Anna completed her specialist training in Obstetrics and Gynaecology at Vall d’Hebron Hospital. In 2014, she was awarded an EBCOG European Scholarship, which enabled her to undertake an honorary clinical fellowship in high-risk obstetrics at St George’s Hospital, where she worked with Dr Chandraharan and developed a passion for fetal monitoring.

After completing her residency, she extended her fellowship to further consolidate her training. During this period, she published several papers and carried out an audit for the CNST (NHS).

Since 2015, she has been a regular speaker at fetal monitoring masterclasses in the UK and Ireland. In 2016, she founded icareCTG, an educational project developed with Dr Chandraharan and Dr Susana Pereira, aimed at providing physiopathology-based training in fetal monitoring for obstetricians and midwives in Spanish-speaking countries. Since its launch, the project has delivered 20 masterclasses to more than 5,000 participants.

Anna serves on the Board of Physiological CTG Interpretation and is a co-author and peer reviewer of the Guideline based on fetal physiology for interpretation of CTGs, implemented in 14 countries. She is also part of the CTG Masterclass training faculty in the UK and internationally.

She leads several multicentre research studies and is currently pursuing a PhD in fetal monitoring. She has published widely on the subject in international journals and has authored multiple book chapters.

Anna is a member of the Perinatal Medicine Section of the Societat Catalana de Ginecologia i Obstetrícia and also contributes to the Working Group for the Study and Prevention of Obstetric Violence (GTepVO). She is an expert medical witness for the Barcelona Medical Association in obstetric cases involving cardiotocography traces.

Yan-ju J, Tullio, Pereira S, Gracia-Perez-Bonfils A, Chandraharan E. Pathophysiology of Fetal Heart Rate Abnormalities: understanding fetal compensatory responses on the Cardiotocograph (CTG). Accepted for publication. American Journal. 2023

Anna Gracia Perez-Bonfils; Edwin Chandraharan. Fetal Compromise: Diagnosis and Management. Obstetric and Intrapartum Emergencies: A Practical Guide to Management. Cambridge University, 10/11/2021.

Gracia-Perez-Bonfils, A, Martinez-Perez O, Llurba E, Chandraharan E. Fetal heart rate changes on the cardiotocograph trace secondary to maternal COVID-19 infection. Eur J Obstet Gynecol Reprod Biol. 2020;252:286-293. Citado 4 veces.

Gracia-Perez-Bonfils, A, Chandraharan, E Does the Saltatory pattern on cardiotocograph (CTG) trace really exist? The ZigZag pattern as an alternative definition and its correlation with perinatal outcomes. The Journal of Maternal-Fetal & Neonatal medicine. 33 (2018). Taylor&Francis. DOI 10.1080/14767058.2019.1686475

Anna Gracia Perez-Bonfils; Edwin Chandraharan. Understanding Fetal Oxygenation. CTG Interpretation: From Patterns to Physiology.Cambridge University Press, 23/02/2017.

Andrea Gascon Portales, María Goya Canino, Manel Mendoza Cobaleda, Anna Gracia Perez Bonfils, Teresa Higueras, Ines Calero, María Ángeles Sanchez, Elisa Llurba Olivé, Lluís Cabero Roura, Elena Carreras Moratonas. Intraobserver and interobserver variability in first trimester transvaginal ultrasound cervical length. The Journal of Maternal-Fetal & Neonatal medicine. 33 (2018). Taylor&Francis. DOI 10.1080/14767058.2018.1487939

Anna Gracia Perez-Bonfils; Edwin Chandraharan. Pathophysiology of CTG and Types of Intrapartum Hypoxia. CTG Interpretation: From Patterns to Physiology. Cambridge University, 23/02/2017.

Anna Gràcia Perez-Bonfils. Gynaecological History and Examination. Essentials of Gynecology. Jaypee Brothers Medical Publishers, 10/06/2016.

