{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:00:23Z","timestamp":1787850023621,"version":"build-2784847793"},"reference-count":117,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["ajog.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Obstetrics and Gynecology"],"published-print":{"date-parts":[[2023,6]]},"DOI":"10.1016\/j.ajog.2022.05.023","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T17:32:41Z","timestamp":1685640761000},"page":"622-644","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":94,"title":["Pathophysiological interpretation of fetal heart rate tracings in clinical practice"],"prefix":"10.1016","volume":"228","author":[{"given":"Yan-Ju","family":"Jia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tullio","family":"Ghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Gracia Perez-Bonfils","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5711-8515","authenticated-orcid":false,"given":"Edwin","family":"Chandraharan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajog.2022.05.023_bib1","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1111\/j.1749-6632.1959.tb44593.x","article-title":"Oxytocin and contractility of the pregnant human uterus","volume":"75","author":"Caldeyro-Barcia","year":"1959","journal-title":"Ann N Y Acad Sci"},{"key":"10.1016\/j.ajog.2022.05.023_bib2","first-page":"267","article-title":"Effects of abnormal uterine contractions on a human fetus","volume":"81","author":"Caldeyro Barcia","year":"1963","journal-title":"Bibl Paediatr"},{"key":"10.1016\/j.ajog.2022.05.023_bib3","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1152\/jappl.1961.16.3.573","article-title":"Recording of intramuscular pressure in the human myometrium","volume":"16","author":"Mendez-Bauer","year":"1961","journal-title":"J\u00a0Appl Physiol"},{"key":"10.1016\/j.ajog.2022.05.023_bib4","first-page":"814","article-title":"Electronic evaluation of the fetal heart rate. Viii. Patterns preceding fetal death, further observations","volume":"87","author":"Hon","year":"1963","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib5","first-page":"137","article-title":"The classification of fetal heart rate. I. A working classification","volume":"22","author":"Hon","year":"1963","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib6","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/AOG.0b013e3181aef106","article-title":"ACOG Practice Bulletin No. 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles","volume":"114","year":"2009","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ijgo.2015.06.020","article-title":"FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography","volume":"131","author":"Ayres-De-Campos","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"10.1016\/j.ajog.2022.05.023_bib9","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1080\/14767058.2016.1276559","article-title":"Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe?","volume":"31","author":"Chandraharan","year":"2018","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0228630","article-title":"Evaluation of 3-tier and 5-tier FHR pattern classifications using umbilical blood pH and base excess at delivery","volume":"15","author":"Kikuchi","year":"2020","journal-title":"PLoS One"},{"key":"10.1016\/j.ajog.2022.05.023_bib11","doi-asserted-by":"crossref","first-page":"163.e1","DOI":"10.1016\/j.ajog.2016.10.009","article-title":"The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia","volume":"216","author":"Clark","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib12","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/AOG.0b013e318185f872","article-title":"Electronic fetal heart rate monitoring: another look","volume":"112","author":"Spong","year":"2008","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib13","doi-asserted-by":"crossref","first-page":"503","DOI":"10.3389\/fped.2020.00503","article-title":"Electronic fetal monitoring-prevention or rescue?","volume":"8","author":"Schifrin","year":"2020","journal-title":"Front Pediatr"},{"key":"10.1016\/j.ajog.2022.05.023_bib14","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ajog.2013.04.030","article-title":"Intrapartum management of category II fetal\u00a0heart rate tracings: towards standardization of care","volume":"209","author":"Clark","year":"2013","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib15","series-title":"Handbook of CTG interpretation: from patterns to physiology","author":"Chandraharan","year":"2017"},{"key":"10.1016\/j.ajog.2022.05.023_bib16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.bpobgyn.2015.03.022","article-title":"Continuous cardiotocography during labour: analysis, classification and management","volume":"30","author":"Pinas","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib17","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1111\/j.1471-0528.1971.tb00198.x","article-title":"The significance of the changes in the continuous fetal heart rate in the