title: A modified fetal heart rate tracing interpretation system for prediction of cesarean section.
abstract: OBJECTIVE
  To investigate whether a modified version of the 2008 National Institute of Child Health and Human Development (NICHD) interpretation system upon admission decreases cesarean delivery risk.
  
  
  METHODS
  This retrospective cohort study ascribed a modified category to the first 30 min of fetal heart rate (FHR) tracings in labor. Category I was divided into two subsets (Ia and Ib) by the presence of accelerations. Category II was divided into four subsets (IIa-IId) based on baseline FHR, variability, response to stimulation and decelerations. Log-binomial regression was used to calculate risk ratios (RR) and 95% confidence intervals (CI).
  
  
  RESULTS
  A category was ascribed to 910 women. Most FHR tracings were Category Ia (65.8%), Ib (7.7%), IIb (11.8%) and IId (14.0%). Category Ib tracings (fewer than two accelerations) were 2.26 (95% CI: 1.13-4.52) times more likely to result in cesarean delivery for abnormal FHR tracing than Category Ia tracings. A similar increase in risk was seen when comparing Category IIb and Category IId with Category Ia.
  
  
  CONCLUSIONS
  Application of a modified version of the 2008 NICHD FHR interpretation system to the initial 30 min of labor can identify women at increased risk of cesarean delivery for abnormal FHR tracing.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. wschnett@bidmc.harvard.edu
authors.forename: William T
authors.initials: WT
authors.lastname: Schnettler
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rogers
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Barber
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
mesh_terms: D000328:Adult; D015148:Cardiotocography / Q000592:standards*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult