CTG non-stress test is positive what does it mean

Cardiotocography (CTG) is a prenatal diagnostic method that allows you to determine the condition of the fetus and how the uterus functions. In combination with ultrasound and Doppler ultrasound, cardiotocography allows you to effectively and quickly identify pregnancy pathologies and take the necessary measures to correct them.

As a rule, CTG is performed after 32 weeks. At this stage, the fetus already lives in a certain rhythm of sleep and activity, and the beating of its heart is clearly audible. However, sometimes cardiotocography is prescribed at earlier stages, since pathological rhythms can be determined after 20 weeks.

The most popular question related to this procedure, which is often asked by future parents, is what is the norm for CTG during pregnancy? Most often, pregnant women are sent for cardiotocography for the first time at 34 weeks (35 weeks). Women are very interested in what each word in conclusion means, how many points are considered normal and when to sound the alarm.

Informative indicators

When deciphering cardiotocography, the following rhythm indicators are taken into account:

• Basal (main) rhythm - it predominates on CTG. To evaluate it objectively, it is necessary to record for at least 20 minutes. We can say that the basal heart rate is an average value that reflects the fetal heart rate during the resting period.
• Variability (variability) is the dynamics of heart rate fluctuations relative to its average level (the difference between the main heart rate and rhythm fluctuations).
• Accelerations (acceleration of the heart rate) - this parameter is taken into account if within 10 seconds or more there are 15 beats more. On the graph they are represented by the tops facing up. As a rule, they appear during the baby’s movements, uterine contractions and functional tests. Normally, at least 2 accelerations of heart rate should occur in 10 minutes.
• Deceleration (slowing down the heart rate) - this parameter is taken into account in the same way as acceleration. On the graph these are the teeth looking down.

The duration of decelerations may vary:

• up to 30 seconds, followed by restoration of the fetal heartbeat;
• up to 60 seconds with high amplitude (up to 30–60 beats per minute);
• more than 60 seconds, with high vibration amplitude.

In addition, in conclusion there is always such a thing as signal loss. This happens when the sensors temporarily lose the sound of your baby's heartbeat. And also in the diagnostic process they talk about the reactivity index, which reflects the ability of the embryo to respond to irritating factors. In deciphering the results, the fetal reactivity index can be assigned a score ranging from 0 to 5 points.

The printout, which is handed to the pregnant woman, contains the following 8 parameters:

• Analysis time/signal loss.
• Basal heart rate.
• Accelerations.
• Decelerations.
• Variability.
• Sinusoidal rhythm/amplitude and oscillation frequency.
• STV.
• Frequency of movements.

With an absolute norm, 8 out of 8 parameters must be met. Depending on which parameters were not met, experts allow 7 out of 8 and 6 out of 8 parameters to be normal. However, in this case, it is impossible to do without repeating CTG. The cardiotocogram displays the heart rate range (two numbers are indicated).

During recording, a graph of two types of signal is displayed on the calibration tape

Why is fetal CTG performed in pregnant women?

What does CTG show? First of all, this type of study is carried out to obtain information about the fetal heart rate , the regularity of its cardiac activity, as well as active movements.

In addition, the information content of CTG is very important in determining the frequency of contractions of the smooth muscle cells of the uterus and the child’s reaction to these contractions.

Cardiotocography is an effective research method for excluding or timely identifying pathological conditions of the mother and child that pose a threat to the course of pregnancy and to the future health of the newborn baby, such as hypoxia, intrauterine infection of the fetus, polyhydramnios, oligohydramnios, congenital abnormal development of the cardiovascular system, fetoplacental insufficiency and threat of labor starting earlier than planned.

Evaluation points

In the process of developing cardiotocography, experts identified objective criteria for assessing recordings and compiled many tables. To interpret the results of CTG, several scales are used. Most often they resort to the Fisher scale (10 points) or Krebs scale (12 points). In conclusion, a double result may be indicated - a fischer and a krebs assessment.

