CARDIOTOCOGRAPHY – ITS ACHIEVEMENTS AND PREDICTABILITY

Abstract

Prikazan je razvoj kardiotokografije, njeni indeksi, karakterizacija normalnih, suspektnih i patoloških zapisa te preporuke FIGO-a, RCOG-a i DGGG-a. Kardiotokografija, točnije gubitak varijabilnosti i pojava kasnih usporenja, odnosno suspektni i patološki zapis, znakovito su povezani s fetalnom asfiksijom, acidozom, hipoksično-ishemičnom encefalopatijom i kasnijim neurorazvojnim poremetnjama djeteta. Gubitak varijabilnosti i/ili kasne deceleracije rezultiraju u 33% do 75% trudnoća do neonatalne depresije, acidoze ili hipoksično-ishemične encefalopatije. Nažalost CTG zapisi mogu biti lažno pozitivni u 25% do 50% rodilja, a lažno negativni zapisi se mogu naći u oko 10% rodilja. U suspektnim, a i patološkim CTG zapisima je prije odluke o operativnom dovršenju poroda potrebna provjera acidobaznog stanja fetusa, a u trudnoći doplerska analiza fetalnog krvotoka. Sugerira se donošenje preporuka-smjernica za uporabu kardiotokografije u Hrvatskoj i za vrjednovanje CTG zapisa.The development of cardiotocography, its scores, the characterization of normal, suspect and pathologic patterns and the recommendations of FIGO, RCOG and DGGG are presented. Cardiotocography, more precisely the loss of variability and the onset of late decelerations, i.e. the suspicious and pathologic patterns are significantly related to fetal asphyxia, acidosis, hypoxic-ishaemic encephalopathy and to late neurodevelopmental disorders of the child. The loss of variability and/or late decelerations in 33% to 75% pregnancies result to neonatal depression, acidosis or hypoxic-ishemic encephalopathy. Regretfully the CTG patterns may be false positive in 25–50% and false negative patterns may be established in around 10% of deliveries. In cases of suspect patterns, but in the pathologic patterns too, before the decision for operative child delivery the fetal blood sampling and the establishment of fetal acid-base status should be done; during pregnancy the Doppler analysis of fetal blood flow should be done. The elaboration of recommendations and guidelines in Croatia for the use of cardiotocography and for evaluation of CTG patterns is recommended