This document provides guidance on evaluating and managing intrapartum fetal heart rate tracings based on a three-tiered categorization system. Category I tracings are normal and require routine surveillance. Category II tracings require more frequent evaluation and potential corrective measures, with the presence of accelerations or variability helping to determine risk of acidemia. Category III tracings indicate the highest risk and preparations for delivery. Specific patterns like variable decelerations are managed initially with positioning and potentially amnioinfusion, while recurrent late decelerations require measures to improve uteroplacental perfusion. Intrapartum tachycardia requires evaluating for underlying causes.
Electronic fetal monitoring uses ultrasound to evaluate the fetal heart rate and assess fetal well-being. There are two types: external monitoring using a transducer on the abdomen and internal monitoring using a scalp electrode. Fetal heart rate patterns are categorized as normal, indeterminate, or abnormal based on the baseline rate, variability, and presence of decelerations. Continuous electronic fetal monitoring is recommended if certain maternal or fetal risk factors are present such as meconium, maternal fever, hypertension, or abnormal fetal heart rate patterns. Guidelines provide guidance on interpreting traces and appropriate management responses.
This document discusses different methods of fetal monitoring during labor, including electronic fetal monitoring (EFM) and intermittent auscultation. While EFM is commonly used, it has high rates of false positives and variable interpretations. Intermittent auscultation is a simpler, less invasive method that is well-liked by patients and may reduce rates of cesarean section. The document also questions whether EFM has been proven to effectively prevent brain damage, as its central hypotheses have never been tested. It argues intermittent auscultation is an acceptable alternative for low-risk patients. The document provides guidelines for appropriate fetal monitoring and interpreting EFM tracings.
The document provides guidelines for interpreting intrapartum fetal heart rate tracings using the NICHD nomenclature system, which classifies tracings as Category I, II, or III based on characteristics such as baseline rate, variability, and presence of decelerations. Category I tracings are normal, Category II indeterminate, and Category III abnormal and predictive of fetal acidosis. The guidelines aim to standardize interpretation of tracings and guide clinical management.
This document provides guidance on interpreting cardiotocography (CTG) readings during labor and delivery. It discusses how to prepare for and perform CTG monitoring, including setting up the machine, positioning the patient, and differentiating the maternal and fetal heart rates. It then describes how to interpret various features of the CTG tracing such as the baseline fetal heart rate, variability, accelerations, decelerations, and overall patterns. Recommendations are provided on the actions to take based on whether the CTG reading is normal, suspicious, or pathological.
The document provides an overview of electronic fetal monitoring, including:
1. It defines the objectives of explaining fetal heart rate patterns using standard terminology and identifying normal and abnormal patterns on fetal heart rate tracings.
2. It reviews elements of the fetal heart rate tracing like baseline rate, variability, accelerations, and decelerations using standard definitions from NICHD.
3. It provides examples of fetal heart rate tracings and asks the reader to interpret them using the described terminology.
Cardiotocography (CTG) involves recording the fetal heartbeat and uterine contractions on a graph. It is used to assess fetal wellbeing and monitor uterine activity. Two transducers are placed on the mother's abdomen to measure fetal heart rate and uterine contractions. Features of the CTG tracing including baseline heart rate, variability, accelerations, and decelerations are analyzed to determine if the tracing is reassuring, suspicious, or abnormal. While a normal CTG provides a high level of reassurance for fetal wellbeing, an abnormal CTG does not always indicate fetal distress.
This document discusses cardiotocography (CTG), which is a method for electronic fetal monitoring. It outlines the basic patterns seen on a CTG including baseline heart rate, variability, accelerations, and decelerations. It then describes how to interpret each component of a CTG reading based on whether findings are reassuring, non-reassuring, or abnormal. Management recommendations are provided depending on the CTG category of normal, suspicious, pathological, or need for urgent intervention. Conservative measures that can be tried include changing the mother's position, giving intravenous fluids, and reducing uterine contractions.
Cardiotocography (CTG) involves using ultrasound and pressure transducers on a pregnant woman's abdomen to monitor the fetal heart rate and uterine contractions. It is used in the third trimester, especially during labor, to detect fetal distress. Abnormal CTG readings may indicate the need for further investigation or emergency c-section. Key elements of CTG interpretation include assessing the baseline fetal heart rate, variability, accelerations, and decelerations in response to contractions. Late or variable decelerations can suggest fetal hypoxia requiring interventions like fetal blood sampling.
Electronic fetal monitoring uses ultrasound to evaluate the fetal heart rate and assess fetal well-being. There are two types: external monitoring using a transducer on the abdomen and internal monitoring using a scalp electrode. Fetal heart rate patterns are categorized as normal, indeterminate, or abnormal based on the baseline rate, variability, and presence of decelerations. Continuous electronic fetal monitoring is recommended if certain maternal or fetal risk factors are present such as meconium, maternal fever, hypertension, or abnormal fetal heart rate patterns. Guidelines provide guidance on interpreting traces and appropriate management responses.
This document discusses different methods of fetal monitoring during labor, including electronic fetal monitoring (EFM) and intermittent auscultation. While EFM is commonly used, it has high rates of false positives and variable interpretations. Intermittent auscultation is a simpler, less invasive method that is well-liked by patients and may reduce rates of cesarean section. The document also questions whether EFM has been proven to effectively prevent brain damage, as its central hypotheses have never been tested. It argues intermittent auscultation is an acceptable alternative for low-risk patients. The document provides guidelines for appropriate fetal monitoring and interpreting EFM tracings.
The document provides guidelines for interpreting intrapartum fetal heart rate tracings using the NICHD nomenclature system, which classifies tracings as Category I, II, or III based on characteristics such as baseline rate, variability, and presence of decelerations. Category I tracings are normal, Category II indeterminate, and Category III abnormal and predictive of fetal acidosis. The guidelines aim to standardize interpretation of tracings and guide clinical management.
This document provides guidance on interpreting cardiotocography (CTG) readings during labor and delivery. It discusses how to prepare for and perform CTG monitoring, including setting up the machine, positioning the patient, and differentiating the maternal and fetal heart rates. It then describes how to interpret various features of the CTG tracing such as the baseline fetal heart rate, variability, accelerations, decelerations, and overall patterns. Recommendations are provided on the actions to take based on whether the CTG reading is normal, suspicious, or pathological.
The document provides an overview of electronic fetal monitoring, including:
1. It defines the objectives of explaining fetal heart rate patterns using standard terminology and identifying normal and abnormal patterns on fetal heart rate tracings.
2. It reviews elements of the fetal heart rate tracing like baseline rate, variability, accelerations, and decelerations using standard definitions from NICHD.
3. It provides examples of fetal heart rate tracings and asks the reader to interpret them using the described terminology.
Cardiotocography (CTG) involves recording the fetal heartbeat and uterine contractions on a graph. It is used to assess fetal wellbeing and monitor uterine activity. Two transducers are placed on the mother's abdomen to measure fetal heart rate and uterine contractions. Features of the CTG tracing including baseline heart rate, variability, accelerations, and decelerations are analyzed to determine if the tracing is reassuring, suspicious, or abnormal. While a normal CTG provides a high level of reassurance for fetal wellbeing, an abnormal CTG does not always indicate fetal distress.
This document discusses cardiotocography (CTG), which is a method for electronic fetal monitoring. It outlines the basic patterns seen on a CTG including baseline heart rate, variability, accelerations, and decelerations. It then describes how to interpret each component of a CTG reading based on whether findings are reassuring, non-reassuring, or abnormal. Management recommendations are provided depending on the CTG category of normal, suspicious, pathological, or need for urgent intervention. Conservative measures that can be tried include changing the mother's position, giving intravenous fluids, and reducing uterine contractions.
Cardiotocography (CTG) involves using ultrasound and pressure transducers on a pregnant woman's abdomen to monitor the fetal heart rate and uterine contractions. It is used in the third trimester, especially during labor, to detect fetal distress. Abnormal CTG readings may indicate the need for further investigation or emergency c-section. Key elements of CTG interpretation include assessing the baseline fetal heart rate, variability, accelerations, and decelerations in response to contractions. Late or variable decelerations can suggest fetal hypoxia requiring interventions like fetal blood sampling.
