Objective Specific fetal heart rate (FHR) patterns are associated with fetal compromise. Several placental histopathology findings are associated with neonatal morbidity and adverse neurodevelopment. The relationships between FHR patterns and placental histopathology in infants with hypoxic ischaemic encephalopathy (HIE) remain uncertain. This study hypothesised that in infants with HIE, placental histopathology findings are related to abnormal FHR patterns. Design Retrospective observational study. Setting A single tertiary centre. Population Infants born at ≥ 36 weeks’ gestation with moderate or severe HIE between September 2006 and December 2021. Methods Placental histopathology was assessed by a perinatal pathologist using the Amsterdam Working Group Criteria. FHR, recorded from intrapartum cardiotocography (CTG) was assessed by an obstetrician using a structured proforma. Assessors were blinded to clinical course and outcomes. Main Outcome Measures Duration and type of FHR abnormality were compared across categories of placental histopathology findings. Results Fifty infants with moderate or severe HIE (with complete data relating to intrapartum CTG and placental histopathology) were included. Increased duration of FHR abnormality, and consecutive FHR abnormality (>1h) at any time during intrapartum CTG monitoring were associated with the presence of abnormal placental histopathology. There was no evidence of associations between placental histopathology findings and specific FHR features on intrapartum CTG. Conclusions This study demonstrates an association between abnormal placental histopathology findings and duration of FHR abnormality in near-term and term infants with moderate or severe HIE. Future research should investigate the utility of multi-modal assessment to improve risk stratification.