International expert consensus statement on physiological interpretation of cardiotocograph (CTG) : first revision (2024)
Chandraharan, Edwin Pereira, Susana Ghi, Tullio Perez-Bonfils, Anna Gracia Fieni, Stefania Jia, Yan-Ju Griffiths, Katherine Sukumaran, Suganya Ingram, Caron Reeves, Katharine
Chandraharan, Edwin
Pereira, Susana
Ghi, Tullio
Perez-Bonfils, Anna Gracia
Fieni, Stefania
Jia, Yan-Ju
Griffiths, Katherine
Sukumaran, Suganya
Ingram, Caron
Reeves, Katharine
Affiliation
Global Academy of Medical Education & Training, London; Barts Health NHS Trust, London; University of Parma, Italy; Germans Trias i Pujol, Barcelona, Spain; George Eliot Hospital NHS Trust, Nuneaton; et al.
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Publication date
2024-10-02
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Abstract
The first international consensus guideline on physiological interpretation of cardiotocograph (CTG) produced by 44 CTG experts from 14 countries was published in 2018. This guideline ensured a paradigm shift from classifying CTG by arbitrarily grouping certain features of the fetal heart rate into different "categories", and then, randomly combining them to arrive at an overall classification of CTG traces into "Normal, Suspicious and Pathological" (or Category I, II and III) to a classification which is based on the understanding of fetal pathophysiology. The guideline recommended the recognition of different types of fetal hypoxia, and the determination of features of fetal compensatory responses as well as decompensation to ongoing hypoxic stress on the CTG trace. Since its first publication in 2018, there have been several scientific publications relating physiological interpretation of CTG, especially relating to features indicative of autonomic instability due to hypoxic stress (i.e., the ZigZag pattern), and of fetal inflammation. Moreover, emerging evidence has suggested improvement in maternal and perinatal outcomes in maternity units which had implemented physiological interpretation of CTG. Therefore, the guideline on Physiological Interpretation of CTG has been revised to incorporate new scientific evidence, and the interpretation table has been expanded to include features of chorioamnionitis and relative utero-placental insufficiency of labour (RUPI-L).
Keywords: Cardiotocograph (CTG); Chorioamnionitis; Fetal heart rate cycling; How is THIS Fetus?; Relative utero-placental insufficiency of labour (RUP-L); Suggestive of Fetal Inflammation (SOFI); ZigZag Pattern.
Citation
Chandraharan E, Pereira S, Ghi T, Gracia Perez-Bonfils A, Fieni S, Jia YJ, Griffiths K, Sukumaran S, Ingram C, Reeves K, Bolten M, Loser K, Carreras E, Suy A, Garcia-Ruiz I, Galli L, Zaima A. International expert consensus statement on physiological interpretation of cardiotocograph (CTG): First revision (2024). Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:346-355. doi: 10.1016/j.ejogrb.2024.09.034. Epub 2024 Oct 2.
Type
Article