CTG involves monitoring the fetal heart rate and uterine contractions during pregnancy using ultrasound and sensors placed on the maternal abdomen. It allows indirect assessment of fetal well-being but cannot directly measure oxygen levels or pH. The trace is analyzed based on baseline heart rate, variability, presence of accelerations or decelerations, and characteristics of uterine contractions. CTG interpretation involves categorizing the trace as normal, non-reassuring, or abnormal based on these features and guiding appropriate clinical management.
Cardiotocography (CTG) is a technique used to monitor the fetal heart rate and uterine contractions during pregnancy using an electronic fetal monitor. It involves using two transducers, one to measure the fetal heart rate and another to measure uterine contractions. The monitor provides data on the baseline fetal heart rate, variability, presence of accelerations or decelerations associated with contractions. Abnormal patterns in these readings can indicate fetal hypoxia or stress requiring delivery.
Cardiotocography (CTG) monitors the fetal heart rate and uterine contractions during pregnancy. A CTG involves using ultrasound to record the fetal heart rate and a transducer to monitor uterine contractions. Abnormal CTG results indicate the need for further investigation and may require emergency c-section if fetal distress is detected. To interpret a CTG, clinicians assess characteristics like the baseline heart rate, variability, presence of accelerations or decelerations, and number of contractions over a 10 minute period. This provides insight into fetal well-being and guides medical management during delivery.
The document discusses cardiotocography (CTG), which involves using transducers to simultaneously monitor the fetal heart rate and uterine contractions during childbirth. It describes how CTG is used to identify signs of fetal distress. CTG can be performed externally or internally and is indicated for patients with certain risk factors or complications. The document outlines how to interpret CTG traces, including normal versus non-reassuring versus abnormal classifications based on factors like baseline heart rate, variability, and types of decelerations observed.
The document discusses various aspects of fetal heart rate monitoring including:
1. Types of fetal heart rate tests including NST, CST, and acoustic stimulation test.
2. Components of fetal heart rate tracings including baseline rate, variability, accelerations, and decelerations.
3. Interpretation of normal, suspicious, and abnormal fetal heart rate tracing patterns.
4. Management recommendations based on the interpretation including continued monitoring, amniotomy, or discontinuing labor stimulating agents.
This document provides guidelines for interpreting intrapartum fetal heart rate monitoring. It defines key terms used to describe fetal heart rate patterns and uterine contractions. These include baseline heart rate, variability, accelerations, early and late decelerations, and tachysystole. The document also presents a three-tiered system for classifying fetal heart rate tracings as Category I (normal), Category II (indeterminate), or Category III (abnormal). This classification system is intended to help evaluate the current acid-base status of the fetus and guide clinical management.
This presentation explains the basic concepts involved in CTG such as how to read it and how it works and the terms associated with it and a machine manufacture by Philips known as the Avalon FM30 : Fetal monitor
This document provides clinical management guidelines for obstetrician-gynecologists regarding intrapartum fetal heart rate monitoring. It summarizes the findings of a workshop that established standardized nomenclature and a three-tiered system for interpreting electronic fetal monitoring (EFM) tracings. While EFM is widely used, evidence shows it increases cesarean and operative vaginal deliveries without reducing perinatal mortality compared to intermittent auscultation. Guidelines are provided for reviewing EFM and managing abnormal tracings.
This document discusses intrapartum fetal heart rate (FHR) monitoring. It finds that while continuous electronic FHR monitoring increases cesarean rates compared to intermittent auscultation, neither approach improves neonatal outcomes. For low-risk women, routine electronic monitoring is not recommended. High-risk pregnancies should be continuously monitored. FHR patterns are categorized as reassuring, nonreassuring, or indeterminate. Nonreassuring patterns may indicate fetal acidosis and require interventions like oxygen, fluids, or discontinuing uterotonic drugs.
This document provides guidelines for the management and interpretation of intrapartum fetal heart rate tracings. It discusses important factors to consider when interpreting tracings such as gestational age, maternal conditions, and fetal conditions. It describes the physiology underlying different fetal heart rate patterns. It also presents the NICHD nomenclature for standardized description of tracings, including definitions for baseline rate, variability, accelerations, and decelerations. Tracings are categorized as Category I, II, or III based on patterns that reflect fetal acid-base status. Category I tracings are normal while Category III tracings indicate abnormal fetal status and need for prompt evaluation and treatment.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
This document discusses the non-stress test, which involves using Doppler ultrasound to detect fetal heart rate accelerations in response to fetal movements as a sign of fetal health. It introduced the current definition of a normal non-stress test as requiring two or more fetal heart rate accelerations of 15 bpm or more above the baseline lasting at least 15 seconds within a 20 minute period. The document also discusses various types of fetal heart rate patterns such as accelerations, decelerations, and abnormalities that can be detected via continuous electronic fetal monitoring and their clinical significance for assessing fetal wellbeing.
Electronic Fetal Heart Rate Monitoring for Nursing studentsEman Mohamed
This document provides an overview of electronic fetal heart rate monitoring (EFHRM). It begins with an introduction describing EFHRM as a screening test used to detect potential issues and need for further assessment. It then discusses common procedures for EFHRM including intermittent auscultation, continuous external monitoring, and continuous internal monitoring. The document outlines nursing care responsibilities and appropriate responses to different fetal heart rate patterns such as decelerations. It concludes with reviewing interpretation of test results and providing a case study scenario.
This document provides information about fetal cardiotocography (CTG), including:
1. CTG can be performed from 28 weeks of gestation as that is when the fetal autonomic nervous system is mature.
2. Normal CTG findings include a baseline heart rate between 110-160 bpm, variability between 5-25 bpm, and an absence of or early decelerations with at least 2 accelerations in 20 minutes.
3. Abnormal findings include bradycardia (<110 bpm), tachycardia (>160 bpm), decreased variability (<5 bpm), and late or variable decelerations which can indicate fetal hypoxia or distress.
Antenatal assessment physical well being /introduction and methodsBabitha Mathew
The tests used to monitor fetal health include fetal movement counts, the nonstress test, biophysical profile, modified biophysical profile, contraction stress test, and Doppler ultrasound exam of the umbilical artery.
Cardiotocography (CTG) involves continuous electronic monitoring of the fetal heart rate and uterine contractions. It is done externally via ultrasound transducers on the mother's abdomen or internally via an electrode attached to the fetal scalp. CTG is used to evaluate the fetal heart rate patterns including baseline rate, variability, accelerations, and decelerations which can indicate fetal well-being or distress. Abnormal patterns may necessitate changes to labor management or delivery.
This document provides information on how to read and interpret a cardiotocography (CTG), which is a graphic recording of the fetal heart rate and uterine contractions. It discusses the components of a CTG apparatus and how to prepare for a CTG. It describes how to assess various characteristics of a CTG tracing using the DR C BRAVADO method, including determining risk, contractions, baseline rate, variability, accelerations, decelerations, and providing an overall assessment. It also discusses conservative techniques that can be used in response to certain CTG tracings and mentions tele-CTG as a potential cost-effective alternative.
Intrapartum fetal monitoring allows assessment of fetal well-being during labor and delivery. Methods include intermittent auscultation of the fetal heart rate, electronic fetal monitoring of the heart rate and uterine contractions, and fetal scalp blood sampling. Patterns in the fetal heart rate tracing like decelerations, variability, and accelerations provide information about fetal oxygenation. Category I tracings are reassuring, Category II tracings are indeterminate, and Category III tracings are nonreassuring and indicate fetal acidosis requiring preparations for delivery to prevent hypoxic injury. Interpretation of fetal monitoring guides management to ensure timely intervention if the fetus is not tolerating labor well.
Fetal heart monitoring involves tracking the fetal heart rate and uterine contractions to evaluate fetal well-being during labor and delivery. There are two main types of monitoring - intermittent auscultation using a doppler and continuous electronic fetal monitoring. Fetal monitoring is indicated for high-risk pregnancies, labors, or when abnormalities arise. Patterns are analyzed for baseline heart rate, variability, accelerations, and decelerations in relation to contractions to assess fetal status as reassuring, non-reassuring, or abnormal requiring intervention. Future advances may provide additional options for fetal surveillance during childbirth.
- A 23-year-old woman at 38 weeks gestation presents with complaints of diminished fetal movement for 2 days. Diminished fetal movement can indicate impending fetal death so this is a significant concern. The next step should be to assess the fetus, such as with a non-stress test (NST).
- Fetal monitoring aims to prevent fetal death and avoid unnecessary interventions. Methods include daily fetal movement counts (DFMC), NST, contraction stress tests (CST), biophysical profiles, and Doppler velocimetry. Interpretation depends on gestational age and fetal viability.
- An NST evaluates fetal condition by looking for fetal heart rate accelerations in response to movement. For gestations over
CTG involves monitoring the fetal heart rate and uterine contractions during pregnancy using ultrasound and sensors placed on the maternal abdomen. It allows indirect assessment of fetal well-being but cannot directly measure oxygen levels or pH. The trace is analyzed based on baseline heart rate, variability, presence of accelerations or decelerations, and characteristics of uterine contractions. CTG interpretation involves categorizing the trace as normal, non-reassuring, or abnormal based on these features and guiding appropriate clinical management.
Cardiotocography (CTG) is a technique used to monitor the fetal heart rate and uterine contractions during pregnancy using an electronic fetal monitor. It involves using two transducers, one to measure the fetal heart rate and another to measure uterine contractions. The monitor provides data on the baseline fetal heart rate, variability, presence of accelerations or decelerations associated with contractions. Abnormal patterns in these readings can indicate fetal hypoxia or stress requiring delivery.
Cardiotocography (CTG) monitors the fetal heart rate and uterine contractions during pregnancy. A CTG involves using ultrasound to record the fetal heart rate and a transducer to monitor uterine contractions. Abnormal CTG results indicate the need for further investigation and may require emergency c-section if fetal distress is detected. To interpret a CTG, clinicians assess characteristics like the baseline heart rate, variability, presence of accelerations or decelerations, and number of contractions over a 10 minute period. This provides insight into fetal well-being and guides medical management during delivery.
The document discusses cardiotocography (CTG), which involves using transducers to simultaneously monitor the fetal heart rate and uterine contractions during childbirth. It describes how CTG is used to identify signs of fetal distress. CTG can be performed externally or internally and is indicated for patients with certain risk factors or complications. The document outlines how to interpret CTG traces, including normal versus non-reassuring versus abnormal classifications based on factors like baseline heart rate, variability, and types of decelerations observed.
The document discusses various aspects of fetal heart rate monitoring including:
1. Types of fetal heart rate tests including NST, CST, and acoustic stimulation test.
2. Components of fetal heart rate tracings including baseline rate, variability, accelerations, and decelerations.
3. Interpretation of normal, suspicious, and abnormal fetal heart rate tracing patterns.
4. Management recommendations based on the interpretation including continued monitoring, amniotomy, or discontinuing labor stimulating agents.
This document provides guidelines for interpreting intrapartum fetal heart rate monitoring. It defines key terms used to describe fetal heart rate patterns and uterine contractions. These include baseline heart rate, variability, accelerations, early and late decelerations, and tachysystole. The document also presents a three-tiered system for classifying fetal heart rate tracings as Category I (normal), Category II (indeterminate), or Category III (abnormal). This classification system is intended to help evaluate the current acid-base status of the fetus and guide clinical management.
This presentation explains the basic concepts involved in CTG such as how to read it and how it works and the terms associated with it and a machine manufacture by Philips known as the Avalon FM30 : Fetal monitor
This document provides clinical management guidelines for obstetrician-gynecologists regarding intrapartum fetal heart rate monitoring. It summarizes the findings of a workshop that established standardized nomenclature and a three-tiered system for interpreting electronic fetal monitoring (EFM) tracings. While EFM is widely used, evidence shows it increases cesarean and operative vaginal deliveries without reducing perinatal mortality compared to intermittent auscultation. Guidelines are provided for reviewing EFM and managing abnormal tracings.
This document discusses intrapartum fetal heart rate (FHR) monitoring. It finds that while continuous electronic FHR monitoring increases cesarean rates compared to intermittent auscultation, neither approach improves neonatal outcomes. For low-risk women, routine electronic monitoring is not recommended. High-risk pregnancies should be continuously monitored. FHR patterns are categorized as reassuring, nonreassuring, or indeterminate. Nonreassuring patterns may indicate fetal acidosis and require interventions like oxygen, fluids, or discontinuing uterotonic drugs.
This document provides guidelines for the management and interpretation of intrapartum fetal heart rate tracings. It discusses important factors to consider when interpreting tracings such as gestational age, maternal conditions, and fetal conditions. It describes the physiology underlying different fetal heart rate patterns. It also presents the NICHD nomenclature for standardized description of tracings, including definitions for baseline rate, variability, accelerations, and decelerations. Tracings are categorized as Category I, II, or III based on patterns that reflect fetal acid-base status. Category I tracings are normal while Category III tracings indicate abnormal fetal status and need for prompt evaluation and treatment.
This document provides information on intrapartum fetal monitoring techniques including fetal heart rate monitoring, indications for continuous electronic fetal monitoring, interpretation of fetal heart rate patterns, and management of non-reassuring fetal status. It discusses techniques like intermittent auscultation, electronic fetal monitoring, fetal scalp pH testing, pulse oximetry, and lactate testing. The goal of intrapartum monitoring is timely identification and rescue of fetuses at risk for neonatal morbidity from hypoxic insult during labor and delivery.
This document discusses the non-stress test, which involves using Doppler ultrasound to detect fetal heart rate accelerations in response to fetal movements as a sign of fetal health. It introduced the current definition of a normal non-stress test as requiring two or more fetal heart rate accelerations of 15 bpm or more above the baseline lasting at least 15 seconds within a 20 minute period. The document also discusses various types of fetal heart rate patterns such as accelerations, decelerations, and abnormalities that can be detected via continuous electronic fetal monitoring and their clinical significance for assessing fetal wellbeing.
Electronic Fetal Heart Rate Monitoring for Nursing studentsEman Mohamed
This document provides an overview of electronic fetal heart rate monitoring (EFHRM). It begins with an introduction describing EFHRM as a screening test used to detect potential issues and need for further assessment. It then discusses common procedures for EFHRM including intermittent auscultation, continuous external monitoring, and continuous internal monitoring. The document outlines nursing care responsibilities and appropriate responses to different fetal heart rate patterns such as decelerations. It concludes with reviewing interpretation of test results and providing a case study scenario.
This document provides information about fetal cardiotocography (CTG), including:
1. CTG can be performed from 28 weeks of gestation as that is when the fetal autonomic nervous system is mature.
2. Normal CTG findings include a baseline heart rate between 110-160 bpm, variability between 5-25 bpm, and an absence of or early decelerations with at least 2 accelerations in 20 minutes.
3. Abnormal findings include bradycardia (<110 bpm), tachycardia (>160 bpm), decreased variability (<5 bpm), and late or variable decelerations which can indicate fetal hypoxia or distress.
Antenatal assessment physical well being /introduction and methodsBabitha Mathew
The tests used to monitor fetal health include fetal movement counts, the nonstress test, biophysical profile, modified biophysical profile, contraction stress test, and Doppler ultrasound exam of the umbilical artery.
Cardiotocography (CTG) involves continuous electronic monitoring of the fetal heart rate and uterine contractions. It is done externally via ultrasound transducers on the mother's abdomen or internally via an electrode attached to the fetal scalp. CTG is used to evaluate the fetal heart rate patterns including baseline rate, variability, accelerations, and decelerations which can indicate fetal well-being or distress. Abnormal patterns may necessitate changes to labor management or delivery.