first stage of labour","volume":"78","author":"Beard","year":"1971","journal-title":"J\u00a0Obstet Gynaecol Br Commonw"},{"key":"10.1016\/j.ajog.2022.05.023_bib18","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1056\/NEJM199603073341001","article-title":"Uncertain value of electronic fetal monitoring in predicting cerebral palsy","volume":"334","author":"Nelson","year":"1996","journal-title":"N\u00a0Engl J Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib19","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/0029-7844(94)00320-D","article-title":"Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta-analysis","volume":"85","author":"Vintzileos","year":"1995","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib20","first-page":"865","article-title":"Fetal health surveillance in labour","volume":"17","year":"1995","journal-title":"J\u00a0Obstet Gynaecol Can"},{"key":"10.1016\/j.ajog.2022.05.023_bib21","series-title":"The use of electronic fetal monitoring","author":"Thomas","year":"2001"},{"key":"10.1016\/j.ajog.2022.05.023_bib22","first-page":"CD006066","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour","volume":"2","author":"Alfirevic","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2022.05.023_bib23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ejogrb.2016.08.017","article-title":"Interobserver agreement in CTG interpretation using the 2015 FIGO guidelines for intrapartum fetal monitoring","volume":"205","author":"Rei","year":"2016","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2022.05.023_bib24","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/aogs.13064","article-title":"Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines","volume":"96","author":"Santo","year":"2017","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib25","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/GCO.0b013e3283505b3c","article-title":"Human factors affecting the interpretation of fetal heart rate tracings: an update","volume":"24","author":"Santo","year":"2012","journal-title":"Curr Opin Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib26","first-page":"214","article-title":"The reproducibility of intrapartum cardiotocogram assessments","volume":"127","author":"Beaulieu","year":"1982","journal-title":"Can Med Assoc J"},{"key":"10.1016\/j.ajog.2022.05.023_bib27","first-page":"1","article-title":"Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts","volume":"110","author":"Blix","year":"2003","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib28","doi-asserted-by":"crossref","first-page":"378.e1","DOI":"10.1016\/j.ajog.2011.06.086","article-title":"Interobserver and intraobserver reliability of the NICHD 3-tier fetal heart rate interpretation system","volume":"205","author":"Blackwell","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib29","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0020-7292(97)02846-4","article-title":"Evaluation of interobserver agreement of cardiotocograms","volume":"57","author":"Bernardes","year":"1997","journal-title":"Int J Gynaecol Obstet"},{"key":"10.1016\/j.ajog.2022.05.023_bib30","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1159\/000327133","article-title":"Intra- and interobserver variability of intrapartum cardiotocography: a multicenter study comparing the FIGO classification with computer analysis software","volume":"72","author":"Schiermeier","year":"2011","journal-title":"Gynecol Obstet Invest"},{"key":"10.1016\/j.ajog.2022.05.023_bib31","doi-asserted-by":"crossref","first-page":"488.e1","DOI":"10.1016\/j.ajog.2016.04.009","article-title":"Web-based comparison of historical vs contemporary methods of fetal heart rate interpretation","volume":"215","author":"Epstein","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib32","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1111\/1471-0528.13882","article-title":"Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study","volume":"123","author":"Reif","year":"2016","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib33","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/j.1471-0528.2011.03003.x","article-title":"Knowledge of adverse neonatal outcome alters clinicians\u2019 interpretation of the intrapartum cardiotocograph","volume":"118","author":"Ayres-de-Campos","year":"2011","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib34","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1515\/JPM.2005.044","article-title":"Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome","volume":"33","author":"Figueras","year":"2005","journal-title":"J\u00a0Perinat Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib35","first-page":"367","article-title":"Interpreting the fetal heart rate tracing. Effect of knowledge of neonatal outcome","volume":"43","author":"Zain","year":"1998","journal-title":"J\u00a0Reprod Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib36","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/S0140-6736(17)31594-5","article-title":"The