Fisher criteria

The scoring chart, developed by an American obstetrician-gynecologist, presents a number of criteria that are scored from 0 to 2 points. The final score is determined by summing all grades. According to Fisher, specialists conduct “manual” calculations, focusing on what they see on the calibration tape.

Having assessed the criteria, there are 3 main conditions of the fetus:

• Normal indicators are 8–10 points. The baby's heart is beating well and he is moderately mobile, and there is absolutely no suspicion of oxygen starvation.
• Condition that raises doubts – 5–7 points. This result may indicate the initial stage of oxygen starvation and requires special monitoring of the pregnant woman.
• Poor fetal condition – 0–4 points. This indicates severe hypoxia. If urgent measures are not taken, the baby may die within a few hours.

If the CTG recording gives a result of 7 or 6 points, then repeat cardiotocography is prescribed within 12 hours, and if labor has begun, then after 1 hour. If the CTG record had a score of 8 or more points, then when labor begins, the procedure is repeated after 2-3 hours, and in earlier stages the pregnant woman is released for 3-7 days before a repeat CTG.

Krebs scale

This rating scale differs from the Fisher scale by one criterion - the number of motor reactions of the baby in 30 seconds: if they are completely absent, 0 points are given, from 1 to 4 motor reactions are scored 1 point, if there are 5 or more reactions in 30 seconds, then 2 are given. points.

In view of this criterion, the Krebs scale has a 12-point rating system. If the result on this scale was from 9 to 12 points, then future parents can be absolutely calm - the results are within the normal range. A score from 0 to 8 points is a reason to sound the alarm. With such results, they speak of the presence of a pathological intrauterine process.

If the CTG report contains 11 points, then there is no doubt that the Krebs scale was used when decoding. If the score is 9 points, then the result is considered good in any case. But if there was no note that the assessment was carried out according to Fisher, then you should still consult with a specialist.

Dawes-Redman tests

How to decipher fetal CTG?

These criteria are developed for automatic devices. The computer evaluates the recording without the participation of a diagnostician, but taking into account all the same parameters as in the “manual” method.

As a result, all significant CTG criteria are summed up and a special variability indicator is displayed - STV. This sensitive parameter can detect signs of fetal distress and predict adverse pregnancy outcomes.

According to Dawes-Redman, the following results are distinguished:

• normal indicators indicating a healthy pregnancy - STV 6–9 ms;
• borderline indicators that require specialist supervision - STV 3–5 ms;
• high risk of oxygen deficiency, requiring emergency measures - STV 2.6–3 ms;
• critical condition of the fetus, which in the coming hours may result in intrauterine death - STV less than 2.6 ms.

This assessment system is not practiced during labor, but is successfully used for monitoring during pregnancy. Typically, CTG is recorded every 2–3 weeks at 28–32 weeks and every 2 weeks at 32–37 weeks. And after 38 weeks they resort to CTG every 7 days.

Frankly bad and questionable CTG results can serve as a serious reason for an emergency cesarean section.

The leading obstetrician-gynecologist evaluates the results

CTG during pregnancy criteria are not met

Pregnancy is not a disease, however, it is a special period during which the condition of the woman and the little resident in her womb is monitored very closely. And that's great!

Timely tests, examinations and procedures allow you to monitor the course of pregnancy and promptly respond to negative deviations in it. They also allow doctors to prepare for childbirth if there is a possibility that it will be complicated.

Therefore, the expectant mother should not be annoyed if the doctor refers her to another procedure called “cardiotocography”.

What can a fetal CTG show during pregnancy?

Cardiotocography (CTG) is a diagnostic method for assessing the condition of the fetus during pregnancy and childbirth through the frequency of its heartbeat and its fluctuations at rest, activity, during contractions of the uterine muscles, and exposure to external stimuli.

CTG is prescribed, according to the Order of the Ministry of Health and Social Development of the Russian Federation, starting from the 28th week of pregnancy.

