The term 'fetal distress' should be replaced by 'suspected fetal compromise' because the diagnosis of 'fetal distress' is often unproven. Cardiotocography remains the cornerstone of making the diagnosis, but as a test it is renowned for its high sensitivity and low specificity. It has reduced intrapartum fetal mortality but not long-term neonatal morbidity or the incidence of cerebral palsy. There is no doubt that when obvious signs of fetal compromise, such as late decelerations in the presence of intrauterine growth retardation and oligohydramnios, are present, the diagnosis of fetal compromise is relatively simple. Often, however, the subtle signs of fetal compromise are missed; these are a change in the grade of meconium in the amniotic fluid, a rising base-line fetal heart rate, the absence of accelerations, the presence of 'atypical' variable decelerations or a combination of the above. To date, there is no test available to replace the cardiotocograph, although fetal pulse oximetry is the most promising adjunctive test. Above all, no test result obtained in isolation must detract from the whole clinical picture.