This document provides information on how to read and interpret a cardiotocography (CTG), which is a graphic recording of the fetal heart rate and uterine contractions. It discusses the components of a CTG apparatus and how to prepare for a CTG. It describes how to assess various characteristics of a CTG tracing using the DR C BRAVADO method, including determining risk, contractions, baseline rate, variability, accelerations, decelerations, and providing an overall assessment. It also discusses conservative techniques that can be used in response to certain CTG tracings and mentions tele-CTG as a potential cost-effective alternative.
Intrapartum fetal monitoring allows assessment of fetal well-being during labor and delivery. Methods include intermittent auscultation of the fetal heart rate, electronic fetal monitoring of the heart rate and uterine contractions, and fetal scalp blood sampling. Patterns in the fetal heart rate tracing like decelerations, variability, and accelerations provide information about fetal oxygenation. Category I tracings are reassuring, Category II tracings are indeterminate, and Category III tracings are nonreassuring and indicate fetal acidosis requiring preparations for delivery to prevent hypoxic injury. Interpretation of fetal monitoring guides management to ensure timely intervention if the fetus is not tolerating labor well.
Fetal heart monitoring involves tracking the fetal heart rate and uterine contractions to evaluate fetal well-being during labor and delivery. There are two main types of monitoring - intermittent auscultation using a doppler and continuous electronic fetal monitoring. Fetal monitoring is indicated for high-risk pregnancies, labors, or when abnormalities arise. Patterns are analyzed for baseline heart rate, variability, accelerations, and decelerations in relation to contractions to assess fetal status as reassuring, non-reassuring, or abnormal requiring intervention. Future advances may provide additional options for fetal surveillance during childbirth.
- A 23-year-old woman at 38 weeks gestation presents with complaints of diminished fetal movement for 2 days. Diminished fetal movement can indicate impending fetal death so this is a significant concern. The next step should be to assess the fetus, such as with a non-stress test (NST).
- Fetal monitoring aims to prevent fetal death and avoid unnecessary interventions. Methods include daily fetal movement counts (DFMC), NST, contraction stress tests (CST), biophysical profiles, and Doppler velocimetry. Interpretation depends on gestational age and fetal viability.
- An NST evaluates fetal condition by looking for fetal heart rate accelerations in response to movement. For gestations over
Cardiotocography (CTG) is a technique used in pregnancy to monitor the fetal heart rate and uterine contractions. It involves using ultrasound to monitor the fetal heart rate and a transducer on the abdomen to monitor uterine contractions. When interpreting a CTG, risk factors are assessed and various characteristics of the fetal heart rate and contractions are evaluated, including baseline heart rate, variability, accelerations, and decelerations. An overall impression is determined based on these factors to assess whether the CTG tracing is reassuring, non-reassuring, or abnormal. An abnormal CTG may indicate fetal distress requiring further investigation or intervention.
CTG - Cardiotocography or Non stress test
A nonstress test is a screening test used in pregnancy to assess fetal status by means of the fetal heart rate and its responsiveness.
A cardiotocograph is used to monitor the fetal heart rate and presence or absence of uterine contractions. The test is typically termed "reactive" or "nonreactive".
This document discusses fetal monitoring techniques used at SGH including intermittent auscultation, electronic fetal monitoring, and cardiotocography. It describes the goals of fetal monitoring and provides details on the different monitoring modalities, terminology used in CTG interpretation, guidelines for monitoring based on risk level, and management of abnormal tracings. Fetal scalp blood sampling is also discussed as a technique to determine fetal acid-base status when CTG changes are non-reassuring.
Fetal surveillance during labor is essential to monitor for hypoxia and acidosis. Methods of monitoring include auscultation, external and internal electronic fetal monitoring. Fetal heart rate patterns provide information on oxygenation through assessment of baseline rate, variability and periodic changes in response to contractions. Abnormal patterns like late decelerations suggest interventions may be needed like changing position or accelerating delivery. Meconium staining and non-reactive heart rates also indicate possible distress. Fetal blood sampling helps assess acidosis risk to guide management.
Fetal surveillance during labor is essential to monitor for hypoxia and acidosis in the fetus. Continuous electronic fetal monitoring allows for early detection of abnormal heart rate patterns associated with conditions like hypoxia. There are various methods of monitoring including external monitoring of heart rate and contractions as well as internal monitoring using a scalp electrode and intrauterine pressure catheter. Fetal heart rate patterns provide information on the fetus' condition by examining baseline rate, variability, and responses to contractions including accelerations, early decelerations, late decelerations, and variable decelerations. Interventions depend on the pattern and severity and may include changes in position, oxygen, medications, or expedited delivery.
Non stress test gynaecology presentationsarathrajum17
The document summarizes the key aspects of non-stress tests (NSTs) used to monitor fetal heart rate (FHR) patterns during pregnancy. It describes how NSTs use Doppler ultrasound to externally monitor FHR. It defines normal and abnormal FHR patterns including baseline rate, variability, accelerations, decelerations, and other periodic changes. It discusses how different FHR patterns may indicate issues like cord compression, fetal distress, or placental insufficiency. It also outlines guidelines for normal NST results and follow-up based on findings.
The document summarizes recommendations for human papillomavirus (HPV) vaccination from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. It recommends routine HPV vaccination for females and males aged 11-12 to help reduce cancers and genital warts caused by HPV. Two HPV vaccines are approved and have shown to be highly effective and safe when administered before the onset of sexual activity according to clinical trials. Obstetrician-gynecologists should educate patients about HPV vaccination.
This document summarizes information on four common infections that can cause complications if acquired during pregnancy: cytomegalovirus (CMV), parvovirus B19, varicella zoster virus (VZV), and toxoplasmosis. It discusses the prevalence, transmission, clinical presentations, risks of perinatal transmission, and maternal, fetal, and infant effects of each infection. CMV is the most common congenital infection, occurring in 0.2-2.2% of neonates. Parvovirus B19 can cause hydrops fetalis in up to 10-18% of cases. VZV exposure in the first or second trimester poses risks of congenital varicella syndrome.
Maternal sepsis is relatively common and usually results from infections originating from the genitourinary tract during labor and delivery or from other common infections exacerbated by pregnancy physiology. These infections have the potential to progress to severe sepsis and septic shock if not promptly recognized and properly managed. The most common causes of maternal sepsis discussed are pyelonephritis, chorioamnionitis, and septic abortion. Labor and delivery units should focus on developing procedures to quickly identify and treat pregnant women experiencing sepsis in order to prevent progression to severe sepsis or septic shock and minimize maternal morbidity and mortality.
This document summarizes guidelines for the management of premature rupture of membranes (PROM). It defines PROM and discusses the risks and outcomes associated with term and preterm PROM. For term PROM at 37 weeks or later, the document recommends inducing labor over expectant management to reduce infection risks and speed delivery. For preterm PROM, it recommends considering delivery versus expectant management based on gestational age and fetal status. While the optimal timing remains unclear, data suggest delivery between 34-37 weeks may reduce infection risks without increasing neonatal risks.
This document provides guidelines for antepartum fetal surveillance techniques based on the latest scientific evidence. It discusses various techniques used for antepartum fetal surveillance including maternal fetal movement assessment, contraction stress test, nonstress test, biophysical profile, and modified biophysical profile. The goal of using these techniques is to prevent fetal death by identifying fetuses that may be undergoing uterine placental compromise. A normal result from these antepartum fetal surveillance tests is highly reassuring, with false negative rates generally below 1%, however, acute catastrophic changes may still result in fetal death.
Prediccion y prevencion del parto preterminorubenhuaraz
This document discusses screening and prevention of preterm birth, which is the leading cause of neonatal mortality in the US. It describes various risk factors for preterm birth such as a prior preterm birth, short cervical length on ultrasound, vaginal bleeding, infections, and behavioral factors like smoking. Transvaginal ultrasound is an effective way to screen for short cervical length, which is a strong predictor of preterm birth risk. The document reviews evidence for different proposed screening and treatment methods, noting that while some risk factors are associated with preterm birth, treatments have not been shown to consistently and definitively reduce that risk.
