Abnormal Intrapartum Cardiotocographic Tracing, Fetal Outcome and Placental Pathology

Background: Cardiotocography (CTG) represents a cornerstone in modern intrapartum fetal surveillance, allowing continuous assessment of fetal well-being through the analysis of fetal heart rate patterns in relation to uterine contractions. Despite its widespread clinical use, the interpretation of CTG tracings remains complex and is often associated with high interobserver variability and limited specificity in predicting adverse outcomes. In recent years, increasing attention has been directed toward placental pathology as a key determinant in the pathophysiology of adverse perinatal events. The placenta, as a dynamic organ mediating maternal-fetal exchange, plays a crucial role in fetal oxygenation and nutrient supply. Alterations in its structure and function may contribute to both chronic and acute fetal compromise. This retrospective study aimed to investigate the relationship between pathological intrapartum CTG tracings and maternal-fetal outcomes, with a particular focus on correlating these findings with macroscopic and microscopic placental abnormalities, compared to a control group of uncomplicated pregnancies with normal CTG patterns. Material and methods: We evaluated maternal, fetal, and placental histopathological data from 85 patients who exhibited pathological intrapartum cardiotocographic tracings. All deliveries occurred between January 2023 and March 2025 at the Obstetrics and Gynecology Departments of the 'A. Gemelli' University Hospital and Careggi University Hospital. A control group consisting of 50 women with normal CTG patterns and uncomplicated term singleton pregnancies, delivered at the same institutions, was used for comparison. Results: Cases with pathological CTG showed poorer neonatal outcomes compared with those with normal CTG. Infants in the pathological CTG group had lower Apgar scores, more frequent NICU admissions, and one case of hypoxic-ischemic encephalopathy. Mode of delivery, Apgar scores, NICU admission, and arterial pH were all significantly associated with CTG classification. A higher birth weight-to-placental weight ratio in the pathological CTG group suggested possible uteroplacental insufficiency. Macroscopic and histological placental findings, including hypercoiled umbilical cords and intervillous thrombosis, were also significantly more frequent in cases with pathological CTG. Conclusions: The findings of this study suggest that pathological CTG reflects not an isolated event but rather a multifactorial dysfunction of the feto-placental unit. Its associations with low Apgar scores, reduced arterial pH, abnormal BW/PW ratio, intervillous thrombi, and umbilical cord hypercoiling are consistent with existing evidence and support the interplay of chronic placental abnormalities and acute mechanical factors in the development of suspected fetal hypoxia. The future development of multivariate predictive models integrating clinical, biochemical, and anatomo-pathological variables may improve the early identification of pregnancies at risk and optimize intrapartum management, thereby reducing adverse perinatal outcomes.