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fetal ctg : tachycardia, bradycardia, decelerations,  low variability : all signs of fetal distress
fetal assessment may be needed for women with: previous stillbirth, neonatal death, diabetes, hypertension. women can also develop reduced fetal movement, interuterine growth restriction, hypertension during pregnancy which also may require fetal monitoring.
(fetal monitoring in practice, Gibb & Arulkumaran, 2008.

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If the woman reports reduced or absent fetal movements.
Before and after an external cephalic version for breech.
CTG is recommended twice weekly for gestations >42 weeks and induction of labour has been declined.

If any of these risk factors are present or arise during labour:
oxytocin use,
presence of significant meconium,
suspected chorioamnionitis or sepsis,
temperature ≥ 38°C,
severe hypertension 160/110 mmHg or above,
fresh intrapartum vaginal bleeding.

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Decelerations heard during intermittent auscultation for an otherwise low risk labour.
Known fetal abnormality.
Prior to and post prostin/propess.

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Group 1.Maternal : APH to assess condition of fetus. Fetal: Reduced fetal movements to assess fetus on Dawes Redman. Conraindications: There should always be a reason for doing the CTG for example for fetal well being

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Group 1.Maternal : APH to assess condition of fetus. Fetal: Reduced fetal movements to assess fetus on Dawes Redman. Conraindications: There should always be a reason for doing the CTG for example for fetal well being

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Indications from fetus:
IUGR.
Prematurity.
Bradycardia.
Tachycardia.
Decelerations.
Reduced/ no movements.
Baby who has experienced ECV.

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NICE recommends continous intrapartum CTG monitoring for maternal pyrexia >38C

NICE also recommends continous CTG for at least 30mins during establishment of PCEA  and after administration of each bolus of 10mls or more.

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-Fresh vaginal bleeding that has began in labour
-Oxytocin use (NICE 2014)

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Any indication of diminished movement - reported by mum, due to position of placenta, e.g placenta previa, also placenta at front of uterus. CTG to record fetal movements and HR.

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Any indication of diminished movement - reported by mum, due to position of placenta, e.g placenta previa, also placenta at front of uterus. CTG to record fetal movements and HR.

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Small for dates babies.
Low levels of amniotic fluid noted in scan.
Indications of pre-eclampsia.
Any sever pain/ illness in mother - e/g influenza (swine flu) or another illness, gall stones/ kidney stones.

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NICE Guidelines (2014):
If any one of the following risk factors is present or arises during labour:
* prolonged period since rupture of membranes (24 hours or more)
* moderate hypertension (150/100 to 159/109 mmHg)
* confirmed delay in the first or second stage of labour
* the presence of non-significant meconium.

Do not regard amniotomy alone for suspected delay in the established first stage of labour as an indication to start continuous cardiotocography.

NICE (2015) Fetal Monitoring During Labour. nice.org.uk [online] Available At: http://pathways.nice.org.uk/pathways/intrapartum-care/fetal-monitoring-during-labour#content=view-node%3Anodes-indications-for-continuous-cardiotocography-and-telemetry.

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Unforseen Indications for CTG:

Fresh vaginal bleeding during labour.
Augmentation of labour using oxytocin.
Maternal pyrexia >38C therefore suspected chorioamnionitis or sepsis
Severe hypertension >160/110mm Hg.
Any 2 or more of :
-confirmed delay in first or second stage.
-non significant meconium
-prolonged period since ROM (24 hours or more)
-moderate hypertension 150/100 to 159/109 mm Hg.

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-Infection or query infection
-Multiple pregnancy
-Over 24 hours since rupture or membranes

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suspected chorioamnionitis or sepsis, or a temperature of 38°C or above

severe hypertension (160/110 mmHg or above)

oxytocin use

the presence of significant meconium

fresh vaginal bleeding that develops in labour.

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suspected chorioamnionitis or sepsis, or a temperature of 38°C or above

severe hypertension (160/110 mmHg or above)

oxytocin use

the presence of significant meconium

fresh vaginal bleeding that develops in labour

(NICE Guidelines)

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Induction Of Labour:
> Ensure drugs given are working effectively
> Monitor uterine contractions
> Keep an eye out for fetal distress

Epidural:
> Continuous Monitoring of the neonate
> ensure no fetal distress
> Monitor uterine contractions and fetal movement
> Monitor Fetal heart Rate

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Maternal Indications for CTG:

VBAC - Continuous monitoring recommended (at the onset of regular uterine contractions) to assess for signs of uterine scar rupture.

Antepartum haemorrhage - CTG commenced to asses condition of the fetus and aid decision on mode and timing of delivery.