In his first patient case review, Dr Ahmed Zaima highlights the importance of the overall clinical picture and what to look for on the CTG trace. Why is a stable baseline at a rate appropriate for gestational age and presence of cycling important? What does the accelerations and decelerations tell you? If you have poor signal quality, consider a Fetal Spiral Electrode (FSE) and if you have a monitor with ST Analysis, activate it. You never know when it will assist you in your decision making. When an ST event occurs, make sure to always review the CTG trace based on your physiological knowledge.

Situation: 

• 31 years old 
• Primigravida 
• Pregnant 37+5 
• Being transferred to LW for augmentation after SROM for 24 hours 

Background: 

• History of anxiety and depression 
• History of eating disorder 
• Low risk at booking 
• Admitted 24 hours ago after SROM because od reduced fetal movements

Assessment:  

• Ongoing reduced fetal movements 
• Irregular contractions, but increasing in intensity