Anna Gracia Perez-Bonfils; Edwin Chandraharan. Impact of a physiology-based “Predictive” CTG Training on the knowledge of types of intrapartum fetal hypoxia amongst midwives and obstetricians. J.Perinat.Med. pp. 152. Walter de Gruyter, 15/10/2015.

Anna Gràcia Perez-Bonfils, Edwin Chandraharan. Fetal compromise: Diagnosis and Management. Chapter In: Obstretric and intrapartum emergencies: A practical guide to management. Cambridge University Press. 2014.

Susana is a clinical lead at The Royal London Hospital and a sub-specialist in fetal medicine. Originally from Portugal, she graduated from the University of Porto in 1998. After qualifying, she volunteered in São Tomé and Príncipe, where she developed her passion for Obstetrics and Gynaecology. She completed her specialty training in Portugal and undertook a fellowship in Fetal Medicine at King’s College Hospital with Professor Nicolaides.

Back in Portugal, she established a Fetal Medicine Unit and led it for three years. In 2014, she returned to London to complete her sub-specialty training in Fetal and Maternal Medicine at King’s College Hospital.

Between 2015 and 2017, she worked as a consultant at Kingston Hospital, where she led a patient safety project introducing physiopathology-based interpretation, improving perinatal outcomes, morbidity and mortality. The project was shortlisted for the HSJ Awards in 2017 and 2018 in the categories of Maternity and Midwifery Services, and Training and Education.

Susana is part of the CTG Masterclass training faculty in the UK and internationally and serves on the Physiological CTG Board. She is also a PROMPT (Practical Obstetric Multi-Professional Training) instructor. In 2015, she received an “Excellent Teaching” certificate at St George’s University and was nominated “Trainer of the Year” by South London trainees.

She currently works as a clinical lead at The Royal London Hospital. She is passionate about improving perinatal outcomes and values multidisciplinary teamwork in the labour ward, as well as the rapid decision-making it sometimes demands.

• Implementation of physiological interpretation of fetal heart rate changes: from scientific principles to frontline practice. Chandraharan E, Mappa I, Gracia Perez-Bonfils A, Pereira S. JMatern Fetal Neonatal Med. 2026Dec;39(1):2612451. doi: 10.1080/14767058.2025.2612451. Epub 2026 Jan 14. PMID: 41535023. 

• Intrapartum recognition and management of fetal inflammation. di Pasquo E, Pereira S, Valentini B, Familiari A, Ghi T. Eur J Pediatr. 2026Jan 15;185(2):81. doi: 10.1007/s00431-025-06738-w. PMID: 41540173. 

• A pragmatic approach to recognize intrapartum chorioamnionitisPereira S, Costa P, Oumar M, Garcia-Ruiz I. Eur J Obstet Gynecol Reprod Biol. 2025 Feb;305:199-203. doi: 10.1016/j.ejogrb.2024.12.012. Epub 2024 Dec 9. PMID: 39705989. 

• Rational approach to fetal heart rate monitoring and management during the second stage of labor.Chandraharan E, Kahar Y, Pereira S, Fieni S, Ghi T. Eur J Obstet Gynecol Reprod Biol. 2025 Feb;305:159-169. doi: 10.1016/j.ejogrb.2024.12.005. Epub 2024 Dec 12. PMID: 39701011. 

• Relative uteroplacental insufficiency of labor. Ghi T, Fieni S, Ramirez Zegarra R, Pereira S, Dall'Asta A, Chandraharan E. Acta Obstet Gynecol Scand. 2024 Oct;103(10):1910-1918. doi: 10.1111/aogs.14937. Epub 2024Aug 6. PMID: 39107951. 

• Long-Term Neurologic Consequences following Fetal Growth Restriction: The Impact on Brain Reserve.Shah DK, Pereira S, Lodygensky GA. Dev Neurosci. 2024 May 14:1-8. doi: 10.1159/000539266. Epub ahead of print. PMID: 38740013. 

