A physiological approach to the interpretation of cardiotocography
Ponimanskaya M.A., Kuznetsov P.A., Dobrokhotova Yu.E., Bragina L.V., Li O.N., Sanaya S.Z.
In recent decades, the number of cesarean section (CS) deliveries has increased significantly worldwide. In Russia, the CS rate rose from 17.9% in 2005 to 30.3% in 2020. One of the main indications for CS is fetal distress, which requires careful monitoring of its condition. Improper or untimely interventions during childbirth can lead to complications for the mother and fetus, including irreversible damage to the central nervous system. Cardiotocography (CTG) remains the main method for monitoring fetal health, but there is often controversy among doctors about how to interpret the data. Various national and international guidelines have been developed to standardize the assessment of fetal heart rate and systematize the types of CTG. However, categorizing fetuses does not provide a personalized approach to evaluating their condition. Currently, more attention is paid to the physiological approach to CTG interpretation. This approach takes into account not only heart rate parameters, but also the adaptive capabilities of the fetus, the type of intrauterine hypoxia, the duration of pregnancy, and the individual functional reserves of the fetus under specific conditions. This method allows for a more personalized assessment of the fetal condition, which helps to make informed decisions about future delivery strategies. The introduction of a physiological approach to CTG interpretation makes it possible to reduce the frequency of neonatal hospitalizations in intensive care units, as well as to reduce the proportion of surgical deliveries.
Conclusion: The physiological approach to CTG assessment, training of medical personnel and continuous monitoring of fetal condition make it possible to optimize the management of labor, reduce the risk of complications and improve outcomes for newborns.
Authors’ contributions: Ponimanskaya M.A., Kuznetsov P.A. – developing the concept of the study, analysis of literature data, writing and editing the article; Dobrokhotova Yu.E. – editing the article; Bragina L.V. – collecting and processing the material, writing the text; Li O.N., Sanaya S.Z. – collecting and processing the material.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Ponimanskaya M.A., Kuznetsov P.A., Dobrokhotova Yu.E., Bragina L.V., Li O.N., Sanaya S.Z.
A physiological approach to the interpretation of cardiotocography.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (8): 215-222 (in Russian)
https://dx.doi.org/10.18565/aig.2025.93
Keywords
cardiotocography
fetal hypoxia
fetal electrocardiography
lactate test
heart rate variability
zigzag pattern
chorioamnionitis
cesarean section
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Received 04.04.2025
Accepted 08.08.2025
About the Authors
Maria A. Ponimanskaya, PhD, Deputy Chief Physician for Obstetric and Gynecological Care, City Clinical Hospital No. 67 named after L.A. Vorokhobov, Moscow City Healthcare Department, 123423, Russia, Moscow, Salam Adilya str., 2/44, ponimanskaya@mail.ru, https://orcid.org/0000-0001-9447-110XPavel A. Kuznetsov, PhD, Associate Professor, Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University,
Ministry of Health of Russia, 117513, Russia, Moscow, Ostrovityanov str., 1, poohsmith@mail.ru, https://orcid.org/0000-0003-2492-3910
Yulia E. Dobrokhotova, Dr. Med. Sci., Professor, Honored Doctor of the Russian Federation, Head of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 117513, Russia, Moscow, Ostrovityanov str., 1, Pr.Dobrohotova@mail.ru,
https://orcid.org/0000-0002-7830-2290
Lyubov V. Bragina, PhD student, Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 117513, Russia, Moscow, Ostrovityanov str., 1, dr.bragina@mail.ru, https://orcid.org/0009-0003-2908-6928
Ok Nam Lee, PhD, Deputy Chief Physician for the Medical Department of the Perinatal Center, City Clinical Hospital No. 67 named after L.A. Vorokhobov, Moscow City Healthcare Department, 123423, Russia, Moscow, Salam Adilya str., 2/44, Li-doctor@mail.ru, https://orcid.org/0000-0002-7770-2751
Sevastina Z. Sanaya, obstetrician-gynecologist, City Clinical Hospital No. 67 named after L.A. Vorokhobov, Moscow City Healthcare Department, 123423, Russia, Moscow, Salam Adilya str., 2/44, sevastina@mail.ru, https://orcid.org/0000-0001-8289-3380
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