INFANT trial","volume":"390","author":"Brocklehurst","year":"2017","journal-title":"Lancet"},{"key":"10.1016\/j.ajog.2022.05.023_bib37","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1097\/AOG.0b013e3181ba18da","article-title":"Evidence-based compared with reality-based medicine in obstetrics","volume":"114","author":"Vintzileos","year":"2009","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib38","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.ajog.2015.05.034","article-title":"Cerebral palsy: causes, pathways, and the role of genetic variants","volume":"213","author":"MacLennan","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib39","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ajog.2021.02.031","article-title":"Fetal heart rate pattern in term or near-term cerebral palsy: looking at the data in the right perspective","volume":"225","author":"Politi","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib40","first-page":"1","article-title":"Timing intrapartum management based on the evolution and duration of fetal heart rate patterns","author":"Vintzileos","year":"2021","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib41","series-title":"Handbook of CTG interpretation: From patterns to physiology","first-page":"180","article-title":"Ensuring competency in intrapartum fetal monitoring: the role of GIMS","author":"Lowe","year":"2017"},{"key":"10.1016\/j.ajog.2022.05.023_bib42","article-title":"Introduction of the physiological CTG interpretation & hypoxia in labour (HIL) tool, and its incorporation into a software programme: impact on perinatal outcomes","volume":"8","author":"Samyraju","year":"2021","journal-title":"Glob J Reprod Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib43","author":"Ingram"},{"key":"10.1016\/j.ajog.2022.05.023_bib45","author":"Chandraharan"},{"key":"10.1016\/j.ajog.2022.05.023_bib46","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1159\/000071530","article-title":"Contribution of the fetal baroreceptor reflex to the low frequency component of fetal heart rate fluctuations","volume":"55","author":"Suzuki","year":"2003","journal-title":"Gynecol Obstet Invest"},{"key":"10.1016\/j.ajog.2022.05.023_bib47","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1203\/00006450-198809000-00014","article-title":"Carotid baroreceptors in fetal and\u00a0newborn sheep","volume":"24","author":"Blanco","year":"1988","journal-title":"Pediatr Res"},{"key":"10.1016\/j.ajog.2022.05.023_bib48","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1159\/000241155","article-title":"Baroreceptor and chemoreceptor responses to umbilical cord occlusion in fetal lambs","volume":"35","author":"Siassi","year":"1979","journal-title":"Biol Neonate"},{"key":"10.1016\/j.ajog.2022.05.023_bib49","doi-asserted-by":"crossref","first-page":"5611","DOI":"10.1113\/JP274937","article-title":"The peripheral chemoreflex: indefatigable guardian of fetal physiological adaptation to labour","volume":"596","author":"Lear","year":"2018","journal-title":"J\u00a0Physiol"},{"key":"10.1016\/j.ajog.2022.05.023_bib50","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/0002-9378(75)90528-1","article-title":"Clinical fetal monitoring. VII. The evaluation and significance of intrapartum baseline FHR variability","volume":"123","author":"Paul","year":"1975","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib51","doi-asserted-by":"crossref","first-page":"523.e1","DOI":"10.1016\/j.ajog.2018.01.026","article-title":"A\u00a0prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia","volume":"218","author":"Cahill","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib52","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1097\/AOG.0b013e3182733b6e","article-title":"Association of atypical decelerations with acidemia","volume":"120","author":"Cahill","year":"2012","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib53","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1111\/j.1552-6909.2008.00284.x","article-title":"The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines","volume":"37","author":"Macones","year":"2008","journal-title":"J\u00a0Obstet Gynecol Neonatal Nurs"},{"key":"10.1016\/j.ajog.2022.05.023_bib54","doi-asserted-by":"crossref","first-page":"19","DOI":"10.23736\/S2724-606X.20.04666-3","article-title":"Fetal heart rate monitoring in labor: from pattern recognition to fetal physiology","volume":"73","author":"Oikonomou","year":"2021","journal-title":"Minerva Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib55","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1111\/jog.14133","article-title":"Intrapartum cardiotocography patterns observed in suspected clinical and subclinical chorioamnionitis in term fetuses","volume":"45","author":"Galli","year":"2019","journal-title":"J\u00a0Obstet Gynaecol Res"},{"key":"10.1016\/j.ajog.2022.05.023_bib56","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ejogrb.2021.03.029","article-title":"Cardiotocograph (CTG) changes and maternal and neonatal outcomes in chorioamnionitis and\/or funisitis confirmed on histopathology","volume":"260","author":"Sukumaran","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2022.05.023_bib57","first-page":"5","article-title":"Clinical chorioamnionitis at term II: the intra-amniotic inflammatory response","volume":"44","author":"Romero","year":"2016","journal-title":"J\u00a0Perinat Med"},{"issue":"Suppl4","key":"10.1016\/j.ajog.2022.05.023_bib58","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.ajog.2015.08.040","article-title":"Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance","volume":"213","author":"Kim","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib59","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1515\/jpm-2018-0271","article-title":"Clinical chorioamnionitis at term IX: in\u00a0vivo evidence of intra-amniotic inflammasome activation","volume":"47","author":"Gomez-Lopez","year":"2019","journal-title":"J\u00a0Perinat Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib60","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1515\/jpm-2020-0297","article-title":"Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia - implications for clinical care","volume":"49","author":"Romero","year":"2021","journal-title":"J\u00a0Perinat Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib61","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/aogs.12932","article-title":"Longitudinal evaluation of computerized cardiotocographic parameters throughout pregnancy in normal fetuses: a prospective cohort study","volume":"95","author":"Amorim-Costa","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib62","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/aogs.14024","article-title":"Intrapartum fetal heart rate between 150 and 160 bpm at or after 40 weeks and labor outcome","volume":"100","author":"Ghi","year":"2021","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib63","first-page":"00168","article-title":"Each fetus matters: an urgent paradigm shift is needed to move away from the rigid \u201cCTG Guideline Stickers\u201d so as to individualize intrapartum fetal heart rate monitoring and to\u00a0improve perinatal outcomes","volume":"5","author":"Chandraharan","year":"2016","journal-title":"Obstet Gynecol Int J"},{"key":"10.1016\/j.ajog.2022.05.023_bib64","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.bpobgyn.2007.02.008","article-title":"Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces","volume":"21","author":"Chandraharan","year":"2007","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib65","first-page":"10","article-title":"Importance of fetal heart rate cycling during the interpretation of the cardiotocograph (CTG)","volume":"1","author":"Preti","year":"2018","journal-title":"Int J Gynecol Reprod Sci"},{"key":"10.1016\/j.ajog.2022.05.023_bib66","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1471-0528.1997.tb10643.x","article-title":"The intrapartum CTG prior to neonatal encephalopathy at term: a case-control study","volume":"104","author":"Spencer","year":"1997","journal-title":"Br J Obstet Gynaecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib67","first-page":"1","article-title":"Absence of fetal heart rate cycling on the intrapartum cardiotocograph (CTG) is associated with intrapartum pyrexia and lower Apgar scores","author":"Pereira","year":"2021","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib68","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1055\/s-2007-999600","article-title":"Relationship between cyclic variation of fetal heart rate patterns and cord pH in preterm gestations","volume":"6","author":"Vintzileos","year":"1989","journal-title":"Am J Perinatol"},{"key":"10.1016\/j.ajog.2022.05.023_bib69","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1055\/s-2007-999595","article-title":"Heart rate cyclicity during labor in healthy term fetuses","volume":"6","author":"Petrikovsky","year":"1989","journal-title":"Am J Perinatol"},{"key":"10.1016\/j.ajog.2022.05.023_bib70","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/S0002-9378(98)70156-5","article-title":"Fetal heart rate patterns in postasphyxiated fetal lambs with brain damage","volume":"179","author":"Ikeda","year":"1998","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib71","doi-asserted-by":"crossref","first-page":"3537","DOI":"10.1080\/14767058.2019.1686475","article-title":"Does the saltatory pattern on cardiotocograph (CTG) trace really exist? The zigzag pattern as an alternative definition and its correlation with perinatal outcomes","volume":"34","author":"Gracia-Perez-Bonfils","year":"2021","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib72","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/aogs.14007","article-title":"Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia: a large obstetric retrospective cohort