Fetal cardiotocography in childbirth

Istomina N.G., Baranov A.N., Dolidze M.Yu.

Northern State Medical University, Ministry of Health of the Russian Federation, Arkhangelsk, Russia
The fetal status during childbirth may be assessed analyzing the patterns of fetal cardiac rhythm. Despite the wide use of the method, interpretation of cardiotocography (CTG) remains controversial due to the absence of significant differences in the number of cerebral palsy diagnoses, infant deaths, and other standard assessments of neonatal well-being as compared to periodic auscultation. The paper considers modern ideas on the pathophysiological processes determining the main patterns of CTG and a new concept CTG assessment in childbirth.
Conclusion: Changing ideas on the pathophysiological mechanism underlying in the interpretation of CTG will be able to formulate a new approach that is more sensitive to the degree of fetal hypoxic changes and will increase its informative value.

Authors’ contributions: Istomina N.G. – concept and design of the review; Istomina N.G., Dolidze M.Yu. – writing the text; Baranov A.N. – editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
For citation: Istomina N.G., Baranov A.N., Dolidze M.Yu. Fetal cardiotocography in childbirth.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (6): 24-28 (in Russian)


fetal hypoxia in childbirth


  1. Freeman R.K., Anderson G., Dorchester W. A prospective multi-institutional study ofantepartum fetal heart rate monitoring. I. Risk of perinatal mortality and morbidityaccording to antepartum fetal heart rate test results. Am. J. Obstet. Gynecol. 1982; 143(7): 771-7. https://dx.doi.org/10.1016/0002-9378(82)90008-4.
  2. Grivell R.M., Alfirevic Z., Gyte G.M., Devane D. Antenatal cardiotocography for fetalassessment. Cochrane Database Syst. Rev. 2015; 2015(9): CD007863. https://dx.doi.org/10.1002/14651858.CD007863.pub4.
  3. Alfirevic Z., Devane D., Gyte G.M.L., Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst. Rev. 2017; 2(2): CD006066.https://dx.doi.org/10.1002/14651858.CD006066.pub3.
  4. Пониманская М.А., Старцева Н.М., Ли Ок Нам, Саная С.З. Оценка состояния плода в родах: противоречия и перспективы. Акушерство и гинекология: новости, мнения, обучение. 2022; 10(3): 56-61. [Ponimanskaya М.А., Startseva N.M., Li Ok Nam, Sanaya S.Z. Assessment of the fetal condition in childbirth: contradictions and prospects. Obstetrics and Gynecology: News, Opinions, Training. 2022; 10(3): 56-61. (in Russian)].https://dx.doi.org/10.33029/2303-9698-2022-10-3-56-61.
  5. Sholapurkar S.L. Interpretation of British experts’ illustrations of fetal heart rate (FHR) decelerations by Consultant Obstetricians, Registrars and midwives: A prospective observational study – Reasons for major disagreement and implications for clinical practice. Open J. Obstet. Gynecol. 2013; 3(3): 454-65. https://dx.doi.org/10.1002/j.1879-3479.1976.tb00560.x.
  6. Cahill A.G., Roehl K.A., Odibo A.O., Macones G.A. Association and prediction of neonatal acidemia. Am. J. Obstet. Gynecol. 2012; 207(3): 206.e1-8.https://dx.doi.org/10.1016/j.ajog.2012.06.046.
  7. Clark S.L., Nageotte M.P., Garite T.J., Freeman R.K., Miller D.A., Simpson K.R.et al. Intrapartum management of category II fetal heart rate tracings: towards standardization of care. Am. J. Obstet. Gynecol. 2013; 209(2): 89-97.https://dx.doi.org/10.1016/j.ajog.2013.04.030.
  8. Приходько А.М., Романов А.Ю., Евграфова А.В., Баев О.Р. Взаимосвязь параметров кардиотокографии с риском развития гипоксически-ишемической энцефалопатии у новорожденного. Акушерство и гинекология. 2020; 3: 80-5. [Prikhodko A.M., Romanov A.Yu., Evgrafova A.V.,Baev O.R. Correlation of cardiotocographic parameters witt the risk of neonatal hypoxic ischemic encephalopathy. Obstetrics and Gynecology. 2020; (3): 80-5.(in Russian)]. https://dx.doi.org/10.18565/aig.2020.3.80-85.
  9. Логинов В.В., Давыдов Д.Г., Приходько А.М., Баев О.Р., Дегтярев Д.Н. Особенности адаптации плода к кардиотокографическому исследованию как критерий оценки его состояния. Акушерство и гинекология. 2021; 3: 138-44. [Loginov V.V., Davydov D.G., Prikhod'ko A.M., Baev O.R.,Degtyarev D.N. Fetal adaptation to cardiotocography as a criterion of fetal condition. Obstetrics and Gynecology. 2021; (3): 138-44. (in Russian)].https://dx.doi.org/10.18565/aig.2021.3.138-144.
  10. Замалеева Р.С., Мальцева Л.И., Черепанова Н.А., Фризина А.В., Зефирова Т.П. Новые возможности кардиотокографии – оценка функционального состояния плода во втором триместре беременности. Акушерство и гинекология. 2018; 12: 29-34. [Zamaleeva R.S., Maltseva L.I., Cherepanova N.A., Frizina A.V., Zefirova T.P. New possibilities to use cardiotocography to assess the fetal functional state in the second trimester of pregnancy. Obstetrics and Gynecology. 2018; (12): 29-34. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.12.29-34.
