Background: Cardiotocography (CTG) is primarily interpreted to detect intrapartum hypoxia, but growing evidence indicates that intrauterine infection and fetal inflammation can independently alter fetal heart rate patterns, often below the conventional tachycardia threshold of 160 beats/minute used to suspect infection. Non-hypoxic, inflammation-driven CTG changes therefore remain under-recognised in routine practice.

Objective: To evaluate the correlation between intrapartum CTG patterns and fetal inflammatory response markers in umbilical cord blood among term pregnancies and perinatal outcome.

Methods: This hospital-based cross-sectional observational study was conducted in the Department of Obstetrics & Gynaecology, Era's Lucknow Medical College & Hospital, on 66 women with singleton term pregnancies (37-41 weeks) in labour, recruited by consecutive sampling. Each participant underwent three 10-minute CTG recordings at least one hour apart, classified as Category II or Category III using physiological interpretation of fetal heart rate. Umbilical cord blood was analysed for total leukocyte count (TLC), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-α). Associations were tested using chi-square/Fisher's exact and Mann-Whitney U tests, and correlation was assessed using Spearman's coefficient.

Results: CTG Category III was seen in 42 (63.6%) women and Category II in 24 (36.4%). Category III was associated with significantly higher median TLC (19,900 vs 18,500/mm³, p=0.041), IL-8 (6.3 vs 5.6 pg/mL, p=0.032) and TNF-α (2.5 vs 2.1 pg/mL, p=0.048), a higher rate of low 5-minute Apgar score (7.1% vs 4.2%, p=0.048), and higher NICU admission (66.7% vs 41.7%, p=0.048). CTG category correlated positively with TLC (r=0.29, p=0.019), IL-8 (r=0.31, p=0.014) and TNF-α (r=0.27, p=0.028); correlations with CRP, IL-6 and cord pH were not statistically significant.