Contractions are classified as normal (no more than five contractions in a 10-minute period) or tachysystole (more than five contractions in a 10-minute period, averaged over a 30-minute window). The term "hyperstimulation" is no





Figure 21-13 Variable decelerations of fetal heart rate.

Figure 21-13 Variable decelerations of fetal heart rate.

longer accepted and should be discontinued. Tachysystole is qualified by the presence or absence of decelerations, and it applies to both spontaneous and stimulated labor.


• The false-positive rate of electronic fetal monitoring (EFM) for predicting adverse outcomes is high (SOR: A).

• The use of EFM is associated with an increase in the rate of surgical interventions (SOR: A).

• Compared with structured intermittent auscultation, continuous EFM shows no difference in overall neonatal mortality (SOR: A).

• Continuous EFM reduces neonatal seizure rates (SOR: A).

• Fetal pulse oximetry has not shown a reduction in cesarean delivery rates (SOR: A).

• The use of EFM does not result in a reduction of cerebral palsy rates (SOR: A).

• The labor of women with high-risk conditions should be monitored continuously (SOR: B).

• Reinterpretation of the fetal heart rate tracing, especially knowing the neonatal outcome, is not reliable (SOR: B).

• The use of fetal pulse oximetry in clinical practice cannot be supported at this time (SOR: B).

Data from ACOG, 2005, 2009b; Alfirevic et al., 2006; East et al., 2007; and Macones et al., 2008.

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