• International expert consensus statement on physiological interpretation of cardiotocograph (CTG): First revision (2024)Chandraharan E, Pereira S, Ghi T, Gracia Perez-Bonfils A, Fieni S, Jia YJ, Griffiths K, Sukumaran S, Ingram C, Reeves K, Bolten M, Loser K, Carreras E, Suy A, Garcia-Ruiz I, Galli L, Zaima A.. Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:346-355. doi: 10.1016/j.ejogrb.2024.09.034. Epub 2024 Oct 2. PMID: 39378709. 

• Is the fetus fit for labor? Introducing fast-and-frugal trees (FFTrees) to simplify triage of women for STAN monitoring: An interobserver agreement comparison with traditional classification Pereira S, Bakker P, Zaima A, Ghi T, Kessler J, Timonen S, Vayssière C, Löser K, Holmberg K, Jacquemyn Y, Chandraharan E, Wertheim D, Olofsson P. Acta Obstet Gynecol Scand. 2024 Jan;103(1):68-76. doi: 10.1111/aogs.14680. Epub 2023Oct 27. PMID: 37890863; PMCID: PMC10755137. 

• Pathophysiological interpretation of fetal heart rate tracings in clinical practice Jia YJ, Ghi T, Pereira S, Gracia Perez-Bonfils A, Chandraharan E. Am J Obstet Gynecol. (2023) Jun;228(6):622-644. doi: 10.1016/j.ajog.2022.05.023. PMID: 37270259.

• Physiological CTG categorisation in types of hypoxia compared with MRI and neurodevelopmental outcome in infants with HIE. Pereira S, Patel R, Zaima A, Tvarozkova K, Chisholm P, Kappelou O, Evanson J, Chandraharan E, Wertheim D, Shah DK. J Matern Fetal Neonatal Med. 2022 Dec;35(25):9675-9683. doi: 10.1080/14767058.2022.2050366. Epub 2022 Mar 13. PMID: 35282752. 

• Absence of fetal heart rate cycling on the intrapartum cardiotocograph (CTG) is associated with intrapartum pyrexia and lower Apgar scores, Susana Pereira, Katherine Lau, Carlotta Modestini, David Wertheim & Edwin Chandraharan The Journal of Maternal-Fetal & Neonatal Medicine (2021), DOI: 10.1080/14767058.2021.1940130  

• Early vaginal progesterone versus placebo in twin pregnancies for the prevention of spontaneous preterm birth: a randomized, double-blind trial.Rehal A, Benkő Z, De Paco Matallana C, Syngelaki A, Janga D, Cicero S, Akolekar R, Singh M, Chaveeva P, Burgos J, Molina FS, Savvidou M, De La Calle M, Persico N, Quezada Rojas MS, Sau A, Greco E, O'Gorman N, Plasencia W, Pereira S, Jani JC, Valino N, Del Mar Gil M, Maclagan K, Wright A, Wright D, Nicolaides KH. Am J Obstet Gynecol. 2020 Jun 26 10.1016/j.ajog.2020.06.050. 

• Recognising Fetal Compromise in the Cardiograph during the Antenatal Period: Pearls and Pitfalls S Pereira, C Ingram, N Gupta, M Singh, E Chandraharan, Asian Journal of Medicine and Health 2020Sep 3 (8): 72-83 https://doi.org/10.9734/ajmah/2020/v18i930238 

• Antenatal corticosteroids and outcomes in gastroschisis: A multicenter retrospective cohort study Carnaghan H, James CP, Charlesworth PB, Ghionzoli M, Pereira S, Elkhouli M, Baud D, Coppi P, Ryan G, Shah PS, Davenport M, David AL, Pierro A, Eaton S; Gastroschisis Study Group. Prenat Diagn. 2020 May 13. doi: 10.1002/pd.5727 

