Synopsis
Choose appropriate fetal monitoring, interpret heart-rate patterns alongside the clinical situation, and respond promptly when changes suggest evolving compromise.
- Monitoring assesses fetal response to labour; it does not diagnose hypoxia from one isolated number.
- Offer intermittent auscultation during established labour when maternal and fetal risk remains low.
- Listen for at least one minute immediately after a palpated contraction, at least every fifteen minutes in first stage and every five minutes in second stage.
- Assess the four CTG features: contractions, baseline, variability and decelerations, then combine them with risk factors and change over time.
- A normal CTG has four white features; one amber feature is suspicious; any red feature or two or more amber features is pathological.
- Absence of accelerations on an otherwise normal intrapartum CTG does not by itself indicate fetal acidosis.
- Do not give maternal oxygen solely to treat an abnormal CTG when maternal oxygenation is normal.
Key red flags
Acute fetal bradycardia or a deceleration lasting at least three minutes requires urgent review and preparations for birth.
Late decelerations are a red CTG feature regardless of whether they are repetitive or how long they have been present.
Absent variability, a sinusoidal pattern or prolonged abnormal variability requires assessment of the whole clinical picture with a low threshold for escalation.
New decelerations with a rising baseline, maternal fever, bleeding or slow progress increase concern for compromise.
An apparently reassuring trace that may be recording the maternal pulse needs immediate signal verification.
Investigation priorities
Sample fetal heart rate in labour without identified complications.
Management branches
Established labour continues without an indication for continuous cardiotocography.
- Explain the monitoring plan, obtain agreement and complete the stage-appropriate auscultation with maternal pulse checks.
- Review maternal observations, contractions, progress and any new risk factors at least hourly, documenting the findings.
- If the rate rises by at least 20/minute from the start of labour or a deceleration is heard, listen more frequently, for example after three consecutive contractions, and perform a full review.
- If concern is confirmed, summon help and recommend CTG; reassess the monitoring method again if a temporary concern resolves and no continuing indication remains.