These tests offer separate snapshots of a baby's condition before, at and after birth. None alone proves negligence. An abnormal result may have several explanations. Experts combine them with the full clinical record to address standard of care and causation.
What each record can show
The CTG records the fetal heart rate alongside contractions during labour. It is interpreted for patterns that may suggest whether a baby is coping. Cord blood gases, taken at birth, give information about the baby's acid-base status around delivery. Apgar scores are a rapid assessment of the newborn's condition in the first minutes. MRI and other brain imaging may show the pattern and approximate timing of any brain injury.
Timing
Each test relates to a different moment. A CTG reflects the course of labour, cord gases reflect conditions close to birth, and imaging performed days later may help experts estimate when an injury occurred. Accurately aligning these records with clinical notes and recorded times is often the most important task in reviewing them.
Limitations
A low Apgar score, an abnormal CTG or a concerning MRI does not by itself prove negligence. CTG interpretation involves judgement and differs between observers. Cord gas samples can be affected by how they were collected. Apgar scores can reflect many factors, including prematurity or medication. Conditions such as cerebral palsy may have multiple causes, some originating before labour.
CTG interpretation must also be assessed against the fetal surveillance guidance applicable at the time, which has been revised across editions.
Combining evidence
Experts look for consistency across sources. Examples include whether a CTG pattern, the cord gas results, the baby's condition at birth and the imaging findings together point to a particular timing and mechanism of injury. Conflicting findings are examined rather than dismissed, and alternative explanations, such as infection, genetic factors or earlier events in pregnancy, are considered.
Expert interpretation
Opinions may be needed from obstetric, midwifery, neonatal, neuroradiology and paediatric neurology experts. A solicitor identifies which questions each must answer and makes sure the expert receives complete original data rather than partial copies.
For your next conversation
- Complete CTG trace with times, in electronic form if available
- Cord blood gas report, noting whether arterial and venous samples were taken
- Apgar scores and the resuscitation record
- Brain imaging reports, and images where obtainable
- Neonatal unit notes covering the first days
- Paediatric neurology or developmental reports
Common questions
The cord gas report has two sets of numbers. Which one matters?
Reports may include arterial and venous samples, which give different information. Whether both were collected correctly affects interpretation. Experts usually consider both together with other evidence rather than relying on a single value.
Can an MRI show when an injury happened?
Imaging can sometimes help experts estimate the likely timing and pattern of a brain injury. It is rarely precise on its own. Neuroradiologists interpret it together with labour records, cord gases and the baby's early condition.
Sources & further reading
- RANZCOG: fetal surveillance guideline (opens in a new tab)
- Healthdirect: cerebral palsy (opens in a new tab)
These references support the topic’s starting points. They do not determine the facts, standard of care or law applicable to an individual matter.