Interpretation of Fetal Heart Rate Recordings

A systematic approach in evaluation of the fetal heart rate (FHR) recordings is recommended to optimize interpretation. Studies have demonstrated poor reliability and consistency among various expert interpreters, even in controlled settings. The initial recommendations in 1997 by a National Institute of Child Health and Human Development (NICHHD) work group have been revised and updated by a 2008 work group cosponsored by the Society for Maternal-Fetal Medicine, in part to simplify and standardize FHR

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Figure 21-10 Accelerations of the fetal heart rate above a baseline rate of 130 to 140 beats per minute. Good variability is present.

Figure 21-10 Accelerations of the fetal heart rate above a baseline rate of 130 to 140 beats per minute. Good variability is present.

interpretation. Five features of the FHR that need to be assessed: baseline, variability, accelerations, decelerations and its sub-classifications, and corresponding contractions. As of 2008, FHR recordings can be considered as belonging to one of three categories: normal (NICHHD Category I), indeterminate (Category II), and abnormal (Category III). Normal tracings are associated with a normal pH and fetal well-being, and current management should continue. Indeterminate tracings and abnormal tracings suggest the need for further evaluation and possible intervention. This evaluation may include vaginal examination, checking maternal vital signs, giving oxygen, changing maternal position, administering fluids, scalp stimulation, and determination of scalp pH measurement. An NICHHD Category II tracing will represent a significant fraction of those encountered in clinical care and will include all tracings that do not belong in categories I and II. An abnormal (NICHHD III) tracing usually indicates the need for the previous measures and consideration of expedited delivery.

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