Intrapartum Fetal Monitoring: CTG Interpretation, Decelerations, Sinusoidal Pattern & Complete Management Guide 2025
About this video
Below are **30 detailed intrapartum fetal monitoring case scenarios with complete management**, written in **NEET PG / INI-CET exam style**.
Each scenario includes **clinical context → CTG finding → diagnosis → step-wise management**.
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# ✅ **30 CASE SCENARIOS WITH DETAILED MANAGEMENT (Intrapartum Fetal Monitoring)**
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## **1️⃣ Case — Late Decelerations in a Preeclamptic Mother**
A 25-year-old primigravida, 4 cm dilated, on oxytocin. CTG shows **recurrent late decelerations**, baseline 150, variability <5 bpm.
### **Diagnosis**
Uteroplacental insufficiency from **preeclampsia + hyperstimulation**.
### **Management**
1. Stop oxytocin
2. Left lateral position
3. IV fluids
4. If contraction frequency >5/10 min → **tocolysis (terbutaline 0.25 mg SC)**
5. If no improvement → **FBS**
6. If pH <7.20 or tracing deteriorates → **Emergency LSCS**
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## **2️⃣ Case — Variable Decelerations with Oligohydramnios**
G2P1, term labor, CTG shows **variable decelerations with shoulders**, adequate variability.
### **Diagnosis**
Cord compression due to oligohydramnios.
### **Management**
1. Maternal repositioning
2. Amnioinfusion
3. Continue labor if variability normal
4. If severe recurrent variables + loss of variability → expedite delivery
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## **3️⃣ Case — Sinusoidal Pattern**
Rh-negative woman, fetus 38 weeks. CTG: **true sinusoidal pattern**.
### **Diagnosis**
Severe fetal anemia.
### **Management**
1. Immediate evaluation (Kleihauer test, ultrasound MCA Doppler if time permits)
2. **Emergency LSCS**
3. Prepare NICU for transfusion
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## **4️⃣ Case — Prolonged Deceleration from Cord Prolapse**
During vaginal exam, a loop of cord felt. CTG shows **bradycardia at 80 bpm** for 4 minutes.
### **Management**
1. Lift presenting part manually
2. Knee–chest position
3. Call for emergency LSCS
4. Warm sterile saline-soaked gauze to prevent vasospasm
5. Deliver within **<30 minutes**
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## **5️⃣ Case — Tachysystole-Induced Late Decelerations**
Oxytocin infusion running, contractions 6/10 min. CTG: recurrent late decels.
### **Management**
1. Stop oxytocin immediately
2. Terbutaline 0.25 mg SC
3. Lateral position
4. Reassess
5. If persists → expedite delivery
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## **6️⃣ Case — Minimal Variability for 50 Minutes**
Primigravida in active labor. CTG: baseline 140, variability <5 bpm for 50 min, no decels.
### **Diagnosis**
Non-reassuring CTG, possibly fetal sleep or medication effect.
### **Management**
1. Scalp stimulation
2. If acceleration present → reassuring
3. If absent → FBS or continuous monitoring
4. Continue labor if other parameters normal
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## **7️⃣ Case — Meconium-Stained Liquor with Abnormal CTG**
Thick meconium + variable decels + reduced variability.
### **Management**
1. Intrauterine resuscitation
2. Amnioinfusion (if available)
3. Prepare for operative delivery
4. NICU standby for Meconium Aspiration Syndrome
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## **8️⃣ Case — Prolonged Deceleration After Epidural**
Immediately after epidural, FHR drops to 90 bpm for 3 minutes.
### **Diagnosis**
Maternal hypotension causing decreased uteroplacental flow.
### **Management**
1. Left lateral position
2. IV fluid bolus
3. Vasopressor (phenylephrine preferred)
4. If persists beyond 5 minutes → consider LSCS
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## **9️⃣ Case — Fetal Tachycardia with Maternal Fever**
CTG shows FHR 180 bpm, moderate variability; maternal temp 101°F.
### **Diagnosis**
Chorioamnionitis.
### **Management**
1. Broad-spectrum antibiotics
2. Acetaminophen
3. Expedite delivery (not LSCS solely for fever)
4. Avoid prolonged labor
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## **🔟 Case — Arrest of Descent + Late Decelerations**
Second stage, fully dilated, prolonged pushing, late decels appear.
### **Management**
1. Check for instrumental eligibility
2. **Forceps or vacuum** if head low
3. If not eligible → emergency LSCS
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## **1️⃣1️⃣ Case — Recurrent Severe Variable Decelerations**
CTG: variable decels dropping to 70 bpm for 60–90 sec.
### **Management**
1. Lateral positioning
2. Amnioinfusion
3. Reduce contractions if tachysystole
4. If persistent → operative delivery
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## **1️⃣2️⃣ Case — Fetal Scalp pH Borderline**
FBS pH = 7.22.
