Physiological CTG Interpretation

Edwin Chandraharan

Edwin Chandraharan


Edwin works as the Lead Clinician for Labour Ward at St. George’s University Hospitals NHS Foundation Trust, London. He is an Honorary Senior Lecturer to St George’s University of London and has been the Clinical Director of Women’s Services from 2011-2016 and the Lead for Clinical Governance from 2005-2017. He is passionate about delivering high quality patient care with a strong focus on Risk Management and Patient Experience. He received Gold Medal for ENT and Head & Neck Surgery and Gold Medals for Obstetrics & Gynaecology at his Medical School and was awarded Gold Medals for the Best Candidate in Master of Surgery in Obstetrics and Gynaecology for both Part 1 & Part 2 examinations. He has been appointed as the Visiting Professor in Obstetrics & Gynaecology at the Tianjin Central Hospital, Tianjin Province, China in 2016.

Edwin has received Clinical Excellence Awards and he was part of the team which received National Awards :the HSJ Value Award in 2016 for “Value and Improvement in Obstetrics & Gynaecology” and the BMJ Award for Clinical Leadership Team of the Year in 2017 for ensuring a low hypoxic ischaemic encephalopathy (HIE) rate in the UK.

Publications & Special Interests

Edwin has published several abstracts in National and International Scientific Meetings and over 80 Chapters and Review articles as well as original research in Scientific Journals. His special interests include intrapartum fetal heart rate monitoring (CTG and Fetal ECG or STAN), operative vaginal delivery and massive postpartum haemorrhage, including Abnormal Invasion of the Placenta. He conducts approximately 25 CTG and STAN Masterclasses in several centres in the UK as well as in Europe, Asia, China, the Middle East and Australia, every year. He is a peer reviewer for the Lancet, BJOG, Journal of Perinatal Medicine, The Green Journal and European Journal of Obstetrics, Gynecology and Reproductive Biology, Acta and the Journal Maternal, Fetal and Neonatal Medicine and he is the current Consultant Editor for Labour and Delivery for the Global Library of Women’s Medicine (GLOWM).

Edwin was the lead investigator of the team that developed a new conservative surgical technique, ‘The Triple P Procedure for Percreta’ and is a co-editor of the Textbook ‘Obstetric and Intrapartum Emergencies: A Practical Guide to Management’. Edwin leads a regional multi-disciplinary Tertiary Referral Service in London for women with Abnormal Invasion of the placenta, especially placenta percreta. He has also been involved in conducting Service Assessments and conducting external reviews of Maternal Deaths. He has been on the Editorial Board of National e-learning for Health on Fetal Monitoring and was one of the 3-member International Development Group which revised the FIGO Guidelines on CTG in 2015. He is an accredited Expert Witness and holds the Cardiff Law School Expert Witness Certificate and provides approximately 20 medico-legal reports every year to assist the Courts.

Edwin was a member of the Guideline Development Group which developed the RCOG Green-top Guideline on Postpartum Haemorrhage (PPH) and conducts several PPH workshops in the UK and abroad. He co-developed the management algorithm ‘HAEMOSTASIS’ for the management of massive postpartum haemorrhage. He has recently edited the Handbook of CTG Interpretation: From Patterns to Physiology (Cambridge University Press, 2017) and is an associate editor of the Postgraduate Textbook ‘High Risk Obstetrics: Management Options. He is the co-organiser of the RCOG Intrapartum Fetal Surveillance Course and the Course Lead for the Baby Lifeline CTG Masterclasses.

Ahmed Zaima

Ahmed Zaima

M.B.B.Ch., M.Sc., M.D., M.R.C.O.G.

Ahmed works as a speciality doctor in obstetrics and gynaecology at University Hospital Lewisham - Lewisham and Greenwich NHS Trust.

He graduated form Cairo University - Egypt in 1998, with a determination to become an obstetrician, with a dream to make pregnancy and labour safer for both mothers and babies worldwide.

Ahmed qualified as a specialist obstetrician and gynaecologist in 2005. He was awarded a Master degree from Cairo University in 2005. He was awarded a Medical Doctorate degree in Obstetrics and Gynaecology from Cairo University in 2008, with a special interest in urogynaecology. Ahmed became a member of the Royal College of Obstetricians and Gynaecologists in 2010, and qualified as a consultant later the same year.

Ahmed has lead the team at Lewisham hospital who established the change of practice on labour ward from traditional fetal monitoring to Physiological Interpretation of CTG. The team was recently awarded the first prize by the RCOG as part of their national programme; Each Baby Counts, to reduce the number of babies who die or are left severely disabled, for successfully halving the rate of hypoxic ischaemic encephalopathy at Lewisham hospital.

Ahmed is also a co-author of the intrapartum fetal monitoring guideline at Lewisham and Greenwich NHS trust, the guideline is currently being considered as the backbone of a unified south London guideline.

