What are the four features assessed on a CTG (the DR C BRAVADO components)?

DR - Define Risk; C - Contractions; then the four fetal heart features: BRA - Baseline RAte; V - Variability; A - Accelerations; D - Decelerations; O - Overall impression (normal/suspicious/pathological).

The four heart-rate features are baseline rate, baseline variability, accelerations and decelerations.

Clinical relevance. DR C BRAVADO ensures no CTG feature is missed, leading to a correct overall classification and management.

More Detail

DR C BRAVADO - structured CTG interpretation

This mnemonic ensures a systematic CTG assessment.

The mnemonic

• DR - Define Risk (is this a high-risk pregnancy/labour?).
• C - Contractions (frequency and duration per 10 minutes).
• BRA - Baseline RAte.
• V - Variability.
• A - Accelerations.
• D - Decelerations.
• O - Overall impression (normal, suspicious or pathological).

The four fetal heart features

The core of interpretation is describing the four features - baseline rate, baseline variability, accelerations and decelerations - each as reassuring, non-reassuring or abnormal, then forming an overall classification.

Setup

The mother should lie lateral or sit upright (avoid supine - aortocaval compression reduces fetal oxygenation); the toco probe goes over the fundus, the heart-rate probe over the fetal back after palpating lie/presentation.