Parto pretermino tardio y a termino tempranorubenhuaraz
The document discusses guidelines for medically indicated late-preterm and early-term deliveries between 34 and 38 weeks gestation. It acknowledges neonatal risks are lower after 39 weeks but certain maternal or fetal complications may warrant earlier delivery. Timing of delivery should balance risks to the mother and baby, considering factors like gestational age accuracy and individual patient circumstances. Recommendations include delivering between 36-37 weeks for conditions like placenta previa or a prior C-section, and no earlier than 38 weeks for an otherwise uncomplicated small baby. All decisions require weighing risks and should be personalized.
- Preterm birth is defined as birth between 20-36 weeks of gestation. Preterm labor is diagnosed based on uterine contractions and cervical changes.
- Tests like fetal fibronectin and cervical length can help predict risk of preterm birth but have poor positive predictive value on their own.
- Antenatal corticosteroids between 24-34 weeks of gestation significantly reduce neonatal mortality and morbidity for preterm births within 7 days and should be considered routine.
- Magnesium sulfate before 32 weeks of gestation reduces the risk of cerebral palsy in surviving infants.
Manejo de embarazo a termino tardio y posterminorubenhuaraz
This document provides guidelines for the clinical management of late-term and postterm pregnancies. Late-term refers to pregnancies between 41 0/7 and 41 6/7 weeks gestation, while postterm refers to pregnancies reaching or exceeding 42 0/7 weeks gestation. Risks to the fetus and neonate increase with advancing gestational age beyond 40 weeks, including complications like meconium aspiration and stillbirth. Accurate determination of gestational age through early ultrasound is important to properly identify and manage late-term and postterm pregnancies. The guidelines recommend antepartum fetal surveillance and induction of labor to decrease morbidity and mortality risks for prolonged pregnancies.
This document provides guidelines for the evaluation and management of nonimmune hydrops fetalis (NIHF). It summarizes that NIHF is excessive fluid accumulation in fetal tissues without red blood cell alloimmunization as the cause. The most common causes are found to be cardiovascular abnormalities, chromosomal anomalies like Down syndrome, and hematologic conditions such as anemia. Evaluation of NIHF includes determining if it is nonimmune, detailed ultrasound exams, fetal testing for structural defects and genetic/chromosomal issues, and middle cerebral artery Doppler to check for anemia. Treatment depends on the underlying cause and gestational age. Outcomes are related to the specific etiology and gestational age at detection and delivery, with aneuploid
This study analyzed data from 4,618 women who had spontaneous vaginal deliveries at term to develop norms for fetal descent in labor. The results show:
1) Multiparous women and those who labored spontaneously without augmentation had faster fetal descent at all stations compared to nulliparous women and those whose labor was induced or augmented.
2) The median time to descend between station levels was less than 2 hours, though there was wide variation, with some women spending over 12 hours at the same high station.
3) By 6 cm dilation, the median station was 0 for nulliparous women and -1 for multiparous women. 95% of all women were at station 0
The document discusses the definition of term pregnancy. Previously, term was considered 37-42 weeks of gestation, but research shows neonatal outcomes vary within this range. To address this, a work group in 2012 recommended replacing "term" with more specific designations: early term (37-38 weeks), full term (39-40 weeks), late term (41 weeks) and post-term (42+ weeks). They encourage clinicians and researchers to uniformly use these new designations to facilitate data reporting, quality care and research.
1) The spectrum and severity of heart disease in reproductive-aged women is changing, with congenital heart disease now accounting for over half of cardiac disease in pregnancy and ischemic heart disease on the rise.
2) A multidisciplinary approach is needed to determine risks and management strategies for pregnant women with heart disease. Pregnancy is generally not advised for those with severe disease like pulmonary hypertension or severe ventricular dysfunction.
3) Preconception counseling provides an opportunity to review risks specific to a woman's cardiac condition and help guide her decision about pregnancy. Assessment of functional status and imaging can help predict maternal and fetal risks.
This document discusses the history and current state of fetal surgery. It begins with a brief history of fetal surgery from the first documented nonhuman fetal surgery in 1884 to the development of techniques in the 1940s-1960s. Key developments include the first reported human fetal surgery in 1965 and the advent of ultrasound technology in the late 1960s, which enabled less invasive fetal procedures. The document outlines the conditions currently treated with closed (non-hysterotomy) surgical therapies, including fetal transfusion and lower urinary tract obstruction. It emphasizes the importance of a multidisciplinary team approach and counseling for families considering fetal surgery.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Monitoreo electronico fetal
1. 1232 VOL. 116, NO. 5, NOVEMBER 2010 OBSTETRICS & GYNECOLOGY
P RAC T I C E
BUL L E T I N
the american college of obstetricians and gynecologists
women’s health care physicians
Background
In 2008, a workshop sponsored by the American College
of Obstetricians and Gynecologists, the Eunice Kennedy
Shriver National Institute of Child Health and Human
Development, and the Society for Maternal–Fetal Med-
icine focused on updating EFM nomenclature, recom-
mending an interpretative system, and setting research
priorities (1). Nomenclature for baseline FHR and FHR
variability, accelerations, and decelerations were reaf-
firmed (Table 1). New terminology was recommended
for the description and quantification of uterine contrac-
tions. Normal uterine activity was defined as five or fewer
contractions in 10 minutes, averaged over a 30-minute
window. Tachysystole was defined as more than five
contractions in 10 minutes, averaged over 30 minutes and
should be categorized by the presence or absence of FHR
decelerations. Tachysystole can be applied to spontaneous
or induced labor. The terms hyperstimulation and hyper-
contractility were abandoned.
A three-tiered system for intrapartum EFM interpre-
tation also was recommended (Box 1), with the nomen-
clature and interpretation described elsewhere (1). This
second Practice Bulletin on intrapartum FHR tracings
reviews the management of heart rate patterns based on
the three-tiered classification system (Figure 1).
Clinical Considerations and
Recommendations
How is a Category I EFM tracing managed?
Category I FHR tracings are normal (Box 1). These trac-
ings are not associated with fetal acidemia (2–6). Cate-
gory I FHR patterns may be managed in a routine manner
with either continuous or intermittent monitoring. Trac-
ings should be periodically evaluated and documented
during active labor by a health care provider (eg, this may
include physician, nurse, or midwife) based on clinical
Management of Intrapartum Fetal Heart
Rate Tracings
Intrapartum electronic fetal monitoring (EFM) is used for most women who give birth in the United States. As such,
clinicians are faced daily with the management of fetal heart rate (FHR) tracings. The purpose of this document is to
provide obstetric care providers with a framework for evaluation and management of intrapartum EFM patterns based
on the new three-tiered categorization.
Number 116, November 2010
clinical management guidelines for obstetrician–gynecologists
Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the Committee on Practice Bulletins—Obstetrics with the assis-
tance of George Macones, MD, and Sean Blackwell, MD, in collaboration with Thomas Moore, MD, Catherine Spong, MD, John Hauth, MD, Gary Hankins,
MD, and representatives from the Association of Women’s Health, Obstetric and Neonatal Nurses–Audrey Lyndon RN, PhD, Kathleen R. Simpson, PhD
RN, and Anne Santa-Donato, RNC, MSN, and the American College of Nurse–Midwives––Tekoa King, CNM, MPH. The information is designed to aid
practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive
course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to
the institution or type of practice.
2. VOL. 116, NO. 5, NOVEMBER 2010 Practice Bulletin Intrapartum Fetal Heart Rate Tracings 1233
Table 1. Electronic Fetal Monitoring Definitions
Pattern Definition
Baseline • The mean FHR rounded to increments of 5 beats per minute during a 10-minute segment, excluding:
—Periodic or episodic changes
—Periods of marked FHR variability
—Segments of baseline that differ by more than 25 beats per minute
• The baseline must be for a minimum of 2 minutes in any 10-minute segment, or the baseline for that time period
is indeterminate. In this case, one may refer to the prior 10-minute window for determination of baseline.