### **Management**
1. Correct reversible causes
2. Repeat FBS in 30 min
3. If worsens → expedite delivery
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## **1️⃣3️⃣ Case — Loss of Variability with Bradycardia**
Baseline 90 bpm, absent variability.
### **Diagnosis**
Advanced fetal hypoxia.
### **Management**
1. Immediate decision for LSCS
2. No role of waiting or FBS
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## **1️⃣4️⃣ Case — CTG Unable to Trace Due to Obesity**
During labor, external CTG poor quality.
### **Management**
1. Switch to **fetal scalp electrode (FSE)**
2. Use IUPC for contraction monitoring
3. Continue labor normally if FHR normal
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## **1️⃣5️⃣ Case — Category III CTG in Trial of Labor After Cesarean (TOLAC)**
Late decels + minimal variability + scar tenderness.
### **Diagnosis**
Scar rupture suspected.
### **Management**
1. Immediate emergency LSCS
2. Do NOT attempt instrumental delivery
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## **1️⃣6️⃣ Case — Hyperstimulation Causing Decelerations**
Misoprostol induction; CTG shows tachysystole + decels.
### **Management**
1. Stop prostaglandin
2. Tocolysis
3. Continuous monitoring
4. If fetal distress → emergency delivery
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## **1️⃣7️⃣ Case — True Sinusoidal Pattern from Fetomaternal Hemorrhage**
CTG sinusoidal; Kleihauer test positive.
### **Management**
1. Emergency delivery
2. Neonatal transfusion preparation
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## **1️⃣8️⃣ Case — Prolonged Decel During Second Stage**
Mother pushing vigorously; CTG shows bradycardia.
### **Management**
1. Stop pushing
2. Reassess for instrument delivery
3. If head + station → vacuum/forceps
4. Otherwise → LSCS
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## **1️⃣9️⃣ Case — Mild Variable Decelerations with Normal Variability**
Intermittent variables, contraction-associated.
### **Management**
1. Reassurance
2. Continue monitoring
No intervention required.
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## **2️⃣0️⃣ Case — Shoulder Dystocia + Bradycardia**
Delivery nearly complete, FHR falls to 70 bpm.
### **Management**
1. McRoberts + suprapubic pressure
2. Deliver shoulders quickly
3. Neonatal resuscitation readiness
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## **2️⃣1️⃣ Case — Cord Around Neck Detected on Ultrasound Before Labor**
During labor → variable decels appear.
### **Management**
1. Continue monitoring
2. If severe or persistent → expedite delivery
3. Do not intervene solely for nuchal cord
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## **2️⃣2️⃣ Case — Prolapsed Cord in Breech**
CTG severe bradycardia.
### **Management**
1. Knee–chest position
2. Manual elevation of presenting part
3. Emergency LSCS
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## **2️⃣3️⃣ Case — Minimal Variability from Opioid Analgesia**
Given pethidine 15 min ago; variability <5.
### **Management**
1. Observe for 30–60 min
2. If variability recovers → continue
3. If not → evaluate for fetal hypoxia
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## **2️⃣4️⃣ Case — Reassuring CTG in Low-Risk Labor**
Baseline 140, variability 10, accelerations present.
### **Management**
Continue routine monitoring.
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## **2️⃣5️⃣ Case — Excessive Maternal Dehydration**
CTG shows fetal tachycardia 170 bpm.
### **Management**
1. IV fluid bolus
2. Assess maternal vitals
3. Continue monitoring
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## **2️⃣6️⃣ Case — Placental Abruption Suspected**
Pain + bleeding + fetal tachycardia → later bradycardia.
### **Management**
1. Stabilize mother
2. Immediate LSCS if fetus alive
3. Vaginal delivery only if imminent
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## **2️⃣7️⃣ Case — IUGR Baby with Recurrent Late Decelerations**
CTG: late decels + reduced variability.
### **Management**
1. Intrauterine resuscitation
2. No role for prolonged labor
3. **Expedite delivery**
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## **2️⃣8️⃣ Case — Maternal Seizure (Eclampsia)**
CTG: prolonged decel.
### **Management**
1. Stabilize mother (MgSO₄, airway)
2. Left lateral position
3. If fetal recovery absent → LSCS
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## **2️⃣9️⃣ Case — Vaginal Birth After Multiple Variables**
CTG mostly reassuring except mild variables.
### **Management**
1. Continue monitoring
2. Check for cord issues
3. No intervention unless severe
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## **3️⃣0️⃣ Case — Failure of Fetal Response to Scalp Stimulation**
Minimal variability, no acceleration after stimulation.
### **Diagnosis**
Hypoxia suspected.
### **Management**
1. FBS if available
2. If pH abnormal → immediate delivery
3. If not available → treat as pathological CTG → expedite delivery
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