A framework for standardized management of intrapartum fetal heart rate patterns.
OBJECTIVE
The purpose of this study was to classify fetal heart rate (FHR) monitor patterns according to risk of fetal acidemia and risk of evolution to a more serious pattern and to use this information to construct a standardized process for FHR pattern management, with the ultimate aim of minimizing newborn infant acidemia without excessive obstetric intervention.


METHODS
We have identified 134 FHR patterns that have been classified by baseline rate, baseline variability, and type of deceleration. Based on the best available evidence, we have assigned a risk of newborn infant acidemia or low 5-minute Apgar score to these patterns. We have also evaluated each pattern for the risk that the pattern would evolve further into a pattern with a higher risk of acidemia.


RESULTS
Each FHR pattern has been color-coded, from no threat of fetal acidemia (green, no intervention required) to severe threat of acidemia (red, rapid delivery recommended). Three intermediate categories (blue, yellow, and orange) require escalated informing of appropriate individuals for intervention and resuscitation (obstetrician, anesthesiologist, and neonatal resuscitator) and preparation for urgent delivery (eg, staff and surgical suite availability and conservative techniques to ameliorate the FHR patterns).


CONCLUSIONS
This framework is applicable potentially to the institutions where it was developed and will need to be modified for other situations, depending on the logistics, facilities, and personnel available. This may provide a framework for developing algorithms for the standardized management of FHR patterns during labor, which can be tested for validity.
Parer
Julian T
JT
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, 94143-0132, USA. parerb@obgyn.ucsf.edu
Ikeda
Tomoaki
T
D000138:Acidosis / Q000175:diagnosis* / Q000503:physiopathology; D015148:Cardiotocography / Q000592:standards*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008297:Male; D007744:Obstetric Labor Complications / Q000175:diagnosis*; D011247:Pregnancy; D018570:Risk Assessment