• Normal FHR baseline: 110–160 beats per minute
• Tachycardia: FHR baseline is greater than 160 beats per minute
• Bradycardia: FHR baseline is less than 110 beats per minute
Baseline variability • Fluctuations in the baseline FHR that are irregular in amplitude and frequency
• Variability is visually quantitated as the amplitude of peak-to-trough in beats per minute.
—Absent—amplitude range undetectable
—Minimal—amplitude range detectable but 5 beats per minute or fewer
—Moderate (normal)—amplitude range 6–25 beats per minute
—Marked—amplitude range greater than 25 beats per minute
Acceleration • A visually apparent abrupt increase (onset to peak in less than 30 seconds) in the FHR
• At 32 weeks of gestation and beyond, an acceleration has a peak of 15 beats per minute or more above baseline,
with a duration of 15 seconds or more but less than 2 minutes from onset to return.
• Before 32 weeks of gestation, an acceleration has a peak of 10 beats per minute or more above baseline, with a
duration of 10 seconds or more but less than 2 minutes from onset to return.
• Prolonged acceleration lasts 2 minutes or more but less than 10 minutes in duration.
• If an acceleration lasts 10 minutes or longer, it is a baseline change.
Early deceleration • Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction
• A gradual FHR decrease is defined as from the onset to the FHR nadir of 30 seconds or more.
• The decrease in FHR is calculated from the onset to the nadir of the deceleration.
• The nadir of the deceleration occurs at the same time as the peak of the contraction.
• In most cases, the onset, nadir, and recovery of the deceleration are coincident with the beginning, peak, and
ending of the contraction, respectively.
Late deceleration • Visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction
• A gradual FHR decrease is defined as from the onset to the FHR nadir of 30 seconds or more.
• The decrease in FHR is calculated from the onset to the nadir of the deceleration.
• The deceleration is delayed in timing, with the nadir of the deceleration occurring after the peak of the contraction.
• In most cases, the onset, nadir, and recovery of the deceleration occur after the beginning, peak, and ending of
the contraction, respectively.
Variable deceleration • Visually apparent abrupt decrease in FHR
• An abrupt FHR decrease is defined as from the onset of the deceleration to the beginning of the FHR nadir of less
than 30 seconds.
• The decrease in FHR is calculated from the onset to the nadir of the deceleration.
• The decrease in FHR is 15 beats per minute or greater, lasting 15 seconds or greater, and less than 2 minutes in
duration.
• When variable decelerations are associated with uterine contractions, their onset, depth, and duration commonly
vary with successive uterine contractions.
Prolonged deceleration • Visually apparent decrease in the FHR below the baseline
• Decrease in FHR from the baseline that is 15 beats per minute or more, lasting 2 minutes or more but less than 10
minutes in duration.
• If a deceleration lasts 10 minutes or longer, it is a baseline change.
Sinusoidal pattern • Visually apparent, smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 3–5 per
minute which persists for 20 minutes or more.
Abbreviation: FHR, fetal heart rate.
Macones GA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal
monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol 2008;112:661–6.
3. 1234 Practice Bulletin Intrapartum Fetal Heart Rate Tracings OBSTETRICS & GYNECOLOGY
status and underlying risk factors. Thus, during the first
stage of labor the FHR tracing should be reviewed every
30 minutes and every 15 minutes during the second stage
(7). Documentation of this review should include descrip-
tion of FHR category and overall pattern. Change in man-
agement may need to occur only if Category II or Category
III features develop (Figure 1).
How is a Category II EFM tracing evaluated
and managed?
Category II FHR tracings include all FHR patterns that
are not classified as Category I or Category III (Box 1).
Category II tracings require evaluation, continued sur-
veillance, initiation of appropriate corrective measures
when indicated, and reevaluation. Once identified, these
tracings may require more frequent evaluation, docu-
mentation, and continued surveillance, unless they revert
to Category I. Given the diverse spectrum of abnormal
FHR patterns in Category II, the presence of FHR accel-
erations (whether spontaneous or elicited by digital scalp
or vibroacoustic stimulation) or moderate FHR variabil-
ity or both are highly predictive of normal fetal acid–base
status and, thus, may help guide clinical management
(Figure1)(8–12).ThemanagementofspecificFHRabnor-
malities within Category II is discussed as follows.
How are intermittent and recurrent variable
decelerations evaluated and managed?
Intermittent variable decelerations, defined as occurring
with less than 50% of contractions, are the most common
FHR abnormality occurring during labor (13), most often
do not require any treatment, and are associated with
normal perinatal outcomes (3). Evaluation of recurrent
variable decelerations includes their frequency, depth and
duration, uterine contraction pattern, and other FHR char-
acteristics such as FHR variability (14, 15). Recurrent vari-
able decelerations, defined as occurring with greater than
or equal to 50% of contractions, that progress to greater
depth and longer duration are more indicative of impend-
ing fetal acidemia (2, 8, 14, 15). In FHR tracings with
recurrent variable decelerations, the presence of moderate
FHR variability or a spontaneous or induced acceleration
suggests that the fetus is not currently acidemic.
Management of recurrent variable decelerations
should be directed at relieving umbilical cord compression
(Table 2). Maternal positioning as an initial therapeutic
maneuver is a reasonable first step (16). Although there
is limited evidence for improvements in short-term or
long-term neonatal outcomes, amnioinfusion has been
shown to decrease the recurrence of variable decelera-
tions as well as the rate of cesarean delivery for “suspected
fetal distress” (17). Adjunctive measures to promote fetal
Box 1. Three-Tiered Fetal Heart Rate
Interpretation System
Category I
• Category I FHR tracings include all of the following:
• Baseline rate: 110–160 beats per minute
• Baseline FHR variability: moderate
• Late or variable decelerations: absent
• Early decelerations: present or absent
• Accelerations: present or absent
Category II
Category II FHR tracings includes all FHR tracings not
categorized as Category I or Category III. Category II
tracings may represent an appreciable fraction of those
encountered in clinical care. Examples of Category II
FHR tracings include any of the following:
Baseline rate
• Bradycardia not accompanied by absent baseline
variability
• Tachycardia
Baseline FHR variability
• Minimal baseline variability
• Absent baseline variability with no recurrent
decelerations
• Marked baseline variability
Accelerations
• Absence of induced accelerations after fetal stimulation
Periodic or episodic decelerations
• Recurrent variable decelerations accompanied by
minimal or moderate baseline variability
• Prolonged deceleration more than 2 minutes but
less than10 minutes
• Recurrent late decelerations with moderate baseline
variability
• Variable decelerations with other characteristics such
as slow return to baseline, overshoots, or “shoulders”
Category III
Category III FHR tracings include either
• Absent baseline FHR variability and any of the
following:
—Recurrent late decelerations
—Recurrent variable decelerations
—Bradycardia
• Sinusoidal pattern
Abbreviation: FHR, fetal heart rate.
Macones GA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008
National Institute of Child Health and Human Development workshop
report on electronic fetal monitoring: update on definitions, interpre-
tation, and research guidelines. Obstet Gynecol 2008;112:661–6.
4. VOL. 116, NO. 5, NOVEMBER 2010 Practice Bulletin Intrapartum Fetal Heart Rate Tracings 1235
oxygenation also may be useful depending on the sever-
ity and duration of the recurrent variable decelerations
(Table 2).
How are recurrent late decelerations evaluated
and managed?
Recurrent late decelerations are thought to reflect tran-
sient or chronic uteroplacental insufficiency (18). Common
causes include maternal hypotension (eg, postepidural),
uterine tachysystole, and maternal hypoxia. Management
involves maneuvers to promote uteroplacental perfusion,
which may include maternal lateral positioning, intrave-
nous fluid bolus, maternal oxygen administration, and
evaluation for tachysystole (Table 2) (16).