study","volume":"100","author":"Tarvonen","year":"2021","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib73","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.ejogrb.2020.06.049","article-title":"Fetal heart rate changes on the cardiotocograph trace secondary to maternal COVID-19 infection","volume":"252","author":"Gracia-Perez-Bonfils","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2022.05.023_bib74","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/s41372-019-0520-9","article-title":"Marked variability in intrapartum electronic fetal heart rate patterns: association with neonatal morbidity and abnormal arterial cord gas","volume":"40","author":"Polnaszek","year":"2020","journal-title":"J\u00a0Perinatol"},{"key":"10.1016\/j.ajog.2022.05.023_bib75","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ajog.2016.05.046","article-title":"Decelerations, tachycardia, and decreased variability: have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia?","volume":"215","author":"Vintzileos","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib77","article-title":"True vs spurious intrapartum fetal heart rate accelerations on the cardiotocograph (CTG): an urgent need for caution","volume":"7","author":"Al Fahdi","year":"2020","journal-title":"Glob J Reprod Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib78","doi-asserted-by":"crossref","first-page":"315","DOI":"10.37871\/jbres1233","article-title":"Erroneous recording of maternal heart rate as fetal heart rate during second stage of labour: isn\u2019t it time to stop this?","volume":"2","author":"Saeed","year":"2021","journal-title":"J\u00a0Biomed Res Environ Sci"},{"key":"10.1016\/j.ajog.2022.05.023_bib79","first-page":"542","article-title":"Characteristics of maternal heart rate patterns during labor and delivery","volume":"99","author":"Sherman","year":"2002","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib80","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1111\/j.1600-0412.2012.01511.x","article-title":"Misidentification of maternal heart rate as fetal on cardiotocography during the second stage of labor: the role of the fetal electrocardiograph","volume":"91","author":"Nurani","year":"2012","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib76","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.pbj.2017.01.004","article-title":"Recognition of chronic hypoxia and pre-existing foetal injury on the cardiotocograph (CTG): urgent need to think beyond the guidelines","volume":"2","author":"Pereira","year":"2017","journal-title":"Porto Biomed J"},{"key":"10.1016\/j.ajog.2022.05.023_bib81","doi-asserted-by":"crossref","first-page":"175","DOI":"10.2174\/157340480903140131111914","article-title":"Saltatory and sinusoidal fetal heart rate (FHR) patterns and significance of FHR \u2018overshoots\u2019","volume":"9","author":"Yanamandra","year":"2013","journal-title":"Curr Wom Health Rev"},{"key":"10.1016\/j.ajog.2022.05.023_bib82","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jogoh.2016.11.005","article-title":"Understanding fetal physiology and second line monitoring during labor","volume":"46","author":"Garabedian","year":"2017","journal-title":"J\u00a0Gynecol Obstet Hum Reprod"},{"key":"10.1016\/j.ajog.2022.05.023_bib83","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1177\/2516043519878583","article-title":"Intrapartum care: an urgent need to question historical practices and \u2018non-evidence\u2019-based, illogical foetal monitoring guidelines to avoid patient harm","volume":"24","author":"Chandraharan","year":"2019","journal-title":"J\u00a0Patient Saf Risk Manag"},{"key":"10.1016\/j.ajog.2022.05.023_bib84","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1080\/14767058.2019.1666819","article-title":"Physiological CTG interpretation: the significance of baseline fetal\u00a0heart rate changes after the onset of decelerations and associated perinatal outcomes","volume":"34","author":"Jia","year":"2021","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib85","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1067\/mob.2003.183","article-title":"Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia","volume":"188","author":"Williams","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib86","first-page":"147","article-title":"Incidence of subacute hypoxia during active maternal pushing during labour","volume":"123","author":"Albertson","year":"2016","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib87","unstructured":"Albertson A, Amer-W\u00e5hlin I, Lowe V, Archer A, Chandraharan E. Association of fetal ECG changes with the subacute hypoxic pattern on the CTG trace during active second stage of labour. Book of abstracts. World Congress of the Royal College of Obstetricians and Gynaecologists (Royal College of Obstetricians and Gynaecologists); 2016."