In fact, doctors rarely prescribe this examination before the 32nd week, believing that until this time CTG is not very informative. In total, during the third trimester, during a normal pregnancy, the woman will have to undergo two CTG.

If necessary, the doctor can prescribe a CTG procedure as often as he sees fit, even daily.

Indications for additional monitoring of fetal heart rate through CTG analysis are:

• unfavorable result of previous CTG;
• suspected pathology of fetal development;
• oligohydramnios or polyhydramnios;
• a decrease in the baby’s physical activity noted by the woman;
• threat of premature birth;
• post-term pregnancy;
• the presence of diseases in a pregnant woman such as: diabetes, hypertension, autoimmune diseases, infectious diseases, etc.;
• late toxicosis;
• Rh conflict between the blood of the expectant mother and the fetus;
• early aging of the placenta noted on ultrasound;
• pathological course of previous pregnancies and childbirths;
• entanglement of the fetus with the umbilical cord detected during ultrasound.

But the information obtained with the help of CTG allows us to identify and reduce the risk of intrauterine suffering in the baby.

The CTG procedure is carried out using a special device consisting of an ultrasound sensor and a strain gauge, which are attached to the woman’s abdomen and an electronic heart monitor system.

The latter receives data on fetal heartbeats and uterine contractions of a pregnant woman, processes them and displays the result on tape in the form of graphs. How to prepare for CTG during pregnancy?

CTG is a completely painless procedure, during which the expectant mother only needs to sit comfortably in a chair or on a couch and not make sudden movements so that the sensors do not slip off the tummy.

Requirements for the patient: remain calm while the cardiotocograph is operating, i.e. for approximately 30-60 minutes. The medical worker and the equipment will do the rest.

First, the midwife or doctor performing the procedure uses a regular ear stethoscope to determine the area on the woman's abdomen in which the fetal heartbeat can be heard most clearly.

At this site, treated with conductive gel, a sensor-electrode is installed and secured with a wide tape-belt, which picks up and amplifies signals about the movement of the fetal heart valves.

Based on the cardiac impulse signals, a graph is drawn showing changes in heart rate throughout the procedure.

At the same time, on the woman’s abdominal wall, just below the navel, in the area of ​​the fundus of the uterus, a pressure sensor (strain gauge) is fixed, which transmits data on the tone of the myometrium (uterine muscles).

The position of the woman during fetal CTG: usually reclining, sitting or lying on her side in a horizontal position, as desired.

Sometimes a situation arises when during the procedure the baby is fast asleep and the woman cannot detect movements. In such a situation, health workers recommend waking up the baby by touching the belly and stroking it. This is absolutely not worth doing.

Additional vibrations are reflected in the recording of the curve, and the device produces false results.

If not a single movement is recorded, you will have to undergo the procedure another day. But this rarely happens, because the baby’s intrauterine sleep is very short and tremors will still be recorded at the beginning of the procedure or at the end.

Determination of CTG, why this type of diagnosis is performed - you will learn about this from the video.

Cardiotocography began to gain popularity only in the last twenty years, when data on the condition of the fetus obtained from CTG began to be confirmed by data on the condition of the same babies after birth.

This happened due to improvements in the equipment developed for conducting the survey.

Currently, almost every antenatal clinic and pregnancy clinic, as well as maternity hospitals, are equipped with cardiotocographs.

The most simple CTG devices or fetal (fetal) monitors only provide data on the tape about the fetal heart rate, its motor activity and uterine contractions. Subsequently, the doctor interprets the graphic indicators and draws conclusions about the satisfactory condition of the baby. Such devices, so to speak, of the first level, are practically not used anymore.

Modern devices for CTG examinations, which are most widely in demand by medical institutions, are expert-level devices.

They are distinguished, firstly, by high power, and secondly by the most sensitive sensors and most accurate data display.

In addition, the devices are configured in such a way that the processing of output graph data occurs automatically. The doctor can only prescribe additional examinations or draw up the necessary treatment tactics, if required.