In Category II tracings with recurrent late decelera-
tions, management includes intrauterine resuscitation and
reevaluation to determine whether an adequate improve-
ment in fetal status has occurred. Given the low predictive
value of late decelerations for acidemia and their known
false-positive rate for fetal neurologic injury (19–23),
evaluation for the presence of accelerations or moderate
FHR variability or both may be useful to assess the risk
of fetal acidemia (24). If despite intrauterine resuscita-
tion measures late decelerations continue in the setting
of minimal FHR variability and absent accelerations, the
presence of fetal acidemia should be considered and the
potential need for expedited delivery should be evaluated.
If FHR variability becomes absent, then the FHR is now
Category III and should be managed accordingly.
How is intrapartum fetal tachycardia evalu-
ated and managed?
Fetal tachycardia is defined as a baseline heart rate greater
than 160 beats per minute (bpm) for at least 10 minutes
(Table 1). Fetal tachycardia should be evaluated for iden-
tifiable underlying causes such as infection (eg, chorio-
amnionitis, pyelonephritis, or other maternal infections),
medications (eg, terbutaline, cocaine, and other stimu-
lants), maternal medical disorders (eg, hyperthyroidism),
obstetric conditions (eg, placental abruption or fetal bleed-
*Given the wide variation of FHR tracings in Category II, this algorithm is not meant to represent assess-
ment and management of all potential FHR tracings, but provide an action template for common clinical
situations.
†
See Table 2 for list of various intrauterine resuscitative measures
‡
Timing and mode of delivery based on feasibility and maternal–fetal status
Assessment of intrapartum FHR tracing
Category I Category II* Category III
Routine management Evaluation and surveillance Prepare for delivery +
Intrauterine resuscitative
measures†
If not improved, consider
prompt delivery‡
FHR accelerations
or
moderate FHR variability
Absent FHR accelerations
and
Absent/minimal FHR
variability
Continue surveillance +
Intrauterine resuscitative
measures†
Intrauterine resuscitative
measures†
If not improved or FHR tracing
progresses to Category III,
consider delivery‡
Figure 1. Management algorithm of intrapartum fetal heart rate tracings based on three-tiered category system. Abbreviation:
FHR, fetal heart rate.
5. 1236 Practice Bulletin Intrapartum Fetal Heart Rate Tracings OBSTETRICS & GYNECOLOGY
also may occur in fetuses with congenital heart abnor-
malities or myocardial conduction defects, such as those
associated with maternal collagen vascular disease. Most
often the onset of bradycardia associated with congenital
heart block occurs in the second trimester; it is extremely
unlikely that new onset intrapartum bradycardia would
be due to this condition.
Treatment for Category II tracing with bradycardia
or prolonged decelerations is directed at the underlying
cause (Table 2). Fetal heart rate variability during baseline
periods should be evaluated in order to better assess the
risk of fetal acidemia (25). If bradycardia with minimal or
absent variability or prolonged decelerations or both do
not resolve, then prompt delivery is recommended.
How is minimal FHR variability evaluated
and managed?
As with other characteristics of the FHR tracing, base-
line variability often changes with fetal sleep or wake
state and over the course of labor, and it may transition
from moderate to minimal and back again. Evaluation
of minimal FHR variability should include evaluation
of potential causes such as maternal medications (eg,
opioid, magnesium sulfate), fetal sleep cycle, or fetal
acidemia (26–28). For minimal variability thought to be
due to recent maternal opiod administration, FHR varia-
bility often improves and returns to moderate variability
within 1–2 hours. A fetal sleep cycle generally lasts 20
minutes but can persist up to 60 minutes, and moderate
variability should return when the fetal sleep cycle is
ing), and fetal tachyarrhythmias (often associated with
FHR greater than 200 bpm). In isolation, tachycardia is
poorly predictive for fetal hypoxemia or acidemia, unless
accompanied by minimal or absent FHR variability or
recurrent decelerations or both.
Treatment for a Category II tracing with tachycardia
should be directed at the underlying cause. In addition,
other characteristics of the FHR tracing need to be evalu-
ated in concert with the tachycardia, especially baseline
variability. For example, a FHR tracing with tachycar-
dia, minimal variability, and no accelerations cannot
reliably exclude fetal acidemia.
How are intrapartum bradycardia and pro-
longed decelerations evaluated and managed?
Fetal bradycardia is defined as a baseline heart rate
less than 110 bpm for at least 10 minutes (Table 1).
Prolonged decelerations are defined as FHR decreases of
at least 15 bpm below baseline that last at least 2 minutes
but less than 10 minutes. Clinical intervention often is
indicated before the distinction can be made between a
prolonged deceleration and fetal bradycardia; thus, the
immediate management of the two is similar.
Prolonged decelerations or fetal bradycardia should
be evaluated for identifiable causes such as maternal
hypotension (eg, postepidural), umbilical cord prolapse
or occlusion, rapid fetal descent, tachysystole, placental
abruption, or uterine rupture. Bradycardia due to these
conditions often occurs in labor and usually is preceded
by an initially normal FHR baseline. Rarely, bradycardia
Table 2. Various Intrauterine Resuscitative Measures for Category II or Category III Tracings or Both
Goal Associated Fetal Heart Rate Abnormality* Potential Intervention (s)†
Promote fetal oxygenation and improve Recurrent late decelerations Initiate lateral positioning (either left or right)
uteroplacental blood flow Prolonged decelerations or bradycardia Administer maternal oxygen administration
Minimal or absent fetal heart rate variability Administer intravenous fluid bolus
Reduce uterine contraction frequency
Reduce uterine activity Tachysystole with Category II or III tracing Discontinue oxytocin or cervical ripening agents
Administer tocolytic medication (eg, terbutaline)
Alleviate umbilical cord compression Recurrent variable decelerations Initiate maternal repositioning
Prolonged decelerations or bradycardia Initiate amnioinfusion
If prolapsed umbilical cord is noted, elevate the
presenting fetal part while preparations are
underway for operative delivery
*Evaluation for the underlying suspected cause(s) is also an important step in management of abnormal FHR tracings.
†
Depending on the suspected underlying cause(s) of FHR abnormality, combining multiple interventions simultaneously may be appropriate and potentially more effec-
tive than doing individually or serially (Simpson KR, James DC. Efficacy of intrauterine resuscitation techniques in improving fetal oxygen status during labor. Obstet
Gynecol 2005;105:1362–8).
Data from Young BK, Katz M, Klein SA, Silverman F. Fetal blood and tissue pH with moderate bradycardia. Am J Obstet Gynecol 1979;135:45–7; Chauhan SP, Roach
H, Naef RW 2nd, Magann EF, Morrison JC, Martin JN Jr. Cesarean section for suspected fetal distress. Does the decision-incision time make a difference? J Reprod Med
1997;42:347–52; Schauberger CW, Chauhan SP. Emergency cesarean section and the 30-minute rule: definitions. Am J Perinatol 2009;26:221–6; and Schifrin BS,
Hamilton-Rubinstein T, Shields JR. Fetal heart rate patterns and the timing of fetal injury. J Perinatol 1994;14:174–81.
6. VOL. 116, NO. 5, NOVEMBER 2010 Practice Bulletin Intrapartum Fetal Heart Rate Tracings 1237
complete. Thus, in these situations, continued observa-
tion and expectant management is appropriate. If minimal
FHR variability is suspected to be due to decreased fetal
oxygenation, then maternal repositioning, administration
of oxygen, or intravenous fluid bolus may be considered
(Table 2). If improvement in FHR variability does not
occur with these measures and there are no FHR accel-
erations, additional assessment such as digital scalp or
vibroacoustic stimulation should be done (12). Continued
minimal variability (in the absence of accelerations or nor-
mal scalp pH) that cannot be explained or resolved with
resuscitation should be considered as potentially indicative
of fetal acidemia and should be managed accordingly.
How is tachysystole with and without FHR
changes evaluated and managed?
