Recognising Fetal Compromise in the Cardiograph during the Antenatal Period: Pearls and Pitfalls

There are several national and international guidelines to aid the interpretation of the cardiotocograph (CTG) trace during labour. These guidelines are based on assessing changes in the fetal heart rate (i.e. cardiograph) in response to mechanical and hypoxic stresses during labour secondary to ongoing frequency, duration and strength of uterine contractions (i.e. tocograph). However, during the antenatal period, uterine contractions are absent, and therefore, these intrapartum CTG guidelines cannot be used to reliably identify fetuses at risk of compromise. Computerised analysis of CTG using the Dawes-Redman Criteria could be used to detect fetal compromise. However, clinicians should be aware of the multiple pathways of fetal damage (i.e. inflammation, infection, intrauterine fetal stroke, chronic fetal anaemia, acute feto-maternal haemorrhage and fetal cardiac or neurological disorders) which can cause changes on the CTG trace which may not be recognised by using CTG guidelines.