Recently, opportunities have emerged for monitoring fetal heart rate remotely. A sensor that picks up signals about the fetal heartbeat via a smartphone connected to the Internet sends data online to the portal, where it is analyzed and sent to the doctor as a result.

Indicator values ​​and norms: interpretation of analysis results

The purpose of the CTG procedure during pregnancy is to obtain quantitative and qualitative values ​​for certain indicators.

CTG norms during pregnancy are as follows:

• Basal fetal heart rate.

Represents the average baby's heart rate. A rate of 110 to 160 beats/min is considered normal.

In case of deviations from the normal basal rhythm, bradycardia is diagnosed if the heart rate is below 110 beats/min. or tachycardia if the heart rate is above 160 beats/min.

More serious deviations indicate possible fetal hypoxia, the presence of intrauterine infection, or umbilical cord entanglement.

The cause of abnormal indicators may be the effect of narcotic substances on the mother’s body, fever, or hormonal disorders in the expectant mother.

• Heart rate variability.

Demonstrates the number of deviations of the fetal heart rate from the basal rate in 1 minute. A variability of more than 6 per minute is considered a good indicator.

In practice, the amplitude of deviations in the number of heartbeats from the basal level per minute is more often assessed. It's good if it is 6-25 beats.

Low variability (less than 5 per minute), in which the graph resembles a straight line, is characterized as a monotonous rhythm of the fetal heartbeat and, in combination with bradycardia, almost certainly indicates intrauterine fetal suffering from hypoxia, or a disturbance in the functioning of the cardiovascular system.

Increased variability values ​​can also be caused by fetal hypoxia, as well as the influence of external stimuli on its nervous system, or the mother taking any drugs that increase heart rate.

The variability of the basal rhythm of the fetal heart rate on the graph in some cases is reflected as a sinusoidal curve. This picture emerges when the amplitude of deviations in the child’s heart rate rhythm is 5-15 beats/min, if the regularity of such deviations is 2-5 per minute.

The described phenomenon is called “sinusoidal rhythm” and in most cases is associated with severe fetal hypoxia, intrauterine anemia, etc..

Increased fetal heart rate compared to the basal rhythm.

If within 10 minutes at least two accelerations are detected, more than 15 beats per minute, lasting more than 15 seconds, then this indicator is counted as excellent.

Monotonous accelerations, especially in combination with pronounced tachycardia, give reason to suspect fetal hypoxia.

This is a decrease in the fetal heart rate compared to the basal rhythm.

Alarm should be caused by the occurrence of decreases of more than 15 beats/min. for more than 15 seconds.

This does not always mean pathology and requires consideration of such a phenomenon in conjunction with an assessment of uterine tone in this episode, as well as previous fetal activity.

The detection of obvious decelerations on the CTG graph indicates severe fetal hypoxia, impaired conductivity of the placenta and its functions.

• Number of fetal movements.

During CTG, the indicator of fetal movements is necessarily taken. The moment of movements is noted either by the expectant mother herself, squeezing a special device with her hand, or they are recorded automatically by monitor sensors.

An unfavorable sign is considered if, when an increase in heart rate is recorded, no movements of the baby in the womb are noted. Or, during movements, no response in the form of accelerations was detected.

If under such conditions there is no deterioration in heart function, then the CTG result is interpreted as favorable.

Otherwise, further measures must be taken.

The decoding of CTG is such that each of the indicators is assessed by the doctor on a point scale.

The Fisher scale is most often used to evaluate CTG. Depending on how close to ideal indicators a particular parameter recorded by a CTG sensor is, 0-2 points are given.

The total value of all points demonstrates the assessment of the child’s condition:

• a score from 8 to 10 is considered normal;
• A score of 5-7 points is a reason for repeat CTG and may indicate mild oxygen starvation of the fetus or an unfavorable condition of the placenta.

As a rule, a CTG score of 5-7 points may indicate incipient fetoplacental insufficiency;

• less than 5 points obtained from CTG results indicate the risk of intrauterine fetal death due to hypoxia;

After the first 10 minutes after the start of the examination, a decision may be made to terminate the CTG procedure, with a statement of the satisfactory condition of the fetus.