• Human Factors: The Dirty Dozen in CTG misinterpretation, Nzelu O, Chandraharan E, Pereira S Glob J Reprod Med 6(2): GJORM.MS.ID.555683 2018 

• The first reported case of successful pregnancy outcome following conservative management of placenta percreta using the Triple P Procedure. Cauldwell M, Chandraharan E, Pinas Carillo A, Pereira S.Ultrasound Obstet Gynecol. 2017 

• Recognition of chronic hypoxia and pre-existing foetal injury on the cardiotocograph (CTG): Urgent need to think beyond the guidelines Susana Pereira and Edwin Chandraharan, Porto Biomedical Journal, 2017; 2(4):124-129 

• Each Fetus Matters: An Urgent Paradigm Shift is needed to Move away from the Rigid “CTG Guideline Stickers” so as to Individualize Intrapartum Fetal Heart Rate Monitoring and to improve Perinatal Outcomes. Chandraharan E, Tahan ME, PereiraS, Obstet Gynecol Int J 2016; 5(4):168.  

• Successful induction of labor: prediction by preinduction cervical length, angle of progression and cervical elastography. Pereira S, Frick AP, Poon LC, Zamprakou A, Nicolaides KH. Ultrasound Obstet Gynecol. 2014; 44(4): 468-475 

• Preterm labor: screening and prevention (Article in Portuguese) Cubal S, Pereira S, Acta Obstet Ginecol Port 2014:8(3): 276-282 

•  Is Early Delivery Beneficial In Gastroschisis?, Carnaghan H, Pereira S, James CP, Charlesworth PB, Ghionzoli M, Mohamed E, Cross KM, Kiely E, Patel S, Desai A, Nicolaides K, Curry JI, Ade-Ajayi N, De Coppi P, Davenport M, David AL, Pierro A, Eaton S., J Pediatr Surg. 2014; 49(6): 928-933 

• First-trimester biochemical markers and small-for-gestational-age, infants (Article in Portuguese) Andrade C, Santos J, Pinto AR, Manso P, Pereira S, Acta Med Port. 2014; 27(2): 191-195 

• Microarray for skeletal dysplasias: Thanatophoric Dysplasia diagnosed in utero using Microarray Technology. Guerra C, Rendeiro P, Pereira E, Rosmaninho A, Nogueira R, Pereira S, Tavares P.Ultrasound Obstet Gynecol. 2013 Jan; 41(1): 95-6   

• Contribution of fetal tricuspid regurgitation in first trimester screening for major cardiac defects. Pereira S, Ganapathy R, Syngelaki A, Maiz N, Nicolaides KH, Obstet Gynecol. 2011; 117 (6):1384-91. 

• Prevalence and outcome of absence of ductus venosus at 11-13 weeks, Staboulidou I, Pereira S, Cruz JJ, Syngelaki A, Nicolaides KH, Fetal Diagn Ther. 2011;30(1):35-40 

• Criteria for screening and diagnosis of gestational diabetes mellitus in the first trimester of pregnancy. Placensia W, Garcia R, Pereira S, Akolekar R, Nicolaides KH, Fetal Diagn Ther. 2011;30(2):108-15. 

• Complications of Obesity in Pregnancy. Raposo R, Ferreira C, Fernandes M, Pereira S, Moura P, Arquivos de Medicina, 2011; 25(3): 115-22 

• Body Stalk Anomaly: report of a rare case diagnosed early in pregnancy. Fernandes M, Pinto A, Raposo L, Pereira SL. Advances in Perinatal Medicine, 2010 

• Extensive subchorionic haematoma – a successful pregnancy outcome. C. Ferreira, V. Silva, L. Raposo, A. Portugal, Pereira S. Controversies in obstetrics, Gynecology and Infertility, 2010 

Books & Book Chapters

• Chapter author: Addressing Human Factors contributing to CTG misinterpretation

1. Pereira (2026) Handbook of CTG Interpretation: From Patterns to Physiology 2nd edition, edited by Chandraharan.      

• Book author: Is the fetus fit for labor? A physiological approach to CTG interpretation

Susana Pereira (2025). Self published. Available on Amazon. 