},{"key":"10.1016\/j.ajog.2022.05.023_bib88","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1111\/1471-0528.16638","article-title":"Deceleration area and capacity during labour-like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep","volume":"128","author":"Georgieva","year":"2021","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib89","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1055\/s-0036-1571316","article-title":"Nonreassuring fetal status in the second stage of labor: fetal monitoring features and association with neonatal outcomes","volume":"33","author":"Triebwasser","year":"2016","journal-title":"Am J Perinatol"},{"key":"10.1016\/j.ajog.2022.05.023_bib90","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1080\/01443615.2019.1652576","article-title":"Types of intrapartum hypoxia on the cardiotocograph (CTG): do they have any relationship with the type of brain injury in the MRI scan in term babies?","volume":"40","author":"Yatham","year":"2020","journal-title":"J\u00a0Obstet Gynaecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib91","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1001\/jama.1997.03550030047032","article-title":"Maternal infection and cerebral palsy in infants of normal birth weight","volume":"278","author":"Grether","year":"1997","journal-title":"JAMA"},{"key":"10.1016\/j.ajog.2022.05.023_bib92","first-page":"594","article-title":"Fever in labour and neonatal encephalopathy: a prospective cohort study","volume":"108","author":"Impey","year":"2001","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib93","first-page":"1","article-title":"The significance of \u2018non-significant\u2019 meconium stained amniotic fluid (MSAF): colour versus contents","volume":"30","author":"Bolten","year":"2019","journal-title":"J\u00a0Adv Med Med Res"},{"key":"10.1016\/j.ajog.2022.05.023_bib94","doi-asserted-by":"crossref","first-page":"775","DOI":"10.3109\/14767058.2013.844124","article-title":"Bacteria and endotoxin in meconium-stained amniotic fluid at term: could intra-amniotic infection cause meconium passage?","volume":"27","author":"Romero","year":"2014","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib95","doi-asserted-by":"crossref","first-page":"366.e1","DOI":"10.1016\/j.ajog.2015.10.009","article-title":"Meconium aspiration syndrome: a role for fetal systemic inflammation","volume":"214","author":"Lee","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib96","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1067\/mob.2000.110632","article-title":"A\u00a0multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns","volume":"183","author":"Garite","year":"2000","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib97","first-page":"CD004075","article-title":"Fetal pulse oximetry for fetal assessment in labour","author":"East","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2022.05.023_bib98","first-page":"CD006174","article-title":"Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace","author":"East","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1016\/j.ajog.2022.05.023_bib99","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1111\/1471-0528.12614","article-title":"Fetal scalp blood sampling during labour: is it a useful diagnostic test or a historical test that no longer has a place in modern clinical obstetrics?","volume":"121","author":"Chandraharan","year":"2014","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib100","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1046\/j.1471-0528.2003.02356.x","article-title":"Influence on fetal blood pH when adding amniotic fluid: an in\u00a0vitro model","volume":"110","author":"L\u00f6sch","year":"2003","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib101","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/aogs.12416","article-title":"Fetal scalp blood sampling during labor: an appraisal of the physiological basis and scientific evidence","volume":"93","author":"Chandraharan","year":"2014","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib102","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0301-2115(02)00472-4","article-title":"French Study Group on Fetal Pulse Oximetry. Predictive value of pulse oximetry and fetal scalp blood pH in the case of meconium-stained amniotic fluid","volume":"109","author":"Carbonne","year":"2003","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2022.05.023_bib103","doi-asserted-by":"crossref","first-page":"3682","DOI":"10.3109\/14767058.2016.1140740","article-title":"Should national guidelines continue to recommend fetal scalp blood sampling during labor?","volume":"29","author":"Chandraharan","year":"2016","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib104","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1111\/1471-0528.13980","article-title":"Fetal scalp blood sampling should be abandoned: FOR: FBS does not fulfil the principle of first do no harm","volume":"123","author":"Chandraharan","year":"2016","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib105","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ejogrb.2014.11.012","article-title":"Neonatal outcome and delivery mode in labors with repetitive fetal scalp blood