This conclusion is made in full compliance with the so-called Dawes-Redman criteria by the 10th minute of CTG , namely:

• no decelerations;
• maintaining the basal rhythm within normal limits (120-160 beats/min);
• the amplitude of heart rate deviations from the basal value is not less than 6 and not more than 25 beats/min;
• recording of at least one fetal movement or at least three accelerations;
• noted sporadic heartbeat;
• short-term variability of at least 3 ms.

Source: https://folkmap.ru/beremennost/ktg-pri-beremennosti-kriterii-ne-soblyudeny/

Fetal health indicators

Having assessed the CTG indicators, doctors determine the value of the PSP (an indicator of the condition of the fetus). There are 4 standard conclusions on PSP. Below 1.0 are normal indicators (sometimes starting from 1.05). At the same time, if borderline values ​​of 0.8-1.0 were obtained, then the recording is recommended to be repeated within 1-2 weeks.

From 1.05 to 2.0 - primary deviations. Such a conclusion requires therapeutic measures and a control CTG recording within a week. From 2.01 to 3.0 - severe deviations. In this case, the woman is recommended to go to hospital to take measures to maintain the pregnancy. PSP of 3.0 or more is a critical condition of the fetus. The pregnant woman should be urgently hospitalized, and emergency delivery will most likely be indicated.

CTG is normally no different from 33 weeks to 36 weeks and is characterized by the following signs: the main rhythm is from 120 to 160 beats/min, within 40–60 minutes there are from 5 accelerations of the heart rate, the range of variability is from 5 to 25 beats per minute. minute, there is no slowdown in rhythm.

What does it mean if the doctor does not approve the CTG results?

The fact that the doctor did not like the results of cardiotocography does not mean a final determination of fetal hypoxia and pathology in principle. There are cases when young doctors without sufficient work experience incorrectly interpreted the information contained in the received graph, although everything was completely normal for the baby and his mother.

Therefore, you should not rush and immediately panic when you get a bad result. But you shouldn’t relax, as this may actually indicate a real pathology that requires immediate treatment and action on the part of medical professionals.

Most likely, if the results show alarming deviations from the norm, the doctor will ask you to go to the maternity hospital , where they will conduct regular CTG and be able to quickly react in a dangerous situation.

Pathological CTG

There are 3 pathological variants of CTG.

Silent or monotonous CTG

It is characterized by the absence of accelerations and decelerations, but the basal heart rate is within normal limits. The graphical representation of such cardiotocography is close to a straight line.

Sinusoidal CTG

The graphical representation of such cardiotocography has the form of a sinusoid. This CTG indicates severe oxygen starvation of the fetus. Sometimes it is detected when a pregnant woman is taking psychotropics or drugs.

Lambda rhythm

It is characterized by rapid alternation of acceleration and deceleration. In most cases, this CTG pathology indicates compression of the umbilical cord. As a rule, it is pinched between the fetal head and the maternal pelvic bones, which leads to a decrease in blood flow and the development of hypoxia.

In addition, there are conditionally pathological types of CTG with characteristic signs: the presence of decelerations immediately following accelerations, passivity of fetal movements, insufficient range and rhythm variability.

If questionable results are obtained with standard CTG, a recording is made with functional tests:

• Non-stress test. Heart rate studies are carried out against the background of natural fetal movements. Normally, after any movement of the child, the heart rate should accelerate. If this does not happen, then we can talk about the presence of pathology.
• Stress test. The pregnant woman is given oxytocin and the baby's heart rate changes are monitored. Normally, accelerations should be observed, the basal rhythm should be within the acceptable range, and decelerations should be absent. If, after the administration of this drug, the fetus does not experience an acceleration of the rhythm, but rather it can be noted that the heart contractions are slowing down, then this indicates oxygen starvation.
• Mammary test. This test produces natural oxytocin in a woman's body by massaging her nipples for 2 minutes. Next, an assessment is made, as in the case of the administration of synthetic oxytocin.
• Exercise test. A CTG recording is made immediately after the pregnant woman performs a series of activities that involve physical activity. Most often she is asked to climb stairs up to 2 flights of stairs. In response to such actions, the fetal heart rate should increase.
• Breath test. During the CTG recording, a pregnant woman should hold her breath first while inhaling and then while exhaling. In the first case, it is expected that the baby’s heart rate will decrease, and in the second it will increase.