• Chapter co-author: Multiple gestation: labour and delivery, B. Lemon and S. Pereira

GLOWM – the global Library of Women’s Medicine

An educational Platform for FIGO (February 2021)

• Chapter co-author: Learning from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) and “Each Baby Counts” (EBC) Reports, Susana Pereira and Edwin Chandraharan 

Obstetric & Intrapartum Emergencies: A Practical Guide to Management, edited by Chandraharan & Arulkumaran (2021)

• Chapter co-author: Addressing Human Factors in Obstetric Emergencies, Susana Pereira and Kim Hinshaw 

Obstetric & Intrapartum Emergencies: A Practical Guide to Management, Edited by Chandraharan & Arulkumaran (2021)

• Multiple chapters author and editor

Problem Based Obstetric Ultrasound (2nd Edition)

Edited By Amar Bhide, Asma Khalil, Aris Papageorghiou, Susana Pereira, Shanthi Sairam and Basky Thilaganathan , Published December 4, (2019) by CRC Press 

• Chapter co-author: Medicolegal Issues in Obstetrics and Gynaecology, Edwin Chandraharan and Susana Pereira, Edited by Swati Jha and Emma Ferriman (2017)

Edwin is the person who, more than 20 years ago, began critically questioning everything we do in the delivery room, practices that had been perpetuated over the years. He applied basic knowledge of general physiology, the latest advances in fetal physiology, and common sense. With all of this, he proposed a different way of working, which has proven to improve perinatal outcomes.

Edwin was Head of Department and Lead for Clinical Governance for Obstetrics and Gynaecology from 2005 to 2017 at St. George’s Hospital, London. He was also Clinical Director for Women’s Services in 2015. He teaches more than 40 courses a year on fetal monitoring, postpartum hemorrhage, and obstetric emergencies, among other topics. He has led the “Training the Trainers” workshop and coordinated the “Basic Practical Skills Course” at the Royal College of Obstetricians and Gynaecologists (RCOG). He was a co-organizer of the RCOG's "Intrapartum Fetal Surveillance Course" and a member of the Editorial Board of the National E-learning for Healthcare in Electronic Fetal Heart Rate Monitoring.

Dr. Chandraharan has over 100 publications in national and international journals and book chapters. Edwin Chandraharan is co-author of the books "Obstetric and Intrapartum Emergencies: A Practical Guide to Management" and "High Risk Pregnancy: Management Options." In 2015, he was one of three members of the international committee that reviewed the FIGO Guidelines for CTG, which have been implemented in approximately 50 countries. In 2016, he published the book "Handbook of CTG Interpretation: From Patterns to Physiology" (Cambridge University Press, 2016).

He is a reviewer for The Lancet, BJOG, Journal of Perinatal Medicine, The Green Journal, and the European Journal of Obstetrics, Gynecology and Reproductive Biology, and an editorial consultant for Labour and Delivery at The Global Library of Women’s Medicine.
Edwin Chandraharan established and led a nationally recognized multidisciplinary team for the management of pregnant women with placenta percreta. He is the author of the “Triple P Procedure,” a surgical technique that allows for a less invasive treatment of placenta percreta without the need for hysterectomy, and which is currently being implemented in several countries.

In 2017, he received the prestigious BMJ Award for Clinical Leadership in Fetal Monitoring.

In 2019, he was hired as an intrapartum management consultant by the NHS at Basildon, Broomfield & Southend University Hospitals Mid and South Essex NHS Foundation Trust, Essex.

He is passionate about ensuring quality patient care with a strong focus on team training as a means to improve risk management and the patient experience.

Publications - Edwin Chandraharan