Cardiotocography/EFM Part II: Management

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Today we are back with our midwifery colleagues Linda Steinhardt and Liz Kettyle, who shepherd us through the management of cardiotocography in labor.

We start this episode by quickly reviewing definitions, and defining categories of tracings, reviewed below:

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Recall that category I tracings virtually exclude fetal acidemia, while category III tracings are associated with acidemia 25% of the time, but also have higher risk of cerebral palsy, neurologic injury, or fetal death. That said, the positive predictive value for bad outcomes of CTG is overall poor.

We review a number of scenarios and resuscitative measures for category II and III tracings. However, much of this episode draws on the 2013 Clark et al. article to describe the management of category II tracings. The algorithm is below:

Clark et al. (AJOG 2013)

Interpreting Cardiotocography/EFM Part I: Definitions

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Today we take a break from STIs to jump back into obstetrics, and are joined by two very special guests: Liz Kettyle and Linda Steinhardt, both of whom are certified nurse midwives (CNMs) and clinical educators at the Warren Alpert Brown School of Medicine.

ACOG PB 106 (membership required) forms the basis for this episode and in a future episode, we will discuss management of cardiotocography (CTG). Also, for a recent article surrounding the naming of CTG vs. EFM vs. all the other names for this technology, check out a recent AJOG article on its now 50-year history.

We also are using some special sound effects for these episodes! As you listen to the various sounds for different types of decelerations, keep in mind that the higher-pitched sound represents a contraction pattern, and the lower-pitched sound represents the fetal heart rate response.