Unlike standard ultrasound and Doppler ultrasound, which demonstrate the anatomy and circulation of the fetus and baby's place, CTG allows you to determine the effect of oxygen and nutrients on the child. In addition, CTG is indispensable in the process of delivery, when other methods cannot be used. Such a study helps to choose the right tactics for labor management, taking into account how the fetus tolerates the emerging loads.

Reasons for referral for a non-stress CTG test

As a rule, pregnant women who have diseases that complicate pregnancy or those who have already developed some complications during pregnancy are sent for such an examination. Here are the most common ones:

1. Diabetes mellitus that you treat with insulin injections
2. If you have high blood pressure, hypertension that developed during pregnancy
3. Post-term pregnancy (40 weeks of pregnancy have passed). When the expected due date has arrived and labor has not begun, the doctor may prescribe a non-stress test to determine how the baby is feeling.
4. If your baby is too small for his due date and if he is gaining weight slowly
5. The child sharply decreased his motor activity
6. If you have too much or too little amniotic fluid
7. You have undergone an external obstetric turn due to abnormal fetal position. After this, the doctor will send you for a test to see how your baby is feeling.
8. You had amniocentesis in the 3rd trimester
9. Your last pregnancy ended in premature birth. Either for an unknown reason, or as a result of problems that may recur in the current pregnancy.

What is the Fetal Reactivity Index?

This indicator tells the specialist about the state of the fetus’s nervous system reactivity to external influences, which, first of all, affects the state of the cardiovascular system.

The calculation is made in a point system and is further interpreted:

• 0 points means an absolute lack of reactivity in the baby.
• 1 point means severe disturbances in the body's reactivity.
• 2 points mean severe disturbances in the baby’s reactivity.
• 3 points indicate a moderate degree of impairment in reactivity.
• 4 points indicate the initial stage of the pathology of the child’s reactivity.
• 5 points means normal reactivity in the fetus.

Video about fetal cardiotocography (CTG)

We invite you to watch a video about fetal CTG. An obstetrician-gynecologist will tell you how and why this examination is carried out, how its results are evaluated, and what are the normal CTG indicators.

Any pregnant woman will sooner or later undergo a CTG procedure; some of the readers have already encountered this study. Therefore, tell us about your impressions of cardiotocography, how its results were deciphered for you, and what this painless manipulation gave you. Don’t forget to leave feedback and ask questions about CTG, the answers to which most concern you or are still unclear.

We recommend reading:

Colostrum during pregnancy Ultrasound during pregnancy: at what time is it done HCG analysis during pregnancy: decoding Norm of protein in urine during pregnancy

Erroneous assessment of CTG results

Errors when interpreting information obtained using cardiotocography are certainly possible. For example, in the case of hypoxia , but despite the fact that the baby’s tissues have already managed to adapt to it, CTG is not able to show this pathological condition. The same can happen if there is a sufficient amount of oxygen in the bloodstream, but the tissues cannot adequately accept and use it, which indicates actual fetal hypoxia.

The presence of errors obliges specialists to evaluate the results of CTG only in conjunction with the results of other studies performed on a pregnant woman, and then make a final diagnosis.

Methods for diagnosing and treating intracranial hypertension

A fairly common pathology of the brain is intracranial hypertension, which occurs as a result of various injuries, tumors, hemorrhages, serious poisoning or metabolic failure. People suffering from this disease often complain of a bursting headache, accompanied by nausea, inhibition of mental activity, and loss of vision.

