and answer before reading the explanation below:

1. Panel A - What do you notice about the fetal heart rate tracing? Is this reassuring or concerning?

2. Panel B - There is a brief rise in the fetal heart rate visible. What is this called, and what does it tell you?

3. Panel C - The fetal heart tracing is described as "flat." What does this mean, and what might cause it?

4. Panel D - The fetal heart rate shows sudden sharp dips. What type of deceleration is this, and what is the likely cause?

5. Panel E - The heart rate dips are labeled. Look at their timing relative to the contractions. What type is this, and why is it dangerous?

Answers (read after you've tried!)

Panel	Pattern	What it means
A	Good variability	The FHR wiggles continuously around the baseline (~120-160 bpm). This is reassuring - it shows an intact fetal autonomic nervous system.
B	Accelerations	Brief rises of FHR above baseline. Reactive = at least 2 accelerations of ≥15 bpm lasting ≥15 seconds. This is the most reassuring CTG feature.
C	Poor / absent variability (flat trace)	The FHR is suspiciously smooth with very little beat-to-beat variation. May indicate fetal hypoxia, deep sleep, or drug effect. Concerning.
D	Variable decelerations	Abrupt, unpredictable dips with no fixed relationship to contractions. Caused by cord compression - the cord is being intermittently squeezed.
E	Late decelerations	Dips that start after the contraction begins and recover slowly after it ends. Caused by uteroplacental insufficiency - the placenta can't deliver enough oxygen during contractions. This is the most sinister pattern.

Key Beginner Framework (remember these 4 features)

Feature	Normal	Concerning
Baseline rate	110-160 bpm	<110 (bradycardia) or >160 (tachycardia)
Variability	Moderate (6-25 bpm fluctuation)	Absent/minimal (<5 bpm)
Accelerations	Present (reactive)	Absent for >40 min
Decelerations	Early decs (benign)	Late or prolonged variable decs

Source: Tintinalli's Emergency Medicine, Fig. 101-1
Source: Textbook of Family Medicine 9e, Chapter 20

Want to move on to the next level - interpreting FIGO categories (I/II/III) or case-based scenarios with management decisions?

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