Tachysystole is defined as more than five contractions in
10 minutes, averaged over 30 minutes. The presence or
absence of associated FHR abnormalities is the key issue
in management (Figure 2). For women with spontaneous
labor, tachysystole coupled with recurrent FHR decel-
erations requires evaluation and treatment. Tachysystole
occurring with less frequent FHR abnormalities may or
may not require treatment, depending on the specific
clinical situation and associated FHR characteristics
such as variability and accelerations. In laboring women
receiving oxytocin, management of tachysystole gener-
ally involves efforts to reduce uterine activity to mini-
mize risk of evolving fetal hypoxemia or acidemia (29).
In labor induction or augmentation or both, a decrease in
the oxytocin dose should be considered if tachysystole
occurs in the presence of a Category I tracing. If there is
a Category II or III tracing, oxytocin should be reduced
or stopped in addition to intrauterine resuscitation (7). In
addition, simultaneous initiation of multiple resuscitative
measures may improve fetal condition more rapidly than
the use of individual therapies (Table 2). If tachysystole
induced FHR abnormalities do not resolve with these
initial maneuvers, then tocolytic medications (eg, terbu-
taline) may be warranted (30, 31).
How is a Category III EFM tracing evaluated
and managed?
A Category III FHR tracing is abnormal and conveys an
increased risk for fetal acidemia at the time of observa-
tion. Category III tracings have been associated with
an increased risk for neonatal encephalopathy, cerebral
palsy, and neonatal acidosis. Nevertheless, the predictive
value of Category III tracings for abnormal neurologic
outcome is poor (32). If unresolved, Category III FHR
tracings most often require prompt delivery. While intra-
uterine resuscitation measures are used, preparations for
delivery should be considered and a time frame for pro-
ceeding to delivery should be determined if the FHR does
not improve (Figure 1). As discussed previously potential
interventions for intrauterine resuscitation are described
in Table 2; these should be modified to the appropriate
clinical circumstance(s) and specific FHR pattern.
Figure 2. Management algorithm for uterine tachystole. Abbreviation: FHR, fetal heart rate.
Uterine tachysystole
Spontaneous labor Labor induction or augmentation
Category I FHR tracing Category II or III FHR tracing
Intrauterine resuscitative
measures*
No interventions required Intrauterine resuscitative
measures*
If no resolution,
consider tocolytic
Category I FHR tracing Category II or III FHR tracing
Decrease uterotonics Decrease or stop uterotonics
If no resolution,
consider tocolytic
*See Table 2 for list of various intrauterine resuscitative measures
7. 1238 Practice Bulletin Intrapartum Fetal Heart Rate Tracings OBSTETRICS & GYNECOLOGY
If a Category III tracing continues and intra-
uterine resuscitative measures are unsuccess-
ful, over what time interval should delivery be
accomplished?
The acceptable time frame to accomplish delivery in
the setting of a Category III FHR tracing has not been
established. Historically, a 30-minute rule from decision-
to-incision time for emergent cesarean delivery in the
setting of abnormal FHR pattern has existed (7); how-
ever, the scientific evidence to support this threshold is
lacking. In a study of 2,808 women who had cesarean
deliveries for emergent indications, investigators found
that more than 30% of the cesarean deliveries began
more than 30 minutes after the decision to operate, yet
adverse neonatal outcomes were not increased among
those infants delivered after more than 30 minutes
(33). Multiple other studies affirm the lack of associa-
tion of increased adverse outcomes with this 30-minute
decision-to-incision time frame (34–38). It also should
be recognized that in some cases immediate delivery in
a woman with an unknown duration of a Category III
tracing may not improve outcome if the fetus has already
experienced hypoxic ischemic injury (39, 40).
Nevertheless, when a decision for operative delivery
in the setting of a Category III EFM tracing is made,
it should be accomplished as expeditiously as feasible.
The decision-to-incision interval and mode of delivery
should be based on the timing that best incorporates
maternal and fetal risks and benefits. For instance many
of these clinical scenarios will include high-risk condi-
tions or pregnancy complications (eg, morbid obesity,
eclampsia, cardiopulmonary compromise, hemorrhage),
which may require maternal stabilization or additional
surgical preparation before performance of emergent
cesarean delivery. These factors also may vary based on
the institution and local circumstances. Preparation for
impending delivery of a woman with a Category III trac-
ing often requires assessment of several logistical issues
depending on the setting and clinical circumstances (see
Box 2).
Summary of Conclusions
and Recommendations
The following recommendations and conclusions
are based on good and consistent scientific evi-
dence (Level A):
Category I FHR tracings may be managed in a rou-
tine manner because they are not associated with
fetal acidemia.
A Category III FHR tracing is abnormal and conveys
an increased risk of fetal acidemia at the time of
observation.
Amnioinfusion has been shown to decrease the
recurrence of variable decelerations as well as the
rate of cesarean delivery for abnormal FHR patterns.
The following recommendations and conclusions
are based on evidence that may be limited or
inconsistent (Level B):
Intravenous fluid bolus, lateral positioning and oxy-
genadministration, when used together, may improve
fetal oxygenation during labor.
Regardless of whether labor is spontaneous or stimu-
lated, tachysystole accompanied by Category II or
Category III FHR tracing requires evaluation and
initiation of appropriate treatment.
Category II tracings require evaluation, continued
surveillance, initiation of appropriate corrective
measures when indicated, and reevaluation. The
presence of FHR accelerations (whether spontane-
ous or elicited) or moderate FHR variability or both
are highly predictive of normal fetal acid–base status
and, thus, may help guide clinical management.
The following conclusion is based primarily on
consensus and expert opinion (Level C):
The optimal time frame to effect delivery in the set-
ting of a Category III FHR tracing has not been
established.
Box 2. Potential Logistical Considerations
in Preparation for Operative Delivery in
Setting of Category III Tracing
• Obtain informed consent (verbal or written as fea-
sible)
• Assemble surgical team (surgeon, scrub technician,
and anesthesia personnel)
• Assess patient transit time and location for operative
delivery
• Ensure intravenous access
• Review status of laboratory tests (eg, complete blood
type and screen) and assess need for availability of
blood products
• Assess need for preoperative placement of indwell-
ing foley catheter
• Assemble personnel for neonatal resuscitation
8. VOL. 116, NO. 5, NOVEMBER 2010 Practice Bulletin Intrapartum Fetal Heart Rate Tracings 1239
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The MEDLINE database, the Cochrane Library, and the
American College of Obstetricians and Gynecologists’
own internal resources and documents were used to con
duct a literature search to locate relevant articles published
between January 1985–December 2009. The search was
restricted to articles published in the English language.
Priority was given to articles reporting results of original
research, although review articles and commentaries also
were consulted. Abstracts of research presented at sympo
sia and scientific conferences were not considered adequate
for inclusion in this document. Guidelines published by
organizations or institutions such as the National Institutes
of Health and the American College of Obstetricians and
Gynecologists were reviewed, and additional studies were
located by reviewing bibliographies of identified articles.
When reliable research was not available, expert opinions
from obstetrician–gynecologists were used.
Studies were reviewed and evaluated for quality according
to the method outlined by the U.S. Preventive Services
Task Force:
I Evidence obtained from at least one properly
designed randomized controlled trial.
II-1 Evidence obtained from well-designed controlled
trials without randomization.
II-2 Evidence obtained from well-designed cohort or
case–control analytic studies, preferably from more
than one center or research group.
II-3 Evidence obtained from multiple time series with or
without the intervention. Dramatic results in uncon
trolled experiments also could be regarded as this
type of evidence.
III Opinions of respected authorities, based on clinical
experience, descriptive studies, or reports of expert
committees.
Based on the highest level of evidence found in the data,
recommendations are provided and graded according to the
following categories:
Level A—Recommendations are based on good and con
sistent scientific evidence.
Level B—Recommendations are based on limited or incon
sistent scientific evidence.
Level C—Recommendations are based primarily on con
sensus and expert opinion.
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Management of intrapartum fetal heart rate tracings. Practice Bulletin
No. 116. American College of Obstetricians and Gynecologists. Obstet
Gynecol 2010;116:1232–40.