Special Interest

Ahmed has developed a special interest in coding, App development and web design. He currently has several projects in use by hospitals and clinicians worldwide to improve the healthcare service provided to pregnant women and newborns. Living more of his dream every day.

Susana Pereira

Susana Pereira

Susana works as a Consultant Obstetrician and Sub-Specialist in Maternal and Fetal Medicine at Kingston Hospital in London. She is also Audit and Quality Improvement Lead at Kingston Maternity and was Lead Consultant for the Sign up to Safety Project (2015-2017), responsible for introducing physiology-based CTG interpretation, leading to an improvement in perinatal mortality and morbidity. The project was shortlisted for the HSJ awards 2017 in the categories of Training and Education and Maternity and Midwifery Services.

Susana is passionated about teaching and medical education. She is a faculty member in CTG Masterclasses in the UK and abroad and a trainer for PROMPT (PRactical Obstetric Multi-Professional Training). She received a Certificate of Commendation for Excellent Teaching from St George's University of London and was nominated 'Trainer of the Year' in 2015 by South London O&G Trainees.

Originally from Portugal, she graduated in Medicine at Oporto University in 1998. She did volunteer work in Women and Children's Health in Africa (São Tomé and Príncipe) where her passion for Obstetrics and Gynaecology became clear. She did a Master’s Degree in Molecular Medicine in 2004 and completed training in Obstetrics and Gynaecology in Portugal in 2008, including a research fellowship in Fetal Medicine at King's College Hospital with Prof. Nicolaides. As a consultant, she set up a Fetal Medicine Unit in her home country, which she led for three years. She subsequently returned to London and completed the Sub-Speciality in Fetal and Maternal Medicine at King's College in 2014. She developed an interest in intra-partum fetal monitoring joining her previous extensive experience in fetal medicine with intra-partum care. She loves the multidisciplinary environment of labour ward, the rapid decision making that often is required and is absolutely passionate about improving fetal-maternal outcomes around the world. She is married with two children and lives in Epsom, UK.

Dagmar Krueger

Dagmar Krueger

State examination Germany, MRCOG

Dagmar is originally from Germany and graduated from medical school there. After a research fellow post in Gestational diabetes she decided to come to England to learn the language and initially started a career in Emergency medicine. She changed to Obstetrics and Gynaecology enjoying the medical challenges, surgical exposure and particular multidisciplinary management of obstetric emergencies on a high risk labour ward. The ability to truly make a change to the outcome to mothers and babies, is her reward and motivation.

She obtained her MRCOG in 2013.  Her special interests during training were advanced labor ward management and labor ward lead, which includes education and risk management.

In an OOPE in Ethiopia she saw herself challenged to improve fetal and maternal outcomes in low resource settings and particularly critically reviewed intrapartum monitoring.

On return to England she worked with Ahmed in a larger team at Lewisham University hospital, London supporting the change of practice on labor ward to physiological interpretation of CTG. She co-authored the guideline for intrapartum monitoring, which was revised and critically appraised (not adapted from any existing guideline).

The team audited and published their data and was awarded by the Royal College of Obstetrician and Gynecologists the first prize during the Each Baby Counts clinical engagement forum for their work in 2017. Ongoing change of practice has reached now a significant reduction in severe states of oxygen deprivation in babies during labor that would result in death or disability (HIE rates) without increasing the intervention rates in mothers.

She completed her CCT and is pursuing her career with emphasis of maternal medicine and global health in Obstetrics and Gynaecology.

Sarah-Ann Evans

Sarah-Ann Evans

Since qualifying  as a midwife from Kings College London in 2008, I have worked across Midwifery in both core and community settings.

  Since 2015,  I have been the Fetal Wellbeing Midwife at University Hospital Lewisham.  In this role I am involved in the Multidisciplinary team that developed the new Fetal Monitoring guidelines, teach about the physiological interpretation of the fetal heart rate, and unifying practice to reduce the rate of hypoxic insult in the intrapartum period by early identification and intervention.

Laura Stacey

Laura Stacey

BM BCh, MA (Oxon)

Laura is a Specialty Trainee currently at Lewisham & Greenwich NHS Trust. Laura applied for a medical degree with the intention of becoming an Obstetrician and Gynaecologist, having had a longstanding fascination with embryology and reproductive physiology. She graduated from Oxford University in 2012 with an intercalated degree in Medical Sciences, specialising in Molecular Medicine. Since then she has tirelessly worked towards her dream of being an Obstetrics & Gynaecology Trainee which she achieved in 2014. She is aiming toward a career as a Reproductive Medicine specialist.

Laura finds significant fulfilment in teaching and training others, and is looking forward to a long career of inspiring others to achieve their goals. Outside of Medicine, Laura is a avid seamstress, crochet fanatic and food enthusiast, with a penchant for creativity and craftsmanship.