title: Assessment of the concordance among 2-tier, 3-tier, and 5-tier fetal heart rate classification systems.
abstract: OBJECTIVE
  In 2008, a National Institute of Child Health and Human Development/Society for Maternal-Fetal Medicine-sponsored workshop on electronic fetal monitoring recommended a new fetal heart tracing interpretation system. Comparison of this 3-tier system with other systems is lacking. Our purpose was to determine the relationships between fetal heart rate categories for the 3 existing systems.
  
  
  METHODS
  Three Maternal-Fetal Medicine specialists reviewed 120 fetal heart rates. All tracings were from term, singleton pregnancies with known umbilical artery pH. The fetal heart rates were classified by a 2-tier, 3-tier, and 5-tier system.
  
  
  RESULTS
  Each Maternal-Fetal Medicine examiner reviewed 120 fetal heart rate segments. When compared with the 2-tier system, 0%, 54%, and 100% tracings in categories 1, 2, and 3 were "nonreassuring." There was strong concordance between category 1 and "green" as well as category 3 and "red" tracings.
  
  
  CONCLUSIONS
  The 3-tier and 5-tier systems were similar in fetal heart rate interpretations for tracings that were either very normal or very abnormal. Whether one system is superior to the others in predicting fetal acidemia remains unknown.
authors: Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.
authors: Cynthia
authors: C
authors: Gyamfi Bannerman
authors: William A
authors: WA
authors: Grobman
authors: Leah
authors: L
authors: Antoniewicz
authors: Maria
authors: M
authors: Hutchinson
authors: Sean
authors: S
authors: Blackwell
mesh_terms: D015148:Cardiotocography / Q000379:methods*; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D007743:Labor, Obstetric; D008297:Male; D054582:National Institute of Child Health and Human Development (U.S.); D011247:Pregnancy; D012189:Retrospective Studies; D014481:United States