The Journal of Maternal-Fetal & Neonatal Medicine

Shifting Paradigm in Intrapartum Fetal Heart Rate Monitoring

Traditional three-tier classification systems for the interpretation of cardiotocographs (CTG) have been shown to have a very high false positive rate of >98%.

Moreover, over-reliance on “pattern-recognition” and the focus on the morphology of ongoing decelerations has resulted in significant inter- and intra-observer variation. Scientific studies have demonstrated that even presumed “CTG Experts” and medico-legal experts exhibit significant inter- and intra-observer variability in the interpretation of cardiotocographs based on the identification of the morphology of fetal heart rate decelerations, and some experts have changed their own earlier classifications when knowledge of perinatal outcomes was made available to them. Repeated Cochrane Systematic Reviews have concluded that the use of CTG, as per the current three-tier classification systems, has not improved long-term perinatal outcomes but has increased the rates of caesarean sections and operative vaginal births. It is therefore unsurprising that four consecutive “Each Baby Counts” Reports produced by the Royal College of Obstetricians and Gynaecologists (RCOG) in the United Kingdom have concluded that substandard care contributed to over 70% of babies who sustained intrapartum-related severe brain damage and/or died during labour or in the first seven days of life.

Physiological CTG interpretation was introduced into clinical practice in 2006 to address the pitfalls of the three-tier classification systems by focusing on fetal responses to hypoxic and inflammatory stresses. Several publications since 2006 have confirmed the key principles and concepts of physiological interpretation of CTG, culminating in the publication of international expert consensus guidelines by more than 50 CTG experts from over 20 countries in 2024, and the development of a CTG artificial intelligence application based on the principles of physiological interpretation. Emerging evidence from multiple countries demonstrates meaningful improvement in maternal and perinatal outcomes following implementation of the principles of physiological CTG interpretation.

This Collection will bring together contributions from leading international experts in physiological fetal heart rate interpretation, intrauterine inflammation, and artificial intelligence as applied to CTG interpretation. The specific objectives are to:

1. Compile all key concepts relating to physiological interpretation of CTG in a single, peer-reviewed journal issue.
2. Accelerate the paradigm shift from traditional pattern-recognition approaches towards evidence-based physiological interpretation.
3. Improve outcomes for mothers and babies worldwide.
4. Eliminate avoidable harm arising from CTG misinterpretation, including intrapartumrelated brain damage and preventable perinatal mortality

All manuscripts submitted to this Article Collection will undergo a full peer-review; the Guest Advisor for this Collection will not be handling the manuscripts. 

Please review the journal scope and author submission instructions prior to submitting a manuscript. 

The deadline for submitting manuscripts is March 31st, 2027.

Please contact Menghan Li at [email protected]  with any queries and discount codes regarding this Article Collection.

Please be sure to select the appropriate Article Collection from the drop-down menu in the submission system.