This is a pathological increase in the intracranial pressure gradient. It is noteworthy that the pressure does not increase locally, but evenly throughout the entire skull. This has a negative impact on all brain structures.

According to WHO statistics, intracranial hypertension is more common in men. In childhood, the appearance is equivalent for both sexes.

The described condition can be caused by tissue fluid, cerebrospinal fluid, blood or a tumor formation.

To understand the reasons for the increase in pressure, it is necessary to understand the normal circulation of cerebrospinal fluid. This fluid is contained in the subarachnoid space and washes the structures of the brain. In this cavity, the cerebrospinal fluid is in continuous movement: it is formed in the ventricles of the brain - in the choroid plexus of the pia mater, reabsorption occurs in the venous sinuses and through the Pachionian granulations of the arachnoid membrane.

The increase in pressure is caused by an increase in the production of intracerebral fluid, or a violation of its release into the bloodstream. The accumulating volume begins to affect the parts of the brain being washed.

If a tumor occurs, the new formation begins to put pressure on the brain tissue. On the other hand, they are affected by cerebrospinal fluid. As a result, the brain begins to resist - hypertension appears.

Indirect sources are considered:

• Congestive heart failure;
• Obstructive pulmonary diseases;
• Impaired blood flow through the internal jugular vein;
• Pericardial effusion.

Reasons for the development of pathology in children:

• Congenital defects;
• Problems during childbirth;
• Prolonged hypoxia;
• Prematurity;
• Infections affecting the nervous system.

Symptoms depend on the individual characteristics of the body and the amount of cerebrospinal fluid.

1. The first sign is a feeling of heaviness, frequent headaches observed at night or in the morning. This is explained by an increase in the secretion of cerebrospinal fluid when a person is in a horizontal position, and a decrease in reabsorption.
2. The maximum pressure observed in the morning provokes nausea on an empty stomach. After the release of vomit, the patient's condition does not improve.
3. Long-term exposure to an irritating factor leads to nervousness, irritability and fatigue.
4. There are complaints of vegetative-vascular disorders: increased heart rate, sharp jumps in blood pressure, frequent fainting states, sweating.
5. Noticeable “bruises” under the eyes against the background of good sleep and a normal rhythm of life. The effect is provoked by the expansion of the venous network of the lower eyelid and infraorbital region.
6. There is a clear dependence of exacerbations and remissions on weather conditions.
7. Sometimes the clinical manifestation is considered to be a lack of libido.

The first sign of deviation is considered to be sudden changes in behavior: excitability quickly turns into lethargy. With high levels of intracranial pressure, the child constantly screams, swelling and characteristic pulsation are noticeable in the springs, there are disturbances of consciousness, vomiting, and convulsions.

The clinical picture is not the basis for making a diagnosis. The most modern and reliable method for determining the diagnosis (including early stages) is magnetic resonance imaging (MRI). There are other diagnostic methods aimed at determining indirect manifestations of hypertension:

• Echoencephalography (EEG),
• Fundus examination,
• Ultrasound examination of cerebral vessels.

Magnetic resonance imaging will show expansion of the subarachnoid spaces or damage to brain tissue. Doppler vascular diagnostics shows a significant decrease in blood volume in the venous sinuses. Checking the fundus, on the contrary, will reveal enlargement and tortuous course of the vessels.

Conducting the study: CTG equipment

Carrying out the cardiotocography procedure

A special device is designed to perform cardiotocography. It is called a cardiotocograph. An ultrasound sensor is used to detect and record the fetal heartbeat. It is attached to the belly of the expectant mother in the place where the fetal heart sounds are best heard.

When performing CTG, the device still records uterine contractions. This is done using a strain gauge sensor. It is fixed in the fundus of the uterus. Changes in heart rate and uterine contractions are displayed on the cardiac monitor.

The information that the device converts is also recorded on paper in the form of an image. Using the graph at the top, experts evaluate the functioning of the fetal heart. At the bottom of the tape, uterine contractions and fetal movements are displayed.