The Intrapartum CTG Changes Associated with Chorioamnionitis and Maternal Sepsis: A Case Series

Abstract

Maternal sepsis is a preventable yet leading cause of maternal and neonatal morbidity and mortality. Infection-induced inflammatory changes during labor can alter fetal heart rate (FHR) patterns on cardiotocography (CTG), serving as early indicators of fetal compromise before clinical deterioration. This case series presents five women diagnosed with chorioamnionitis or maternal sepsis during labor, highlighting specific CTG changes and their correlation with maternal and neonatal outcomes. Across cases, recurrent abnormalities included fetal tachycardia, loss of cycling, reduced baseline variability, and recurrent decelerations, often preceding fever or laboratory confirmation. Predominant pathogens included Group B Streptococcus (GBS), Staphylococcus aureus, and Streptococcus pyogenes. Timely initiation of antibiotics and appropriate obstetric intervention yielded favorable maternal outcomes, with minimal neonatal morbidity. Findings suggest that CTG may serve as a non-invasive early-warning tool for sepsis-related compromise. Further prospective studies are warranted to validate CTG-based sepsis markers and integrate them into clinical practice.