  11. Sholapurkar S.L. Critical imperative for the reform of british interpretation of fetal heart rate decelerations: analysis of FIGO and NICE guidelines, post-truth foundations, cognitive fallacies, myths and occam's razor. J. Clin. Med. Res. 2017; 9(4): 253-65. https://dx.doi.org/10.14740/jocmr2877e.
  12. Lear C.A., Galinsky R., Wassink G., Yamaguchi K., Davidson J.O., Westgate J.A. et al. The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex. J. Physiol. 2016; 594(17): 4711-25. https://dx.doi.org/10.1113/JP271205.
  13. Schifrin B.S., Koos B.J., Cohen W.R., Soliman M. Approaches to preventing intrapartum fetal injury. Front. Pediatr. 2022; 10: 915344.https://dx.doi.org/10.3389/fped.2022.915344.
  14. Xodo S., Londero A.P. Is it time to redefine fetal decelerations in cardiotocography? J. Pers. Med. 2022; 12(10): 1552. https://dx.doi.org/10.3390/jpm12101552.
  15. Harris A.P., Koehler R.C., Gleason C.A., Jones M.D. Jr, Traystman R.J. Cerebral and peripheral circulatory responses to intracranial hypertension in fetal sheep. Circ. Res. 1989; 64(5): 991-1000. https://dx.doi.org/10.1161/01.res.64.5.991.
  16. Harris A.P., Koehler R.C., Nishijima M.K., Traystman R.J., Jones M.D. Jr. Circulatory dynamics during periodic intracranial hypertension in fetal sheep. Am. J. Physiol. 1992; 263 (1, Pt 2): R95-102. https://dx.doi.org/10.1152/ajpregu.1992.263.1.R95.
  17. Itskovitz J., LaGamma E.F., Rudolph A.M. Heart rate and blood pressure responses to umbilical cord compression in fetal lambs with special reference to the mechanism of variable deceleration. Am. J. Obstet. Gynecol. 1983; 147(4): 451-7. https://dx.doi.org/10.1016/s0002-9378(16)32243-8.
  18. Itskovitz J., La Gamma E.F., Rudolph A.M. Effects of cord compression on fetal blood flow distribution and O2 delivery. Am. J. Physiol. 1987; 252 (1, Pt 2): H100-9. https://dx.doi.org/10.1152/ajpheart.1987.252.1.H100.
  19. Giussani D.A., Unno N., Jenkins S.L., Wentworth R.A., Derks J.B., Collins J.H., Nathanielsz P.W. Dynamics of cardiovascular responses to repeated partial umbilical cord compression in late-gestation sheep fetus. Am. J. Physiol. 1997; 273(5): H2351-60. https://dx.doi.org/10.1152/ajpheart.1997.273.5.H2351.
  20. Lear C.A., Westgate J.A., Ugwumadu A., Nijhuis J.G., Stone P.R., Georgieva A.et al. Understanding fetal heart rate patterns that may predict antenatal and intrapartum neural injury. Semin. Pediatr. Neurol. 2018; 28: 3-16.https://dx.doi.org/10.1016/j.spen.2018.05.002.
  21. Lear C.A., Wassink G., Westgate J.A., Nijhuis J.G., Ugwumadu A., Galinsky R.et al. The peripheral chemoreflex: Indefatigable guardian of fetal physiological adaptation to labour. J. Physiol. 2018; 596(23): 5611-23.https://dx.doi.org/10.1113/JP274937. Epub 2018 Apr 26.
  22. Westgate J.A., Wibbens B., Bennet L., Wassink G., Parer J.T., Gunn A.J. The intrapartum deceleration in center stage: a physiological approach to interpretation of fetal heart rate changes in labor. Am. J. Obstet. Gynecol. 2007; 197(3): 236.e1-11. https://dx.doi.org/10.1016/j.ajog.2007.03.063.
  23. Cahill A.G., Roehl K.A., Odibo A.O., Macones G.A. Association and prediction of neonatal acidemia. Am. J. Obstet. Gynecol. 2012; 207(3): 206.e1-8.https://dx.doi.org/10.1016/j.ajog.2012.06.046.
  24. Ugwumadu A. Are we (mis)guided by current guidelines on intrapartum fetal heart rate monitoring? Case for a more physiological approach to interpretation. BJOG. 2014; 121(9): 1063-70. https://dx.doi.org/10.1111/1471-0528.12900.
  25. Pinas A., Chandraharan E. Continuous cardiotocography during labour: analysis, classification and management. Best Pract. Res. Clin. Obstet. Gynaecol. 2016; 30: 33-47. https://dx.doi.org/10.1016/j.bpobgyn.2015.03.022.

Received 27.01.2023

Accepted 06.04.2023

About the Authors

Natalia G. Istomina, PhD, Associate Professor, Department of Obstetrics and Gynecology, Ob/Gyn Dept., Northern State Medical University, Ministry of Health of Russia, nataly.istomina@gmail.com, 163000, Russia, Arkhangelsk, Troitsky pr., 51.
Alexey N. Baranov, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Northern State Medical University, Ministry of Health of Russia,
163000, Russia, Arkhangelsk, Troitsky pr., 51.
Maria Yu. Dolidze, Teaching Assistant, Department of Obstetrics and Gynecology, Northern State Medical University, Ministry of Health of Russia,
163000, Russia, Arkhangelsk, Troitsky pr., 51.

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