sampling","volume":"184","author":"Holzmann","year":"2015","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2022.05.023_bib106","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejogrb.2019.06.012","article-title":"Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: a UK multicentre observational study","volume":"240","author":"Al Wattar","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2022.05.023_bib107","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1080\/14767058.2016.1181169","article-title":"Does ST analysis have a place in electronic fetal monitoring?","volume":"30","author":"Turnbull","year":"2017","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib108","doi-asserted-by":"crossref","first-page":"34","DOI":"10.23736\/S2724-606X.20.04690-0","article-title":"STAN: a reappraisal of its clinical usefulness","volume":"73","author":"Cagninelli","year":"2021","journal-title":"Minerva Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib109","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/aogs.12828","article-title":"ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials","volume":"95","author":"Blix","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib110","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/aogs.12830","article-title":"Fetal monitoring in labor: implications of evidence generated by new systematic review","volume":"95","author":"Bhide","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2022.05.023_bib111","first-page":"428","article-title":"Impact of fetal ECG (STAN) and competency based training on intrapartum interventions and perinatal outcomes at a teaching hospital in London: 5 year analysis","volume":"120","author":"Chandraharan","year":"2013","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib113","doi-asserted-by":"crossref","first-page":"102039","DOI":"10.1016\/j.jogoh.2020.102039","article-title":"Fetal physiology cardiotocography training, a regional evaluation","volume":"50","author":"Zhu","year":"2021","journal-title":"J\u00a0Gynecol Obstet Hum Reprod"},{"key":"10.1016\/j.ajog.2022.05.023_bib114","first-page":"1","article-title":"Diagnostic capacity and interobserver variability in FIGO, ACOG, NICE and Chandraharan cardiotocographic guidelines to predict neonatal acidemia","author":"Zamora Del Pozo","year":"2021","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib115","first-page":"1","article-title":"Physiological CTG categorization in types of hypoxia compared with MRI and neurodevelopmental outcome in infants with HIE","author":"Pereira","year":"2022","journal-title":"J\u00a0Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ajog.2022.05.023_bib116","doi-asserted-by":"crossref","DOI":"10.1111\/1471-0528.17133","article-title":"Short-term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study","author":"di Pasquo","year":"2022","journal-title":"BJOG"},{"key":"10.1016\/j.ajog.2022.05.023_bib117","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1055\/s-0039-1688998","article-title":"Acidemia can occur despite category I tracing","volume":"37","author":"Bruno","year":"2020","journal-title":"Am J Perinatol"},{"key":"10.1016\/j.ajog.2022.05.023_bib118","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/GRF.0b013e31820a062b","article-title":"Intrauterine resuscitation during labor","volume":"54","author":"Garite","year":"2011","journal-title":"Clin Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib119","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/01.gco.0000162184.45854.88","article-title":"Acute tocolysis","volume":"17","author":"Chandraharan","year":"2005","journal-title":"Curr Opin Obstet Gynecol"},{"key":"10.1016\/j.ajog.2022.05.023_bib120","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1053\/sper.2000.7079","article-title":"Fetal heart rate observations in the brain-damaged infant","volume":"24","author":"Phelan","year":"2000","journal-title":"Semin Perinatol"}],"container-title":["American Journal of Obstetrics and Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937822003684?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0002937822003684?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:36:45Z","timestamp":1762079805000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0002937822003684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6]]},"references-count":117,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["S0002937822003684"],"URL":"https:\/\/doi.org\/10.1016\/j.ajog.2022.05.023","relation":{},"ISSN":["0002-9378"],"issn-type":[{"value":"0002-9378","type":"print"}],"subject":[],"published":{"date-parts":[[2023,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Pathophysiological interpretation of fetal heart rate tracings in clinical practice","name":"articletitle","label":"Article Title"},{"value":"American Journal of Obstetrics and Gynecology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajog.2022.05.023","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}